Presentation is loading. Please wait.

Presentation is loading. Please wait.

Kontraception U-kursus 2014 Kresten R. Petersen overlæge, dr.med Gynækologisk-obstetrisk afd. Odense Universitetshospital.

Similar presentations


Presentation on theme: "Kontraception U-kursus 2014 Kresten R. Petersen overlæge, dr.med Gynækologisk-obstetrisk afd. Odense Universitetshospital."— Presentation transcript:

1 Kontraception U-kursus 2014 Kresten R. Petersen overlæge, dr.med Gynækologisk-obstetrisk afd. Odense Universitetshospital

2 Disposition • Kontraception i forskellige aldersgrupper med særlig vægt på de unge og de ”gamle”. • Medicinske fordele ved kontraception

3 Legal abortions/1000 w. in Denmark •Statens Seruminstitut 2014

4 Antal tilfælde af Klamydia T. i Danmark Statens Seruminstitut

5 Use of contraception in women seeking legal abortion - 00 Abortion – Danish (n=1028) Abortion – Non-Danish (n=214) Contraceptive use (%)44,736,0 No contraceptive use (%)55,060,7 Condom (%)25,221,5 OC (%)15,09,3 Other (%)3,84,2 None (%)55,060,7 Rasch et al: Human Reprod 2007;22:1320-6

6 Teoretisk effektivitetFaktisk effektivitet Ingen kontraception85 Afbrudt samleje427 Kondom215 Pessar616 Kombinations p-piller0,38 P-plaster og P-ring0,38 Gestagen stav0,5 Kobberspiral0,60,8 Gestagenspiral0,2 Kvindelig sterilisation0,5 Mandlig sterilisation0,10,15 Contraceptive efficacy - % women pregnant during first year Hatcher RA, et al Contraceptive Technology: Nineteenth Revised Edition. New York NY: Ardent Media, 2007

7 De unge • Ca 50 % bruger p-piller • Dårlig compliance • Glemmer tabletterne • Generet af bivirkninger

8 Discontinuation of OCs Rosenberg, Am J Obstet Gynecol 1998;179:577

9 Discontinuation of OC European study Side effects Weight gain Health problems/risk Not natural Forgot to take No need for contr. 24 % 8 % 16 % 5 % 30 % Skouby. Eur J Contracep Reprod Health 2004;9:57

10 Discontinuation of OC during first 6 months – American study Bleeding irreg. Nausea Weight gain Mood changes Breast tenderness Headaches Method related No need for contr. 12 % 7 % 5 % 4 % 14% 23 % Rosenberg, Am J Obstet Gynecol 1998;179:577

11 Alternatives to OC’s

12 Ring and patches Patches: 20 mcg EE NGT 3 x1 w.patch 1 w without Pearls index < 1.5 Continous use Rings 15 mcg EE ETO 3 w.ring 1 w without Pearls index < 1 Can be removed for 3 h Same contraindications as OCs

13 NuvaRing

14 Common questions. Can the ring be felt ?? • 87 % of the women never/seldomly felt the ring during intercourse • 74% of the partners never/seldomly felt the ring during intercourse • 5% considered it a problem Dieben et al. Obstet Gynecol 2002;100:585-93

15 Implant – Implanon NXT

16 Etonorgestrel implant Contraceptive effect - 3 y • At registration • cykles • No pregnancies • Latest post marketing report*: • 218 pregnancies in insertions • 13 directly method related Harrison. Contraception 2005;71:306

17 Progestogen Depot Depo-Provera

18 Depo Provera • 150 mg MPA given i.m. every 3 months • Pearls index far below 1 • Well suited for women with questionable compliance

19 What about Cupper IUDs ???? Mode of action: Foreing body reaction in endometrium Cu ions are toxic to spermatozooes Reduced fertilisation Main concerns: Decreased fertility due to PID Increased menstrual flow and pain

20 Proportion of women with tubal infertility, non- tubal infertility and fertile women who had used IUDs Hubacher. N Engl J Med 2004;345:561-67

21 IUDs in nulliparous women

22 1 year clinical performance of OCs and LNG- IUDs in nullips – a randomized study OC (n=99)LNG-IUD (n=94) Pain06,7* Hormonal9,84,9 Bleeding/spotting1,32,5 ExpulsionNA1,2 Other medical1,12,1 Pl. pregnancy2,60 Personal15,44,6* Cont. rate72,779,8 Suhonen. Contraception 2004:69:407-12

23 Hvad så med de ældre kvinder ??

24 Særlige hensyn • Konkurerende medicinske sygdomme (adipositas, DM, hypertension,cancer) • Gynækologiske tilstande (fibromer, blødningsforstyrrelser)

25 WHO – medical eligibility for contraceptive use 2004 The eligibility was graded in four categories: 1: OCs can be used in any circumstances 2: OCs can generally be used 3: OCs not usually recommended unless other more appropriate methods are not available or not acceptable 4: OCs should not be used

26 WHO – medical eligibility for oral contraceptive use - Smoking: Age < 35 y Age > 35 y. Light Heavy (>20 cig/day

27 WHO – medical eligibility for oral contraceptive use - Headache • Mild • Severe (recurrent incl. Migraene without focal neurological sympt). • With focal neurological sympt

28 Only one risk factor allowed • Age > 35 • Smoking • Obesity • Varicose veins • Mild hypertension • DM without complications • Migraine

29 Non contraceptive effects of EE+Progestogen methods Positive: Bleeding disturbances, endometriosis, dysmenore, hirsutism, ovarian cysts, endometrial- and ovarian cancer Negative: Vascular disease

30 OCs and reprod. cancer RCGP: w recr. from w. years Never users (31%) Ever users (69%) Breast1 (448)0.98 (891) Cervix1 (36)1.33 (118) Endometrial1 (75)0.58* (81) Ovary1 (93)0.54* (96) Gyn.Combined10.71* Hannaford.BMJ 2007:335:651-9

31 Ovarian cancer and oral contraceptives Collaborative Group on Epidemiological Studies of Ovarian Cancer Lancet 2008;371: • 45 epidemiological studies from21 countries • women with ovarian cancer. • controls without ovarian cancer • Median age of cancer diagnosis: 56 y. • Median year of diagnosis: 1993 • Average duration of use: 4.4 y (cancer) 5.0 y (controls)

32 Relative risk of ovarian cancer in ever users. Effect of duration of use Never users =1


Download ppt "Kontraception U-kursus 2014 Kresten R. Petersen overlæge, dr.med Gynækologisk-obstetrisk afd. Odense Universitetshospital."

Similar presentations


Ads by Google