Getting contraception right for women in 2012 and beyond Anne Connolly The Ridge Medical Practice

Objectives Practical issues New products New recommendations New(ish) advice

Births per 1000 women age 16–19 1.United Nations Population Division 2009

Teenage pregnancy matters >40,000 under-18 conceptions in % of under-18 conceptions are repeat pregnancies Babies of teenage mothers have a 60% higher risk of dying in their first year and have a significantly increased risk of living in poverty, achieving less at school and being unemployed in later life Teenage pregnancy is both a cause and result of exclusion, poverty and inequality

Rate per 1,000 women aged 15–44 Abortion rates in the UK remain high

Number of abortions is highest in the age group 3,718 34,551 55,481 40,800 27,978 27, ,000 20,000 30,000 40,000 50,000 60,000 under Age Number of abortions

Other influences

Poor marketing!

Contraceptive choices BC crocodile dung pessaries BC women drank mercury Genesis – withdrawal method 1550BC Ebers Papyrus mixed dates, acacia bark, honey on wool pessary 200AD Soranus suggested jumping backwards 7 times after SI Native Americans drank dried beaver testicles European women in middle ages wore dried weasel testicles 1640 male barriers from fish bladders Victorians block wood pessary

‘Doc I want the pill’

Accidental pregnancy in first year of use – typical use Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J et al. Contraceptive Technology, revised edition 19. NY: Ardent Media, 2007 percent

Contraceptive use in the UK percent Office for National Statistics, 2010

‘Doc I want the pill’ 23 year old Raynaud’s disease Wants ‘the pill’ Can she?

UKMEC

UKMEC 2009 Raynauds diseaseCHCPOPDMPAIMPCu-IUDIUS a)Primary b)Secondary i)Without lupus anti- coagulant ii)With lupus anti- coagulant

COCPs Microgynon 30Ovysmenn

COCPs FemodetteFemodeneCilest Microgynon 30Ovysmenn

COCPs Yasmin FemodetteFemodeneCilest Microgynon 30Ovysmenn

Qlaira

FSRH CHC guidance

‘Doc I want the pill’ 30 year old Epileptic on Lamotrigine Wants ‘the pill’ Can she?

Drug interactions

Guidance on antibiotics and contraceptive pill interaction changed No need to use extra precautions when using antibiotics and combined hormonal contraception

‘Doc I want the pill’ 37 year old lady wants to restart her ‘pill’ BMI 44

UKMEC 2009 ObesityCHCPOPDMPAImplantCu-IUDIUS a)BMI ≥ b)BMI ≥

Can we use Yasmin? Epidemiological studies have shown that the risk of VTE for drospirenone COCs is higher than for levonorgestrel-containing COCs and may be similar to the risk for COCs that contain desogestrel or gestodene. The risk of VTE with Yasmin remains very small and, like other oral contraceptives, is less than that associated with pregnancy. MHRA 2011

VTE/10,000 WY Age BMI EURAS results: Impact of age and BMI in VTE incidence in OC users WITHOUT other known risk factors 1 26,5 18,9 14,9 21,1 15,4 7,7 19,9 4,9 1, < <25 [25-30[ EURAS study, data on file

Missed pill rules If two or more pills are missed (> 48 hours) take last forgotten pill (may mean taking 2 pills in 1 day) and the next when it is due continue with the packet of pills use extra precautions for 7 days If there are less than 7 pills left in the packet miss hormone free interval and start new packet immediately use condoms for 7 days MHRA 2011