Long acting contraception to whom and why Øjvind Lidegaard Gynaecological Clinic Rigshospitalet Copenhagen University.

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Presentation transcript:

Long acting contraception to whom and why Øjvind Lidegaard Gynaecological Clinic Rigshospitalet Copenhagen University

Long acting contracpetion Long acting contraceptive methods Use pattern today To whom and why Li/10

Long acting contracpetion Long acting contraceptive methods Use pattern today To whom and why Li/10

Length of effect of different contraceptive methods after application Li/10 Hours 5 years 3 years 3 months 1-2 days 1 day <1 hour Life long 4 weeks

Long acting contracpetion Long acting contraceptive methods Use pattern today To whom and why Li/10

Depo-provera and implanone Li/ DDD

Implanone in Denmark 2009 Li/10 DDD per 1,000 per day

Depo-provera in Denmark 2009 Li/10 DDD per 1,000 per day

Sale hormone-IUD in Denmark 2009 Li/10 Number

Use of oral contraceptives according to age DDD/100 women/day at different ages Li/10

Hormonal contraception according to estrogen dose and progestagen type Li/10 Progestogen type EE NETA Norgestimate Gestodene CPA Dose Levonor Desogestrel Drospire- In ug gestrel Etonogestrel none 50 ug 30-40ug 15-20ug POP Injection Stick 1 st gen 2 nd gen Cerazette 3 rd gen NuvaRing 4 th gen EVRA Implanone MPA

Per cent age distribution of different combined contraceptive pills 2009 Li/10 %

Per cent age distribution of different combined contraceptive pills 2009 Li/10 %

Per cent age distribution of different combined contraceptive pills 2009 Li/10 %

Per cent age distribution of different combined contraceptive pills 2009 Li/10 %

Per cent age distribution of different combined contraceptive pills 2009 Li/10 %

Hormonal contraception DK 2009 Li/08 Low-dose OC Middle dose OC CPA Sale statistics. DDD/day

Hormonal contraception DK 2009 Li/08 Low-dose OC Middle dose HC Impla- none Sale statistics. POP

Conditions to take into account when deciding type of contraception Risk of venous thrombosis - family disposition - previous thrombosis - adiposity Risk of arterial thrombosis - smoking, diabetes, hypertension - migraine, with or without aura Contraceptive compliance Sexual practice / social situation

OC and VTE: Progestagen type adjusted for duration of use ug EE Neta Levo Norg Deso Gest Dros Cypr na na na na na Ref na na na na na POP na Mirena na Li/09 Lidegaard et al. BMJ 2009; 339; b2890

OCs and thrombosis Current status June 2010 CTA AMI VTE Non use nd gen: rd gen: th gen: na na 4.0 5th gen: ? ? ? Li/10

Adiposity in Danish women and men in 1994 and 2005 Li/07 Adiposity: BMI >25

Severe adiposity in Danish women in 1994, 2000 and 2005 Li/07 Adiposity: BMI  30

Induced abortions in DK Li/ Number per 1,

Leiden V mutations, prevalence Larsen et al. Thrombosis Res 1998; 89:

Long acting contraception could be considered in women with Difficulty in remembering to take a daily pill Wish of high degree of protection against pregnancy Women who due to thrombotic predisposition could not take combined OC Women concerned about the risk of VTE Adipose women

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