Implantable contraceptives (subdermal implants and hormonally impregnated intrauterine systems) versus other forms of reversible contraceptives: two systematic reviews to assess relative effectiveness, acceptability, tolerability and cost-effectiveness.

Abstract

et al. Implantable contraceptives (subdermal implants and hormonally impregnated intrauterine systems) versus other forms of reversible contraceptives: two systematic reviews to assess relative effectiveness, acceptability, tolerability and cost-effectiveness. Health Technol Assess 2000;4(7). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see overleaf). NHS R&D HTA Programme T he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Pharmaceutical Panel and funded as project number 95/41/01. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work either prioritised by the Standing Group on Health Technology, or otherwise commissioned for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors.

Compliance and user satisfaction with the intra-uterine contraceptive device in Family Planning Service: The results of a survey in Fife, Scotland, August 2004

“…The only significant difference is the LNG-IUS doubles the incidence of moodiness. A systematic review has identified no differences in side-effects (acne, headaches, breast tenderness, nausea, prolonged bleeding, embedded device and pelvic inflammatory disease) between LNG-IUS and IUD 24 . Although serum levonorgestrel levels are low in LNG-IUD users (compared with oral or subdermal administration), wide inter-individual differences in systemic absorption of levonorgestrel occur 25 .…”

“…The rate of teenage pregnancy and termination of pregnancy is amongst the highest in the UK. Of concern, this rate is increasing (an absolute increase of 28% in pregnancies in [13][14][15][16][17][18][19][20][21][22][23][24][25] year age group from 2002 to 2003), with a corresponding increase in abortions 12 . Therefore, it is important that Fife has an effective contraceptive service.…”

Perforation of the bowel from intrauterine contraceptive devices: case series and discussion

“…This is known as the "Pearl index." Both the newer copper-containing devices and the levonorgestrel-releasing device are effective methods of contraception, with a Pearl index of less than 1 per 100 woman-years [2].…”

Intrauterine devices – perceptions overestimate the hazards

“…Low ectopic pregnancy rates of 0.25/1000 woman-years are reported with use of modern copper devices containing more than 350 mm 2 of copper (CuT380) 21 . The LNG IUS has even lower ectopic pregnancy rates compared to modern copper IUDs 22,23 .…”

“…Copper IUDs also provide a far more effective option than condoms/diaphragms for women not wishing to use hormonal methods. Cumulative pregnancy rates of 1.4-2.7/100 womanyears are reported with CuT380, Multiload Cu375 Ò and GyneFix Ò21, 22 . Other benefits are that no user motivation is required, there are no systemic metabolic effects and a rapid return to pre-existing fertility occurs.…”