Unanswered questions in contraceptive management: What do the experts do?

Brooker, Catherine; Guillebaud, John

doi:10.1783/0000000042177063

Cited by 2 publications

(4 citation statements)

References 30 publications

(33 reference statements)

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“…Because of reduced fertility and a diminishing need for a powerful contraceptive in premenopausal women, and because synthetic estrogens in the COC are prothrombotic even in healthy women, a generally accepted policy is to switch to an alternative method no later than 50 or 51 years of age 9,[40][41][42] . For women up to that age, who may have difficulty in remembering to take the COC daily, the transdermal combined contraceptive patch designed to deliver norelgestromin and ethinylestradiol, and the combined contraceptive vaginal ring releasing etonogestrel and ethinylestradiol offer new hope.…”

Section: Hormonal Methods Combined Oral Contraceptivesmentioning

confidence: 99%

“…Although the progestogen-only pill (POP) has been available for several years, it has limited acceptability and accounts for less than 10% of the current oral contraceptive market in the UK 41,48 . The POP is currently used by 7% of women aged over 40 years 39 .…”

Section: The Progestogen-only Pillmentioning

confidence: 99%

“…The IUD or a barrier method may be used concomitantly. The POP may be used together with HRT, but there are no data to support the efficacy of this regimen 41 .…”

Section: Discontinuationmentioning

confidence: 99%

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Contraception for the older woman: an update

Bhathena¹,

Guillebaud

2006

Climacteric

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Although fertility declines with advancing age as the woman approaches the menopause, some risk of pregnancy persists, and effective contraception needs to be offered to avoid an unintended pregnancy. An older woman may have menstrual dysfunction or climacteric symptoms and these factors would need consideration when making the choice of contraception. Low-estrogen dose combined oral contraceptives may be prescribed to healthy non-smoking women up to about 50 years of age. The progestogen-only pill may be an appropriate option in an older woman with declining fertility. The copper intrauterine device is an optimal method for parous women free of pre-existing menstrual problems. The levonorgestrel-releasing intrauterine system is considered the contraceptive method of choice for perimenopausal women with menstrual dysfunction. The woman should be provided with individualized advice so that she has a choice between the newer, effective, largely safe, reversible methods and sterilization.

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Section: Hormonal Methods Combined Oral Contraceptivesmentioning

confidence: 99%

Section: The Progestogen-only Pillmentioning

confidence: 99%

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Contraception for the older woman: an update

Bhathena¹,

Guillebaud

2006

Climacteric

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“…Certainly, the licensing and the advice from pharmaceutical companies was conservative and, in many scenarios, a majority of practitioners indicated that in order to serve the best interests of their clients they felt constrained to practise outside the Summary of Product Characteristics (Brooker and Guillebaud 2004).…”

Section: Practice Habitsmentioning

confidence: 99%

Emergency contraception: a contraceptive intervention approaching target despite controversy and opposition

Sarkar

2006

J Public Health

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The objective of this study is to make the public aware of progress, safety, effectiveness of use, acceptance, and over-the-counter availability of emergency contraception (EC). Data were extracted from the literature for the period 2000-2006 via MEDLINE using a keyword, and also from some pre-2000 journals. Randomised trials, reviews, surveys, clinical investigations, and articles relevant to the subject matter are considered in this review. Approximately 85%, 57% and 84% of unintended pregnancy could be prevented by using levonorgestrel, the Yuzpe regimen (levonorgestrel plus ethinylestradiol), and mifepristone, respectively, as EC. Levonorgestrel was more effective than the Yuzpe regimen in preventing pregnancy. A dose of 1.5 mg levonorgestrel seemed to have similar effectiveness as that of split doses (0.75 mg twice) at 12 h apart, and that of a low-dose (10 mg) of mifepristone. Nausea and vomiting, dizzy spells and fatigue were less frequent in women using levonorgestrel only than in those receiving the Yuzpe regimen. The mode of action of EC is associated primarily with inhibition of ovulation. EC acts before implantation and hence does not amount to abortion. Teenagers are more likely to be repeat users of EC. Easy access to EC over the counter is likely to increase its use but will widen the chance of misuse or abuse. Both adolescents and health care providers need to be adequately educated and informed about EC to make this method successful. Over the counter supply of EC without prescription but with pharmacists' counselling may increase reduction of unintended pregnancy and abortion. The controversy surrounding, and opposition to, EC may subside with more awareness and knowledge among the public about its mode of action, safety and effectiveness. Educational programmes on EC and further studies on the psychosocial aspects of its use may resolve hurdles for implementation of 'advance provision' or 'over the counter supply' of EC in the community.

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Unanswered questions in contraceptive management: What do the experts do?

Abstract: Context

Cited by 2 publications

References 30 publications

Contraception for the older woman: an update

Contraception for the older woman: an update

Emergency contraception: a contraceptive intervention approaching target despite controversy and opposition

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