Contraception
- current issues: Summary
Volume 17 Number 2
November 2006
Summary
There
are many methods of contraception currently available
in the UK. This Bulletin discusses some current
issues, including information on the effectiveness of
different methods, and the risks associated with use
of combined oral contraceptives (COCs). The newer contraceptives
— Evra▼, Yasmin
and Cerazette — are discussed, as is
the recent NICE guidance on long-acting reversible contraception.
This summary document is a collation of the key messages
from the main
Bulletin. |
What
are the risks associated with COCs?
Venous
thromboembolism (VTE)
All COCs increase the risk of VTE. There is a small excess
risk associated with COCs containing desogestrel or gestodene.
However, in absolute terms, the risk is still low and is lower
than the risk of VTE in pregnancy.
On
a population level, it would seem sensible to prescribe COCs
that do not contain desogestrel or gestodene first-line. However,
on an individual level, providing women are fully informed
of the risks and do not have medical contraindications, it
should be a matter of clinical judgement and personal choice
as to which type of oral contraceptive is prescribed.
All
COCs should be prescribed with caution to women with a higher
baseline risk of VTE.
Breast
cancer
Any increased risk of breast cancer with COC use is likely
to be small, but is in addition to background risk, which
is particularly relevant to older women.
Cervical
cancer
Recent studies strengthen the evidence that long-term oral
contraceptive use may contribute to the development of cervical
cancer in women with human papillomavirus (HPV) infection,
but these studies are not conclusive. The absolute risk of
developing cervical cancer is low, whether women use oral
contraceptives or not. All sexually active women, especially
those on long-term oral contraceptives, should be encouraged
to have regular cervical smears.
Myocardial
infarction (MI) and stroke
The absolute risk of a MI in young non-smoking women with
no cardiovascular risk factors is very low, whether or not
they take COCs.
COCs
are associated with a very small increase in the absolute
risk of ischaemic stroke in non-smoking, normotensive women.
COCs
should be used with caution in any woman with risk factors
for cardiovascular disease (e.g. obesity, age over 35 years,
smoking), and avoided in women with severe or multiple risk
factors.
Back
to top
What
about progestogen-only pills (POPs)?
There
is very little evidence to describe the risks associated with
POPs. See the BNF, individual Summaries of Product Characteristics
(available at www.medicines.org.uk)
and the UK Medical Eligibility Criteria (UKMEC) for contraceptive
use (available at www.ffprhc.org.uk)
for further information.
Back
to top
Newer
contraceptives
Evra▼
Evra may be an option for some women who wish to use a reversible
hormonal method of contraception and are experiencing compliance
problems with COCs. However, routine prescribing of Evra
in place of COCs is not supported by the evidence to date.
Yasmin
Yasmin is an option for those women suitable for
a COC. However, current evidence indicates that on a population
level Yasmin has no conclusive advantages over other
standard strength COCs.
Cerazette
Although Cerazette may be more effective at preventing
ovulation than other POPs, from current data it is not known
whether this translates into improved contraceptive efficacy.
Cerazette is an option for women who are suitable
for a POP, possibly for those who may have difficulty complying
with the stricter dosage regimen of other POPs.
Back
to top
Long-acting
reversible contraception (LARC)
In
October 2005, the National Institute for Health and Clinical
Excellence (NICE) published guidelines on LARC. NICE recommends
that women requiring contraception should be given information
about, and offered a choice of, all methods, including LARC.
Women considering LARC methods should receive detailed information,
tailored to their individual needs, that will enable them
to make a choice. The NICE guidance discusses each LARC method
in detail and includes features to discuss with women to assist
decision making, such as mode of action, failure rate, duration
of use, risks and possible side effects, effects on periods
and return to fertility. If LARC is not provided within a
contraceptive service, an agreed mechanism should be in place
for referring women for LARC.
Back
to top
The
National Institute for Health and Clinical Excellence (NICE)
is associated with MeReC Publications published by the NPC
through a funding contract. This arrangement provides NICE
with the ability to secure value for money in the use of NHS
funds invested in its work and enables it to influence topic
selection, methodology and dissemination practice. NICE considers
the work of this organisation to be of value to the NHS in
England and Wales and recommends that it be used to inform
decisions on service organisation and delivery. This publication
represents the views of the authors and not necessarily those
of the Institute.
NPC materials may be downloaded / copied freely by people
employed by the NHS in England for purposes that support NHS
activities in England. Any person not employed by the NHS,
or who is working for the NHS outside England, who wishes
to download / copy NPC materials for purposes other than their
personal use should seek permission first from the NPC.
Email: copyright@npc.nhs.uk
Copyright 2006
National
Prescribing Centre, The Infirmary, 70 Pembroke Place, Liverpool,
L69 3GF Tel: 0151 794 8146 Fax: 0151 794 8139
|
