Dr. Iñaki LeteDr. Iñaki LeteJefe de Servicio de GinecologíaJefe de Servicio de GinecologíaHospital Santiago. VitoriaHospital Santiago. Vitoria

How to prescribe ?

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What to consider

Non contraceptive benefits EBM

Contraceptive needs

Prescription

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1.- Contraceptive needs

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Contraceptive needs of U.S. women

• Easy to use, 91%• Sure, 90%• Reliable, 89%• Without side effects, 85%• Non hormonal, 63%• Monthly administration, 62%

www.drkop.com/news/special-reports/birthcontrol

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Contraceptive needs of Spanish women

• Reliable, 72,2%• Sure, 18%• Good bleeding pattern, 8,5%• Comfortable, 0,8%• Cheep, 0,4%

Haya J y cols. Preferencias anticonceptivas en la mujer que solicita anticoncepción. Toko-Gin Pract 2003;62:279-84.

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Needs of women

• Efficacy• No side effects• Easy to use. Comfortable• Confidence with the method

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Method Pearl Index

< 1 2 - 10 > 10

Hormonal Combined Minipill Implant InjectableIUDCondomSterilizationWithdrawal

+++++

+

+

+

Efficacy

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Method

Bleeding

disorders Weight gain Pain

Hormonal Combined Minipill Implant InjectableIUDCondomSterilizationWithdrawal

++++ +

Side effects

+

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Method Needs compliance

Hormonal Combined Minipill Implant InjectableIUDCondomSterilizationWithdrawal

++

+

+

Easy to use

Yes

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Method Pearl Index

< 1 2 - 10 > 10

Hormonal Combined Minipill Implant InjectableIUDCondomSterilizationWithdrawal

+++

+

+

+

Effectiveness

++

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28

29

39

53

57

81

83

72

71

61

46

42

19

16

1

1

0 20 40 60 80 100

Cooper IUD

Ring

Patch

Pill (current)

Condom

Rythm

Withdrawal

Yes No NS/NC

Confidence with the contraceptive method

Have you ever been relieved when period

started?

The TNS Nippo Study. European survey about the confidence on contraception and the emotional consequences of forgetting the pill. N=8531 women & men.

The TNS Nippo Study. European survey about the confidence on contraception and the emotional consequences of forgetting the pill. N=8531 women & men.

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2.- Non contraceptive benefits

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Adolescence

• Can we prevent STD and to preserve the fertility ?

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Perimenopause

• Can We:– To prevent osteoporosis– To treat the menorrhagia– To prevent some genital cancers

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Conditions Naturals Barrier Cu IUD LNG IUD CHC Gestagens Sterilization

High efficacy - + ++ +++ +++ +++ +++

Simptoms treat - - - + +++ + - Osteoporosis prevention - - - - ++ - -

Treat menorrhagia - - - +++ ++ +++ -

+

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3.- EBM

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Medical eligibility criteria

• Category 1: any restriction• Category 2: benefits > risks• Category 3: risks > benefits• Category 4: only under further

evaluation

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Conclusions

• The prescription of any contraceptive method is a two way process

• The most important fact is to listen the women and men and to discuss the advantages and risks of the contraceptive methods

• Any medical analysis, exploration, smear…. can supply the adequate information

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How to prescribe ?

Prescription

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How to prescribe ?

Contraception

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How to prescribe ?

Family Planning

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How to prescribe ?

Reproductive Health Care

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How to prescribe ?

Human Rights