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Contraception

Contraception. Facilitating choice. GLOBAL CONTEXT. Approximately 250 million pregnancies occur world wide each year > 1/3 are unintended 23 million pregnancies in developed countries 40% unintended 28% TOP 182 million pregnancies in developing countries > 1/3 unintended

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Contraception

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  1. Contraception Facilitating choice

  2. GLOBAL CONTEXT • Approximately 250 million pregnancies occur world wide each year • > 1/3 are unintended • 23 million pregnancies in developed countries • 40% unintended • 28% TOP • 182 million pregnancies in developing countries > 1/3 unintended • 19% TOP - 11% unsafe. • Guttmacher Institute “facts on Induced Abortion world wide” October 2008, www.guttmacher.org/pubs/fb_IAW.html

  3. “ My friend (a girl) and I ended up hooking up with a guy we know ….i went down on this guy, than later i went down on my girlfriend, later i started thinking! Could his sperm be swimming around my mouth and then go up my friends kooch???!?!! DOSE SHE NEED EC?? I hope you can answer b/c we are for real wigging out!!” • Email sent to Not-2-Late.com • LL Wynn, Angel M Foste, James Trussell • “Can I get Pregnant from oral sex? Sexual health misconceptions in email to a reproductive health website” Contraception 79(2009) 91-97.

  4. Contraception Continuum LESS POTENTIAL FOR SIDE EFFECTS MORE POTENTIAL FOR SIDE EFFECTS WITHDRAWAL BARRIER METHODS INJECTABLE CONTRACEPTIVES NATURAL METHODS CONTRACEPTIVE IMPLANTS SPERMICIDE ALONE IUD CONTRACEPTIVE PILLS OR RINGS LESS EFECTIVE MORE EFFECTIVE Adapted fromSexual Health Medicine. Russell et al (eds) 2005

  5. What’s Available in Australia • Hormonal • Barrier • Other

  6. Combined Hormonal Methods • COCP, • 99.7% perfect – 92% typical • Generally very safe in women under 30 who do not smoke • Nuva Ring • Efficacy 99.7% • Ethinyloestradiol and etonogestrel, Lower dose of hormones = fewer side effects

  7. 7 Day Rule • Late Pill – if no more than 24 hours late : • Take pill as soon as it is remembered • Keep taking pills at usual time – even if that means taking more th pill in one day. • Missed Pill/s – if a pill is more than 24 hours late it has been missed. • Take the pill as soon as it is remembered • Keep taking the pill at the usual time • Use another form of contraception or abstain from sex for 7 days • If the missed pill was in the first week of active pills after the sugar pills and UPSI has occurred give EC • If the missed pill was in the last week of active pills before the sugar pills, skip the sugar pills

  8. Progestogen Only Methods POP – 99.7% perfect and 92% typical use 3 hour window 40% women still ovulate Injectable contraceptives: 99.7% perfect – 97% typical

  9. Implanon: • Etonogestrel slow release long term (3 years) • 99.9% perfect and typical use • Mirena • Levonorgestrel 20mcg slow release long term (5yrs) • >99% efficacy • Reduced bleeding but irregular bleeding in first 5 months • Infection risk – at time of insertion, and elevated risk ongoing

  10. Withdrawal: Perfect use 96% Typical use 73% Emergency Contraception Pill Levonorgestrel: Two pills making up 1.5g stat dose taken within 120 hours of UPSI, more effective the sooner it is used Efficacy 85% Available over counter

  11. “ Would it be dangerous or life threatening if I took the ecp again, while I am still taking the yasmin?” • “Could I get pregnant if I’m on the three month shot? Because I had sex but the condom broke. Do the shot keep you from getting pregnant?” • LL Wynn, Angel M Foste, James Trussell • “Can I get Pregnant from oral sex? Sexual health misconceptions in email to a reproductive health website” Contraception 79(2009) 91-97.

  12. What’s New? • Postinor 1 : One pill stat dose1.5g levonorgestrel now available through pharmacies however not on PBS therefore more expensive. • Medical Abortion now available in Victoria through Marie Stopes in East St Kilda Clinic. Up to 98% efficacy up to 9 weeks, compared to 99% surgical.

  13. Studies: • New OCP Monash university women’s health Program “Pillow Talk Study” • A Multi-centre, double-blind, randomized study to investigate the impact of a sequential oral contraceptive containing oestradiol valerate and dienogest (SH T00658ID) compared to a monophasic contraceptive containing ethinylestradiol and levonorgestrel (Microgynon) over 6 treatment cycles on alleviating complaints of reduced libido in women with acquired female sexual dysfunction (FSD) associated with oral contraceptive use. • Male contraceptive: under development. Everything from nanotechnology to post meiotic blockage of epipdymal sperm maturation and hormonal prevention of sperm production. • Anzac Research Institute Sydney.

  14. Resources Marie Stopes:www.mariestopes.com.au Women’s Health Victoria : www.whv.org.au Family Planning Victoria www.fpv.org.au World Health Organisation: www.who.int/reproductivehealth/publications/mec www.who.int/reproductivehealth/publications/sprl Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit : www.ffprhc.org.uk

  15. References • Allen, Katrina, “Catching up on Contraception” Australian Family Physician vol.38, No6, June2009 • Guttmacher Institute “facts on Induced Abortion world wide” October 2008, www.guttmacher.org/pubs/fb_IAW.html Sexual Health and Family Planning Australia, Contraception: An Australian Clinical handbook 2006, • Jean-Jacques, Amy. Vrijesh Tripathi, “Contraception for women: an evisdence based overview” BMJ September 2009, Volume 339 • LL Wynn, Angel M Foste, James Trussell “Can I get Pregnant from oral sex? Sexual health misconceptions in email to a reproductive health website” Contraception 79(2009) 91-97. • McDonald S. Thompson, C. 2005, Women’s Health: A Handbook, Elsevier Churchill Livingstone. • Foran T, 2005 “ A clinical approach to contraception” Chapter 21 in Russell, Bradford and Fairley (eds) Sexual Health Medicine, IP Communications 2005 • Sexual Health and Family Planning Australia, Contraception: An Australian Clinical handbook 2006.

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