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Kontraception U-kursus 2014

Kontraception U-kursus 2014. Kresten R. Petersen overlæge, dr.med Gynækologisk-obstetrisk afd. Odense Universitetshospital. Disposition. Kontraception i forskellige aldersgrupper med særlig vægt på de unge og de ”gamle”. Medicinske fordele ved kontraception.

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Kontraception U-kursus 2014

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  1. KontraceptionU-kursus2014 Kresten R. Petersen overlæge, dr.med Gynækologisk-obstetrisk afd. Odense Universitetshospital

  2. Disposition • Kontraception i forskellige aldersgrupper med særlig vægt på de unge og de ”gamle”. • Medicinske fordele ved kontraception

  3. Legal abortions/1000 w. in Denmark 1975-2012 • StatensSeruminstitut2014

  4. Antal tilfælde af Klamydia T. i Danmark 1994-2011 Statens Seruminstitut

  5. Use of contraception in women seeking legal abortion - 00 Rasch et al: Human Reprod 2007;22:1320-6

  6. Contraceptive efficacy - % women pregnant during first year Hatcher RA, et al ContraceptiveTechnology: NineteenthRevised Edition. New York NY: Ardent Media, 2007

  7. De unge • Ca 50 % bruger p-piller • Dårlig compliance • Glemmer tabletterne • Generet af bivirkninger

  8. Discontinuation of OCs Rosenberg, Am J Obstet Gynecol 1998;179:577

  9. Side effects Weight gain Health problems/risk Not natural Forgot to take No need for contr. 24 % 8 % 16 % 5 % 5 % 30 % Discontinuation of OCEuropean study Skouby. Eur J Contracep Reprod Health 2004;9:57

  10. Discontinuation of OC during first 6 months – American study Bleeding irreg. Nausea Weight gain Mood changes Breast tenderness Headaches Method related No need for contr. 12 % 7 % 5 % 5 % 4 % 4 % 14% 23 % Rosenberg, Am J Obstet Gynecol 1998;179:577

  11. Alternatives to OC’s

  12. Ring and patches Patches: 20 mcg EE + 150 NGT 3 x1 w.patch 1 w without Pearlsindex < 1.5 Continoususe Rings 15 mcg EE + 120 ETO 3 w.ring 1 w without Pearlsindex < 1 Canberemoved for 3 h Same contraindications as OCs

  13. NuvaRing

  14. Common questions.Can the ring be felt ?? • 87 % of the women never/seldomly felt the ring during intercourse • 74% of the partners never/seldomly felt the ring during intercourse • 5% considered it a problem Dieben et al. Obstet Gynecol 2002;100:585-93

  15. Implant – Implanon NXT

  16. Etonorgestrel implantContraceptive effect - 3 y • At registration • 73429 cykles • Nopregnancies • Latestpost marketing report*: • 218 pregnancies in 205.000 insertions • 13 directlymethodrelated Harrison. Contraception 2005;71:306

  17. Progestogen DepotDepo-Provera

  18. DepoProvera • 150 mg MPA given i.m. every 3 months • Pearlsindex far below 1 • Wellsuited for womenwithquestionablecompliance

  19. Whatabout Cupper IUDs ???? Mode of action: Foreingbodyreaction in endometrium Cu ions aretoxic to spermatozooes Reduced fertilisation Main concerns: Decreasedfertility due to PID Increasedmenstrual flow and pain

  20. Proportion of women with tubal infertility, non-tubal infertility and fertile women who had used IUDs Hubacher. N Engl J Med 2004;345:561-67

  21. IUDs in nulliparouswomen

  22. 1 year clinical performance of OCs and LNG-IUDs in nullips – a randomized study Suhonen. Contraception2004:69:407-12

  23. Hvad så med de ældre kvinder ??

  24. Særlige hensyn • Konkurerende medicinske sygdomme (adipositas, DM, hypertension,cancer) • Gynækologiske tilstande (fibromer, blødningsforstyrrelser)

  25. WHO – medical eligibility for contraceptive use 2004 The eligibility was graded in four categories: 1: OCs can be used in any circumstances 2: OCs can generally be used 3: OCs not usually recommended unless other more appropriate methods are not available or not acceptable 4: OCs should not be used

  26. WHO – medical eligibility for oral contraceptive use - Smoking: Age < 35 y Age > 35 y. Light Heavy (>20 cig/day 2 3 4

  27. WHO – medical eligibility for oral contraceptive use - Headache • Mild • Severe (recurrent incl. Migraene without focal neurological sympt). • With focal neurological sympt 1 2 4

  28. Onlyonerisk factor allowed • Age > 35 • Smoking • Obesity • Varicoseveins • Mild hypertension • DM withoutcomplications • Migraine

  29. Non contraceptive effects of EE+Progestogen methods Positive: Bleeding disturbances, endometriosis, dysmenore, hirsutism, ovarian cysts, endometrial- and ovarian cancer Negative: Vascular disease

  30. OCs and reprod. cancerRCGP: 46.000 w recr. from 1968-69 1.083.000 w. years Hannaford.BMJ 2007:335:651-9

  31. Ovarian cancer and oral contraceptivesCollaborative Group onEpidemiological Studies of Ovarian CancerLancet 2008;371:303-14 • 45 epidemiological studies from21 countries • 23257 women with ovarian cancer. • 87303 controls without ovarian cancer • Median age of cancer diagnosis: 56 y. • Median year of diagnosis: 1993 • Average duration of use: 4.4 y (cancer) 5.0 y (controls)

  32. Relative risk of ovarian cancer in everusers. Effect of duration of useNeverusers =1

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