1. Getting contraception right for women in 2012 and beyond Anne Connolly The Ridge Medical Practice

2. Objectives Practical issues New products New recommendations New(ish) advice

3. Births per 1000 women age 16–19 1.United Nations Population Division 2009

4. Teenage pregnancy matters >40,000 under-18 conceptions in 2008 20% of under-18 conceptions are repeat pregnancies Babies of teenage mothers have a 60% higher risk of dying in their first year and have a significantly increased risk of living in poverty, achieving less at school and being unemployed in later life Teenage pregnancy is both a cause and result of exclusion, poverty and inequality

5. Rate per 1,000 women aged 15–44 Abortion rates in the UK remain high

6. Number of abortions is highest in the 20-24 age group 3,718 34,551 55,481 40,800 27,978 27,046 0 10,000 20,000 30,000 40,000 50,000 60,000 under 1616-1920-2425-2930-3435+ Age Number of abortions

7. Other influences

8. Poor marketing!

9. Contraceptive choices 3 000 BC crocodile dung pessaries 2 000 BC women drank mercury Genesis – withdrawal method 1550BC Ebers Papyrus mixed dates, acacia bark, honey on wool pessary 200AD Soranus suggested jumping backwards 7 times after SI Native Americans drank dried beaver testicles European women in middle ages wore dried weasel testicles 1640 male barriers from fish bladders Victorians block wood pessary

10. ‘Doc I want the pill’

11. Accidental pregnancy in first year of use – typical use Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J et al. Contraceptive Technology, revised edition 19. NY: Ardent Media, 2007 percent

12. Contraceptive use in the UK percent Office for National Statistics, 2010

13. ‘Doc I want the pill’ 23 year old Raynaud’s disease Wants ‘the pill’ Can she?

14. UKMEC

15. UKMEC 2009 Raynauds diseaseCHCPOPDMPAIMPCu-IUDIUS a)Primary b)Secondary i)Without lupus anti- coagulant ii)With lupus anti- coagulant 124124 122122 112112 112112 111111 112112

16. COCPs Microgynon 30Ovysmenn

17. COCPs FemodetteFemodeneCilest Microgynon 30Ovysmenn

18. COCPs Yasmin FemodetteFemodeneCilest Microgynon 30Ovysmenn

19. Qlaira

20. FSRH CHC guidance

21. ‘Doc I want the pill’ 30 year old Epileptic on Lamotrigine Wants ‘the pill’ Can she?

22. Drug interactions

23. Guidance on antibiotics and contraceptive pill interaction changed No need to use extra precautions when using antibiotics and combined hormonal contraception

24. ‘Doc I want the pill’ 37 year old lady wants to restart her ‘pill’ BMI 44

25. UKMEC 2009 ObesityCHCPOPDMPAImplantCu-IUDIUS a)BMI ≥ 30-34 b)BMI ≥ 35 2323 1111 1111 1111 1111 1111

26. Can we use Yasmin? Epidemiological studies have shown that the risk of VTE for drospirenone COCs is higher than for levonorgestrel-containing COCs and may be similar to the risk for COCs that contain desogestrel or gestodene. The risk of VTE with Yasmin remains very small and, like other oral contraceptives, is less than that associated with pregnancy. MHRA 2011

27. VTE/10,000 WY Age BMI EURAS results: Impact of age and BMI in VTE incidence in OC users WITHOUT other known risk factors 1 26,5 18,9 14,9 21,1 15,4 7,7 19,9 4,9 1,7 0 10 20 30 40 50 60 <25 25-3940+ <25 [25-30[ 30+ 1. EURAS study, data on file

28. Missed pill rules If two or more pills are missed (> 48 hours) take last forgotten pill (may mean taking 2 pills in 1 day) and the next when it is due continue with the packet of pills use extra precautions for 7 days If there are less than 7 pills left in the packet miss hormone free interval and start new packet immediately use condoms for 7 days MHRA 2011