1. Long acting contraception to whom and why Øjvind Lidegaard Gynaecological Clinic Rigshospitalet Copenhagen University

2. Long acting contracpetion Long acting contraceptive methods Use pattern today To whom and why Li/10

3. Long acting contracpetion Long acting contraceptive methods Use pattern today To whom and why Li/10

4. Length of effect of different contraceptive methods after application Li/10 Hours 5 years 3 years 3 months 1-2 days 1 day <1 hour Life long 4 weeks

5. Long acting contracpetion Long acting contraceptive methods Use pattern today To whom and why Li/10

6. Depo-provera and implanone 05-09 Li/10 www.laegemiddelstyrelsen.dk 1000 DDD

7. Implanone in Denmark 2009 Li/10 www.laegemiddelstyrelsen.dk DDD per 1,000 per day

8. Depo-provera in Denmark 2009 Li/10 www.laegemiddelstyrelsen.dk DDD per 1,000 per day

9. Sale hormone-IUD in Denmark 2009 Li/10 www.laegemiddelstyrelsen.dk Number

10. Use of oral contraceptives according to age DDD/100 women/day at different ages Li/10 www.laegemiddelstyrelsen.dk

11. Hormonal contraception according to estrogen dose and progestagen type Li/10 Progestogen type EE NETA Norgestimate Gestodene CPA Dose Levonor Desogestrel Drospire- In ug gestrel Etonogestrel none 50 ug 30-40ug 15-20ug POP Injection Stick 1 st gen 2 nd gen Cerazette 3 rd gen NuvaRing 4 th gen EVRA Implanone MPA

12. Per cent age distribution of different combined contraceptive pills 2009 Li/10 www.laegemiddelstyrelsen.dk %

13. Per cent age distribution of different combined contraceptive pills 2009 Li/10 www.laegemiddelstyrelsen.dk %

14. Per cent age distribution of different combined contraceptive pills 2009 Li/10 www.laegemiddelstyrelsen.dk %

15. Per cent age distribution of different combined contraceptive pills 2009 Li/10 www.laegemiddelstyrelsen.dk %

16. Per cent age distribution of different combined contraceptive pills 2009 Li/10 www.laegemiddelstyrelsen.dk %

17. Hormonal contraception DK 2009 Li/08 Low-dose OC Middle dose OC CPA Sale statistics. www.laegemiddelstyrelsen.dk DDD/day

18. Hormonal contraception DK 2009 Li/08 Low-dose OC Middle dose HC Impla- none Sale statistics. www.laegemiddelstyrelsen.dk POP

19. Conditions to take into account when deciding type of contraception Risk of venous thrombosis - family disposition - previous thrombosis - adiposity Risk of arterial thrombosis - smoking, diabetes, hypertension - migraine, with or without aura Contraceptive compliance Sexual practice / social situation

20. OC and VTE: Progestagen type adjusted for duration of use ug EE Neta Levo Norg Deso Gest Dros Cypr 50 1.4 1.2 na na na na na 1.0-2.1 0.9-1.7 30-40 1.0 Ref 1.2 1.81.9 1.6 1.9 0.7-1.4 1.0-1.5 1.5-2.2 1.6-2.2 1.3-2.1 1.5-2.4 20 na na na 1.51.5 na na 1.3-1.8 1.2-1.9 POP na 0.3 0.2-0.5 0.5 0.2-1.7 Mirena na 0.4 0.3-0.6 Li/09 Lidegaard et al. BMJ 2009; 339; b2890

21. OCs and thrombosis Current status June 2010 CTA AMI VTE Non use 1 1 1 2nd gen: 2.51.5 2.5 3rd gen: 1.51.5 4.0 4th gen: na na 4.0 5th gen: ? ? ? Li/10

22. Adiposity in Danish women and men in 1994 and 2005 Li/07 www.si-folkesundhed.dk Adiposity: BMI >25

23. Severe adiposity in Danish women in 1994, 2000 and 2005 Li/07 www.si-folkesundhed.dk Adiposity: BMI  30

24. Induced abortions in DK 1998-2008 Li/10 15-19 35-39 25-29 10-14 20-24 40-44 Number per 1,000 www.TiGrAb.dk 30-34

25. Leiden V mutations, prevalence Larsen et al. Thrombosis Res 1998; 89: 211-15

26. Long acting contraception could be considered in women with Difficulty in remembering to take a daily pill Wish of high degree of protection against pregnancy Women who due to thrombotic predisposition could not take combined OC Women concerned about the risk of VTE Adipose women

27. Thank you for your attention Presentation at www.Lidegaard.dk