Slide 1

How to prescribe ?

Dr. Iñaki Lete
Jefe de Servicio de Ginecología
Hospital Santiago. Vitoria


Slide 2

What to consider
Contraceptive needs
Non contraceptive
benefits

EBM

Prescription
Servicio de Ginecología


Slide 3

1.- Contraceptive
needs

Servicio de Ginecología


Slide 4

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
Servicio de Ginecología


Slide 5

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.
Servicio de Ginecología


Slide 6

Needs of women
•
•
•
•

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

Servicio de Ginecología


Slide 7

Efficacy
Method

Pearl Index
<1

Hormonal
Combined
Minipill
Implant
Injectable
IUD
Condom
Sterilization
Withdrawal

+
+
+
+
+

2 - 10

> 10

+

+

+
Servicio de Ginecología


Slide 8

Side effects
Method
Bleeding disorders

Hormonal
Combined
Minipill
Implant
Injectable
IUD
Condom
Sterilization
Withdrawal

+
+
+
+

Weight gain

Pain

+
+

Servicio de Ginecología


Slide 9

Easy to use
Method

Needs compliance
Yes

Hormonal
Combined
Minipill
Implant
Injectable
IUD
Condom
Sterilization
Withdrawal

+
+

+

+
Servicio de Ginecología


Slide 10

Effectiveness
Method

Pearl Index
<1

Hormonal
Combined
Minipill
Implant
Injectable
IUD
Condom
Sterilization
Withdrawal

2 - 10

> 10

+
+
+
+
+

+

+

+
Servicio de Ginecología


Slide 11

Confidence with the contraceptive method
Have you ever been relieved when period started?
Cooper IUD

28

72

Ring

29

71

Patch

39

Pill (current)

61
53

Condom

46

57

Rythm

42
81

Withdrawal

19

83

0

20
Yes

1

16

40

60
No

80

1

100

NS/NC

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

Servicio de Ginecología


Slide 12

2.- Non contraceptive
benefits

Servicio de Ginecología


Slide 13

Adolescence
• Can we prevent STD and to
preserve the fertility ?

Servicio de Ginecología


Slide 14

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

Servicio de Ginecología


Slide 15

Conditions

Naturals

Barrier

Cu IUD

LNG IUD

CHC

Gestagens

Sterilization

High
efficacy

-

+

Simptoms

-

-

-

+

+++

+

-

Osteoporosis

-

-

-

-

++

-

-

Treat

-

-

-

+++

-

treat

prevention

menorrhagia

+++ +++ +++ +++ +++

+++ ++

Servicio de Ginecología


Slide 16

3.- EBM

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Slide 17

Medical eligibility criteria
•
•
•
•

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

Servicio de Ginecología


Slide 18

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
Servicio de Ginecología


Slide 19

How to prescribe ?

Prescription

Servicio de Ginecología


Slide 20

How to prescribe ?

Contraception

Servicio de Ginecología


Slide 21

How to prescribe ?

Family Planning

Servicio de Ginecología


Slide 22

How to prescribe ?

Reproductive Health Care

Servicio de Ginecología


Slide 23

How to prescribe ?

Human Rights

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