Long acting contraception to whom and why Øjvind Lidegaard Gynaecological Clinic Rigshospitalet...
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Long acting contraception to whom and why Øjvind Lidegaard Gynaecological Clinic Rigshospitalet Copenhagen University
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Transcript of Long acting contraception to whom and why Øjvind Lidegaard Gynaecological Clinic Rigshospitalet...
Long acting contraceptionto whom and why
Øjvind Lidegaard
Gynaecological ClinicRigshospitaletCopenhagen University
Long acting contracpetion
• Long acting contraceptive methods
• Use pattern today
• To whom and why
Li/10
Long acting contracpetion
• Long acting contraceptive methods
• Use pattern today
• To whom and why
Li/10
Length of effect of different contraceptive methods after application
0,1 1 10 100 1000 10000 100000
Condom
POP
COC
Vag Ring
Depot prog
Implanone
IUD
Sterilisation
Li/10
Hours
5 years
3 years
3 months
1-2 days
1 day
<1 hour
Life long
4 weeks
Long acting contracpetion
• Long acting contraceptive methods
• Use pattern today
• To whom and why
Li/10
Depo-provera and implanone 05-09
0
500
1000
1500
2000
2500
2005 2006 2007 2008 2009
DepoProvera Implanone
Li/10www.laegemiddelstyrelsen.dk
1000 DDD
Implanone in Denmark 2009
0
4
8
12
16
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
Li/10www.laegemiddelstyrelsen.dk
DDD per 1,000 per day
Depo-provera in Denmark 2009
0
0,4
0,8
1,2
1,6
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
Li/10www.laegemiddelstyrelsen.dk
DDD per 1,000 per day
Sale hormone-IUD in Denmark 2009
0
1000
2000
3000
4000
5000
6000
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
Li/10www.laegemiddelstyrelsen.dk
Number
Use of oral contraceptives according to ageDDD/100 women/day at different ages
2
43
54
36
24
1711
720
10
20
30
40
50
60
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54
Li/10www.laegemiddelstyrelsen.dk
Hormonal contraception according to estrogen dose and progestagen type
Li/10
Progestogen type
EE NETA Norgestimate Gestodene CPADose Levonor Desogestrel Drospire-In ug gestrel Etonogestrel none
50 ug30-40ug15-20ugPOPInjectionStick
1st gen 2nd gen
Cerazette
3rd genNuvaRing
4th gen
EVRA
Implanone
MPA
Per cent age distribution of differentcombined contraceptive pills 2009
0
5
10
15
20
25
30
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
1st gen
Li/10www.laegemiddelstyrelsen.dk
%
Per cent age distribution of differentcombined contraceptive pills 2009
0
5
10
15
20
25
30
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
1st gen 2nd gen
Li/10www.laegemiddelstyrelsen.dk
%
Per cent age distribution of differentcombined contraceptive pills 2009
0
5
10
15
20
25
30
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
1st gen 2nd gen
3rd gen 4th gen
Li/10www.laegemiddelstyrelsen.dk
%
Per cent age distribution of differentcombined contraceptive pills 2009
0
5
10
15
20
25
30
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
1st gen 2nd gen3rd gen 4th genQlaira
Li/10www.laegemiddelstyrelsen.dk
%
Per cent age distribution of differentcombined contraceptive pills 2009
0
5
10
15
20
25
30
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
1st gen 2nd gen3rd gen 4th genQlaira Cerazette
Li/10www.laegemiddelstyrelsen.dk
%
Hormonal contraception DK 2009
0
20000
40000
60000
80000
100000
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
Implanone
Qlaira
POP
Low
Middle
EVRA
Li/08
Low-dose OC
Middle dose OC
CPA
Sale statistics. www.laegemiddelstyrelsen.dk
DDD/day
Hormonal contraception DK 2009
0%
20%
40%
60%
80%
100%
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
Implanone
Qlaira
POP
Low
Middle
EVRA
Li/08
Low-dose OC
Middle dose HC
Impla-none
Sale statistics. www.laegemiddelstyrelsen.dk
POP
Conditions to take into accountwhen 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
OC and VTE: Progestagen typeadjusted 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 1.8 1.9 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 1.5 1.5 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/09Lidegaard et al. BMJ 2009; 339; b2890
OCs and thrombosisCurrent status June 2010
CTA AMI VTENon use 1 1 12nd gen: 2.5 1.5 2.53rd gen: 1.5 1.5 4.04th gen: na na 4.05th gen: ? ? ?
Li/10
Adiposity in Danish women and men in 1994 and 2005
1221
37
18
36 40
13
41
61
24
4961
0
10
20
30
40
50
60
70
16-24 25-44 45-66
94 women 2005 women 94 men 2005 men
Li/07www.si-folkesundhed.dk
Adiposity: BMI >25
Severe adiposity in Danish women in 1994, 2000 and 2005
24
11
3
911
5
1112
0
3
6
9
12
16-24 25-44 45-64
1994 2000 2005
Li/07
www.si-folkesundhed.dk
Adiposity: BMI 30
Induced abortions in DK 1998-2008
0,2
0,3
0,4
0,5
0,6
0,7
98 99 00 01 02 03 04 05 06 07 08 98 99 00 01 02 03 04 05 06 07 085
10
15
20
25
30
Li/10
15-19
35-39
25-29
10-14
20-24
40-44
Number per 1,000
www.TiGrAb.dk
30-34
Leiden V mutations, prevalence
2,32,5
4,555,2
6,67,2
8,18,7
10,9
00
0 2 4 6 8 10 12
Japan
Greenland
Italy
Saudi Arabia
Netherlands
Iceland
USA
Denmark
Germany
Greece
UK
Sweden
%
Larsen et al. Thrombosis Res 1998; 89: 211-15
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
Thank you for your attention
Presentation at www.Lidegaard.dk
