ORAL CONTRACEPTION (OC) - OVER THE COUNTER (OTC)?
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ORAL CONTRACEPTION (OC) - ORAL CONTRACEPTION (OC) - OVER THE COUNTER (OTC)?OVER THE COUNTER (OTC)?
Arie Yeshaya, M.D.Arie Yeshaya, M.D.Pediatric Adolescent ClinicPediatric Adolescent Clinic
Schneider Children’s HospitalSchneider Children’s Hospitalandand
Department of Obstetrics and GynecologyDepartment of Obstetrics and GynecologyRabin Medical Center, Petah Tikva, IsraelRabin Medical Center, Petah Tikva, Israel
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OC - OTC ?OC - OTC ?
The pill off prescription? (The pill off prescription? (Lester, 1974Lester, 1974))
The pill without prescription (The pill without prescription (Winaver,Winaver, 19751975))
OC without prescription (OC without prescription (Houghton, 1993)Houghton, 1993)
Making OC available over the counter Making OC available over the counter
( (Youngkin et al. 1996Youngkin et al. 1996))
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POSTCOITAL EMERGENCY POSTCOITAL EMERGENCY CONTRACEPTIONCONTRACEPTION
((Yuzpe, 1974Yuzpe, 1974))
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A prescription drug should be switched toover the counter Status if:
The drug is safe for self medicationThe drug is effective when self administeredThe condition to be treated is self diagnosableThe drug’s labeling is tailored to self administration
Should Oral Contraceptives Be Sold Over the-Counter?
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OC - OTCOC - OTCPROSPROS
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OC - OTCOC - OTC
Easier to achieveEasier to achieve
More usersMore users
Less unwanted pregnanciesLess unwanted pregnancies Less abortionsLess abortions
Lower maternal morbidity and mortalityLower maternal morbidity and mortality
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WORLDWIDE STATISTICSWORLDWIDE STATISTICS
>1 of 2 pregnancies >1 of 2 pregnancies are unwantedare unwanted
Induced abortions Induced abortions >50x10>50x1066/year/year
Maternal mortality - Maternal mortality - 600,000/year600,000/year
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GYNECOLOGICAL EXAMINATION -GYNECOLOGICAL EXAMINATION -
INCONVENIENT EXPERIENCEINCONVENIENT EXPERIENCE
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DR. OC-OTCDR. OC-OTC
On vacation until …..On vacation until …..
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NON-CONTRACEPTIVENON-CONTRACEPTIVE BENEFITS OF OC BENEFITS OF OC
Reduction in:Reduction in: Ovarian cancerOvarian cancer Endometrial cancerEndometrial cancer PIDPID Ectopic pregnancyEctopic pregnancy AnemiaAnemia DysmenorrheaDysmenorrhea
Functional ovarian cystsFunctional ovarian cysts Benign breast diseaseBenign breast disease AcneAcne HirsutismHirsutism Irregular mensesIrregular menses MenorrhagiaMenorrhagia
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Various OC - no differencesVarious OC - no differences Deleterious effect - Deleterious effect - minimal/reversibleminimal/reversible Follow-up - limitedFollow-up - limited
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SEVERE COMPLICATIONS SEVERE COMPLICATIONS WITH OC ARE RAREWITH OC ARE RARE
Venous thrombosis - 6/10,000Venous thrombosis - 6/10,000 (Without OC - 3/10,000)(Without OC - 3/10,000)
UnavoidableUnavoidable
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THE ROLE OF THE PHYSICIANTHE ROLE OF THE PHYSICIAN
ExpensiveExpensive Sex is not a diseaseSex is not a disease
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OC - OTC — CONSOC - OTC — CONS Counseling for reproduction and Counseling for reproduction and
sexual healthsexual health Avoidance of counseling for Avoidance of counseling for
family planning, reproduction family planning, reproduction and sexual health and sexual health
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OC - OTC — CONSOC - OTC — CONSNo counseling - No counseling - Higher dropoutHigher dropout
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OC CONTRAINDICATIONSOC CONTRAINDICATIONS
ThrombophlebitisThrombophlebitis Breast cancerBreast cancer Cervical, endometrial and ovarian Cervical, endometrial and ovarian
cancercancer Focal migraineFocal migraine Smokers >35 years of ageSmokers >35 years of age
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OC - DIFFERENT EFFECTSOC - DIFFERENT EFFECTS
EstrogensEstrogensProgesteronesProgesteronesAndrogensAndrogens
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Gynecological counselingGynecological counseling
Gynecological examination Gynecological examination can be avoided, can be avoided,
especially especially in adolescentsin adolescents
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OC FOLLOW-UP : OC FOLLOW-UP : IMPORTANCEIMPORTANCE
Over 35 years of ageOver 35 years of age SmokersSmokers HypertensionHypertension DiabetesDiabetes HyperlipidemiaHyperlipidemia
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ATTITUDE OF FEMALE COLLEGE ATTITUDE OF FEMALE COLLEGE STUDENTS TOWARDS AVAILABILITY OF OC STUDENTS TOWARDS AVAILABILITY OF OC
OTC OTC Forman et al. (1997)Forman et al. (1997)
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No. - 290No. - 290Age - 20 ± 3Age - 20 ± 384% - previous sexual 84% - previous sexual intercourseintercourseAge at first sexual encounter - Age at first sexual encounter - 16.6 ± 216.6 ± 252% used OC at first encounter52% used OC at first encounter
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65% - against OC-OTC65% - against OC-OTC Side effects could be preventedSide effects could be prevented Users would not go for regular checkupsUsers would not go for regular checkups
35% - pro OC-OTC35% - pro OC-OTC Fewer unwanted pregnanciesFewer unwanted pregnancies
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OC - OTC : PROS and CONSOC - OTC : PROS and CONS
Not significant:Not significant:–RaceRace–Previous OC usePrevious OC use–Previous sexual activityPrevious sexual activity
Significant:Significant:–A previous pregnancy (ProA previous pregnancy (Pro))
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Should Oral Contraceptives Be Should Oral Contraceptives Be Sold Over the-CounterSold Over the-Counter??
Potential AdvantagesPotential Advantages Increased access to affective Increased access to affective
birth control for all womenbirth control for all women Increased access for younger Increased access for younger
women, the prime users of women, the prime users of OCs OCs
Reduced rate of unintended Reduced rate of unintended pregnanciespregnancies
Cost savings from reduction of Cost savings from reduction of physician and family planning physician and family planning clinic visitsclinic visits
Encouragement of the national Encouragement of the national trend toward self-caretrend toward self-care
Potential DisadvantagesPotential Disadvantages Increased rate of unintended Increased rate of unintended
pregnancies due to unproper pregnancies due to unproper use of OCsuse of OCs
Reduced OC compliance Reduced OC compliance because of lack of counseling because of lack of counseling and management of nuisance and management of nuisance side effectsside effects
Increase in liability due to errors Increase in liability due to errors in self-prescribingin self-prescribing
Possible cost increases for Possible cost increases for Medicaid and family planning Medicaid and family planning clinic patientsclinic patients
Possible price increases due to Possible price increases due to the costs of marketing to the costs of marketing to consumersconsumers
Reduced opportunities for Reduced opportunities for preventive medical carepreventive medical care
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OC - OTCOC - OTC Population, social and Population, social and religious attitudereligious attitude Availability of local family Availability of local family planning service planning service Availability of providersAvailability of providers
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ConclusionIn order to expand OCs use:Reinforce the activity of family planning ClinicsFacilitate public access to professionalsInstituting charge free visitsOrganizing visits to schools
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ConclusionBetter access to physicians might be the best way toEstablish the OC as the main and most efficaciousContraceptive method
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So….should it be prescribed, So….should it be prescribed, or OTC?or OTC?
THE END