Contraception: five key messages

Find the best match between contraceptive method and recommended the course of every woman, through a doctor-consultant relationship with promoting choice, led Anaes (National Agency for Accreditation and Evaluation in Health) , AFSSAPS (French Agency for the Safety of Health Products) and INPE (National Institute for Prevention and Health Education) to develop new recommendations for clinical practice strategies choice of contraceptive methods among women.
These recommendations were presented to the press (Seine Saint Denis) Saint-Denis, the headquarters of the Anaes.

A high number of women using contraception (75%) in France. However, the number of unwanted pregnancies remains high, resulting in some 200,000 abortions (abortion) per year, a figure that has remained stable for more than a decade.

The objective of this approach has been to seek a better balance between contraceptive method and life and the choice of every woman.

Fifteen key messages were able to be developed by the working group:

1 / The gap between the optimal effectiveness of contraceptive methods observed during clinical trials and their effectiveness in practice is a strong argument for the woman and the couple are involved in a range suitable for their daily reality.

2 / Involving people affected their choice of contraceptive method generates greater satisfaction and more effective use of this method. It is important to get if possible partner involvement in contraceptive approach.

3 / The first consultation in which contraception is addressed should be specifically dedicated to this issue.

4 / If it is a girl, she will be received without their parents, care is confidential, even if the mention of them in the conversation face-to-face is essential. The preferred methods are condoms (prevention of sexually transmitted diseases, especially AIDS) and progestogen pill.

5 / It is necessary for the health professional:

- Adjust the prescription for each consultant;
- Extend the scope of its maintenance beyond only medical criteria taking into account the psychological, sociological or economic factors;
- To explore the motivations of the consultant vis-à-vis contraception;
- Accompany the consultant or the couple to think and choose the form of contraception is best for their personal situation.

GATHER the WHO model takes into account these different dimensions and can be an aid to the consultation.

6 / In the first visit, a clinical examination including a search for personal or family history (hypertension, diabetes, hyperlipidemia, migraine, thromboembolic events) must be carried out systematically. In the absence of family or personal medical problems, gynecological and blood tests can be scheduled for future reference (in 3-6 months), especially among teenagers. At this time of life, the smear is useful in cases of prior sexual relations.

7 / The oral contraceptive is one of the methods of the first intention for women having no particular risk factors (cardiovascular, cancer, liver ...). This method of contraception has benefits in terms of prevention of some cancers (endometrial, ovarian, colorectal).

Every generation progestogen pills are associated with an increased risk of thromboembolic events. The greatest danger is to ignore the presence of cardiovascular risk factors.

8 / If cons-indication of progestogen pill (especially in cases of cardiovascular risk), a progestin contraceptive may be proposed by the second intention, knowing that microprogestative pill involves a rigorous decision (every day at the same time, even during menstruation) and may cause undesirable that the user should know (increased risk of bleeding) effects.

9 / Intrauterine devices (IUDs) are not only for women who had one or more children (multiparous). It is a method of contraception for the first highly effective, long duration of action (five years) and for which no cancer or cardiovascular risk has not been established.

If the risk of pelvic inflammatory disease associated with the installation turned out, its occurrence is largely restricted to three weeks after insertion. Furthermore, no risk of tubal infertility has been demonstrated, including women who have never given birth (nulliparous). Given the high contraceptive efficacy of IUDs, the risk of ectopic pregnancy (ectopic pregnancy) is extremely low.

An IUD can be offered when the cons-indications for its installation are taken into account, the risk of infection and ectopic pregnancy evaluated and discarded, the woman informed of the risk of pelvic inflammatory disease and ectopic pregnancy, as well as potential risks, but unproven tubal infertility. This information, said the working group appears dominant in nulliparous women.

10 / It is important to inform the woman of opportunities to catch up if unprotected intercourse. Two types of methods exist: hormonal emergency issued by pharmacies freely (without a prescription) and guest (free for girls) in school clinics or family planning center contraception copper IUD, considered the the most effective method.

After taking a hormonal emergency contraception (it is a progestin-only) should be recommended to the patient to adopt an effective method of contraception (condoms) until the end of the current cycle and achieve a pregnancy test if the rules do not occur within 5 to 7 days after the expected date.

11 / sterilization methods should be presented as irreversible. The Public Health Code states that tubal ligation or the vas deferens in humans can not be performed on a minor. A reflection period of 4 months must be allowed after initial decision and signing an informed consent is required.

12 / Condoms are the only method that has proven its effectiveness in preventing the transmission of sexually transmitted infections.

An estimated risk due to the existence of several partners, the evocation of casual relationships or lack of stable relationship (especially in adolescents) situation should lead the healthcare professional to recommend the use of this contraceptive method (in addition to whether or not another medical) method, which requires targeted education.

13 / In post-partum, exclusive breastfeeding protects the mother for 8 to 10 weeks (comparable to an oral contraceptive effectiveness). "There is therefore no need to prescribe immediately microprogestatif which may cause a lot of discomfort related to the occurrence of bleeding. Better to await the return of layers that usually occurs after a month promoting local contraception. An IUD can be placed one month after delivery, "said Dr. Guy Masson (CHU de Nîmes), one of the experts involved in the development of recommendations.

14 / The increase in cancer and cardiovascular risk with age and premenopausal should lead to reassess the adequacy of the contraceptive method used from 35-40 years.

15 / When a forgotten pill is renewed too often or it is found a real lack of compliance, it is recommended to consider another method of contraception (IUD, patch, hormonal implant).

These recommendations should be studies to assess their impact, particularly in terms of reduction in the number of abortions, which remains relatively high in France.