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Contraceptive Update

Contraceptive Update. Caroline Hewitt, MSN,NP Director Clinical Education Cicatelli Associates, Inc. Disclosure Statement.

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Contraceptive Update

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  1. Contraceptive Update Caroline Hewitt, MSN,NP Director Clinical Education Cicatelli Associates, Inc

  2. Disclosure Statement “I have no real or perceived vested interests that relate to this presentation nor do I have any relationships with pharmaceutical companies, biomedical device manufacturers, and/or other corporations whose products or services are related to pertinent therapeutic areas.”

  3. Objectives Describe a variety of contraceptive methods and review updated recommendations for their use. Identify the benefits, efficacy profiles and potential side effects associated with each method. Develop skills needed to identify and match contraceptive users to appropriate methods.

  4. Increasing Access • Minor’s Rights / Confidentiality • Deferring Pelvic Exam • Quick Start

  5. Current Trends • Extended release • Very low dose • New delivery methods • Prescribing

  6. Compliance Compliance improves when Prescribed initial method Possible side effects discussed Perception of quality care Partner involved with counseling Proper management of patient expectations

  7. Absolute No • Previous embolism or stroke • History of estrogen dependant tumor • Liver disease • Pregnancy • Undiagnosed abnormal vaginal bleeding • Cerebral vascular or coronary artery disease • >35 year old smokers • Women with known clotting disorders

  8. MMWR Weekly 2005; 54:152.

  9. Lybrel® 1st Continuous Oral contraceptive 20 mcg ethinyl estradiol/90 mcg levonorgestrel FDA approved May, 2007 Return to menses by 90 days Davis AR, Kroll R, Soltes B et al. Return to Menses after continuous use of a low dose oral contraceptive. Obstet Gynecol 2006:107:113S

  10. Seasonique® Extended biphasic regimen 84 tablets 0.15mg levonorgestrel/ 0.03 mg ethinyl estradiol Then 7 tablets 0.01 mg ethinyl estradiol Method failure rate 0.64%

  11. LoEstrin 24® 24 hormone days with only 4 placebo days norethindrone acetate 1mg/ethinyl estradiol 20 mcg 20 mcg EE Moderate androgen s/e Low endometrial s/e

  12. Yaz® 24 hormone days with only 4 placebo days drospirenone 3 mg/ethinyl estradiol 20mcg New PMDD indication Mild diuretic s/e ’d androgen s/e Avoid if liver/renal dx or chronic NSAID user

  13. Femcon Fe ® Chewable birth control Comparable to Ovcon 35 Spearmint flavored

  14. DMPA- Side Effects/Drawbacks • Irregular bleeding and spotting • Weight gain • Mood Lability • Hair Loss • ’d Bone Mineral Density • Black box warning in package insert • >2 yr use significant loss of BD • Recommend 1,000-1,200 mg Ca daily w/ 400-600 mIU Vitamin D. • Quick Start (Depo Now)

  15. Contraceptive Implant Single Implant Rod (4 cm in Length and 2 mm in Diameter) Ethylene Vinylacetate, non radio opaque Contains 68 mg of progestin Etonogestrel www.contraceptiononline.org

  16. The Patch: not what we thought Package Insert Change to reflect increased exposure to EE compared to 35mcg OCP Re:  risk of VTE 2 government funded trials, results contradictive Updated FDA labeling

  17. Nuvaring® • A non-biodegradable, flexible contraceptive vaginal ring containing EE and Etonogestrel (0.015mg/0.120mg per day) • Efficacy : similar rates to OCP’s • MOA- Primarily suppression of ovulation, thickening of cervical mucus, and endometrial thinning. Nuvaring Package Insert, Organon, 2005

  18. Quick Start • Initiate OC’s anytime during cycle • Rule out pregnancy • Use back up method for one week Initiation of Oral Contraceptives Using a Quick Start Compared With a Conventional Start: A Randomized Controlled Trial. AUWesthoff C; Heartwell S; Edwards S; Zieman M; Cushman L; Robilotto C; Stuart G; Morroni C; Kalmuss D SOObstet Gynecol. 2007 Jun;109(6):1270-1276.

  19. Quick Start • Breast Exam, Cervical Cancer Screening and STI screening unnecessary for initial prescription OC’s • ACOG, WHO, RCOG Clinical breast and pelvic examination requirements for hormonal contraception: Current practice vs evidence. AUStewart FH; Harper CC; Ellertson CE; Grimes DA; Sawaya GF; Trussell J SOJAMA 2001 May 2;285(17):2232-9.

  20. Levonorgestrel Intrauterine System Releases 20 g of Levonorgestrel Per 24 hrs Duration: 5 Years Packaged With Sterile inserter High Efficacy 0.1% First-Year Failure Rate (This is a schematic and is not anatomically proportional.) www.contraceptiononline.org Lahteenmaki P, et al. Steroids. 2000;65:693-697.

  21. Cervical Mucus is Thickened Sperm Motility and Function Inhibited Endometrium Suppressed Weak Foreign Body Reaction Ovulation Inhibited (In Some Cycles) Levonorgestrel Intrauterine System: MOA Jonsson B, et al. Contraception. 1991;43:447-458. Videla-Rivero L, et al. Contraception. 1987;36:217-226. www.contraceptiononline.org

  22. Femcap® Latex Free Remain in place 24 hrs Prescription needed “self-fitting”  risk TSS/UTI 86% efficacy nulliparous 71% efficacy parous

  23. Lea’s Shield®

  24. Natural Family Planning Standard Days and TwoDay www.irh.org Ovulation method www.woomb.org Symptothermal Method www.fertilityuk.org

  25. MALE CONTRACEPTION: ON THE HORIZON • RISUG (Reversible Inhibition of Sperm Under Guidance • Injection of Polymer gel into vas deferens which kills sperm • IVD (Intra Vas Device) • Implanted, soft, hollow silicone plugs • Long-term infertility • Reversible

  26. ON THE HORIZON • Chemical barriers • Contraceptive microbicides • Inhibiting sperm function and attachment of pathogens to target cells (PRO 2000, cellulose sulfate) • Non contraceptive microbicides • Spermicides (non N-9) • Ushercell • BufferGel • Possible HIV protection

  27. ON THE HORIZON • BufferGel Duet® • Used with Diaphragm-like barrier dome • SILS Intravaginal Barrier • One size. No clinician fitting • Various improvements on Female Condom • Jadelle® 5 year implant • 2 rods • Not in US

  28. Conclusion • chewitt@cicatelli.org

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