WHICH CONTRACEPTIVE

OPTION IS RIGHT FOR ME?

MYTHS & FACTS

DATIN DR KAMALJIT KAUR

The 1995 pill scare and its consequences

October 1995
The UK Committee on Safety of Medicines issued a warning that third generation
oral contraceptive pills increases the risk of potentially life threatening
thrombosis

October 18th, 1995
Dear Doctor letter was sent to 190,000 GPs, pharmacists and directors of public
health throughout UK along with a statement to the press and broadcast media

Results
A significant number of women stopped taking the pill
Decrease of OC use from 40 (1995-1996) to 27% (1996-1997) in the <16 years old
age group
Some 13,600 additional abortions in the next year in England and Wales
Extra 46M (US$73.6M) for abortion provision costs + 21M (US$ 33.6M) for
maternity care for the NHS


Furedi Ann. The public health implications of the 1995 "pill scare." Hum Reprod Update 1999;5:621-6.


Myths & Misperceptions!

Question:
Is taking the pill associated with fewer
health risks than pregnancy?

Answer: Only 4% strongly agreed!
Furedi Ann. The public health implications of the 1995 "pill scare." Hum Reprod Update 1999;5:621-6.


Misperceptions about pills & pregnancy!


Women appear to overestimate the risk of hormonal
contraception and underestimate the risk of
pregnancy


They might not be aware of any additional
non-contraceptive benefits

Why are we here today?


Strategies to improve adherence, acceptability,
continuance of hormonal methods of contraception
and to prevent unwanted pregnancies
Increase access to hormonal contraception

Dispel myths and misperceptions about
hormonal contraception

Raise awareness and knowledge about
additional benefits of hormonal contraception

Improve prescribing practice
- Improve knowledge
- Structured counselling including the choice to
choose


Making
evidence
from studies
in practice
Acne
Weight
Cancer
Cardio-
vascular
events
MYTH 1:


Using hormonal contraceptives
leads to future infertility
Pill infertility?
No connection
Fertility returns almost immediately

Initial fertility not known
Delay childbearing late 30s/40s
Time when natural fertility wanes
Fertility declines with age
Age Infertility (%)
20s 7
30s 15
40s 30
55
th
annual clinical meeting ; American College of O&G, 2010

MYTH 2:


All hormonal methods are the same
ABSTINENCE
Abstinence

100% effective

Eliminate most threats of STIs

No devices

Private
Barrier Method

Female condom

Male condom

Spermicide

Diaphragm

IUD
Condoms
90-98% effective

Easy & cheap

Protects against STI

Reliability proper/improper use

Latex allergy polyurathane condom

Use a new condom every time!
Spermicide
85-90% effective

Easy

Must be inserted before each act!

Possible irritation
Diaphragm
86-97% effective

Inserted 1 hour before sexual intercourse

Must be used with spermicide

Must leave in 6-8 hours after sexual
intercourse

Not for people with latex allergy
IUD
Mirena
Releases
hormones
5 years
99%
effective
Copper
No
hormones
3-5 years
97%
effective
Hormonal
Pill

Patch

Nuvaring

Depo Provera (IUD)
Pill
1 pill/day

More than 40 different kinds

98-99% effective

Less painful periods & lighter flow

May reduce acne

NO PROTECTION against STIs
OCP - monophasic
Same amt of E2/P2
Less side effects
Classified by amount of E2

Ultra-low 20 mcg
Low 30 mcg
High 50 mcg

1
st
choice, cheap, works well
< breast tenderness/bloating
> spotting
Ocp - biphasic
Level of E2 consistent
Progestin - halfway in the cycle
P/E - 1
st
half - endometrium thickens
- 2
nd
half shedding
- last 7 days - placebo
Ocp - triphasic
3 different doses of hormones
1
st
week E2 progestin same dose
2
nd
week E2 same progestin
3
rd
week E2 same progestin

Patch (Evra)

Once a week

99% effective
Nuvaring
Flexible ring

Releases steady stream of hormones

3 weekly

99% effective

Depo Provera

12 weekly injection

99% effective
Permanent
Sterilization

Vasectomy

Surgery

*99% effective
*Usually Irreversible
Emergency Contraceptive
75-95% effective

Works up to 120 hours after sexual
intercourse

Does not affect an already established
pregnancy

MYTH 3:


Low dose pills are not as
effective as higher dose pills

FACT: Equal effectiveness of
low-dose COCs supported by
Cochrane review

In a systematic review of 13 comparisons of 20 g versus
>20 g estrogen COCs, there was no difference in
pregnancy rates

Low-dose estrogen COCs may provide potential
additional benefits:
-Reduced vascular complications
-Reduced hormone-withdrawal symptoms

Incidences of bleeding irregularities were higher with
lower dose estrogen


COC=combined oral
contraceptive


Gallo MF et al. Cochrane Database Syst Rev 2005;18:CD003989





MYTH 4:


pills cause acne







MYTH 5:


There is a high risk of pregnancy
even while taking an effective
hormonal contraceptive








MYTH 6:


Hormonal contraception causes
weight gain







Question...

Doctor, does the
pill cause cancer?


MYTH 7:


A woman should take breaks from
taking hormonal contraceptives so
her body can get back to normal.
MYTH 8:

HORMONAL CONTRACEPTION DISRUPTS THE
NORMAL CYCLE OF A WOMANS BODY

MYTH 9:


AN ABORTION IS SAFER THAN
TAKING HORMONES EVERY DAY

MYTH 10:


THE PILL IS NOT SAFE AND
CAUSES BIRTH DEFECTS
Fact
Most researched and prescribed medicine
Prevents ovulation
Thickens cervical mucus
NO effect on development of baby
MYTH 11:


the most risky time to miss
the pill is in the middle of
the cycle
Myth
The most fertile period on OCP is : mid-cycle

FACT
In OCP cycle - NO ovulation
- no mid cycle concept of ovulation
28/7 cycle 1
st
7 days. Most unsafe
- most critical
- prevent ovulation
Safest period : last 7 days


MYTH 12:


Women > 35 cant use the pill
Teens need permission
Fact
Healthy women normal BP
- non-smoker
- no risk of stroke/MI
Beneficial in perimenopausal mid 40s
(heavy/irregular menses after investigations)
Teens counseled by medical practitioner
MYTH 13:


The only use of the pill is for
contraception
Fact
risk of ovarian cancer (1/3) suppression of ovulation
risk of endometrial cancer (1/2)
Regulation of cycle
Improves menstrual cycles lighter periods
- shorter periods
- < painful
anaemia
benign breast lumps
ovarian cysts
PMDD
Defer menstrual periods





Things that DONT work
Wishful thinking

Swimming pools & hot tubs

Creative


YOU NEED PLANS!
NOT A FORM OF CONTRACEPTION!
WITHDRAWAL / RHYTHM

Birth Control Myths
You cant get pregnant the first time you have sex

If you jump up and down really fast after sex, youll
confuse the sperm

You cant get pregnant if you have sex during your
period

If you go to the bathroom after sex, you wont get
pregnant

Birth control is a womans responsibility

Myths
I cant get pregnant if he pulls out
I cant get pregnant if I shower/pee
I cant get pregnant if I exercise after
I cant get pregnant if we do it standing up
The EC is the abortion pill
Contraception prevents STIs
I cant get pregnant if I am breastfeeding
Myths
A male can use the clingfilm/plastic wrap or a
balloon if there is no condom
Not having an orgasm is a gr8 method of
contraception (pleasure has nothing to do with
birth control)
The tighter the condom, the better the
protection ( higher rupture risk!)
If I have unprotected sex- I can do a UPT the
next day
Myths
Condoms un-enjoyable for guys
The pill / contraception makes a lady
promiscuous
Putting a watch around the penis
radioactivity kills the sperms
Coca-cola douche spermicide

SUMMARY (1)
185 millions pregnancies / year
40% unintended
25% of unintended abortions
Pregnancy is associated with risks
Family planning maternal health/ world population
Evolution of hormonal contraception (1960-2013)
Progressive estrogen + improving progestins
(favourable properties ; better tolerability)
Effective if used correctly
SUMMARY (2)
In the US, a womans lifetime risk of dying
from a pregnancy and pregnancy related
cause : 1: 2100
The mortality rate associated with the birth
control pill 1: 1,667,000
The pill is rapidly and completely reversible
SUMMARY PILL (3)
The pill is used with caution in smokers,
obese, diabetes
The pill might be beneficial for acne
The pill might be beneficial for hairy girls
SUMMARY PILL (3)
The pill protects against ovarian cancer
The pill protects against uterine cancer
The pill is no different than placebo for
depression
The pill reduces the need for abortion
Pill users have no greater risk of weight gain
Monthly bleeding with the pill offers no
health benefits

Every pregnancy should be a
wanted one..
AVOID.
It would make a suitable gift to all women
that every pregnancy be a safe one,
ending happily with a healthy Baby & Mum!
This should be the irrevocable right of every
lady
Take home message
Every pregnancy should be an intended
pregnancy, when a woman is
psychologically, physically and
financially well prepared.
International Womans Day
Tribute to local Women
Prominent O & G figures of Malaysia


Dr Tang Boon Nee
O & G President
Dr Goh Hoay Yee
Organising Chairperson of I Me
Professor Emeritus
Dr Nafisah Adeeb
Vicars daughter, Norway
17/18 children
Her sister had to give up her child
suicide
Journalist, Social Worker, WW1/WW2
The use of Diaphragm Nation-wide
tour (Sweden) Illegal
+ Swedish Drs Swedish Association
for Sex Education
1
st
President of IPPF (1953-1956)
Elise Ottensen
Jensen
Ottar (1886-1973)
Youngest PhD holder in in UCL
Major role in breaking down taboos
about sex
Knowledge about Family Planning
Built a network of FP clinics
1920s
Protest from church of England +
Roman Catholic church

Maries Stopes
(1880-1958)
Paleobotanist, UCL
Pioneer in field of Birth Control
Sex educator, nurse
Birth-control activist
Legalised contraception in USA
Her mother 18 children in 22 years
- died at 50 of Ca Cervix
1916 opened 1
st
BC clinic in US
Arrested
President IPPF 1956-1959
1879-1966
Lawyer, activist
1
st
lady at 19-pass bar exams, Cambridge
Pioneer of sexual/reproductive health, FP
(India/International)
Formed IPPF (Otter, Sanger)
Founder FPAI, 1949
President, IPPF 1980s
Family planning could be successful only
if voluntarily done thru choice
Padmashri/Padmabushan Awards-
services to womenhood




































Mrs Avabai Wadia
(1913-2005)

Thank you for listening