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EMQ Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
A Combined hormonal contraceptionWomen on combined hormonal contraception may be present with common side effects of mood changes, headaches, nausea, fluid retention and breast tenderness. Rare complications include deep vein thrombosis, stroke and heart attacks. (Heavy Menstrual Bleeding: Assessment and Management. NICE, January 2007, Updated: August 2016)
Contraception
Published in James M. Rippe, Lifestyle Medicine, 2019
The patch, like other combined hormonal contraception, works primarily through ovulation inhibition by hormonal suppression of gonadotropins.17 Because transdermal contraception has the same mechanism of action, it should be given the same considerations for contraindications and non-contraceptive benefits as with COCs. Breast discomfort may be greater than with COCs in the first two cycles of use.7 Because there is not a need for daily administration, the patch can be an excellent option for adolescents.
Prevalence of non-preferred family planning methods among reproductive-aged women in Burkina Faso: results from a cross-sectional, population-based study
Published in Sexual and Reproductive Health Matters, 2023
Brooke W. Bullington, Nathalie Sawadogo, Katherine Tumlinson, Ana Langer, Abdramane Soura, Pascal Zabre, Ali Sie, Leigh Senderowicz
Similarly, non-preferred method use may be indicative of a lack of access to a range of methods, representing barriers to full choice. Access and availability of contraceptive methods, including method stock-outs, may influence method selection.28 Medical contraindications to a contraceptive method are one reason that someone may be prevented from using their first choice of method. Legitimate medical contraindications may limit which methods may be safely offered to which people. In a multi-institution US study, less than 5% of women had a contraindication to progestin-only contraceptive pills.29 In another US-based study, 29% of reproductive-aged veterans had at least one contraindication to combined hormonal contraception.30 Data on the prevalence of medical contraindications in in low- and middle-income countries are limited. In addition to legitimate medical contraindications, however, there is evidence that medical criteria may be applied inappropriately in many contexts, unnecessarily limiting contraceptive method choice and contributing to non-preferred method use.31,32
Women’s attitudes about combined hormonal contraception (CHC) - induced menstrual bleeding changes - influence of personality traits in an Italian clinical sample
Published in Gynecological Endocrinology, 2023
Rossella E. Nappi, Lara Tiranini, David Bosoni, Laura Cucinella, Manuela Piccinino, Andrea Cumetti, Valeria Perone, Chiara Benedetto
There was a growing interest on the possible use of extended combined hormonal contraception (CHC) among women and health care providers (HCPs) [1]. Monthly bleeding induced by CHC did not seem to be medically necessary, especially in women with specific needs, menstruation-related conditions and/or withdrawal symptoms, and even perceived costs of hygiene products [2–6]. A real-world experience of women receiving extended-cycle combined oral contraception (COC) versus monthly-cycle COC in the United States found a preferential prescription for extended-cycle COC among those reporting more health-related diagnoses and poor health [7]. Sexuality, social life, work and sporting activities were also key factors affecting women’s preference for reducing the frequency of menstrual bleeding in Europe [8]. About 60% of women would like less frequent menstrual bleeding [8], with a frequency ranging from once every 3 months (around 1 out of 5 women) to no periods at all (around 1 out of 4 women) [9].
Management of perimenopause disorders: hormonal treatment
Published in Gynecological Endocrinology, 2021
Libera Troìa, Simona Martone, Giuseppe Morgante, Stefano Luisi
In 2010, the ‘Centers for Disease Control and Prevention’ (CDC) published the first document that provides practical recommendation, evidence-based, for a safe and effective use of different contraceptive options [17]. This document, updated in 2016, weighs risks and benefits associated with the use of the various contraceptive method considering medical comorbidities and patient characteristic [18]. There is no single contraceptive choice contraindicated based on age alone, because there is no evidence to suggest that age itself is a risk factor for contraceptive-related complications [18]. However, aging is associated with increased risk of developing medical conditions, including obesity, hypertension, diabetes, and cancer. In particular, the incidence of cardiovascular complications increases with age and therefore age should be considered when assessing the safety of combined hormonal contraceptive (CHCs) methods in patients who have other preexisting cardiovascular risk factors. The use of CHCs in patients aged 35 or older is contraindicated if they are heavy smokers (15 or more cigarettes/die) and cautioned against if they are light smokers (less than 15 cigarettes/die). Furthermore, CHCs are contraindicated or recommended with caution in older women with multiple cardiovascular risks factors, including hypertension (controlled and otherwise) and diabetes [18].