ABSTRACT
BACKGROUND: Most contraceptive users are medically fit and can use any available method. Some medical conditions are associated with theoretical safety concerns when certain contraceptives are used. Nevertheless, most contraceptive clinical trials exclude subjects with chronic medical conditions, and direct evidence on which to base sound contraceptive prescribing is limited. The World Health Organization (WHO) Medical Eligibility Criteria provide recommendations on the safe use of contraception. This document is aimed at policymakers and program managers working in less developed countries in which the risks of pregnancy usually far outweigh the risks associated with contraceptive use. STUDY DESIGN: The Faculty of Sexual and Reproductive Healthcare used formal consensus methods to adapt the WHO document to reflect clinical practice and health care systems in the United Kingdom. CONCLUSION: This structured group consensus method adds authority, rationality and scientific credibility to the UK version, which makes best use of published evidence and captures collective expert knowledge. Not all clinicians will agree with the recommendations made in the UK version of the Medical Eligibility Criteria, but for the vast majority, they will be a valuable reference to guide clinical practice for women with many conditions that theoretically affect contraceptive use.
Subject(s)
Clinical Trials as Topic/standards , Consensus , Contraception , Patient Selection , World Health Organization , Adult , Contraindications , Female , Humans , United KingdomABSTRACT
This Guidance provides information for clinicians and women considering the use of contraception outside the terms of the product licence. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: CEU, Clinical Effectiveness Unit; COC, combined oral contraception/contraceptive; DMPA, depot medroxyprogesterone acetate; ENG, etonogestrel; IUD, copper-bearing intrauterine contraceptive device; LNG-IUS, levonorgestrel-releasing intrauterine system; NET-EN, norethisterone enantate; PGD, Patient Group Direction; PIL, Patient Information Leaflet; POC, progestogen-only contraception/contraceptive; POEC, progestogen-only emergency contraception; POP, progestogen-only pill; RCT, randomised controlled trial; SPC, Summary of Product Characteristics; UPSI, unprotected sexual intercourse; WHO, World Health Organization; WHOMEC, WHO Medical Eligibility Criteria for Contraceptive Use; WHOSPR, WHO Selected Practice Recommendations for Contraceptive Use.
Subject(s)
Contraception , Drug Prescriptions , Legislation, Drug , Female , Humans , Liability, Legal , Physicians/legislation & jurisprudence , United KingdomSubject(s)
Contraceptives, Postcoital/administration & dosage , Progestins/administration & dosage , Contraceptives, Postcoital/adverse effects , Drug Interactions , Emergency Treatment , Enzyme Induction/drug effects , Evidence-Based Medicine , Female , Humans , Liver/enzymology , Practice Guidelines as Topic , Progestins/adverse effectsSubject(s)
Mucous Membrane/drug effects , Nonoxynol/adverse effects , Sexually Transmitted Diseases/prevention & control , Spermatocidal Agents/adverse effects , Vagina/drug effects , Condoms , Evidence-Based Medicine , Female , Humans , Nonoxynol/pharmacology , Risk Factors , Spermatocidal Agents/pharmacologySubject(s)
Contraception/methods , Family Planning Services/statistics & numerical data , Information Services/statistics & numerical data , Treatment Outcome , Contraceptive Agents/adverse effects , Contraceptive Devices, Female/adverse effects , Contraindications , Female , Humans , Risk Assessment , United KingdomABSTRACT
This Guidance provides information for clinicians providing women with copper-bearing intrauterine devices as long-term contraception. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: acquired immune deficiency syndrome (AIDS); actinomyces-like organisms (ALOs); automated external defibrillator (AED); blood pressure (BP); British National Formulary (BNF); confidence interval (CI); copper-bearing intrauterine contraceptive device (IUD); emergency contraception (EC); Faculty Aid to Continuing Professional Development Topic (FACT); levonorgestrel-releasing intrauterine system (IUS); human immunodeficiency virus (HIV); Medicines and Healthcare products Regulatory Agency (MHRA); non-steroidal antiinflammatory drugs (NSAIDs); odds ratio (OR); pelvic inflammatory disease (PID); relative risk (RR); Royal College of Obstetricians and Gynaecologists (RCOG); Scottish Intercollegiate Guidelines Network (SIGN); sexually transmitted infection (STI); termination of pregnancy (TOP); World Health Organization (WHO); WHO Medical Eligibility Criteria (WHOMEC); WHO Selected Practice Recommendations (WHOSPR).
Subject(s)
Family Planning Services/standards , Intrauterine Devices, Copper/standards , Reproductive Medicine/standards , Risk Assessment , Women's Health Services/standards , Consumer Product Safety/standards , Contraindications , Counseling/standards , Device Removal/standards , Female , Humans , Intrauterine Devices , Intrauterine Devices, Copper/adverse effects , Intrauterine Devices, Copper/statistics & numerical data , Menstruation Disturbances/etiology , Patient Education as Topic/standards , Postpartum Period , Pregnancy , Sexually Transmitted Diseases/diagnosis , United KingdomSubject(s)
Contraceptive Agents, Female/pharmacokinetics , Drug Interactions , Liver/enzymology , Medroxyprogesterone Acetate/pharmacokinetics , Contraceptive Agents, Female/administration & dosage , Contraceptive Agents, Female/therapeutic use , Cytochrome P-450 Enzyme System/metabolism , Delayed-Action Preparations/pharmacokinetics , Enzyme Activation/drug effects , Evidence-Based Medicine , Female , Humans , Injections/standards , Liver/drug effects , Medroxyprogesterone Acetate/administration & dosage , Medroxyprogesterone Acetate/therapeutic use , PolypharmacySubject(s)
Anticonvulsants/pharmacokinetics , Contraceptives, Oral, Combined/pharmacokinetics , Epilepsy/drug therapy , Anticonvulsants/therapeutic use , Contraceptives, Oral, Combined/therapeutic use , Drug Interactions , Drug Therapy, Combination , Evidence-Based Medicine/standards , Female , Humans , Time Factors , United States , Women's HealthABSTRACT
The nominal group technique for consensus development was used to consider the World Health Organization Selected Practice Recommendations for Contraceptive Use for adoption or adaptation in the United Kingdom. The nominal group comprised 11 opinion leaders who agreed that 74% of the WHO recommendations were consistent with current UK practice. Of 63 recommendations considered by the group to be at odds with current practice, 23 were adopted with advice that United Kingdom practice should change in line with WHO. Twenty-five were adopted because, although the group felt that the WHO recommendation differed from practice in the UK, it was unable to reach a consensus on an alternative recommendation. Thirteen WHO recommendations underwent minor revision for UK use. The group rejected two further WHO recommendations [on the timing of starting low-dose progestogen-only contraception (POC) during lactation] but was unable to reach consensus on any alternative guidance. It was agreed clinicians should be left to decide for themselves how to advise breastfeeding women about when to start low-dose POC. A UK version of the WHO Selected Practice Recommendations should help to standardize practice and improve the quality of care for couples using contraception.
Subject(s)
Contraception/standards , Practice Guidelines as Topic , Female , Humans , Pregnancy , Surveys and Questionnaires/standards , United Kingdom , World Health OrganizationSubject(s)
Body Weight , Contraceptive Agents, Female/administration & dosage , Progesterone Congeners/administration & dosage , Administration, Oral , Adult , Body Mass Index , Body Weight/drug effects , Cohort Studies , Contraception/methods , Dose-Response Relationship, Drug , Evidence-Based Medicine , Family Planning Services/methods , Female , Humans , United KingdomSubject(s)
Contraceptives, Oral, Synthetic/administration & dosage , Desogestrel/administration & dosage , Evidence-Based Medicine/standards , Progesterone Congeners/administration & dosage , Contraception/methods , Female , Humans , Outcome Assessment, Health Care , Ovulation/drug effects , Practice Patterns, Physicians' , Randomized Controlled Trials as Topic/standards , Reproducibility of Results , Research Design , United KingdomABSTRACT
Premenstrual dysphoric disorder is a complex disorder characterized by severe physical and psychological symptoms. The pathophysiology and effective treatment of premenstrual dysphoric disorder are presented. Evidence for the effective treatment of premenstrual dysphoric disorder by correction of neuroendocrine abnormalities or suppression of cyclical ovarian activity is reviewed.