Oral contraception and venous thromboembolism. A New Zealand perspective.

Several recent case control studies have shown an excess rate of venous thromboembolism in women using third generation progestogen-containing combined contraceptive pills compared to second generation combined contraceptive pills. This excess is about 1 in 10,000 women per year of use. It is likely that second and third generation pills have been preferentially prescribed to users who have varying susceptibility to venous thromboembolism and that this may account for at least part of the observed differences. In practice, it is essential that all women using combined oral contraceptive pills have a thorough history taken to exclude any contraindications or risk factors. Each client should be counselled about the risks and benefits of oral contraception. In New Zealand, the Ministry of Health has recommended that prescribers for women starting a contraceptive pill for the first time should consider a pill that does not contain a third generation progestogen. Women already receiving a third generation pill may elect to continue that pill after the differential rates of venous thromboembolism have been discussed.

A comparative study of the ease of removal of intrauterine contraceptive devices.

This study compares the rates of easy and difficult removals of various types of IUDs. Eight-hundred-sixteen IUDs were removed in Auckland Family Planning Clinics in an 8-month period. Nearly 80% were the standard Multiload Copper 250. Eight-eight percent of all IUDs were easy to remove with another 7% requiring a hard pull. Of the remaining 5%, 3.5% required simple intracervical exploration, 1% required intrauterine exploration and 0.5% were referred to hospital. When compared with the standard Multiload, no IUD was statistically easier and only the Mini-Copper 7 was harder to remove at the 5% level of significance.

PIP: During an 8-month period in 1985-86, 816 IUDs were removed at Auckland (New Zealand) family planning clinics and the ease of removal was rated in 1 of 4 categories: easy, unusually hard pull required, strings came off but IUD removed intact, and unable to remove IUD in family planning clinic. The vast majority (88%) of IUDs were categorized as easy to remove and only 4.5% required more than a hard pull. Most of the IUDs in this study (78%) were Standard Multiload Copper 250 IUDs. The easy removal rate ranged from 67% for the Mini-Copper 7, to 88% for the Standard Multiload Copper 250, to 100% for the Nova T and Copper T devices. Given the small number of IUDs not in the Multiload Copper 250 group, no significant correlations between IUD type and relative ease of removal could be obtained. In addition, no association was noted between ease of removal and duration of time the IUD had been in utero. Although 12% of the Standard Multiload Copper 250 IUDs in this study were considered hard to remove, the special design of this IUD that ensures its low expulsion rate compensates for this disadvantage. The fact that such a high percentage (33%) of removals of the Mini-Copper 7 IUD were difficult was attributable to the tendency of the string of this device to retract into the uterus. Overall, given the lack of significant differences between the various IUDs examined in this study, there appears to be no need to consider ease of removal when prescribing these devices.