FREE ESC Webinar

26 January 2022, 4PM (CET)

Contraceptive Counselling 2022:
A focused approach to improve Women’s Quality of life

Moderators: Katarina Sedlecky (Serbia) – Johannes Bitzer (Switzerland)

  • It is a women’s choice, new challenges in contraceptive advice
    Massimo Lombardo, Germany
  • Dispelling myths on contraception
    Teresa Bombas, Portugal

Questions and answers (unanswered during the webinar)

The presented data Is from different countries and reflect the situation across Europe

Showing that I havent read the coco-study – are the results really compareable minding setting of the studies? Tanco is surely an international study, is COCO also international or a one country only?
The Coco Study is national in Germany. But the questionnaire is comparable between the two studies. although the end points were different you can compare the questions and answers very good.

You said the « high level of induced abortion » but the slide didn’t show a diminution? Appreciated if you can clarify, thank you.
The induced abortions were decreasing since the 1980s and coming to the deepest point around 2012. up to this moment there is a growth again. this increasing numbers are related possibly to a certain generation here, the Generation X.

It’s not just teaching health care staff about contraception, it’s also their embarassment about talking about sex, and religious objections, even in 2022!
Fully agree!

Which method of contraception is safe for women of reproductive age with metabolic syndrome and anemia?
I would consider very effective each kind of Intra Uterin system. Copper or LNG possible without any exclusion. Due to the fact that we are talking about anemia as well I would reduce the bleedings by using the LNG iUS.

The IUS- LNG is the first choice for contraception and heavy menstrual bleeding. If the women have androgenic signs and need to improve it we could discuss COC (Qlaira- estradiol – less TVT risk and Dienogest with positive impact on androgenic signs and heavy mnstrual bleeding.

Increasing the number of nurses and midwives that are able to insert IUD and implant can improve the access to women to effective contraception? In Brazil, we see some resistance to the nurses that are trying to work in this area.
This question receives a different answer depending on the place in the world we talk about. In countries where there are large distances between people and medical facilities, patients always benefit from long-acting contraception. This increased need can then certainly be met by more specialized healthcare workers. In central Europe with a significantly higher density between the medical institutes and the patients, the lack of knowledge about contraceptives and the needs of the patients seems to be the limiting factor. In addition, there are financial considerations for the individual woman, depending on the coverage of the national health system, which also determine the spread of certain contraceptives.

Was the perspective of women on female condom (no longer femidom but rather FC2) examined?
Female condoms, FC2, are quite common in Europe, but their frequency is rather negligible. There are certainly national differences here. In the studies I mentioned, however, they were not explicitly mentioned. Thank you very much for this question, but I will encourage this in the future

Any issues relating hormonal contraception and breast cancer?
Data from more than 150,000 women in 54 epidemiologic studies showed that, overall, women who had ever used oral contraceptives had a light (7%) increase in the relative risk of breast cancer compared with women who had never used oral contraceptives. Women who w Untraceptives had a 24% increase in risk that did not increase with the durwhile using the pillned after use of oral contraceptives stopped, and no risk incrthe risk came back to the origin before the use ter use had stopped (4).

A 201alysis of data from the Nurses’ Health Study, which has been following more than 116,000 female nurses who were 24 to 43 years old when they enrolled in the study in 1989, also found that participants who used oral contraceptives had a slight increase in breast cancer risk (5, 6). However, nearly all of the increased risk was seen among women who took a specific type of oral contraceptive, a “triphasic” pill, in which the dose of hormones is changed in three stages over the course of a woman’s monthly cycle. An elevated risk associated with specific triphasic formulations was also reported in a nested case–control study that used electronic medical records to verify oral contraceptive use

  • Current use HC RR 1.2 s
  • Current use CHC RR 1.19
  • Breast cancer cases in non-users based on 100000 person-years: 55 RR 1.0
  • Breast cancer cases in CHC users based on 100000 person-years: 68 RR 1.19
  • This corresponds to 13 additional BC cases in 100000 person-years or 1 additional BC for every 7690 women using CHC for 1 year

Are there any differences in IUCD models for young nulliparous women in terms of ease of insertion and expulsion rates?
Unfortunately, there is no published data on this topic for copper-containing procedures, whether classic T-frame copper spiral, intrauterine ball (ballerine, IUB) or copper chain. Here I only know data from the manufacturers. These are based on consumer information and correspond to the expulsion rates of around 4.5% found in the literature. These rates do not appear to differ among the copper-based processes. With LNG, there are study data on the difference not between the individual spirals, which are all about the same in size, but related to multiparae vs. nulliparae. Here. Nulliparae have lower expulsion rates. The level of difficulty with the Einalga depends at most on the exercise of the depositor. The procedure is not as important here as the learning curve of the HCP.

high rate of adolescent marriages in my place what methods can you advise very conversative population
Very conservative people always tend to be critical of contraception. Long-term contraception in particular. Here it is of particular importance to know the wishes and the family planning exactly. Then every remedy that is desired is to be considered completely regardless of age. Religious Restrictions: Jewish or Islam Religion has specific bleeding considerations as well as for the cycle to be natural. Additionally, there are considerations regarding the insertion tube profile

Why is the IUD insertion pain always downplayed? I went through it myself and it was one of the worst pains ever. Women / people with cycles should have the option to ask for anesthesia.
There are a lot well done studies. I would like to introduce this one here: Ultrasound-guided intrauterine device insertion: a step closer to painless insertion a randomized control trial
Dina Mohamed Dakhly & Ya smin Ah med Bassiouny
Pages 349-353 Received 10 Jun 2017 Accepted 13 Sep 20 17 Published Online

Also why don’t health services offer different shapes like the IUB (Ballerine) that actually work with women’s bodies and it reduces the risk of perforation / the need to measure the length and direction of cervix and uterus? There needs to be more innovation in the field and women’s voices heard as was mentioned.
I totally agree. In fact, we all need to renew ourselves here. New insertion techniques and offering all possible procedures is the only way that women can make a wide selection that optimally adapts to their personal circumstances. In fact, the perforation rates of the IUB are comparable to all other intrauterine systems. There are certainly situations in which a ball can be an advantage, but there are also situations in which a chain or a classic spiral tee are more suitable. I don’t think it makes sense to make a basic selection beforehand because this would limit the wishes of women.

The different sizes of the copper ball were tried out in the registration studies. In fact, only the medium size of 15 mm has proven to be suitable. The smaller procedure, Mini, had an expansion rate that was too high, while the larger variant resulted in increased bleeding and pain. Because of this, Ocon decided to let middle ball. Manufacturer information from the IUB say expulsions at 3.37% and perforation at 0.05%. This corresponds to the values given in the literature for all other approved methods. Neither better nor worse. However, this is data from the manufacturer in the absence of studies

EC fails a lot of people, creating pregnancy emergencies. Many people report being shocked it did not work. This is why failures should be talked about more, and shame-fre infor about abortions should be discussed to eliminate abortion stigma when people are shocked that their EC failed.
UPA is better than LNG. None of that are 100% efective.

Do you advise anesthesia in induced abortion? my procedures were performed without.
On medical abortion we must give a prescription of a pain killer. Like ibuprofeno. Misopristol induce contractions that are not comfortable for the majory of the women.

The problem with PCOS ( and possible metabolic syndrome) a woman may have problems with acne and a POP may not help
For women wih POCs and androgenic signs discuss the COC – qlaira

Women with metablic syndrome often have HMB. What to use in these women
Discuss IUS-LNG or COC – Qlaira

In risk counseling — Should counselors be more transparent with people that contraceptives fail for a variety of reasons — both product fallbility and human use fallibility, high expense, difficulty accessing — and include in all data presentation additional data about the safety and prevalence of abortions? In many parts of the world, silence and stigma prevent people from understanding that contraceptives can never eliminate the need for abortions. There is societal and individual shame when people have unintended pregnancies, but contracpetive counselors can help teach people there is no shame.
WE must me clear on counselling. Clear in the discussion of risks and beneficts.

How often can use emergency contraception?
There is no limit for use of EC LNG per cycle. The UPA must be used only per cycle.

Are there any links/associations between progesterone-only contraceptives and depression?
Not a link related with POP and depression on healty women but we must be carefull on women with clinical story of depression.

Can you show back the slide about the different questions to ask in counselling?
First discuss all methods, advantages and details. Clarify in detail: Tromboembolic risk; Breast cancer risk; increase of weight and give space to other questions from the women. For explain the risks use visual materials. Look some other information at the TTT material.

Please find here the slides of Dr. Lombardo

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