ESC Masterclass Thursday 18 May (14:00 – 15:30)
Moderators: G. Bartfai (Hungary) – B. Frey (Switzerland)
14:00 – 14:20 How to use the WHO Medical eligibility criteria wheel for contraceptive use – G. Bartfai (Hungary)
14:20 – 14:40: The emergency contraceptive, ulipristal acetat and interaction with hormonal contraception – B. Frey (Switzerland)
14:40 – 15:0 Training in sexual medicine for gynaecologists – J. Bitzer (Switzerland)
15:00 – 15:20 Decrease the risk for VTE in CHC users: is general screening for thrombophilia useful? – J. Bitzer (Switzerland)
15:20 – 15:30Discussion
How to use the WHO – MEC wheel for contraceptive use
G. Bartfai showed in a very clear way how the WHO – medical eligibility criteria are helpful in daily practice. He demonstrated the new WHO-MEC-wheel and with the help of an animation explained, using the example of different risk factors (e.g. smoking, history of VTE, hypertension) how they can influence contraceptive choice. For example, with no risk factor, a 35 year old woman can use a combined hormonal contraception (WHO-MEC category 2), whereas if the 35 year old smokes > 15 cigarettes the WHO-MEC category is 4, and means the CHC should not be used. This is a situation which represents an unacceptable health risk if this contraceptive method is used. The wheel can be ordered on the following homepage: www.who.int/reproductivehealth/publications/family_planning/mec-wheel-5th
The emergency contraceptive ulipristal acetate (UPA) and interaction with hormonal contraception B. Frey gave an overview of oral emergency contraceptives (EC). Studies on UPA show it is more effective than LNG as the window of effectiveness is longer. B. Frey discussed the issue of using UPA and then ‘quickstarting’ a hormonal contraception (HC). She showed from various studies that there is an interaction between UPA and hormonal contraceptives. Desogestrel ‘quick-started’ after UPA reduces the efficacy of UPA. CHC ‘quick-started’ after UPA requires up to 14 days to achieve ovarian suppression. These findings lead many professionals to advise the woman to wait 5 days after UPA before starting any hormonal contraceptive and to use condoms for 2 weeks.
Training in sexual medicine for gynecologists
Johannes Bitzer gave some insights from his rich knowledge of sexual medicine. He showed how doctors can help patients overcome barriers to talk about sex, how to establish a descriptive diagnosis of the sexual problem. He explained how different diseases impact on sexual function and the dynamic of a couple and how drugs affect sexuality. This interesting lecture concluded with possible therapeutic interventions for patients with sexual problems in the context of disease.
Decrease the VTE risk in combined hormonal contraceptive (CHC) users: is general screening for thrombophilia useful?
J. Bitzer: First he explained the influence of ethinylestradiol on the haemostatic system. The prevalence of hereditary thrombophilia in the population is low but the VTE risk in women with APC resistance and Anti-thrombin deficiency using CHC is even higher than the risk of VTE in the postpartum phase. The most common defect in Caucasian women is Factor V Leiden mutation with 5% prevalence; although most of these women using CHC do not experience a VTE. The negative predictive value is low and until now cost effectiveness is low too. Universal population screening is inappropriate and should be avoided. However, a careful family and personal history of VTE should be evaluated in all women before initiating CHC. Women with known thrombogenic mutations are a MEC- category 4 for CHC, which means this method should not to be used in these women.