FSRH | Family planning bits and bobs

There have been several new guidelines and statements released from the FSRH in the last few weeks, which have some relevance to us.

One size contraceptive diaphragm (Caya)

This new guideline discusses a new diaphragm that women can buy over the counter, or online. I suspect that few women will be using this, but as they don't need to see a doctor or nurse to get it - you wouldn't know if they were without asking.

Despite being 'one size fits all' it actually only fits about 80% of women and it seems that there is no obvious way for the woman to know if it actually fits her well or not, without it being checked by a fitter.

There is a pregnancy rate of 17.8% over 1 yr with typical use and 13.7% with perfect use.

Combined oral contraceptive and breast cancer risk

New research on the COC and breast cancer risk shows that basically most of the COC pills we use in the UK have a small increase of risk of breast cancer with an odds ratio of 1.6. Pills with ethinylestradiol 20mcg have not been shown to have any increased risk in breast cancer.

Pills with norethisterone 1mg or more, or norethisterone acetate 1.5mg or more, also had a higher risk. This would include pills like Loestrin 30 and Norimin. Triphasic pills with an average norethisterone of 750mcg or more, had an odds ratio for breast cancer of 3.1 (binovum / trinovum).

The FSRH advises that all pills remain safe to use, but advises that women be warned of the small increased risk of breast cancer. Women should be reassured that the risk declines after stopping the COC and also that the COC is protective for some other cancers (eg ovarian / endometrial).

Combined oral contraceptive and mood

Apparently this has been in the papers recently, though it passed me by. The statement advises that there is no consistent evidence of an effect on mood by the COC, though they advise that women be warned about the possibility of a change in mood.

Contraception in women with cardiac disease

This guideline gives advice on contraceptive choice in women with cardiac disease. I'm not going to summarise it, as it is likely to affect so few patients, but it is worth knowing that it is there if you have a patient with a cardiac disorder.

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