7 facts you should know from national meetings
By Robert A. Hatcher, MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta
The following information is from the Washing ton, DC-based Association of Reproductive Health Professionals meeting and the New York City-based Planned Parenthood Federation of America’s National Medical Committee session, both held recently in Dallas:
1. Plan B, the progestin-only emergency contraceptive pill (ECP), is available.
Distribution of Plan B (Women’s Capital Corp., Bellevue, WA) to drugstores is hampered by expiration date problems. The same problem plagued Preven (Gynétics, Belle Mead, NJ). Sharon Camp, PhD, president of Women’s Capital Corp., is optimistic the date will be changed. In several Euro pean countries, exactly the same preparation (0.75 mg of levonorgestrel) is approved for five years.
While progestin-only contraception has fewer failures than combined oral contraceptives (OCs) used for emergency contraception, the failure rate goes up with each 12-hour delay. This rate emphasizes the importance of actually getting Plan B into the hands of each sexually active woman who hopes not to become pregnant at this time in her life.
2. ECP provision by pharmacists in Wash ington state has had an immense impact.
In the year prior to pharmacist provision of ECPs without a prescription, 140 pharmacies filled 10 prescriptions. The same 140 pharmacies provided ECPs to 9,700 women in the year after women could obtain ECPs from those same pharmacies without a provider’s prescription, according to Don Downing, RPh, pharmaceutical care provider with Washington State University in Pullman and the University of Washington and the Washington State Pharmacists Association, both in Seattle.
3. Watch the upswing of prescriptions for third-generation OCs.
"Now we are pretty close to saying that the data suggesting a 100% increase in venous thromboembolism in women on desogestrel and gestodene pills [compared to older pills] were wrong," states Felicia Stewart, MD, assistant adjunct professor in the department of obstetrics and gynecology in the School of Medicine at the University of California, San Francisco. In Britain, the media are calling the reversal of prescriptions of desogestrel and gestodene the "pill U-turn."
4. Teen pregnancy rates are dropping.
Use of Depo-Provera (depot medroxyprogesterone acetate or DMPA) contraceptive injections and Norplant implants by U.S. teens rose from 0% in 1988 to 13% in 1995 (Norplant 3%, DMPA 10%). This shift toward more effective contraception accounts for 80% of the fall in pregnancies in teens ages 15 to 19, while 20% of the drop in teen pregnancies may be ascribed to abstinence, according to Jacqueline Darroch, PhD, senior vice president at the Alan Guttmacher Institute in New York City.
5. Nulligravid women may be appropriate candidates for IUDs.
Nulligravid women are appropriate candidates for intrauterine devices (IUDs), suggests research co-authored by David Hubacher, PhD, senior research associate at Family Health International in Research Triangle Park, NC, and Roger Lara, MD, head of the department of family planning of the National Perinatology Institute in Mexico City. Use of IUDs among 663 women with primary tubal infertility was compared to IUD use by 341 infertile women without tubal pathology and 251 primigravid women in their first or second trimester of pregnancy. Prior use of a copper IUD was not associated with an increased risk for infertility in this retrospective case control analysis.
6. There is no cure — yet — for human papilloma virus (HPV).
"As far as I know at this time, even if warts disappear completely, there is nothing that cures human papilloma virus," says Mary Rubin, RNC, PhD, CRNP, director of clinical education for Education Programs Associates in Campbell, CA.
7. Look for U.S. introduction of Lunelle, the combined injectable contraceptive.
Lunelle, the once-a-month injection of 25 mg of DMPA and 5 mg of estradiol cypionate from Pharmacia & Upjohn of Bridgewater, NJ, is closer to being an option for U.S. women. In U.S. trials, there were no pregnancies in the 872 women studied, says Andrew Kaunitz, MD, professor and assistant chair of the department of obstetrics and gynecology at the University of Florida Health Sciences Center in Jacksonville, FL. (See CTU, November 1999, p. 125, for more on Lunelle.) Only 6.3% discontinued because of menstrual irregularities. Researchers did note a several-pound weight gain in the first year of use.
Return of fertility is faster than with every-three-months Depo-Provera injections. In more than 10,000 users, there has not been a case of deep vein thrombosis, pulmonary embolism, or death. These are still small numbers, but positive. Lab studies demonstrate that the medication is not thrombophilic.
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