CURRENT THERAPEUTICAL INDICATIONS OF MODERN CONTRACEPTION
David SERFATY
Saint-Louis Hospital, Paris
9 Rue de Villersexel, 75007 Paris, France
Contraception is primarily used to prevent pregnancy. However some modern contraceptive methods may be prescribed solely for their non-contraceptive benefits for woman who does not require it for contraception.
I – BARRIER METHODS
Consistent condom use appears to significantly reduce the risk of HIV, Chlamydia, gonorrhoea and cervical and vulvovaginal HPV infections.
II –HORMONAL CONTRACEPTION
Hormonal contraception, through suppression of ovarian activity or endometrial proliferation, can be used to treat or to prevent a range of gynecological disorders.
COMBINED ORAL CONTRACEPTIVES (COCs) AND NON-CONTRACEPTIVE BENEFITS
-Significant reduction of epithelial ovarian cancer with COCs use with duration effect and long-lasting protection effect. This protection may be present in women with genetic mutations (e.g., BRCA1 or BRCA2) probably without increasing risk of breast cancer in these high risk women.
-Significant reduction of endometrial cancer with duration effect and long-lasting protection effect.
-Significant reduction of colorectal cancer but without duration effect.
-COCs appear to reduce the risk of benign breast disease (fibroadenoma and chronic cystic disease).
-Prevention of functional ovarian cysts
-Possible prevention of uterine fibroids with duration effect.
-Prevention and therapeutical option of endometriosis.
-Plausible prevention of pelvic inflammatory diseases (PID)
-Prevention and treatment of dysmenorrhoea, menstrual irregularities, functional menorrhagia and iron-deficiency anemia.
-Prevention and treatment of premenstrual syndrome (PMS). Treatment of PMS with dysphoria (PMDD) with COCs containing drospirenone.
-Prevention and treatment of moderate acne (acne vulgaris) particularly with COCs containing cyproterone acetate, chlormadinone acetate, dienogest, drospirenone or norgestimate.
-Possible therapeutical effects of COCs on rheumatoid arthritis
-Incertain effects of COCs on multiple sclerosis.
PROGESTOGEN-ONLY CONTRACEPTIVES (POCs)
• Levonorgestrel-releasing intrauterine device (LNG-IUS) = Mirena®
-Treatment of functional menorrhagia. This indication is approved by 102 countries.
-As part of a hormonal replacement therapy (HRT) regimen (+E2). This indication is approved by 92 countries.
-Plausible protection against endometrial cancer particularly in high risk women (e.g. in Tamoxifen users).
-Possible treatment of endometrial hyperplasia.
-Potential therapeutical indications in adenomyosis, endometriosis and inherited bleeding disorders.
Several future LNG-IUS are in progress: LCS® (levonorgestrel contraceptive system), Fibroplant-LNG®, Femilis®, Femilis Slim®, Levosert®. These new LNG-IUS may have the same benefits than the Mirena®IUS.
•DMPA
-Plausible prevention of functional ovarian cysts with DMPA use.
-Plausible treatment of functional menorrhagia.
-Possible benefits in dysmenorrhoea, endometriosis, sickle cell crises, epilepsy, and uterine fibroids.
-Plausibe reduction in ovarian and endometrial cancers.
•Progestogen subdermal implant
-Possible treatment of pelvic endometriosis with etonogestrel subdermal implants (Implanon®/Nexplanon®).
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CONCLUSION
According Z.Haider, 2009 “…It is good practice to mention and quantify any risks as well as benefits of contraceptives methods when the woman is first counseled…
The risk of the various contraceptive methods available must be put into perspective and are frequently outweighed by the benefits…”
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