Contraceptive failure in the United States

Methods: Members of this consensus group were selected based on individual expertise to represent a range of practical and academic experience both in terms of location in Canada and type of practice, as well as subspecialty expertise along with general gynaecology backgrounds. The consensus group reviewed all available evidence through the English and French medical literature and available data from a survey of Canadian women. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. Results: This document provides a summary of up-to-date evidence regarding the diagnosis, investigations, and medical and surgical management of dysmenorrhea. The resulting recommendations may be adapted by individual health care workers when serving women who suffer from this condition. Conclusions: Dysmenorrhea is an extremely common and sometimes debilitating condition for women of reproductive age. A multidisciplinary approach involving a combination of lifestyle, medications, and allied health services should be used to limit the impact of this condition on activities of daily living. In some circumstances, surgery is required to offer the desired relief. Outcomes: This guideline discusses the various options in managing dysmenorrhea. Patient information materials may be derived from these guidelines in order to educate women in terms of their options and possible risks and benefits of various treatment strategies. Women who find an acceptable management strategy for this condition may benefit from an improved quality of life.

Primary dysmenorrhea consensus guideline.

Objective This guideline reviews the investigation and treatment of primary dysmenorrhea. Intended Users Health care providers. Target Population Women and adolescents experiencing menstrual pain for which no underlying cause has been identified. Evidence Published clinical trials, population studies, and review articles cited in PubMed or the Cochrane database from January 2005 to March 2016. Validation Methods Seven clinical questions were generated by the authors and reviewed by the SOGC Clinical Practice-Gynaecology Committee. The available literature was searched. Guideline No. 169 was reviewed and rewritten in order to incorporate current evidence. Recommendations addressing the identified clinical questions were formulated and evaluated using the ranking of the Canadian Task Force on Preventive Health Care. Benefits, Harms, and Costs Primary dysmenorrhea is common and frequently undertreated. Effective therapy is widely available at minimal cost. Treatment has the potential to improve quality of life and to decrease time lost from school or work. Guideline Update This guideline is a revision and update of No. 169, December 2005. Sponsors SOGC. Summary Statements 1.Dysmenorrhea is highly prevalent and commonly undertreated (III). 2.Non-steroidal anti-inflammatory drugs are more effective than placebo but have more gastrointestinal side effects. All currently available non-steroidal anti-inflammatory drugs are of comparable efficacy and safety (I). 3.Suppression of ovulation is associated with decreased menstrual pain (II-1). 4.Amenorrhea induced by any means is beneficial for the treatment of dysmenorrhea (II-2). 5.Hysterectomy is effective treatment (II-2). 6.There is some evidence to support laparoscopic nerve ablation in selected cases (II-1). 7.Endometrial ablation is likely to reduce symptoms of dysmenorrhea when it occurs in the presence of menorrhagia (I). Recommendations 1.Both primary and secondary dysmenorrhea are likely to respond to the same medical therapy. Therefore, initiation of treatment should not depend on establishing a precise diagnosis (II-1A). 2.Health care providers should include specific questions regarding menstrual pain when obtaining a woman's medical history (III-B). 3.A pelvic examination is not necessary prior to initiating therapy (III-D). 4.A pelvic examination is indicated in patients not responding to conventional therapy and when organic pathology is suspected (III-B). 5.Non-steroidal anti-inflammatory drugs, administered with regular dosing regimens, should be considered first-line treatment for most women (I-A). 6.Hormonal therapies should be offered to women and girls who are not currently planning pregnancy unless contraindications exist (I-A). 7.Continuous or extended use combined hormonal contraceptives are recommended (I-A). 8.Regular exercise is likely to improve symptoms of dysmenorrhea and should be recommended (II-1A). 9.Local heat in the form of heated pads or patches should be recommended as a complementary treatment for dysmenorrhea (I-A). 10.High-frequency transcutaneous electrical nerve stimulation should be considered as a complementary treatment or in women unable or unwilling to use conventional therapy (II-1B). 11.Acupoint stimulation should be considered for women wishing to use complementary or alternative therapies (II-1B). 12.Ginger is recommended for women wishing to use complementary or alternative therapies (I-A). 13.Preoperative investigations should include a detailed history and physical examination, ultrasound, and possibly magnetic resonance imaging to discover secondary causes for dysmenorrhea and to direct appropriate therapy (III-A). 14.Surgical intervention should only be considered if a concerted trial of medical therapy has not been successful (III-A).

No. 345-Primary Dysmenorrhea Consensus Guideline

Effect of counseling to improve compliance in Mexican women receiving depot-medroxyprogesterone acetate

This study purported to determine the effect of pretreatment counseling upon discontinuation of 150 mg depot-medroxyprogesterone acetate (Depo-Provera) given for contraception. A total of 350 Mexican women participated: 175 received detailed structured pretreatment counseling about the hormonal effects of the injectable vs. routine counseling upon duration of use and efficacy of the method. Study termination rates were significantly lower in the structured counseling group than in the control group. Cumulative life table discontinuation rates were 17% (30/175) and 43.4% (76/175), respectively (p ,0.05). The most common reasons for terminating DMPA were menstrual changes (8.6 and 32% for counseling and control group, respectively). The findings suggest that pretreatment counseling on expected side effects increases the continuation rates of DMPA users. © 2001 Elsevier Science Inc. All rights reserved.

Original research article Effect of counseling to improve compliance in Mexican women receiving depot-medroxyprogesterone acetate

A multicentred phase III comparative clinical trial of depot-medroxyprogesterone acetate given three-monthly at doses of 100mg or 150mg: 1. Contraceptive efficacy and side effects

A multicentred pharmacokinetic. pharmacodynamic study of once-a-month injectable contraceptives I. Different doses of HRP112 and of depoprovera

A multicentered phase III comparative clinical trial of depot-medroxyprogesterone acetate given three-monthly at doses of 100 mg or 150 mg: II. The comparison of bleeding patterns. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation Special Programme of Research, Development and Research Training in Human Reproduction.

S. Koloszar

Papers

A multicentred phase III comparative clinical trial of depot-medroxyprogesterone acetate given three-monthly at doses of 100mg or 150mg: 1. Contraceptive efficacy and side effects

A multicentred pharmacokinetic. pharmacodynamic study of once-a-month injectable contraceptives I. Different doses of HRP112 and of depoprovera