Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group.

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

Prevention of unintended pregnancies by using emergency contraception: the differences between levonorgestrel and ulipristal acetate. A theoretical model using data from a survey on the use of emergency contraception in Spain, 2017.

Objective: To estimate the differences in unintended pregnancies avoided using either levonorgestrel (LNG) or ulipristal acetate (UPA) emergency contraception (EC). Design: Cross-sectional study. Setting: Survey carried out in Spain. Participants: 1000 Spanish women reporting unprotected sex in 2017. Main measurements: EC use, reasons for not using EC, calculation of the number of unintended pregnancies avoided. Results: 39% of Spanish women having had unprotected sex used EC. 61% of those women did not use EC and 11% did not know the existence of this resource. In 2017 the use of EC prevented 101,271 unintended pregnancies. If instead of using LNG every woman had used UPA another 15,979 additional pregnancies could have been prevented. Conclusions: If all Spanish women having unprotected sex used EC we could expect a significant decrease in the number of unintended pregnancies and abortions. Using UPA instead of LNG would have a greater impact on that reduction with the corresponding benefit for women and society as a whole.

Cross-sectional evaluation of the impact of information on flexible extended regimens of oral contraceptives in the choices made by women seeking contraceptive counselling: the FLEXO study.

OBJECTIVE: Oral combined hormonal contraceptives (CHCs) are available that limit the number of menses when used in a flexible extended regimen. Our aim was to investigate the decision-making processes of women presented with a flexible extended CHC option. METHODS: The FLEXO study is an epidemiological, cross-sectional, multicentre study conducted under typical clinical practice conditions to determine women's acceptance of a flexible continuous CHC regimen versus a cyclical 21/7 day regimen, after receiving standardised information during contraceptive counselling. RESULTS: A total of 1350 women were invited to participate, of whom 1156 were enrolled. Of these, 47.2% chose the flexible extended CHC regimen. Their main reason for choosing this regimen was to reduce the number of menses (25.7%), followed by the desire to avoid symptoms related to menstruation (21.6%). The reasons given for rejecting this regimen were the desire to have monthly menstrual cycles (24.9%) and the fear of becoming pregnant and not being aware of it due to the absence of menstruation (18.1%). CONCLUSION: Many women chose the extended flexible regimen when they received information about this option. Women primarily chose this pattern to relieve or eliminate discomfort related to menstruation.

Economic Burden of Contraception Management in Spain.

BACKGROUND: A wide variety of contraceptive methods are available, some of them reimbursed by the Spanish National Health System (SNHS). However, the number of unintended pregnancies (UP) is still significant, leading to a high economic burden, mainly derived from non-adherence to and the incorrect use of contraceptive methods. OBJECTIVES: This study aims to estimate the economic burden associated with reversible contraception management in Spain, from the perspectives of both the SNHS and women, over a 5-year period. METHODS: A survey was performed to identify contraception management in Spain based on the experience of a panel of six expert gynecologists. An economic model was conducted to quantify the current burden of contraception according to healthcare resources use over 5 years. The costs included in the analysis were diagnostic tests, initial and follow-up consultations, methods acquisition costs, and UP derived from therapy failure. RESULTS: Reversible contraception costs in Spain amount to €12.5 billion over a 5-year period. Condoms and combined oral contraceptives (COC) account for 86.8% of the total cost and the other methods only 13.2%. There are differences in contraceptive use according to women's age. Short-acting reversible contraceptives (SARC) such as COC, condom and vaginal ring, are most commonly used by younger women. However, SARC are correlated with the highest failure rate, resulting in over €7.2 billion cost, explained by the high number of UP. Long-acting reversible contraceptives (LARC), such as the levonorgestrel-releasing intrauterine system (LNG-IUS20), implant and copper intrauterine devices (IUD), are selected by women over 35 years of age due to user-independent compliance. SARC methods result in a higher cost per woman over 5 years: vaginal ring €2427.8, patch €2402.6, condom €2060.1 and COC €1895.1; while LARC methods are the most economic option per women: LNG-IUS20 €630.4, copper IUD €658.2, LNG-IUS12 €703.8, intramuscular injectable €907.8 and implant €940.5. CONCLUSIONS: LARC methods result in lower costs compared with SARC options from the perspectives of the SNHS and women, explained by user-independent compliance, preventing a significant number of UP and its elevated economic burden. An increased LARC methods use could avoid UP events, leading to significant cost-savings for the SNHS.

Effect on quality of life of switching to combined oral contraception based on natural estrogen: an observational, multicentre, prospective phase IV study (ZOCAL Study).

OBJECTIVES: This observational, multicentre, prospective phase IV study examined change in health-related quality of life (QOL) from baseline to 6 months in women initiating combined oral contraception (COC) based on natural estrogen. METHODS: Eligible women attending a baseline and 6-month gynaecology appointment belonged to one of three groups: group 1 used barrier contraception (condoms) and elected to continue this method; group 2 used condoms and elected to switch to COC based on natural estrogen; group 3 used COC based on ethinylestradiol and elected to switch to COC based on natural estrogen. The Spanish Society of Contraception (SEC)-QOL scale assessed health-related QOL. Secondary outcomes included symptoms of premenstrual syndrome, intermenstrual bleeding, duration and intensity of menstrual bleeding, contraception continuation rate, and tolerability. RESULTS: A total of 857 women were enrolled and 785 completed the study. Group 2 (n = 224 completed) had significantly lower SEC-QOL global and dimension scores at baseline and significantly greater increases in SEC-QOL from baseline to 6 months compared with groups 1 (n = 72) and 3 (n = 489). Group 3 reported a similar SEC-QOL score to that of group 1 at baseline but showed significantly greater improvement in SEC-QOL global and psychological scores from baseline to 6 months. Among women receiving COC based on natural estrogen, the contraception continuation rate was 713/780 (91.4%); treatment-related adverse events were reported by 13/780 (1.7%). CONCLUSIONS: Improved SEC-QOL after 6 months was found in women who were dissatisfied with their current contraception at baseline and chose to switch to COC based on natural estrogen.

Estudio observacional, transversal, de una muestra representativa de las mujeres españolas en edad fértil, sobre los cuidados, hábitos y promoción de la salud previamente y durante el embarazo: Estudio GESTMUJER / Cross-sectional study of vitamin and folic acid supplementation in a representative sample of Spanish women of fertile age before and during pregnancy: The GESTMUJER study

Objetivo. Conocer los hábitos de las mujeres españolas en edad fértil, respecto al uso de suplementos vitamínicos y ácido fólico antes y durante el embarazo. Material y método. Encuesta telefónica realizada a una muestra representativa de 1.020 mujeres residentes en España de 15 a 49 años de edad, durante el mes de marzo del 2013. Resultados. Una de cada 4 mujeres españolas planifica su embarazo. Como consecuencia de esta falta de planificación, solo el 28,6% de las mujeres había tomado un suplemento de ácido fólico con anterioridad al momento de quedar embarazada. Conclusiones. Sigue existiendo la necesidad de informar y aconsejar a las mujeres en edad fértil sobre la conveniencia de utilizar ácido fólico previamente a un embarazo. Parecen necesarias campañas institucionales que promuevan tanto la planificación de un futuro embarazo, como el uso de suplementos vitamínicos antes y durante el mismo (AU)

Objective. To identify the use of folic acid and other vitamins in Spanish women of fertile age before and during pregnancy. Material and method. A representative survey of 1020 Spanish women aged 15 to 49 years was carried out in March 2013. Results. Only one quarter of Spanish women planned their pregnancies and,as a result, only 28.6% of women took folic acid before becoming pregnant. Conclusions. There is a lack of information about the role and importance of folic acid to prevent neural tube defects. Institutional campaigns are needed to promote both pregnancy planningand the use of vitamin supplements before and during pregnancy (AU)

Alcohol and drug abuse and risky sexual behaviours in young adult women.

OBJECTIVE: To assess alcohol abuse as a predictor of risky sexual behavior among adolescents and young adult women, a high-risk population for unintended pregnancies. SUBJECTS: Totally 3163 adolescent and young adult women, 18-29 years, were assessed on sociodemographics, alcohol and drug use and risky sexual behaviors. INTERVENTIONS: Participants answered a structured questionnaire on their leisure habits, drug and alcohol consumption, contraception and sexual behaviors. RESULTS: Most of the young adult women perceive that sexuality is an important part of their life but not a main concern (77.6%) and that alcohol removes the barriers to have sex (62.3%). Additionally, 77.0% claimed that contraception had "a lot" (53.4%) and "quite" (23.6%) influence on the quality of their sexuality. However, up to a 38.4% of the interviewed women had had sex without using any contraception and 29.6% of them acknowledged that had taken alcohol and of these, 40.7% said that alcohol was responsible for not using contraception. Alcohol abuse predicted an increase in risky sexual behaviours (4.45 CI: 2.01-9.75, p < 0.0001). The effect of alcohol was independent of age. CONCLUSIONS: These findings suggest that contraception-related behavioural interventions for young adult women should discuss the link between alcohol and sexual risk behavior.

Differences in contraceptive use between Spanish female healthcare providers and Spanish women in the general population aged 23 to 49 years: the HABITS Study.

OBJECTIVE: To compare the contraceptive modalities used in the general female population with those of female healthcare providers (HCPs) in Spain. METHODS: A nationwide survey of a representative sample of Spanish women and female Spanish HCPs aged 23 to 49 years (total sample size: 3200). RESULTS: The condom was the most widely used contraceptive method in both groups (30% and 23% in the general population and among HCPs, respectively). The reasons cited for relying on this method were ease of use (19% and 13%, respectively; p = 0.2), effectiveness (16% and 22%, respectively; p = 0.2), absence of side effects (14% and 22%, respectively; p = 0.1), and fear of side effects associated with oral contraception (13% and 2%, respectively; p < 0.0001). After the condom, oral contraceptives, the intrauterine device and the vaginal ring were the most widely used methods among HCPs (13% each). CONCLUSIONS: The spectrum of contraceptive methods used by female HCPs differs from that of women in the general Spanish population. HCPs opt more often for long-acting reversible contraceptives because of their effectiveness and safety whereas women in the general population rely more frequently on the condom and surgical methods.

Preferencias de las usuarias colombianas en cuanto al uso de anticonceptivos orales. Estudio descriptivo / Colombian users’ preferences regarding the use of oral contraceptives. A descriptive study

Los anticonceptivos orales combinados han evolucionado aceleradamente durante las últimas décadas reduciendo los efectos adversos sin afectar la eficacia y ajustándose a las preferencias de las mujeres. Es importante conocer las percepciones y expectativas de las usuarias para mejorar la adherencia y disminuir los fallos de la anticoncepción. Para tal fin se realizó un estudio encuestal con una muestra de 389 usuarias entre los 18 y 45 años de edad en las 4 ciudades principales de Colombia, evaluando además de las variables sociodemográficas el conocimiento y las preferencias de las usuarias relacionadas con los beneficios adicionales de esta terapia anticonceptiva. La muestra estuvo integrada en su mayoría por mujeres pertenecientes a los estratos socio-económicos medio (62,7%) y alto (37,3%). El 40,9% de las participantes se encontraban en el grupo de 18 a 25 años, 43,0% en el de 26 a 35 años y 16,1% en el de 36 a 45 años. 58,4% de las participantes refirieron conocer al menos un beneficio adicional de los anticonceptivos orales y cuando se les pidió que ordenaran por importancia cinco atributos propuestos por el encuestador como potenciales efectos beneficiosos, se obtuvo para todos los grupos de edad el siguiente orden: 1) que no afecte el peso corporal (35,2%), 2) disminución de la dismenorrea (26,6%), 3) mejorar la calidad de la piel (20,1%), 4) disminución en duración y volumen del sangrado menstrual (13,3%) y 5) reducir las fluctuaciones del estado anímico (5%). Una asesoría anticonceptiva individualizada y completa, donde se evalúen el conocimiento previo de los potenciales efectos beneficiosos de los anticonceptivos orales, las expectativas y preferencias de usuarias contribuirán a disminuir las tasas de embarazos no planificados relacionados con el uso incorrecto o con la suspensión de la terapia (AU)

Combined oral contraceptives have evolved rapidly in recent decades to reduce side effects without affecting the efficacy and according to the preferences of women. It is important to understand the perceptions and expectations of users to improve adherence and reduce the failure of contraception. To this end we conducted a survey-based study within a sample of 389 users aged 18 and 45 years of age in 4 major cities of Colombia, to assess sociodemographic variables in addition to knowledge and preferences of users related to the additional benefits of this contraceptive therapy. The sample consisted mostly of women belonging to middle (62.7%) and high (37.3%) socioeconomic groups. 40.9% of participants were in the group of 18 to 25 years, 43.0% in the group of 26 to 35 years and 16.1% in the group of 36 to 45 years. 58.4% of participants reported knowing at least one additional benefit of oral contraceptives, and when they were asked to rank by importance five attributes proposed by the interviewer as potential beneficial effects was obtained for all age groups the following order: 1) that it does not affect body weight (35.2%), 2) reduction of dysmenorrhea (26.6%), 3) improve the quality of the skin (20.1%), 4) decrease in duration and volume of menstrual bleeding (13.3%) and 5) reduce mood fluctuations (5%). An individualized and comprehensive contraceptive counseling, which assesses the prior knowledge of the potential beneficial effects of oral contraceptives, expectations and preferences of users will contribute to reducing unplanned pregnancy rates associated with incorrect use or with early discontinuation of therapy (AU)

Trends in contraception use in Spanish adolescents and young adults (15 to 24 years) between 2002 and 2008.

OBJECTIVE: To assess changes in the use of contraceptive methods, and induced abortion rates, in Spanish adolescents and young adults aged 15 to 24 years, between 2002 and 2008. STUDY DESIGN: Representative samples of Spanish men and women aged 15 to 24 years were surveyed in 2002 (N = 1826) and 2008 (N = 2000). RESULTS: The rate of use of contraceptive methods increased from 61% in men and 60% in women in 2002 to 80% and 75%, respectively, in 2008. The most commonly used method was the condom (51% in 2002 and 71% in 2008), followed by the contraceptive pill (18% in 2002 and 18% in 2008). None of the adolescents and young adults surveyed used natural methods or the diaphragm, or had undergone sterilisation. The induced abortion rate increased from 9.28 to 13.48 per 1000 women in the group aged between 15 and 19 years, and from 14.37 to 21.05 per 1000 women in the group aged 20 to 24 years. CONCLUSION: Despite an increase in the use of effective birth control methods, the rates of abortion rose during the study period, which may indicate that compliance with the use of condoms is inadequate. There is an urgent need to develop educational campaigns or to design specific policies addressing contraception-related issues for young people.

Contraceptive practices of women requesting induced abortion in Spain: a cross-sectional multicentre study.

OBJECTIVES: To collect information on (i) contraceptive methods used immediately before unwanted pregnancy, and (ii) planned contraception following induced abortion among Spanish residents. METHODS: Eight centres officially accredited to perform abortions participated in a cross-sectional study. The study population included 2475 women requesting induced abortion between 1 January and 31 March 2007. RESULTS: Contraceptive methods used before unwanted pregnancy were condoms in 40% of the cases, combined hormonal contraception in 14%, and other methods (mainly natural methods and withdrawal) in 10%. Thirty-six percent of women did not use any contraceptive method. Failure of the method due to incorrect use was reported by 77% of those using condoms and by 84% of those using hormonal contraception. Only 23% of women planned to use a contraceptive method after abortion. Almost half of the women were immigrants. CONCLUSION: Despite the use of effective contraceptive methods, the majority of women requesting induced abortion in Spain became pregnant during the use of these methods. These data reflect a lack of compliance. More education programmes are needed to improve compliance rates. The long-acting reversible contraceptive methods could constitute an appropriate approach.

Venous and pulmonary thromboembolism and combined hormonal contraceptives. Systematic review and meta-analysis.

OBJECTIVE: A systematic review of studies published between January 1995 and April 2010 aimed at determining the effect of combined hormonal contraceptives (CHCs), administered orally, transdermally or vaginally, on the risk of venous thromboembolism (VTE). RESULTS: Of the 625 potentially eligible references reviewed, 25 studies meeting the inclusion and exclusion criteria were entered in the meta-analysis. The pooled relative risks of VTE associated with the various CHCs, depending on their progestogen, were: gestodene vs. levonorgestrel 1.33 (95% confidence interval [CI]: 1.08-1.63); desogestrel vs. levonorgestrel 1.93 (95% CI: 1.31-2.83); and drospirenone vs. levonorgestrel 1.67 (95% CI: 1.10-2.55). The pooled adjusted odds ratio for norgestimate vs. levonorgestrel was 1.11 (95% CI: 0.84-1.46) and that for cyproterone acetate vs. levonorgestrel 1.65 (95% CI: 1.30-2.11). CONCLUSIONS: The safest CHCs in terms of VTE are those containing levonorgestrel or norgestimate. The risk of VTE associated with desogestrel-, drospirenone- or cyproterone acetate-containing CHCs is greater than that associated with CHCs containing levonorgestrel. The increased risk of VTE found for CHCs with gestodene compared to CHCs with levonorgestrel seems smaller than in previous analyses. There were no differences in VTE risk between oral and transdermal CHCs containing norgestimate or norelgestromin, respectively.

Continuation rate of combined hormonal contraception: a prospective multicenter study.

BACKGROUND: Data from clinical trials regarding continuation of use and contraceptive efficacy do not always apply to the general public. Therefore, a study among typical users was conducted to assess the continuation rate at the end of 12 cycles of combined hormonal contraceptive methods, reasons for discontinuation, and the Pearl index. METHODS: Prospective, observational, and multicenter study of 3443 women aged 18 to 49 years starting one of the three combined hormonal contraception methods available in Spain (the vaginal ring, the contraceptive pill, and the transdermal skin patch). RESULTS: The study population (intention-to-treat analysis) included 3443 women, of whom 45.4% were included in the vaginal ring group, 42.6% the pill group, and 12.1% the skin patch group. The continuation rate at 12 cycles was 45.9% for the pill, 42.3% for the vaginal ring, and 26.0% for the skin patch. The Pearl index was 0.61 (95% confidence interval [CI] 0-1.2) for the pill, 0.61 (95% CI 0-1.1) for the vaginal ring, and 2.34 (95% CI 0.3-9) for the skin patch (p<0.001). CONCLUSION: At 12 cycles, the vaginal ring and the pill showed similar continuation rates and effectiveness, which were significantly higher than the skin patch.

Development and validation of the SEC-QOL questionnaire in women using contraceptive methods.

OBJECTIVES: Develop and validate a Spanish society of contraception quality-of-life (SEC-QOL) questionnaire to assess the impact of contraceptive methods on the health-related quality of life (HRQOL) of women. METHODS: SEC-QOL was developed following a standardized procedure including review of the literature, interviews with contraception users, and the administration of a pilot questionnaire to 187 women. SEC-QOL consists of 19 items and includes five dimensions. To validate the questionnaire, a multicenter, observational, prospective study was conducted in Spain. The following three study groups were defined: group A (n = 129) comprised women using effective contraceptive methods; group B (n = 251), comprised women about to start using an effective method; and group C (n = 73) comprised women using no or poorly effective contraception. All women attended baseline and final visits (4 ± 1 months). Participants completed the SEC-QOL, psychological well-being index, EuroQol five-dimensional questionnaire, and perceived health state questionnaires. RESULTS: At baseline, women from group A had a better HRQOL in all SEC-QOL dimensions, except for breast symptoms. Heavier menstrual bleeding, more androgenic and breast symptoms, menstrual pain, and not using hormonal contraceptive methods were associated with lower HRQOL. SEC-QOL scores showed moderate correlations to psychological well-being index and slightly lower correlation to EuroQol five-dimensional questionnaire scores. At follow-up, HRQOL had improved in all groups; most markedly in group B, which obtained an average effect size of 0.59. The minimum important difference was established as a 3.4-point change in the global SEC-QOL score. SEC-QOL obtained a Cronbach's α of 0.88 and an intraclass correlation coefficient of 0.82. CONCLUSIONS: SEC-QOL is a valid, reliable, and sensitive to change questionnaire for use in daily clinical practice and future research projects on contraception.

Attitudes of Spanish women toward premenstrual symptoms, premenstrual syndrome and premenstrual dysphoric disorder: results of a nationwide survey.

OBJECTIVE: To assess the attitudes of women with premenstrual symptoms in relation to their perception of complaints and request for medical advice. STUDY DESIGN: Cross-sectional study of a representative cohort of 2018 Spanish women aged 15-49 years. Participants were personally interviewed at home and completed the premenstrual symptoms screening tool. RESULTS: A total of 1554 women (73.7%) complained of some of the premenstrual symptoms during the last 12 menstrual cycles. The prevalence of moderate or severe premenstrual syndrome (PMS) was 8.9% and the prevalence of premenstrual dysphoric disorder (PMDD) 1.1%. Only 291 (18.7%) women had sought medical advice. The main reason given by 90.6% of symptomatic women for not seeking medical consultation was to consider that symptoms were normal. A total of 175 (60.1%) women received pharmacological treatment (hormonal contraceptives in 95% followed by analgesics in 50% and anti-inflammatory agents in 44%), 20% were not treated because physicians considered that symptoms were not important and would disappear spontaneously, and 12% received only advice to change life style. CONCLUSION: Women suffering from PMS or PMDD do not usually seek medical advice and among those seeking medical care, in many cases, an adequate response to their demands is not obtained.

Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in a representative cohort of Spanish women of fertile age.

OBJECTIVE: To assess the prevalence of premenstrual symptoms, premenstrual syndrome and premenstrual dysphoric disorder in a cohort of women of fertile age representative of the general Spanish population. STUDY DESIGN: During the period between November 27th and December 22nd, 2008, a cross-sectional nationwide survey was conducted among a cohort of Spanish women aged between 15 and 49 years. Participants were personally interviewed at home and completed the premenstrual symptoms screening tool. RESULTS: Of the 2108 participants, 1554 women (73.7%) complained of some of the premenstrual symptoms during the last 12 menstrual cycles. A total of 1415 (91%) women presented isolated symptoms and 139 (8.9%) a moderate/severe premenstrual syndrome. Twenty-four (1.1%) women fulfilled criteria for a diagnosis of premenstrual dysphoric disorder. CONCLUSION: The prevalence of premenstrual symptoms (73.7%) and premenstrual dysphoric disorder (1.1%) in Spanish women aged between 15 and 49 years is similar to that reported in other Western countries. Only women with moderate or severe premenstrual syndrome or premenstrual dysphoric disorder, however, had daily life activities significantly impaired by premenstrual symptoms.

Trends in the use of contraceptive methods and voluntary interruption of pregnancy in the Spanish population during 1997-2007.

BACKGROUND: This study was designed to acquire information about the use of contraceptive methods in order to reduce the number of elective abortions. STUDY DESIGN: Since 1997, representative samples of Spanish women of childbearing potential (15-49 years) have been surveyed by the Daphne Team every 2 years to gather data of contraceptive methods used. RESULTS: During the study period, 1997 to 2007, the overall use of contraceptive methods increased from 49.1% to 79.9%. The most commonly used method was the condom (an increase from 21% to 38.8%), followed by the pill (an increase from 14.2% to 20.3%). Female sterilization and IUDs decreased slightly and were used by less than 5% of women in 2007. The elective abortion rate increased from 5.52 to 11.49 per 1000 women. CONCLUSIONS: The factors responsible for the increased rate of elective abortion need further investigation.

Ethinylestradiol/dienogest in oral contraception.

The low-dose combined oral contraceptive of ethinylestradiol 30 microg and dienogest 2 mg was launched in Germany in 1995, and is now the most commonly prescribed oral contraceptive in this country. Dienogest is a novel 19-nortestosterone-derived progestin with a unique pharmacokinetic and pharmacological profile, including antiandrogenic properties. Clinical studies have demonstrated that ethinylestradiol/dienogest is a reliable ovulation inhibitor with high contraceptive efficacy that is comparable with other combined oral contraceptives. It also provides effective cycle control, with reduced intensity and duration of menstrual bleeding, and improves dysmenorrhoea. The combination of ethinylestradiol and dienogest reduces serum androgen levels, and increases the levels of thyroid hormones; however, although thyroid hormone levels increase, there is no increased activity due to increases in transporter protein. Like other low-dose oral contraceptives, ethinylestradiol/dienogest has only minor influences on lipid and carbohydrate metabolism, adrenal hormones and blood pressure parameters, and appears to have a balanced effect on the haemostatic system. Ethinylestradiol/dienogest also has beneficial effects on hair and skin; a number of studies have reported decreased hair and skin greasiness, and improvements in acne vulgaris following treatment with ethinylestradiol/dienogest. After discontinuation of ethinylestradiol/dienogest, there may be a small delay in conception during the first three cycles, but there is no subsequent impairment of fertility. Furthermore, the duration of use of ethinylestradiol/dienogest does not seem to influence the rate of conception or time to conception. Ethinylestradiol/dienogest is well tolerated; adverse reactions associated with treatment include breast pain, headache and nausea/vomiting. These adverse reactions are rare and decrease in incidence over time.

La juventud española y el doble método: un análisis de la situación actual. Resultados de un estudio transversal de una muestra amplia / Spanish 15-24-year-olds and the «double method»: Analysis of the current situation. Results of a cross-sectional study in a broad sample

Objetivos: Conocer el porcentaje de jóvenes españoles de ambos sexos, con edades comprendidas entre los 15 y los 24 años, que utilizan o conocen el doble método. Material y métodos: Estudio descriptivo, transversal, realizado en el mes de marzo de 2005 mediante una encuesta nacional entre una muestra de 2.015 jóvenes españoles con edades comprendidas entre los 15 y los 24 años. Los datos fueron recogidos en una base de datos diseñada para el estudio y su tratamiento estadístico se realizó mediante el paquete SPSS. Resultados: El 70% de los jóvenes es sexualmente activo. El método anticonceptivo más utilizado es el preservativo. Sólo el 3,4% de los jóvenes varones españoles y el 7,3% de las mujeres han utilizado, en alguna ocasión, un doble método, y este porcentaje desciende hasta el 0,2 y el 2,9%, respectivamente, cuando se refiere a la última relación sexual mantenida. El 31% de los varones y el 36,8% de las mujeres conocen el doble método. Conclusiones: El uso y el conocimiento del doble método entre la población joven española son bajos

Objectives: To determine the percentage ofSpanish 15-24-year-olds of both sexes that use orknow about the double method.Material and methods: We performed a crosssectionalstudy in March 2005 through a national survey of a sample of 2015 Spanish 15-24-yearolds.The data were collected in a databasespecifically designed for the study and wereanalyzed using the SPSS statistical system.Results: Seventy percent of the 15-24-year-oldswere sexually active. The most widely usedcontraceptive method was the condom. Only 3.4%of males and 7.3% of females had ever used thedouble method and this percentage decreased to0.2% and 2.9%, respectively, in the last sexualrelationship. Thirty-one percent of males and 36.8%of females were aware of the double method.Conclusions: Use and knowledge of the double method are low among young Spaniards (AU)