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Selected Practice Recommendations for Contraceptive Use (SPR) Guidelines Was Discussed

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Selected Practice Recommendations for Contraceptive Use (SPR) Guidelines Was Discussed Contact World Health Organization Department of Reproductive Health and Research Department of Reproductive Health and Research World Health Organization Avenue Appia 20 CH-1211 Geneva 27 Selected practice Switzerland Fax: +41.22.791.4171 Email: [email protected] recommendations for www.who.int/reproductivehealth contraceptive use Third edition 2016 Web annex: Development of updated guidance for the third edition ISBN 978 92 4 156540 0 WHO Library Cataloguing-in-Publication Data Selected practice recommendations for contraceptive use – 3rd ed. 1.Contraception – methods. 2.Contraceptive Agents, Female. 3.Contraceptives, Oral, Combined. 4.Intrauterine Devices. 5.Natural Family Planning Methods. 6.Vasectomy. 7.Practice Guideline. I.World Health Organization. ISBN 978 92 4 156540 0 (NLM classification: WP 630) © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (http://www.who.int/about/licensing/copyright_form). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Layout: L’IV Com Sàrl, Villars-sous-Yens, Switzerland. Contents Acronyms and abbreviations 3 1. Background: overview and scope of the guidelines 4 2. Methods 6 2.1 Development of earlier editions of the Selected practice recommendations for contraceptive use ......................................................... 6 2.2 Development of the third edition of the SPR ...................................... 6 2.3 Prioritization of topics for the revision process .................................... 7 2.4 Evidence identification and synthesis ............................................ 8 2.5 Decision-making during the Guideline Development Group meetings .................. 9 3. Dissemination and evaluation 12 4. Reviewed recommendations 13 4.1 Recommendations for addition of Sino-implant (II)® as a new method to the SPR ................................................................ 13 4.1.a Initiation of Sino-implant (II) ............................................ 13 4.1.b Examinations and tests needed before initiation of Sino-implant (II) .............. 14 4.1.c Duration of Sino-implant (II) use .......................................... 16 4.1.d Follow-up after Sino-implant (II) initiation .................................. 17 4.2 Recommendations for addition of subcutaneously administered depot medroxyprogesterone acetate as a new method to SPR ............................ 20 4.2.a Initiation of DMPA-SC .................................................. 20 4.2.b Examinations and tests needed before initiation of DMPA-SC ................... 21 4.2.c Reinjection interval for DMPA-SC ......................................... 22 4.3 Recommendations for addition of the combined contraceptive transdermal patch and the combined contraceptive vaginal ring as new methods to the SPR ................................................................ 24 4.3.a Initiation of the patch and CVR ........................................... 24 4.3.b Examinations and tests needed before initiation of the patch and CVR ............ 27 4.3.c Management of dosing errors during patch and CVR use ....................... 28 4.3.d Follow-up after patch and CVR initiation ................................... 31 4.4 Recommendations for addition of ulipristal acetate emergency contraceptive pills as a new method to the SPR ................................... 33 4.4.a Initiation of UPA-ECPs .................................................. 33 4.4.b Nausea and vomiting when taking UPA-ECPs ................................ 35 4.5 Recommendations for the resumption or initiation of regular contraception after using emergency contraception as a new topic in the SPR ...................... 37 4.5.a Resumption or initiation of regular contraception after levonorgestrel-only ECPs and combined estrogen–progestogen ECPs ............. 37 4.5.b Starting regular contraception after UPA-ECPs ............................... 38 1 Appendix 1: Systematic reviews 40 1.1 Levonorgestrel (LNG) implant: Sino-implant (II)® .................................. 40 Sino-implant (II) initiation .................................................... 40 Sino-implant (II) examinations and tests ......................................... 40 Sino-implant (II) follow-up .................................................... 40 Duration of Sino-implant (II) ................................................... 41 1.2 Progestogen-only injectable contraceptive: subcutaneously administered depot medroxyprogesterone acetate (DMPA-SC) .................................. 41 DMPA-SC initiation .......................................................... 41 DMPA-SC examinations and tests ............................................... 41 DMPA-SC repeat injections .................................................... 41 1.3 The combined contraceptive patch and the combined contraceptive vaginal ring (CVR) .......................................................... 41 Patch and CVR initiation ...................................................... 41 Patch and CVR examinations and tests ........................................... 41 Patch and CVR dosing errors .................................................. 42 Patch and CVR follow-up ..................................................... 42 1.4 Emergency contraception: ulipristal acetate emergency contraceptive pills (UPA-ECPs) ............................................................ 43 UPA-ECP initiation .......................................................... 43 Nausea and vomiting after UPA-ECP use ......................................... 43 1.5 Resumption or initiation of regular contraception after using emergency contraception .. 43 Appendix 2: Declarations of interests 44 2 Selected practice recommendations for contraceptive use • Third edition 2016 Acronyms and abbreviations CIRE Continuous Identification of Research Evidence COC combined oral contraceptive Cu-IUD copper-bearing intrauterine device CVR combined contraceptive vaginal ring DMPA depot medroxyprogesterone acetate DMPA-IM DMPA, administered intramuscularly DMPA-SC DMPA, administered subcutaneously EC emergency contraception ECP emergency contraceptive pill ETG etonogestrel GDG Guideline Development Group GRADE Grading of Recommendations Assessment, Development and Evaluation GRC Guidelines Review Committee IM intramuscular IUD intrauterine device LNG levonorgestrel LNG-ECP levonorgestrel emergency contraceptive pill LNG-IUD levonorgestrel-releasing intrauterine device MEC Medical eligibility criteria for contraceptive use (WHO publication) NET-EN norethisterone enanthate NIH National Institutes of Health (United States of America) OC oral contraceptive PICO population, intervention, comparator, outcome PID pelvic inflammatory disease POC progestogen-only contraceptive POI progestogen-only injectable POP progestogen-only pill RCT randomized controlled trial SC subcutaneous SI(II) Sino-implant (II)® SPR Selected practice recommendations for contraceptive use (WHO publication) STI sexually transmitted infection UPA ulipristal acetate UPA-ECP ulipristal acetate emergency contraceptive pill WHO World Health Organization 3 1 Background: overview and scope of the guidelines Over the past 40 years, there have been recommendations (primarily targeted towards significant advances in the development of health-care providers). All four cornerstones are new contraceptive technologies, including best interpreted and used in a broader context changes in formulations and dosing, schedules of reproductive and sexual health care. These for administration and novel delivery systems. documents are updated periodically to reflect However, current policies and health-care changes in medical and scientific knowledge practices in some countries are based on (see Figure 1). scientific studies of contraceptive products that are no longer in wide use, on long-standing Evidence-based guidelines on contracep-tion theoretical concerns that have never been for policy-makers
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