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Criteri Medici Di Eligibilità All'impiego Dei Contraccettivi

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Criteri Medici Di Eligibilità All'impiego Dei Contraccettivi s Società Medica Italiana per la Contraccezione ISBN 88 - 6135 - 094 - 1 978 - 88 - 6135 - 094 - 6 CRITERI MEDICI DI ELIGIBILITÀ ALL’IMPIEGO DEI CONTRACCETTIVI s Società Medica Italiana per la Contraccezione Pubblicato dalla Organizzazione Mondiale della Sanità nel 2004. A titolo: Medical eligibility criteria for contraceptive use. © Organizzazione Mondiale della Sanità 2004 Il Direttore Generale della Organizzazione Mondiale della Sanità ha concesso i diritti di tradu- zione dell’edizione in italiano alla Società Medica Italiana per la Contraccezione, che è il solo responsabile per l’edizione italiana. ISBN 88 - 6135 - 094 - 1 978 - 88 - 6135 - 094 - 6 Copyright © 2009 Via Gennari 81, 44042 Cento (FE) Società Medica Italiana Tel. 051.904181/903368 per la Contraccezione Fax 051.903368 http://www.editeam.it e-mail: [email protected] Progetto Grafico: EDITEAM Gruppo Editoriale. Tutti i diritti sono riservati, nessuna parte di questa pubblicazione può essere riprodotta, trasmessa o memorizzata in qualsiasi forma e con qualsiasi mezzo senza il permesso scritto dell’Editore. L’Autore e l’Editore, declinano, dopo attenta e ripetuta correzione delle bozze, ogni responsabilità derivante da eventuali errori, peraltro, sempre possibili. L’utilizzo in questa pubblicazione di denominazioni generiche, nomi commerciali, marchi registrati, ecc. anche se non specificatamente identificati, non implica che tali denominazioni o marchi siano protetti dalle relative leggi e regolamenti. Responsabilità legale per prodotti: l’Editore non può garan- tire l’esattezza delle indicazioni sui dosaggi e l’impiego dei prodotti menzionati nella presente opera. Il lettore dovrà di volta in volta verificarne l’esattezza consultando la bibliografia di pertinenza. Finito di stampare nel mese di Dicembre 2009. INDICE PREFAZIONE ............................................................................................................................................................................ V RINGRAZIAMENTI ........................................................................................................................................................... VI SINTESI E PANORAMICA ........................................................................................................................................ 1 TABELLE Contraccettivi orali combinati a basso dosaggio (COC) .................................................................... 21 Contraccettivi iniettabili combinati, cerotto e anello (CIC/P/R) .................................................... 49 Contraccettivi di solo progestinico (POC) ........................................................................................................ 71 Pillola contraccettiva d’emergenza (ECP) ......................................................................................................... 95 Dispositivi intrauterini (IUD) .......................................................................................................................................... 99 IUD al rame per casi di contracceziones d’emergenza (E-IUD) ...................................................... 121 Metodi di barriera (BARR) ............................................................................................................................................... 123 Medoti basati sulla consapevolezza della fertilità (FAB) ........................................................................ 139 Metodo basato sull’amenorrea da allattamento (LAM) ......................................................................... 145 Coito interrotto (CI) .............................................................................................................................................................. 147 Procedimenti di sterilizzazione chirurgica (STER) ......................................................................................... 149 Tabelle riassuntive (SUMM) ........................................................................................................................................... 173 ALLEGATI Allegato 1. COC e terapia antiretrovirale ........................................................................................................ 185 Allegato 2. Lista dei partecipanti ............................................................................................................................. 186 AGGIORNAMENTO 2008 (WHO/RHR/08.19) ................................................................................. 189 CRITERI MEDICI DI ELIGIBILITÀ ALL’IMPIEGO DEI CONTRACCETTIVI III s PREFAZIONE I “Criteri medici di eligibilità all’impiego dei contraccettivi” sono una delle quattro guide dell’Organizzazione Mondiale della Sanità (OMS) dedicate alla pianificazione familiare e basate sull’evidenza, e rappresentano sicuramente una pietra miliare nella produzione dei documenti per la salute sessuale e riproduttiva. Essi raccolgono in tre successive edizioni a partire dal 1996, la sintesi delle evidenze della letteratura per quanto è razionalmente consigliato per ogni metodo anticoncezionale in relazio- ne ad alcune centinaia di condizioni cliniche filtrate da un gruppo di esperti interna- zionali con una complessa metodologia di validazione. Per questo possono essere tenuti sul tavolo di lavoro di ogni operatore sanitario, sia esso ginecologo ospedalie- ro, consultoriale, universitario o libero professionista, medico di medicina generale, operatore della salute riproduttiva in generale, comunque coinvolto in processi deci- sionali rispetto alle scelte contraccettive, perché queste scelte possa fare con la dovu- ta competenza. Alcune condizioni cliniche sono talmente complesse da meritare particolari con- siderazioni (lo sono ad esempio tutte le situazioni correlate all’uso di farmaci per l’AIDS, oppure il complesso delle situazioni cliniche che configurano rischi cardio- circolatori o metabolici, od ancora certe patologie immunitarie), specialmente quan- do più condizioni si associano. Altre condizioni cliniche sono all’apparenza più sem- plici, perchè magari più quotidiane,s ma anche loro possono presentare difficoltà o complessità decisionali nel momento in cui si associano a certi momenti fisiologici della vita della donna, come il puerperio con o senza allattamento, oppure si pre- sentano in età particolari, come l’adolescenza. In ognuna delle condizioni mediche presentate il conforto di indicazioni certe e validate sarà importante per ognuno di noi che crede quanto i metodi o gli strumenti di pianificazione familiare siano capaci di migliorare la qualità della vita della don- na e della coppia, ma anche dei figli presenti ed a venire. Per tutto questo abbiamo percorso volentieri l’idea di tradurre in italiano questi “Criteri”, perchè anche i professionisti italiani della salute riproduttiva ne potessero usufruire appieno. Di ciò ringraziamo caldamente l’OMS, che ha autorizzato la SMIC (Società Medica Italiana per la Contraccezione) alla versione italiana, e ringraziamo chi vi ha lavorato. Ringraziamo infine anche tutti coloro che vorranno ritenere come, con questo impegno, la SMIC (Società Medica Italiana per la Contraccezione) cerchi di esprimere profonda attenzione ad una gestione di qualità della salute sessuale e riproduttiva nel nostro Paese. Emilio Arisi Dicembre 2009 Presidente SMIC CRITERI MEDICI DI ELIGIBILITÀ ALL’IMPIEGO DEI CONTRACCETTIVI V RINGRAZIAMENTI Questo documento è il risultato di una collaborazione tra il Dipartimento di Sanità e Ricerca sulla Riproduzione della World Health Organization (Organizzazione Mondiale della Sanità - OMS) e un vasto numero di Enti internazionali e di Organizzazioni attive nel campo delle politiche e dei programmi di pianificazione familiare. Il finanziamento e il sostegno di questo progetto sono stati garantiti dal Governo degli Stati Uniti d’America (attraverso l’Agenzia Americana per lo Sviluppo Internazionale, i Centri per il Controllo delle Malattie e la Prevenzione, e l’Istituto Nazionale della Sanità Infantile e lo Sviluppo Umano), la Federazione Internazionale della Pianificazione Familiare e il Fondo per la Popolazione delle Nazioni Unite, delle quali con gratitudine riconosciamo il sostegno. I rappresentanti di 10 Enti e Organizzazioni, insieme ad altri 19 singoli individui, hanno partecipato in qualità di esperti all’incontro volto ad ottenere un consenso su queste raccomandazioni per l’uso dei contraccettivi. Vorremmo esprimere loro la nostra più pro- fonda riconoscenza per aver messo il loro tempo e la loro competenza a disposizione del processo di costruzione del consenso. Le prove alla base delle affermazioni di questo documento sono state ottenute in gran parte dall’analisi sistematica della letteratura condotta e sintetizzata dal Dott. KM Curtis, dal Dott. ME Gaffield, dal Dott. AP Mohllajee, dal Dott. K Nanda, e dal Dott. JS Smith, i quali hanno offerto un sostegno sostanziale anche al Segretariato. Il Dott. H Peterson è stato il coordinatore generale del Segretariato della OMS, che includeva anche le signore K Church, K Curran, S Johnson e G Lamptey. La signora C Hamill, anch’ella parte del Segretariato, ha contribuito notevolmente all’incontro ed è stata la responsabile del design e del layout della pubblicazione. La signora M NíMhearáins è stata la responsabile della copertina. Vorremmo esprimere la nostra più profonda gratitudine verso tutti loro, così come verso i dottori L Edouard, C Huezo e J Shelton per il loro notevole sostegno in questa impresa. Siamo riconoscenti ai seguenti ricercatori
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