- Birth Control Pills and Headaches - WHW Dec 2006
- Maori youth and contraception - WHW June 2006
- More on Depo-Provera and Bone density - WHU November 2005
- Depo-provera, bone density & young women - WHU July 2005
- Higher risk of blood clots with birth-control patches - WHW September 2005
- Depo Provera strips bone density - WHU Octobr 2004
- Proposed Sole Supplier Contract with Medisafe (NZ) - Dec 2002
- Judge rules on third generation pills - WHW Sept 2002
- Blood clots on Diane-35 & Estelle-35 - WHU April 2002
- New warnings about third generation oral contraceptives - WHW Sept 2001
- Oral Contraceptives Opinion - Health & Disability Commissioner's opinion 2001
- Code of Rights breaches in Pill death case - WHU July 2001
- Third generation Pill use declines - WHU Oct 1999
- No increase in cancer for pill users - WHW Sept 1999
- Pharmac funding for three more contraceptive pills - WHW Sept 1999
- Prescribers should act on Pill studies- WHU July 1999
- Swallow this Pill -The Pill and Blood Clots Saga - WHW April 1999
- Few long-term risks of The Pill - WHU April 1999
- Deaths from third generation oral contraceptives - WHU Jan 1999
- New recommendations on Morning After Pill - WHU Nov 1998
- Smokers and The Pill - WHU Oct 1997
- Third generation oral contraceptive use falls - WHU July 1997
- Free pills for women - WHU April 1997
- WHIS fact sheet: Oral Contraceptives and Blood Clots
- WHIS fact sheet: IUCDs
- MIRENA Information pack now available - August 2005
- WHIS Mirena Fact sheet now available - June 2005
- WHIS fact sheet: Depo-provera (for health workers)
- WHIS fact sheet: Depo-provera (abridged)
See also Depo provera
December 2006 Women's Health Watch
The study did not find a dose-response relationship among present users of estrogen containing OCs. However, the authors caution that they believe this is because the difference in estrogen levels in current low-dose OCs is small (30 ug-50ug). It is proposed that because even at the lowest dosages OCs contain four times a women's natural menstrual cycle level of estrogen, the smaller difference between currently available dosages is less significant. Because participants in this survey registered both exposure (OC use) and disease (headaches) at the same time a causal relationship could not be established. The fact that women who had never taken OCs containing estrogen had significantly lower prevalence of headaches indicates that we should question and investigate this relationship.
Aegidius, K et al. (2006) Oral contraceptives and increased headache prevalence Neurology 66:349-53.
June 2006 Women's Health Watch
November 2005 Women's Health Update
A contribution from Dr Christine Roke, the National Medical Advisor from the Family Planning Association. The Family Planning Association has been aware of the link between Depo Provera and lowered bone density for more than a decade since some of our clients were involved in research on the issue at Auckland Medical School. Unfortunately not enough teenagers wished to participate in the observational study at the time so we were left with no clear answers for this age group. However the Auckland work and overseas studies indicated that bone loss plateaus after a few years on Depo Provera and that bone loss was reversible on stopping Depo Provera use. Read More (pdf)
July 2005 Women's Health Update
Back in November 2004 the FDA issued its strongest possible warning about the substantial loss of bone mineral density that research shows follows long term use (two or more years) of the drug. As a result of a new study published in September 2002 the drug manufacturer Pfizer wrote to health professionals advising that the contraceptive injection should be used for no longer than two years and only when other birth control methods are inadequate. Read More (pdf)
September 2005 Women's Health Watch
Women like Zakiya Kennedy, an 18-year-old Manhattan fashion student who collapsed and died in a New York subway station last April; Sasha Webber, a 25-year-old mother of two from Baychester, New York who died of a heart attack after six weeks on the patch last March; and Kathleen Thoren, a 25-year-old mother of three who died last November after developing a blood clot in her brain two weeks after she started on the Ortho Evra contraceptive patch.
An analysis of reports filed with the American Food and Drug Administration (FDA) appear to indicate that the risk of blood clots is three times greater for women using the patch than for women using contraceptive pills. However, as the FDA's reporting system is voluntary and has other significant weaknesses, the actual incidence may be even higher... Read More
October 2004 Women's Health Watch
If the reason for this decision is to save money then we believe that the small savings made can not be justified by the impact on social behaviour. Restricting choice to one brand will decrease the use of condoms by high risk groups already somewhat resistant to the safe sex message... Read More
September 2002 Women's Health Watch
The women, who had strokes, pulmonary embolisms and deep vein thromboses, argued that the newer pills were defective products under the Consumer Protection Act.
Both sides had agreed that the case would fail unless the women could prove a more than twofold risk for the newer products. The judge reached his conclusion after reviewing the studies and testimony from 10 expert witnesses, and halted the trial eight weeks early.
The most compelling evidence was a Cox regression analysis on data from a Transnational Research Group study on oral contraceptives. The original transnational study found a relative VTE risk of about 1.7 for the newer pills. However the analysis included full lifetime oral contraceptive exposure for over 90% of the subjects and found no association between third generation pills and any increased risk of VTE.
The judgement is unlikely to resolve the controversy, which has raged since a UK safety committee issued a warning letter about the new pills in 1995. The judgement is available online at www.courtservice. gov.uk.
April 2002 Women's Health Update
But in March the Ministry of Health's Medsafe revealed that the medication was not as benign as it had seemed. New research had confirmed that Diane, and its generic sister, Estelle (both containing the anti-androgen cyproterone), increased the risk of blood clots in users even more than third generation oral contraceptives. The risk is still small, but it's a risk that women need not take unless they need treatment for severe acne or another androgen-related disorder... Read More
September 2002 Women's Health Update
The study, published in the British Medical Journal looked at all the published studies assessing risk of venous thromboembolism among women using oral contraceptives before October 1995. It found a 1.7-fold increased risk among women taking third generation oral contraceptives compared to women using second generation pills. The risk was highest among first-time users of oral contraceptives.
However, an accompanying editorial in the British Medical Journal notes that prescribers still await a consensus on risk factors for thromboemolism. The editorial by Professor Drife from the General Infirmary in Leeds says editorials and reviews written over the past year have advised that second generation pills should be used as the first choice. However Professor Drife points out official advice is less specific, with the British Department of Health saying third generation pills may be offered as first choice provided the slightly increased risk is explained to the woman. According to the British National Formulary, women with a body mass index above 39 should avoid the pill but another review states obesity is not a problem for pill users.
Professor Drife questions how doctors can explain the conflicting information to women wanting oral contraception. He says doctors and women are getting used to commentators'talking up' or'talking down' the pill's risks. Doctors would be helped and lives might by saved- by clear guidance on asking about a family history or history of thromboembolism with a view to screening, he says.
Refs: BMJ 2001; 323:119-20; BMJ 2001: 323:1-9
2001 Here is a copy of the Health & Disability Commissioner's opinion (pdf) 146kb
The questions that arose during the investigation of the case, were, whether the new GP should have reviewed her contraception and given her the chance to change her method after the Ministry of Health had issued extensive advice to doctors and patients about third generation pills in July 1996. The Ministry's advice emphasised that continuing on the Pill must be the woman's informed choice, but the GP said she was within her rights to have relied on her predecessor. There were also questions about the safety of a number of doctors renewing prescriptions without seeing the woman and carrying out periodic checks of her health.
The Health Commissioner found a number of breaches of the Code of Rights. He said that the woman's medication should have been reviewed at least once a year and that when the advice by the Ministry of Health was promulgated, it should have been reviewed at the next visit she attended. It was not good practice to issue repeat prescriptions without carrying out such reviews. The Commissioner found that the woman had never been advised to have such a review. These were breaches of Right 4(1) and (2) regarding the standards of services.
The Commissioner decided that the woman should have been given the chance in the first visit after the Ministry advice was sent out to be told of the new information about third generation Pills. A reasonable consumer would want such information, so that breaches of rights 6(1)(b), 6(1)(e) and 6(2) regarding the giving of information were upheld. Finally, the Commissioner found that Right 7(1) had been breached, in that the woman was not given the chance to make an informed choice about whether to continue the Pill.
Pharmac figures show that the steep decline in use of third generation pills from 3,266,370 units dispensed in December1998 to 1,812,412 in March 1999, was accompanied by a marked increase in prescriptions of second generation pills. These increased from 2,164,768 to 3,283,919 in the same period. There was also a slight increase in progestogen-only pills.
Figures for abortion supplied by the Abortion Supervisory Committee showed that the scare had little effect on the number of abortions in New Zealand. There were 6432 abortions in the first six months of 1999 compared to 6311 during the same period in 1998.
September 1999 Women's Health Watch
Ref: Pharmac, July 1999
July 1999 Women's Health Update
April 1999 Women's Health Watch
After the initial publicity, WHA was contacted by Dr Karen Poutasi, Director-General of Health, asking what the calls to us were highlighting and what further action needed to be taken by the Ministry... Read More
April 1999 Women's Health Watch
An analysis of the data collected over 25 years found an increased death rate from circulatory diseases and cervical cancer among women who were using oral contraceptives or had used them in the past 10 years. There was a decreased death rate from ovarian cancer... Read More
January 1999 Women's Health Update
At the time of the publication of this advice it was estimated that the annual number of New Zealand cases of VTE from the use of these contraceptives was 40 and that the case fatality rate would be 1-2%. At this level one death would be expected every 1.5 to 2.5 years. Four deaths in 18 months is an unexpectedly high number, says the Ministry. The reason for this high number is not clear.
In two of the women there had been symptoms of recent thromboembolic activity, in the form of pain in the leg or legs. Another who was slightly obese had evidence at autopsy of thromboembolic activity in the lungs in recent days or weeks. In two women recent injury may have played a part, one woman having been immobilised due to a knee injury and the other having injured her knee five months previously. One woman had evidence of an old pulmonary embolism. Thus only one woman was contraindicated for combined oral contraceptives.
- check women with risk factors for VTE before prescribing OCs. These include family history of VTE, personal history of VTE, hereditary thrombophilia, excessive varicose veins, obesity (body mass index over 30 kg/m2) lupus anticoagulant, malignancy and long-term immobility.
- temporary risk factors may also increase the risk of VTE. These include immobility (because of illness or during a long plane flight), surgery (during and in the recovery period), trauma and dehydration.
- advise women to report to a doctor immediately symptoms of deep vein thrombosis or pulmonary embolism. These include pain, heat and swelling in the leg, particularly following injury or after surgery or during immobilisation. The most common and often only symp-tom of pulmonary embolism is dyspnoea.
- consider prescribing low dose OCs containing levonorgestrel or norethisterone rather than those containing desogestrel or gestodene.
The Pill and Blood ClotsThe Ministry of Health has developed new information resources for women on oral contraceptives and blood clots. For copies of Oral Contraceptives and Blood Clots contact Medsafe, PO Box 5013, Wellington or phone +04 496 2000 Also available on Medsafe's web site: www.medsafe.govt.nz Infoline for women: 0800 930 039
In the trial, women in 21 centres from around the world who requested emergency contraception were given levonorgestrel alone or the current combination treatment of ethinyloestradiol plus levonorgestrel. Results showed a 1.1% pregnancy rate among the women using levonorgestrel alone compared with 3.2% for the group using combination treatment. Women given levonorgestrel were less likely to experience nausea and vomiting than women given the combined hormones.
The trial findings also found both treatments are more successful if the first dose is taken soon after coitus. When levonorgestrel only was started within 24 hours of coitus, its failure rate was only 0.4% compared with 2.0% for the combined method. The failure rate of the new method was 2.7% up to 72 hours after exposure.
Ref: BMJ 1998;317:432
The women studied were aged from 20 to 44 and it was found that while there was a small increase in risk of both types of stroke in users of oral contraceptives, the risk was greater in current smokers, hypertensives and those older than 35.
For iscaemic stroke, current smoking increased the risk seven times in European countries over non-users of oral contraceptives who did not smoke, and the association appeared to be synergistic. In Europe the background incidence of this form of stroke is 3 per 100 000 woman-years for women under 35 and 10 per 100 000 woman-years for those over 35.
Current smokers also increased their risk of haemorrhagic strokes three times. As checking blood pressure reduced the risk of stroke compared to those whose who were not checked, the Ministry of Health has reinforced the need to check for hypertension before prescribing oral contraceptives.
July 1997 Women's Health Update
Pharmac reports that third generation pills are still the most commonly subsidised oral contraceptives, but the number of subsidised cycles of second generation agents (combined oral contraceptives using levonorgestrel or norethisterone) and injectable progestogen have increased.
April 1997 Women's Health Update
Pharmac is talking with drug companies to try to get further fully subsidised brands. Special provisions which allow women on low incomes to receive oral contraceptives free will continue, no matter which brand is prescribed.
WHIS fact sheet: Oral Contraceptives and Blood Clots
1999 Online version
WHIS fact sheet: IUCDs
MIRENA Information pack
August 2005 Find here
WHIS Mirena Fact sheet
June 2005 Find here
WHIS fact sheet: Depo-provera (for health workers)
WHIS fact sheet: Depo-provera (abridged)