Contraception
About this Priority Setting Partnership
The goal of the Contraception Priority Setting Partnership (PSP) was to create - by democratic consultation - a Top 10 priority list of research uncertainties, put together by patients, their partners and clinicians.
The PSP hopes that this Top 10 will help guide researchers in answering questions that are equally important to all people affected by contraceptive care. It was an invaluable opportunity to work collaboratively with patients and clinicians to set pertinent research priorities which otherwise might have been overlooked by researchers themselves or the pharmaceutical industry.
The Faculty of Sexual and Reproductive Healthcare also believes that this project presents an ideal opportunity to raise the profile of contraceptive care across the UK and sexual and reproductive health as a medical specialty.
In the initial survey run by this PSP, 318 respondents suggested 480 potential questions for research. After combining questions and removing those already answered by research, the PSP issued 57 unanswered questions in a second survey. 407 people responded to this second survey commenting on the order of priority of the questions. A final priority setting workshop was held in April 2017, attended by service users and health professionals/service providers.
The Contraception Top 10 was published in April 2017.
“It was an incredible learning experience to hear from the other attendees, both patients and clinicians, and to be able to work with them to ensure that the concerns and experiences of young people were heard and valued.”
Top 10 priorities
- Which interventions (decision support aids, ease of access, motivational interviewing) increase uptake and continuation of effective contraception including long-acting methods (implants, injections and intrauterine contraceptives)?
- What is the risk of side effects (vaginal bleeding, mood, weight gain, libido) with hormonal contraception (pills, patches, rings, implants, injections and hormonal intrauterine system)?
- What are the long-term effects of using contraception (pills, patches, rings, injections, implants, intrauterine) on fertility, cancer and miscarriage?
- What models of care increase access and support decision-making for vulnerable groups (such as young people, people who don't speak or read English)?
- Which interventions are safe and effective for women who have irregular bleeding on long-acting hormonal contraception?
- Does pharmacy provision of contraceptive services increase uptake and/or continuation of contraception?
- What are the risks or benefits to using combined hormonal contraception (pill, patch or ring) continuously to stop or reduce periods?
- What factors (advice from friends, family, professionals, beliefs, experience) influence women making decisions about contraception?
- Are there tests or factors such as age that can reliably identify women who no longer require contraception around the menopause (including women using methods which can stop periods such as implants, hormonal coils, pills)?
- Are there effective new methods of contraception available for men?
The following questions were also discussed and put in order of priority at the workshop:
- What are the most effective methods of promoting sexual health services (to everyone, including young people, those who don't speak or read English or who are vulnerable)?
- What are the benefits and risks of using micronised progestogen or newer progestogens (such as Nomegestrol acetate, drospirenone) either in pill form or in long acting preparations, such as implants or in combined hormonal contraception?
- If the progestogen-only pill was available over the counter would this be acceptable and safe?
- What is the risk of stroke for women suffering from migraines who are using combined hormonal contraception (pill, patch, ring)?
- Are there health risks for women who take emergency contraception repeatedly?
- Do progestogens used alone or in combined hormonal contraception interact with anti-depressants?
- Are there factors (ethnicity, past experience) that can predict who is at risk of irregular bleeding when using hormonal contraception (progestogen only or combined)?
- Does providing women who are pregnant with information about contraceptive services and choices increase the uptake of contraception after childbirth?
- Do models of care (video information, telephone assessments, single appointments) increase access to intrauterine contraceptives and implants?
- How effective are 'natural family planning methods' (monitoring menstrual cycle, basal body temperature, cervical mucus), and do fertility apps and/or urine testing improve this?
- Are intrauterine contraceptives (IUC) affected if not correctly positioned (eg if low lying, embedded in or dislodged from the uterus)?
- What are the health risks (osteoporosis, bone fracture) of using contraceptive injections, and do these increase with duration of use or vary with age of use?
- Does ovulation, menstrual cycles and fertility return to normal immediately after contraception is stopped?
- How frequently do women stop using the implant because of side effects?
- How common is it for side effects (mood/weight gain/loss of libido) to occur in women who are using combined hormonal contraception (pill, patch or ring)?
- What methods of pain relief are effective during intrauterine contraceptive insertion (oral analgesia, local anaesthetic gel, spray or injection)?
- Why aren't there progestogen only transdermal patches, gels, vaginal rings or combined injections available for use as contraception?
- Why don't more young women choose to use intrauterine contraception (is this influenced by friends, family, professionals, access to services)?
- What risk factors are there for deep insertion of implants?