Priority 3 from the Contraception PSP

UNCERTAINTY: What are the long-term effects of using contraception (pills, patches, rings, injections, implants, intrauterine) on fertility, cancer and miscarriage? (JLA PSP Priority 3)
Overall ranking	3
JLA question ID	0049/3
Explanatory note	This mirrors a NICE LARC guideline research recommendations: “Most women will need to use contraception for more than 30 years… a woman's choice and acceptance of LARC may be influenced by potential health dis-benefits (side effects and risks) as well as non contraceptive benefits of LARC (such as alleviation of menorrhagia)” The short and long term effects of contraceptive choices were a frequently raised. The RCGP oral contraceptive study provides an important update on the effect of contraceptives on cancer outcomes. It takes time to study these long term outcomes, this cohort of more than 40,000 women were recruited in 1968, they have been followed them for more than 40years. Evaluation of LARC methods and up to date oral regimens/topical regimes are needed.
Evidence	NICE LARC Guideline 2014: Research recommendation: 2.2 Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners' Oral Contraception Study. Iversen L1, Sivasubramaniam S2, Lee AJ2, Fielding S2, Hannaford PC2. Am J Obstet Gynecol. 2017 Jun;216(6):580.e1-580.e9. doi: 10.1016/j.ajog.2017.02.002. Epub 2017 Feb 8. Endometrial cancer and oral contraceptives: an individual participant meta-analysis of 27 276 women with endometrial cancer from 36 epidemiological studies. Oral Contraceptive Use and Risk of Breast, Cervical, Colorectal, and Endometrial Cancers: A Systematic Review, Jennifer M. Gierisch, Remy R. Coeytaux, Rachel Peragallo Urrutia, Laura J. Havrilesky, Patricia G. Moorman, William J. Lowery, Michaela Dinan, Amanda J. McBroom, Vic Hasselblad, Gillian D. Sanders and Evan R. Myers. Cancer Epidemiol Biomarkers Prev November 1 2013 (22) (11) 1931-1943; https://doi.org/10.1158/1055-9965.EPI-13-0298
Health Research Classification System category	Reproductive Health and Childbirth

Extra information provided by this PSP
Original uncertainty examples	“Is there long term side effects of using the oral contraceptive pill? Women can use this medication for many years, in some cases (maybe a lot of cases) from their teenage years until they get menapause. Is this bad for your health? Is there a cancer risk? “ (Patient) ~ “Coil/mirena/pill - Does it increase my chance of getting cancer?” (Patient) ~ “I am often asked about the long term effects of the implant and ius.” (HCP) ~ “More clarity about long term effects on fertility in regard to all forms of hormonal contraception and the IUD. I have found particular concerns surrounding the IUS and IUD in this matter.” (both)
Submitted by	Healthcare Professionals x 2~Patients x 28~Both x 9

Extra information provided by this PSP

Original uncertainty examples

“Is there long term side effects of using the oral contraceptive pill? Women can use this medication for many years, in some cases (maybe a lot of cases) from their teenage years until they get menapause. Is this bad for your health? Is there a cancer risk? “ (Patient) ~ “Coil/mirena/pill - Does it increase my chance of getting cancer?” (Patient) ~ “I am often asked about the long term effects of the implant and ius.” (HCP) ~ “More clarity about long term effects on fertility in regard to all forms of hormonal contraception and the IUD. I have found particular concerns surrounding the IUS and IUD in this matter.” (both)

Submitted by

Healthcare Professionals x 2~Patients x 28~Both x 9

PSP information
PSP unique ID	0049
PSP name	Contraception
Total number of uncertainties identified by this PSP.	57 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	21 April 2017