NEW RECOMMENDATIONS FOR CONTRACEPTIVE COUNSELING ADVICE BASED ON THE LIFESTYLE. RESULTS OF A DELPHI STUDY
ESC Congress Library. Lete I. May 28, 2014; 50525; A-110 Disclosure(s): This study was founded by an educational research grant from MSD Spain
Prof. Iñaki Lete
Prof. Iñaki Lete
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Abstract
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Introduction:


The aim of contraceptive counseling advice should be the selection and prescription of the contraceptive method that best suits the individual needs of women. 


 


Aims and objectives:


Prepare a list of recommendations that go beyond the medical conditions established by the World Health Organization (WHO) to assist decision-making during the process of contraceptive counseling advice.


 


Methods:


The Delphi methodology was used to perform this study with the aim of optimizing the consultation process of 27 scientific experts. The experts responded to 24 questions from the coordinators of the study.  For questions with a nominal response scale, a consensus was established when at least 50% of the experts agreed or disagreed in a given question. In the case of questions with an ordinal response scale (from 1 to 9 points or from 0 to 10 points), the level of agreement required a median equal to or higher than 7 points and/or a relative interquartile range (RIR) equal to or lower than 25%. A consensus of disagreement with the wording of the question was established in all cases that achieved a median response equal to or less than 3 points.


 


Measurements and main outcomes:


After the DELPHI process, 20 recommendations were made on issues related to contraceptive counseling advice including medical conditions (endometriosis, diabetes mellitus type 1, malabsorption), life stage (adolescence, youth, breastfeeding, perimenopause), lifestyle, employment status, educational level, economic status, sexual activity, contraceptive methods and contraceptive adherence.


 


Conclusions:


As is the case with medical conditions, contraceptive counseling advice must contemplate issues related to lifestyle and the life stage of women in order to improve the selection to the most appropriate contraceptive method (condom, contraceptive pill, intrauterine device, LNG-intrauterine system, contraceptive implant, contraceptive patch, vaginal ring). Among the different conclusions, the sole use of condoms is not a method recommended for women who want highly effective contraception; in order to achieve greater adherence by the user, the long-term hormonal methods (LNG-intrauterine system/contraceptive implant) or vaginal/transdermal pathway non-daily methods are recommended. Additionally, the use of the vaginal ring is recommended for women who wish to use the lowest level of hormones as possible to prevent pregnancy.


 


KEY WORDS: contraceptive counseling advice; Lifestyle; DELPHI Methodology

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