Writing in the Conversation yesterday, Sydney-based academic gynaecologist, Kirsten Black, said a segment aired earlier this week on the ABCs 7.30 report, about the adverse effects from long acting reversible contraception (LARC), was “unbalanced and alarmist.”
Many health professionals agreed, with medical groups such as the The Royal Australian College of General Practitioners, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists issuing statements affirming the safety and efficacy of these agents.
It is in some ways not surprising that the ABC framed its report around the stories of two women. Contraceptive decisions are not always clear cut. They vary markedly between women and at various stages of life, depending on individual characteristics, needs and concerns. There are many different stories to tell.
As Jodie Duggan, acting CEO of Family Planning NSW, writes in the post below, this is why women need access to the best information available, a full suite of options, and advice that is individualised and unbiased.
Jodie Duggan writes:
Recent reporting on long-acting reversible contraception (LARC) has significantly missed the mark when it comes to providing an accurate reflection of current contraceptive choices available in Australia.
These reports on LARC, namely inter-uterine devices (IUDs) and the contraceptive implant, come soon after other reporting about the potential side-effects of hormonal oral contraception including increased mood disorders and risk of breast cancer. The picture created is one where the risks and side-effects associated with different contraceptives are unbalanced and often overstated and causes real worry and alarm.
Informed contraceptive decisions
Contraception is an individual decision that has to be made by women in consultation with their clinicians in an informed way. Each woman will have her own unique needs – physical, emotional and lifestyle – that need to be taken into account when deciding what kind of contraception to use.
Every person is different and will need different kinds of contraception to suit their body and life circumstances. The evidence-based pros and cons of each method have to be weighed up when determining what is most suitable for each individual. Side-effects also vary between individuals which is why it is essential to have a range of options to suit each woman’s needs.
LARC, including the hormonal and copper IUD and the contraceptive implant, are some of the most reliable forms of contraception, preventing unwanted pregnancy at the same rate as permanent sterilisation.
The most common forms of contraceptives used in Australia continue to be the pill (33%), condoms (30%), and sterilisation (19%).
LARC and health
While preventing pregnancy is its main use, there are other significant health benefits of LARC, particularly in reducing heavy menstrual bleeding. Heavy menstrual bleeding can lead to anaemia and can have a significant impact on women’s health and well-being and is now recognised with a new Clinical Care Standard from the Australian Commission on Quality and Safety in Health Care.
The Standard recommends the hormonal IUD as one of the most effective treatment options. The hormonal IUD can also help to mitigate the symptoms of endometriosis.
Expanding the options
Increasing awareness and use of LARC, within the context of informed choice, is one of the clinical goals of Family Planning NSW because they are so effective at preventing unplanned pregnancy. Women’s fertility returns to normal very soon after a LARC is removed, giving them control over if and when they choose to have children.
There is only one brand of hormonal IUD and one brand of contraceptive implant available currently in Australia (in addition to two types of copper-bearing IUDs), demonstrating the real need for a wider array of contraceptive options for women to choose from. There needs to be increased commitment from the pharmaceutical industry and the wider research community to develop and market new contraceptive options.
The comprehensive and detailed information Family Planning NSW provides about contraception is evidence-based and developed through a comprehensive review of the academic literature.
Evidence supports informed choice
The LARC consensus statement, released by Australian Healthcare and Hospitals Association (AHHA) in September 2017, was developed by a range of multi-disciplinary experts, including family planning experts such as Family Planning NSW.
One of the major stated goals of the statement is to support women to make an informed choice about contraception.
While the statement and associated workshop were sponsored by Merck Sharp and Dohme, the planning and implementation of the forum from which the statement was developed and the content of the statement itself was completely independent of any input or influence from this company.
The statement very clearly includes the range of LARC contraceptive products which are produced by other companies and the sponsorship is stated at the front of the document. It was also subject to additional review by experts who did not attend the meeting.
Women need access to a wide range of credible and trustworthy places to obtain information about contraception, in order to make the best decisions for themselves.
Jodie Duggan Acting CEO of Family Planning NSW.
*Family Planning NSW senior clinical staff have received support to present at educational conferences and attend advisory committees on behalf of Family Planning NSW from Bayer Healthcare and MSD. From time to time, Family Planning NSW enter into contractual arrangements with pharmaceutical manufacturers for specific training courses. This is documented in such a way as to ensure transparency and independence.