CONTRACEPTION OLD FRIENDS, NEW TRENDS

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1 CONTRACEPTION OLD FRIENDS, NEW TRENDS

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4 AAP RECOMMENDATIONS Council about and ensure access to all contraceptive methods safe and appropriate describing most effective first. PEDIATRICS 134 (4) Oct, 2014: e1251

5 TEEN (15-19) PREGNANCY RATE 2012 DATA 1. DC New Mexico Mississippi Texas Arkansas 73 No data for Guam or Puerto Rico Pregnancies/1000 Women The national campaign to prevent teen and unplanned pregnancy the national campaign.org

6 TEEN (15-19) BIRTH RATE 2012 DATA Births/1000 Women 1. Guam Puerto Rico New Mexico Oklahoma Mississippi Arkansas Texas Bulgaria 41.7 National Vital Statistics Reports August 20, 2014

7 AAP RECOMMENDATIONS LARC methods should be first-line contraceptive choices for adolescents. May need to refer patients to other provider. PEDIATRICS 134 (4) Oct., 2014: e1251

8 AAP RECOMMENDATIONS 2014 A significant departure from prior recommendation of condoms as first-line contraception based on cost and protection from STI s. Condoms use now recommended (#6) with every sexual act to prevent STI s, but not primarily for pregnancy prevention. PEDIATRICS 134 (4) Oct., 2014: e1251

9 AAP RECOMMENDATIONS 2014 Emphasize confidentiality and non-disclosure consistent with state and federal law. PEDIATRICS 134 (4) Oct., 2014: e1251

10 ADOLESCENT CONFIDENTIALITY & CONSENT Minor can consent to diagnoses and treatment if: 1. On active duty with armed services. 2. > or = 16 years old, residing apart from parents or guardian, and managing own financial affairs. 3. Of a reportable infections, contagious or communicable disease. Texas Family Code

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13 Table 1 Contraceptive Method Efficacy Method % of Women Experiencing an % of Women Continuing Use Unintended Pregnancy Within at 1 Year the Frist Year of Use Typical Use a Perfect Use a No Method Spermicides (forms, creams, gels suppositories, and film) Fertility awareness-based methods Withdrawal Condom Female Male Diaphragm Combined pill and progestin-only pill Contraceptive Patch Contraceptive Ring DMPA contraceptive injection IUD Copper Levonorgestrel Single-rod contraceptive implant Female sterilization Male sterilization

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19 Once a month injectable LUNELLE may come back, but it may be call CYCLOFEM. INT J Womens Health 2014;

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23 Important Safety Information If you have a pelvic infection, get infections easily, or have certain cancers, don t use Skyla. Less than 1% of users get a serious pelvic infection called PID. If you have persistent pelvic or stomach pain or if Skyla comes out, tell your doctor... WHAT IS SKYLA?

24 IUDS IN DEVELOPMENT LNG 16 mcg/day - 5 years LNG 20 mcg/day - 4 years Ulipristal - monkeys, only so far INT J Womens Health 2014; 6:

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31 NESTORONE 19 nor progesterone derivative Ineffective orally No adrogenic or estrogenic activity Potent ovulation inhibitor INT J Womens Health 2014; 6:

32 POP COUNCIL IMPLANT NESTORONE Some successful clinical trials Pearl Index 0.6 No further development planned (cost) INT J Womens Health 2014; 6:

33 AAP RECOMMENDATIONS 2014 Combined hormonal methods provide excellent cycle control for contraception and also provide medical management for acne, dysmenorrhea, and heavy menstrual bleeding. Pediatrics 134 (4) Oct, 2014: e1951

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41 QUARTETTE Extended cycle LNG/EE 84/7 42 Pills 150 mcg LNG +20 mcg EE 21 Pills 150 mcg LNG + 25 mcg EE 21 Pills 150 mcg LNG + 30 mcg EE 7 Pills 10 mcg EE - Bleeding occurs

42 ESTROGEN/PROGESTIN PILLS IN DEVELOPMENT Nomegestrol Acetate/E2 US Study PEARL Index 1.3 European Study PEARL Index 0.38 INT J Womens Health 2014; 6:

43 ESTROGEN/PROGESTIN PILLS IN DEVELOPMENT DESOGESTREL 150 mcg + ESTETROL (E4) 20 mg INT J Womens Health 2014; 6:

44 ESTROGEN/PROGESTIN PILLS IN DEVELOPMENT YAZ Flex YAZ Stop and go INT J Womens Health 2014; 6:

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47 NESTORONE TRANSDERMAL IN DEVELOPMENT Nestorone Gel Periumbilacal NES/E2 Gel Allows cyclic bleeding Transdermal Spray Patchless patch Bruising or pain at site of admin INT J Womens Health 2014; 6:

48 TRANSDERMAL CONTRACEPTION IN DEVELOPMENT LNG Patch For Breastfeeding women LNG/EE Patch called TWIRLA GSD/EE PHASE III clinical trials NEA Patch with Patch free week: PHASE III INT J Womens Health 2014, 6:

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51 NESTERONE VAGINAL RINGS NES/EE Cyclic use but last 13 cycles NES/E2 To be evaluated INT J Womens Health 2014, 6:

52 VAGINAL CONTRACEPTIVE RINGS IN DEVELOPMENT Progesterone 3 Month Breast Feeding Ulipristal 3 Month INT J Womens Health 2014, 6:

53 MALE CONTRACEPTION Combination Nesterone Gel and Testosterone Gel is acceptable to 56% of men in study. Efficacy not measured CONTRACEPTION 2014 Oct; 90(4):

54 AAP recommends emergency contraception be available to adolescents. PEDIATRICS Dec. 2012; 130:

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62 CONTRACEPTION ON DEMAND Couples having infrequent intercourse Condoms unacceptable or unreliable

63 CONTRACEPTION ON DEMAND Systematic review of world literature on pericoital (just before or after) use of LNG to prevent pregnancy Pearl Index 5.4 Most women liked the method in spite of Frequent menstrual irregularities COCHRANE DATABASE SYST Rev 2014, Sept 26

64 CONTRACEPTION ON DEMAND Rigous research is needed to confirm efficacy and safety. COCHRANE DATABASE SYST Rev 2014, Sept 26

65 AAP RECOMMENDATIONS 2014 Childhood obesity is of concern Obesity may impact contraception efficacy No specific recommendation Pediatrics 134 (4) Oct, 2014: e1250

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68 AAP RECOMMENDATIONS 2014 Condoms should be used consistently and correctly with every act of sexual intercourse. Pediatrics 134 (4) Oct, 2014: e1951

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70 ORIGAMI Male Condom (OMC)

71 ORIGAMI Female Condom (OFC)

72 ORIGAMI Anal Condom (OAC)

73 Enrollment in our US clinical trials has been completed. ORIGAMI Condoms are not yet available commercially. Global distribution and online sales are expected to be announced following regulatory reviews in Media Liaison: Mark Bardwell ORIGAMI HEALTHCARE PRODUCTS, Inc. LOS ANGELES, CA USA Administrative Office

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77 Feds-spending $224k for customfit condom study

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