Transcript No Slide Title

ORAL CONTRACEPTION (OC) OVER THE COUNTER (OTC)?
Arie Yeshaya, M.D.
Pediatric Adolescent Clinic
Schneider Children’s Hospital
and
Department of Obstetrics and Gynecology
Rabin Medical Center, Petah Tikva, Israel
OC - OTC ?
 The pill off prescription?
(Lester, 1974)
 The pill without prescription (Winaver, 1975)
 OC without prescription
(Houghton, 1993)
 Making OC available over the counter
(Youngkin et al. 1996)
POSTCOITAL EMERGENCY
CONTRACEPTION
(Yuzpe, 1974)
Should Oral Contraceptives Be
Sold Over the-Counter?
A prescription drug should be switched to
over the counter Status if:
The drug is safe for self medication
The drug is effective when self administered
The condition to be treated is self diagnosable
The drug’s labeling is tailored to self
administration
OC - OTC
PROS
OC - OTC
Easier to achieve
More users
Less unwanted pregnancies
Less abortions
Lower maternal morbidity and mortality
WORLDWIDE STATISTICS
 >1 of 2 pregnancies
are unwanted
 Induced abortions
>50x106/year
 Maternal mortality 600,000/year
GYNECOLOGICAL EXAMINATION INCONVENIENT EXPERIENCE
DR. OC-OTC
On vacation until …..
NON-CONTRACEPTIVE
BENEFITS OF OC
Reduction in:






Ovarian cancer
Endometrial cancer
PID
Ectopic pregnancy
Anemia
Dysmenorrhea






Functional ovarian cysts
Benign breast disease
Acne
Hirsutism
Irregular menses
Menorrhagia
 Various OC - no differences
 Deleterious effect minimal/reversible
 Follow-up - limited
SEVERE COMPLICATIONS
WITH OC ARE RARE
 Venous thrombosis - 6/10,000
(Without OC - 3/10,000)
 Unavoidable
THE ROLE OF THE PHYSICIAN
 Expensive
 Sex is not a disease
OC - OTC — CONS
 Counseling for reproduction and
sexual health
 Avoidance of counseling for
family planning, reproduction
and sexual health
OC - OTC — CONS
No counseling Higher dropout
OC CONTRAINDICATIONS
 Thrombophlebitis
 Breast cancer
 Cervical, endometrial and ovarian
cancer
 Focal migraine
 Smokers >35 years of age
OC - DIFFERENT EFFECTS
Estrogens
Progesterones
Androgens
 Gynecological counseling
 Gynecological examination
can be avoided,
especially in adolescents
OC FOLLOW-UP : IMPORTANCE
 Over 35 years of age
 Smokers
 Hypertension
 Diabetes
 Hyperlipidemia
ATTITUDE OF FEMALE COLLEGE
STUDENTS TOWARDS AVAILABILITY OF OC
OTC
Forman et al. (1997)
No. - 290
Age - 20 ± 3
84% - previous sexual
intercourse
Age at first sexual encounter 16.6 ± 2
52% used OC at first encounter
65% - against OC-OTC
 Side effects could be prevented
 Users would not go for regular checkups
35% - pro OC-OTC
 Fewer unwanted pregnancies
OC - OTC : PROS and CONS
 Not significant:
–Race
–Previous OC use
–Previous sexual activity
 Significant:
–A previous pregnancy (Pro)
Should Oral Contraceptives Be
Sold Over the-Counter?
Potential Advantages
Potential Disadvantages






Increased access to affective
birth control for all women
Increased access for younger
women, the prime users of
OCs
Reduced rate of unintended
pregnancies
Cost savings from reduction of
physician and family planning
clinic visits
Encouragement of the national
trend toward self-care





Increased rate of unintended
pregnancies due to unproper
use of OCs
Reduced OC compliance
because of lack of counseling
and management of nuisance
side effects
Increase in liability due to errors
in self-prescribing
Possible cost increases for
Medicaid and family planning
clinic patients
Possible price increases due to
the costs of marketing to
consumers
Reduced opportunities for
preventive medical care
OC - OTC
 Population, social and
religious attitude
 Availability of local family
planning service
 Availability of providers
Conclusion
In order to expand OCs use:
Reinforce the activity of family
planning Clinics
Facilitate public access to professionals
Instituting charge free visits
Organizing visits to schools
Conclusion
Better access to physicians
might be the best way to
Establish the OC as the main
and most efficacious
Contraceptive method
So….should it be prescribed,
or OTC?
THE END