Letters

New group will review evidence for effective care in family planning

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7020.1638a (Published 16 December 1995) Cite this as: BMJ 1995;311:1638
  1. Paul O'Brien
  1. Sessional clinical medical officer Raymede Clinic, London W10 5SH

    EDITOR,--One of the problems in the provision of family planning is the dearth of useful, clinical randomised controlled trials on which to base our practice. For some rare events such as thrombosis, heart attacks, and stroke, randomised controlled trials are clearly not feasible and we rely on the epidemiological data from well conducted studies. Some factors, however, are readily amenable to randomisation. John Guillebaud suggests that it would be appropriate for a client to start taking a pill containing desogestrel or gestodene if the predictable incidence of breakthrough bleeding, acne, headache, and weight gain with alternative pills is higher.1 It is extraordinary that, although three million women in Britain are using the pill for contraception, we have little evidence to support this advice.

    I have performed a Medline search, from 1976 to the present, for randomised controlled trials comparing these minor side effects associated with second generation pills with those associated with the newer combined pills containing desogestrel or gestodene and found only one trial. In a randomised trial of 456 women Louden et al found a reduced incidence of breakthrough bleeding with a pill containing gestodene compared with one containing levonorgestrel but no difference in weight gain.2 There is no evidence on headache and acne.

    The Cochrane Collaboration, which prepares, maintains, and disseminates systematic reviews of the effects of health care, will be organising an exploratory meeting early next year with a view to establishing a Fertility Control Cochrane Review Group. The aim of the group will be to review the evidence for effective care in family planning. This will involve an extensive search for published and unpublished trials and the preparation of systematic reviews for wide distribution. Anyone interested in this project can contact me for further details.

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