Letters Contraception for women

Evidence based counselling

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3869 (Published 22 September 2009) Cite this as: BMJ 2009;339:b3869
  1. Richard Lyus, doctor, bpas1
  1. 1Stratford upon Avon CV37 9BF
  1. rich.lyus{at}bpas.org

    In their review of contraception for women, Amy and Tripathi emphasise the importance of patient choice and discussion of typical use failure rates.1 However, they focus on the hormonal contraceptive pill, with only brief analysis of more effective methods such as intrauterine devices.

    Whereas perfect use failure rates are the theoretical minimum risk of pregnancy associated with a method, typical use figures provide patients with a more accurate picture of their risk of pregnancy. Research shows that, for women, the most important characteristic of a contraceptive method is its effectiveness in preventing pregnancy,2 3 4 and the World Health Organization has developed a chart to help to communicate this information. The hormonal contraceptive pill remains the most widely used method in the United Kingdom, but it is associated with a significantly higher typical use failure rate (8% in the first year of use) than more effective methods (well under 1%).5 More effective methods also have equal or better acceptability ratings and continuation rates (proxy measures of how tolerable any side effects are) compared with the pill.5 For contraception counselling to be evidence based clinicians should ensure that women understand the lower pregnancy risk and high acceptability of the most effective methods. Then their choice of method will be fully informed.


    Cite this as: BMJ 2009;339:b3869


    • Competing interests: None declared.


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