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The authors appear unduly pessimistic about the currently available
contraceptive options. Progestogen only methods are particularly suitable
in women with congenital heart disease. Implanon has very good efficacy
and is particularly suitable for adolescents because there are no concerns
about bone density. In contrast Depoprovera may reduce oestradiol levels
and is no longer recomended as a first line method in young women. The
latest Progestogen only pill, Cerazette, inhibits ovulation and hopefully
will provide as effective in effiacy as the combined preparations (this
awaits demonstration in randomised trials).
The Mirena device has been an important advance but the newer copper
IUDs (inter uterine devices) which contain 380mm2 are nearly as effective
in efficacy terms and do not have the problems of irregular bleeding.
All of the long acting methods (Implanon, Mirena and copper IUDs) are
as good if not better than sterilisation at preventing pregnancy. They
avoid the surgical risks of the procedure and perhaps some of the
psycological problems asociated with sterilisation in young women who must
avoid pregnancy because of their medical condition.
No competing interests
18 February 2006
Gillian E Robinson
Associate Specialist Sexual and reproductive Health