Priority 2 from the Contraception PSP

UNCERTAINTY: What is the risk of side effects (vaginal bleeding, mood, weight gain, libido) with hormonal contraception (pills, patches, rings, implants, injections and hormonal intrauterine system)? (JLA PSP Priority 2)
Overall ranking 2
JLA question ID 0049/2
Explanatory note This mirrors NICE LARC guideline research recommendations “Most women will need to use contraception for more than 30 years… a woman's choice and acceptance of LARC may be influenced by potential health dis-benefits (side effects and risks) as well as non contraceptive benefits of LARC (such as alleviation of menorrhagia)” )” The short and long term effects of contraceptive choices were a frequently raised by patients and healthcare professionals.  Traditional meta-analysis have evaluated- a treatment and one comparison,  in reality women often consider several options and want to know the effects on several outcomes (for example- commonly weight, mood, periods, skin). Methods such as network MA enable comparisons of multiple interventions  for different outcomes, and help provide evidence to support informed decision making.  Larger RCTs of new methods in comparison to older methods are needed to evaluate the potential common advantages/disadvantages of treatment and their effectiveness at preventing pregnancy. 
Evidence

NICE LARC Guideline 2014: Research recommendation: 2.2 and 2.3

Progestin‐only contraceptives: effects on weight. Laureen M Lopez, Shanthi Ramesh, Mario Chen, Alison Edelman, Conrad Otterness, James Trussell, Frans M Helmerhorst. August 2016

Combination contraceptives: effects on weight Maria F Gallo, Laureen M Lopez, David A Grimes, Florence Carayon, Kenneth F Schulz, Frans M Helmerhorst. January 2014

Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus Laureen M Lopez, David A Grimes, Kenneth F Schulz. April 2014 
Health Research Classification System category Reproductive Health and Childbirth
Extra information provided by this PSP
Original uncertainty examples

“Implanon is the trickiest, I think. It seems to have a huge variation in side effects and deciding whether to use it or not was a hard decision to make because all the Info was uncertain and "You may experience X, Y or Z...or none of these".” (Patient) ~ “-Can it effect my mental health? “ (Patient) ~ “which formulation of the contraceptive pill is least likely to cause weight gain?” (Both) ~ “Lots of women complain about loss of libido with contraception. It would be interesting to learn why this is.” (HCP) “ ~ Is there any Info about depression as a side effect of taking the contraceptive pill?  Do different contraceptive pills have different risks for depression as a side effect?” (Patient)
Submitted by Healthcare Professionals x 8~Patients x 33~Both x 5
PSP information
PSP unique ID 0049
PSP name Contraception
Total number of uncertainties identified by this PSP. 57  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 21 April 2017