Priority 25 from the Contraception PSP

UNCERTAINTY: How common is it for side effects (mood/weight gain/loss of libido) to occur in women who are using combined hormonal contraception (pill, patch or ring)?  (JLA PSP Priority 25)
Overall ranking 25
JLA question ID 0049/25
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.  There are 7.2 million prescriptions for oral contraception in England (NHS 2013-14) or which about 2/3 are for the combined pill. Newer progestogens such as drosperinone are derived from spironolactone rather than 19-nor testosterone. Compared to placebo the drosperinone ethinyl estradiol pill seemed to help women with severed symptoms in the short term, the placebo also had a positive effect. his may have an influence on fluid balance, and reduce side effects. Differences between progestogens were minimal in the systematic review comparing different formulations- it was noted the RCTs in the quality of the evidence was low, outcomes were unblinded, 23/33 RCTs were sponsored by the pharmaceutical companies. The potential risks of newer progestogens is uncertain.  There is overlap between the question raised in this priority and priorities 2, 7, 12 and 16. 

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

Combined oral contraceptive pills for treatment of acneAyodele O Arowojolu, Maria F Gallo, Laureen M Lopez, David A Grimes: July 2012 


Extra information provided by this PSP
Original uncertainty examples

“What are the side effects of the COCP or patch? How often do they occur?” (Patient)  ~  “Why is weight gain on the COC ignored ?” (HCP)

Submitted by Healthcare Professionals x 3~Patients x 2~Both x 0
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