Gabriele Merki

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    Long cycle combined hormonal contraception

    Gabriele Merki (Switzerland)

    Family planning clinic, University hospital, Zürich, Switzerland

    Prolonged use of combined pill preparations (COC) has been widely performed to suppress menstruation in women with clinical conditions like premenstrual symptoms, endometriosis, or cyclic headache. At present there is in several European countries a trend to use the long-cycle to suppress normal menstruations for convenience, particularly for women who are already taking COC. Some authors medicalize and pathologize the natural event of menstruation and declare normal cycles as unnecessary annoyance and as possibly health risk. We intend to discuss open questions concerning the safety of the long-cycle and long-term health risks specially on the breast and the endometrium. Furthermore we speculate about the consequences of cycle suppression in healthy adolescents for their later attitude towards menstruation.

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    Post-abortion contraception

    Gabriele Susanne Merki-Feld, MD, PhD, Universtiy Hospital, Zürich, Switzerland

    Contraceptive counseling is an important part of postabortion care and should include accurate and comprehensive information about different contraceptive options. Surprisingly not all studies provide evidence for a higher acceptance and lower rate of  repeat abortions in women after extensive postabortion counseling. Other studies investigate preabortion counseling in comparison to postabortion counseling.

    Today most abortions are performed with medical procedures. Use of combined contraceptive pills is recommended to start already on day 3 of abortion ( day of misoprostol administration). After abortion 80% of all women ovulate before the first menstrual period and many of them ovulate within 22 days. Thus providing the pill before leaving the hospital is of importance. Immediate IUD insertion after surgical abortion is effective and safe, even if some studies suggest a slightly increased rate of partial or complete expulsions. Since medical abortion takes longer than surgical abortion, IUD insertion is recommended during the first menstrual cycle after medical abortion. This procedure is of course associated with a small risk for another pregnancy. Progestagen-only methods can be started immediately after medical abortion. The implant in an important alternative for women with desire for longterm contraception.

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    Abortion in minors

    Gabriele Merki-Feld University Hospital, Zürich, Switzerland - gabriele.merki@usz.ch

    Teenage pregnancies must be viewed in the context of sexual and reproductive health (SRH) and rights, with the understanding that the social environment ha a major influence. Most teenage pregnancies in Europe occur unplanned. Therefore access to effective contraceptive methods is a critical point in the prevention of abortions in minors.The decision to pursue or end an unintended pregnancy is based on factors like cultural and religious background, access to safe and legal abortion, access to confidential counselling and support from partners, friends and parents. The availability of legal abortion, the covering of costs and the question of parental consent varies across Europe. Very little is known about factors asscociated with coping afterwards. Across Europe there are countries with very high abortion rate in teenagers, especially in some Northern and Eastern European countries. The majority of southern European and western European countries report numbers below the EU mean of 12.2/1000. Interestingly there is in contrast to other countries a balance between teenage live birth and teenage legally-induced abortions in the UK. Also there are differences between countries. There is a clear trend to decreasing number of abortions in minors in most European countries.