Search

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

Objective: To estimate the differences in unintended pregnancies avoided using either levonorgestrel (LNG) or ulipristal acetate (UPA) emergency contraception (EC). Design: Cross-sectional study. Setting: Survey carried out in Spain. Participants: 1000 Spanish women reporting unprotected sex in 2017. Main measurements: EC use, reasons for not using EC, calculation of the number of unintended pregnancies avoided. Results: 39% of Spanish women having had unprotected sex used EC. 61% of those women did not use EC and 11% did not know the existence of this resource. In 2017 the use of EC prevented 101,271 unintended pregnancies. If instead of using LNG every woman had used UPA another 15,979 additional pregnancies could have been prevented. Conclusions: If all Spanish women having unprotected sex used EC we could expect a significant decrease in the number of unintended pregnancies and abortions. Using UPA instead of LNG would have a greater impact on that reduction with the corresponding benefit for women and society as a whole.

Oral combined hormonal contraceptives (CHCs) are available that limit the number of menses when used in a flexible extended regimen. Our aim was to investigate the decision-making processes of women presented with a flexible extended CHC option.The FLEXO study is an epidemiological, cross-sectional, multicentre study conducted under typical clinical practice conditions to determine women's acceptance of a flexible continuous CHC regimen versus a cyclical 21/7 day regimen, after receiving standardised information during contraceptive counselling.A total of 1350 women were invited to participate, of whom 1156 were enrolled. Of these, 47.2% chose the flexible extended CHC regimen. Their main reason for choosing this regimen was to reduce the number of menses (25.7%), followed by the desire to avoid symptoms related to menstruation (21.6%). The reasons given for rejecting this regimen were the desire to have monthly menstrual cycles (24.9%) and the fear of becoming pregnant and not being aware of it due to the absence of menstruation (18.1%).Many women chose the extended flexible regimen when they received information about this option. Women primarily chose this pattern to relieve or eliminate discomfort related to menstruation.

Resumen Objetivo Conocer los habitos de las mujeres espanolas en edad fertil, respecto al uso de suplementos vitaminicos y acido folico antes y durante el embarazo. Material y metodo Encuesta telefonica realizada a una muestra representativa de 1.020 mujeres residentes en Espana de 15 a 49 anos de edad, durante el mes de marzo del 2013. Resultados Una de cada 4 mujeres espanolas planifica su embarazo. Como consecuencia de esta falta de planificacion, solo el 28,6% de las mujeres habia tomado un suplemento de acido folico con anterioridad al momento de quedar embarazada. Conclusiones Sigue existiendo la necesidad de informar y aconsejar a las mujeres en edad fertil sobre la conveniencia de utilizar acido folico previamente a un embarazo. Parecen necesarias campanas institucionales que promuevan tanto la planificacion de un futuro embarazo, como el uso de suplementos vitaminicos antes y durante el mismo.

To assess alcohol abuse as a predictor of risky sexual behavior among adolescents and young adult women, a high-risk population for unintended pregnancies.Totally 3163 adolescent and young adult women, 18-29 years, were assessed on sociodemographics, alcohol and drug use and risky sexual behaviors.Participants answered a structured questionnaire on their leisure habits, drug and alcohol consumption, contraception and sexual behaviors.Most of the young adult women perceive that sexuality is an important part of their life but not a main concern (77.6%) and that alcohol removes the barriers to have sex (62.3%). Additionally, 77.0% claimed that contraception had "a lot" (53.4%) and "quite" (23.6%) influence on the quality of their sexuality. However, up to a 38.4% of the interviewed women had had sex without using any contraception and 29.6% of them acknowledged that had taken alcohol and of these, 40.7% said that alcohol was responsible for not using contraception. Alcohol abuse predicted an increase in risky sexual behaviours (4.45 CI: 2.01-9.75, p0.0001). The effect of alcohol was independent of age.These findings suggest that contraception-related behavioural interventions for young adult women should discuss the link between alcohol and sexual risk behavior.

Perimenopause is an imprecise period in woman over 40 years of age, which comprises the time between the moment that the first changes in the menstrual cycle appear and the year following the definitive cessation of the menses. Besides irregular bleeding, many women also complain of hot flashes and other characteristic symptoms of postmenopause. Moreover, most of them are concerned about the future impact that these events may have on their health, such as needing health exams or continuing to use contraceptive methods. A panel of experts from the Spanish Menopause Society has met to establish diagnostic and therapeutic guidelines for this period based on the best available evidence.

Objectives: This observational, multicentre, prospective phase IV study examined change in health-related quality of life (QOL) from baseline to 6 months in women initiating combined oral contraception (COC) based on natural estrogen. Methods: Eligible women attending a baseline and 6-month gynaecology appointment belonged to one of three groups: group 1 used barrier contraception (condoms) and elected to continue this method; group 2 used condoms and elected to switch to COC based on natural estrogen; group 3 used COC based on ethinylestradiol and elected to switch to COC based on natural estrogen. The Spanish Society of Contraception (SEC)-QOL scale assessed health-related QOL. Secondary outcomes included symptoms of premenstrual syndrome, intermenstrual bleeding, duration and intensity of menstrual bleeding, contraception continuation rate, and tolerability. Results: A total of 857 women were enrolled and 785 completed the study. Group 2 (n = 224 completed) had significantly lower SEC-QOL global and dimension scores at baseline and significantly greater increases in SEC-QOL from baseline to 6 months compared with groups 1 (n = 72) and 3 (n = 489). Group 3 reported a similar SEC-QOL score to that of group 1 at baseline but showed significantly greater improvement in SEC-QOL global and psychological scores from baseline to 6 months. Among women receiving COC based on natural estrogen, the contraception continuation rate was 713/780 (91.4%); treatment-related adverse events were reported by 13/780 (1.7%). Conclusions: Improved SEC-QOL after 6 months was found in women who were dissatisfied with their current contraception at baseline and chose to switch to COC based on natural estrogen.

Objective A systematic review of studies published between January 1995 and April 2010 aimed at determining the effect of combined hormonal contraceptives (CHCs), administered orally, transdermally...

Objectives Develop and validate a Spanish society of contraception quality-of-life (SEC-QOL) questionnaire to assess the impact of contraceptive methods on the health-related quality of life (HRQOL) of women. Methods SEC-QOL was developed following a standardized procedure including review of the literature, interviews with contraception users, and the administration of a pilot questionnaire to 187 women. SEC-QOL consists of 19 items and includes five dimensions. To validate the questionnaire, a multicenter, observational, prospective study was conducted in Spain. The following three study groups were defined: group A (n = 129) comprised women using effective contraceptive methods; group B (n = 251), comprised women about to start using an effective method; and group C (n = 73) comprised women using no or poorly effective contraception. All women attended baseline and final visits (4 ± 1 months). Participants completed the SEC-QOL, psychological well-being index, EuroQol five-dimensional questionnaire, and perceived health state questionnaires. Results At baseline, women from group A had a better HRQOL in all SEC-QOL dimensions, except for breast symptoms. Heavier menstrual bleeding, more androgenic and breast symptoms, menstrual pain, and not using hormonal contraceptive methods were associated with lower HRQOL. SEC-QOL scores showed moderate correlations to psychological well-being index and slightly lower correlation to EuroQol five-dimensional questionnaire scores. At follow-up, HRQOL had improved in all groups; most markedly in group B, which obtained an average effect size of 0.59. The minimum important difference was established as a 3.4-point change in the global SEC-QOL score. SEC-QOL obtained a Cronbach's α of 0.88 and an intraclass correlation coefficient of 0.82. Conclusions SEC-QOL is a valid, reliable, and sensitive to change questionnaire for use in daily clinical practice and future research projects on contraception.

Objective: To assess the prevalence of premenstrual symptoms, premenstrual syndrome and premenstrual dysphoric disorder in a cohort of women of fertile age representative of the general Spanish population. Study design: During the period between November 27th and December 22nd, 2008, a cross-sectional nationwide survey was conducted among a cohort of Spanish women aged between 15 and 49 years. Participants were personally interviewed at home and completed the premenstrual symptoms screening tool. Results: Of the 2108 participants, 1554 women (73.7%) complained of some of the premenstrual symptoms during the last 12 menstrual cycles. A total of 1415 (91%) women presented isolated symptoms and 139 (8.9%) a moderate/severe premenstrual syndrome. Twenty-four (1.1%) women fulfilled criteria for a diagnosis of premenstrual dysphoric disorder. Conclusion: The prevalence of premenstrual symptoms (73.7%) and premenstrual dysphoric disorder (1.1%) in Spanish women aged between 15 and 49 years is similar to that reported in other Western countries. Only women with moderate or severe premenstrual syndrome or premenstrual dysphoric disorder, however, had daily life activities significantly impaired by premenstrual symptoms.

Background This study was designed to acquire information about the use of contraceptive methods in order to reduce the number of elective abortions. Study Design Since 1997, representative samples of Spanish women of childbearing potential (15–49 years) have been surveyed by the Daphne Team every 2 years to gather data of contraceptive methods used. Results During the study period, 1997 to 2007, the overall use of contraceptive methods increased from 49.1% to 79.9%. The most commonly used method was the condom (an increase from 21% to 38.8%), followed by the pill (an increase from 14.2% to 20.3%). Female sterilization and IUDs decreased slightly and were used by less than 5% of women in 2007. The elective abortion rate increased from 5.52 to 11.49 per 1000 women. Conclusions The factors responsible for the increased rate of elective abortion need further investigation.

El primer objetivo del uso de un anticonceptivo oral combinado (AOC) es el de evitar un embarazo. En ocasiones el AOC se asocia a efectos secundarios, pero cada dia se conocen mejor los efectos beneficiosos no anticonceptivos del mismo. Existe evidencia de una buena calidad que asocia el uso de AOC con la mejoria de la dismenorrea, la disminucion del sangrado menstrual y la mejoria del sindrome premenstrual. Tambien se sabe que el uso de AOC protege frente a la enfermedad inflamatoria pelvica (EIP) y el embarazo ectopico, reduce la perdida mineral osea y es eficaz en el tratamiento del acne leve y moderado. Ademas, la AOC disminuye la incidencia de cancer de ovario y cancer de endometrio. Conocer estos efectos beneficiosos resulta de interes tanto para los profesionales sanitarios como para las mujeres.

Resumen Objetivos Conocer el porcentaje de jovenes espanoles de ambos sexos, con edades comprendidas entre los 15 y los 24 anos, que utilizan o conocen el doble metodo. Material y metodos Estudio descriptivo, transversal, realizado en el mes de marzo de 2005 mediante una encuesta nacional entre una muestra de 2.015 jovenes espanoles con edades comprendidas entre los 15 y los 24 anos. Los datos fueron recogidos en una base de datos disenada para el estudio y su tratamiento estadistico se realizo mediante el paquete SPSS. Resultados El 70% de los jovenes es sexualmente activo. El metodo anticonceptivo mas utilizado es el preservativo. Solo el 3,4% de los jovenes varones espanoles y el 7,3% de las mujeres han utilizado, en alguna ocasion, un doble metodo, y este porcentaje desciende hasta el 0,2 y el 2,9%, respectivamente, cuando se refiere a la ultima relacion sexual mantenida. El 31% de los varones y el 36,8% de las mujeres conocen el doble metodo. Conclusiones El uso y el conocimiento del doble metodo entre la poblacion joven espanola son bajos.

A number of factors related to the user and the method affect contraceptive compliance.This cross-sectional multicenter study was designed to assess self-described impact of noncompliant behavior among 26,250 typical users of a combined hormonal contraceptive method who consulted their physicians for control visits. A self-administered questionnaire was completed.Sixty-five percent of women used the pill, 23% the vaginal ring and 12% the transdermal patch. Noncompliant behavior (missing/delays in taking/application, insertion or removal of the pill/skin patch/vaginal ring) was recorded in 71% of pill users, 32% of patch users and 21.6% of vaginal ring users (p.0001). Emergency contraception was requested by 14% of pill users, 11% of patch users and 6.3% of ring users. About 40% of women in all groups called or visited a physician. Seventy percent of women continued to have active sex life, and 60% used an additional contraceptive method. Noncompliant behavior negatively affected work activities and/or couple relationships in 10-20% of cases. More than 50% of women reported they were worried and about 20% were scared due to inconsistent use of the contraceptive method. After filling out the questionnaire, 64.7% of pill users continued to prefer the pill, 61.7% of patch users preferred the patch and 96.6% of women using the vaginal ring preferred the ring.Noncompliant behavior had noticeable effects on emotional well-being, prompted request for physicians' advice, and use of emergency contraception. Despite recognition of problems associated with inconsistent use, women tended to prefer the currently used contraceptive method.

Resumen Objetivos Conocer los metodos anticonceptivos utilizados segun la edad de las mujeres. Material y metodos Desde 1997 los autores venimos realizando, en Espana, una encuesta bienal sobre la utilizacion de metodos anticonceptivos en las mujeres en edad fertil (15-49 anos). Resultados En el grupo de mujeres adolescentes el metodo mas utilizado es el condon. En el grupo de 20 a 29 anos, el condon sigue siendo el metodo mas utilizado, seguido de la pildora. El grupo de 30-39 anos es el que mas utiliza el dispositivo intrauterino (DIU). En el grupo de mujeres de 40- 49 anos los metodos quirurgicos son utilizados hasta por el 28% de las mujeres. Conclusiones En los ultimos 6 anos se ha incrementado el uso de metodos anticonceptivos en la poblacion espanola. Se observan diferencias en la eleccion del metodo anticonceptivo segun la edad de las mujeres.

To compare the contraceptive modalities used in the general female population with those of female healthcare providers (HCPs) in Spain.A nationwide survey of a representative sample of Spanish women and female Spanish HCPs aged 23 to 49 years (total sample size: 3200).The condom was the most widely used contraceptive method in both groups (30% and 23% in the general population and among HCPs, respectively). The reasons cited for relying on this method were ease of use (19% and 13%, respectively; p = 0.2), effectiveness (16% and 22%, respectively; p = 0.2), absence of side effects (14% and 22%, respectively; p = 0.1), and fear of side effects associated with oral contraception (13% and 2%, respectively; p0.0001). After the condom, oral contraceptives, the intrauterine device and the vaginal ring were the most widely used methods among HCPs (13% each).The spectrum of contraceptive methods used by female HCPs differs from that of women in the general Spanish population. HCPs opt more often for long-acting reversible contraceptives because of their effectiveness and safety whereas women in the general population rely more frequently on the condom and surgical methods.

To assess changes in the use of contraceptive methods, and induced abortion rates, in Spanish adolescents and young adults aged 15 to 24 years, between 2002 and 2008.Representative samples of Spanish men and women aged 15 to 24 years were surveyed in 2002 (N = 1826) and 2008 (N = 2000).The rate of use of contraceptive methods increased from 61% in men and 60% in women in 2002 to 80% and 75%, respectively, in 2008. The most commonly used method was the condom (51% in 2002 and 71% in 2008), followed by the contraceptive pill (18% in 2002 and 18% in 2008). None of the adolescents and young adults surveyed used natural methods or the diaphragm, or had undergone sterilisation. The induced abortion rate increased from 9.28 to 13.48 per 1000 women in the group aged between 15 and 19 years, and from 14.37 to 21.05 per 1000 women in the group aged 20 to 24 years.Despite an increase in the use of effective birth control methods, the rates of abortion rose during the study period, which may indicate that compliance with the use of condoms is inadequate. There is an urgent need to develop educational campaigns or to design specific policies addressing contraception-related issues for young people.

Concerns about the appropriateness of high heterogeneity in the meta-analysis evaluating the risk of venous thromboembolism in users of combined hormonal contraceptives are discussed in this reply to a critical response of the original study. The response claimed that some of the study’s meta-analyses were compromised by the high heterogeneity which affected two studies one pertaining to drospirenone and the other one to desogestrel. The authors acknowledge previously pointed out methodological flaws in the cohort studies. Finally taking into account the discussed limitations the authors consider that observational studies will not add relevant information and only well-designed prospective studies will help to better understand the real risks of hormonal contraception.

To collect information on (i) contraceptive methods used immediately before unwanted pregnancy, and (ii) planned contraception following induced abortion among Spanish residents.Eight centres officially accredited to perform abortions participated in a cross-sectional study. The study population included 2475 women requesting induced abortion between 1 January and 31 March 2007.Contraceptive methods used before unwanted pregnancy were condoms in 40% of the cases, combined hormonal contraception in 14%, and other methods (mainly natural methods and withdrawal) in 10%. Thirty-six percent of women did not use any contraceptive method. Failure of the method due to incorrect use was reported by 77% of those using condoms and by 84% of those using hormonal contraception. Only 23% of women planned to use a contraceptive method after abortion. Almost half of the women were immigrants.Despite the use of effective contraceptive methods, the majority of women requesting induced abortion in Spain became pregnant during the use of these methods. These data reflect a lack of compliance. More education programmes are needed to improve compliance rates. The long-acting reversible contraceptive methods could constitute an appropriate approach.

Objective To assess the attitudes of women with premenstrual symptoms in relation to their perception of complaints and request for medical advice. Study design Cross-sectional study of a representative cohort of 2018 Spanish women aged 15–49 years. Participants were personally interviewed at home and completed the premenstrual symptoms screening tool. Results A total of 1554 women (73.7%) complained of some of the premenstrual symptoms during the last 12 menstrual cycles. The prevalence of moderate or severe premenstrual syndrome (PMS) was 8.9% and the prevalence of premenstrual dysphoric disorder (PMDD) 1.1%. Only 291 (18.7%) women had sought medical advice. The main reason given by 90.6% of symptomatic women for not seeking medical consultation was to consider that symptoms were normal. A total of 175 (60.1%) women received pharmacological treatment (hormonal contraceptives in 95% followed by analgesics in 50% and anti-inflammatory agents in 44%), 20% were not treated because physicians considered that symptoms were not important and would disappear spontaneously, and 12% received only advice to change life style. Conclusion Women suffering from PMS or PMDD do not usually seek medical advice and among those seeking medical care, in many cases, an adequate response to their demands is not obtained.

Background: Contraceptive efficacy and side effects are primary concerns of women when choosing a contraceptive method. Study Design: This cross-sectional multicenter study was designed to assess the reasons for selecting the contraceptive pill, the skin patch or the vaginal ring in 9700 women, aged 18–49 years, who consulted their doctors for starting or re-initiating combined hormonal contraception. A self-administered questionnaire regarding the reasons for the selection made and for the refusal of the remaining two methods was completed. Results: The vaginal ring showed the highest acceptance (46%) compared with the pill (39%) and the skin patch (15%), particularly in women aged 35–39 years. The ring and the skin patch were mainly preferred because of the lower probability of inadvertent omission (62% of cases), convenience, and monthly or weekly frequency of use. The pill was preferred because of its proven efficacy (60% of cases) and ease of use. The acceptance of the skin patch increased with age and the pill was mostly accepted only by women in the youngest age groups. Conclusions: Convenience, frequency of use and lower probability of inadvertent omission were the primary determinants of contraceptive choice rather than the women's profile.

**Background:** A wide variety of contraceptive methods are available, some of them reimbursed by the Spanish National Health System (SNHS). However, the number of unintended pregnancies (UP) is still significant, leading to a high economic burden, mainly derived from non-adherence to and the incorrect use of contraceptive methods. **Objectives:** This study aims to estimate the economic burden associated with reversible contraception management in Spain, from the perspectives of both the SNHS and women, over a 5-year period. **Methods:** A survey was performed to identify contraception management in Spain based on the experience of a panel of six expert gynecologists. An economic model was conducted to quantify the current burden of contraception according to healthcare resources use over 5 years. The costs included in the analysis were diagnostic tests, initial and follow-up consultations, methods acquisition costs, and UP derived from therapy failure. **Results:** Reversible contraception costs in Spain amount to €12.5 billion over a 5–year period. Condoms and combined oral contraceptives (COC) account for 86.8% of the total cost and the other methods only 13.2%. There are differences in contraceptive use according to women’s age. Short-acting reversible contraceptives (SARC) such as COC, condom and vaginal ring, are most commonly used by younger women. However, SARC are correlated with the highest failure rate, resulting in over €7.2 billion cost, explained by the high number of UP. Long-acting reversible contraceptives (LARC), such as the levonorgestrel-releasing intrauterine system (LNG-IUS20), implant and copper intrauterine devices (IUD), are selected by women over 35 years of age due to user-independent compliance. SARC methods result in a higher cost per woman over 5 years: vaginal ring €2427.8, patch €2402.6, condom €2060.1 and COC €1895.1; while LARC methods are the most economic option per women: LNG-IUS20 €630.4, copper IUD €658.2, LNG-IUS12 €703.8, intramuscular injectable €907.8 and implant €940.5. **Conclusions:** LARC methods result in lower costs compared with SARC options from the perspectives of the SNHS and women, explained by user-independent compliance, preventing a significant number of UP and its elevated economic burden. An increased LARC methods use could avoid UP events, leading to significant cost-savings for the SNHS.