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Over-the-counter access, changing WHO guidelines, and contraindicated oral contraceptive use in Mexico.
Studies in Family Planning. 2006 Sep; 37(3):197-204.This study examines the prevalence of contraindications to the use of oral contraceptives in Mexico by sociodemographic characteristics and by whether this family planning method was obtained with or without a doctor's prescription. Using data on smoking behavior and blood-pressure measurements from the 2000 Mexican National Health Survey, the authors found that, under the 1996 World Health Organization (WHO) medical eligibility guidelines, the prevalence of contraindications is low and that no significant differences in contraindications exist at any level between those who obtain oral contraceptives at clinics and those who obtain them at pharmacies. In 2000, however, WHO substantially revised its criteria regarding the level of hypertension that would constitute a contraindication for oral contraceptive use. Applying the new guidelines, the authors found that 10 percent of pill users younger than 35 and 33 percent aged 35 and older have health conditions that are either relative or absolute (Category 3 or 4) contraindications. The relevance of these findings to the larger debate concerning screening and over-the-counter access to oral contraceptives is discussed. (author's)
IPPF Medical Bulletin. 1977 Oct; 11(5):1-2.Lancet recently published 2 papers which reported research fundings indicating that oral contraceptive users, over 35 years of age, are at greater risk of death from cardiovascular disease than nonusers. The findings also suggested that oral contraceptive users who have taken the pill for more than 5 years, who smoke, or who have diabetes, hypertension, or obesity are also at increased risk of death than nonusers. In view of these findings the Presidents of the Royal College of General Practitioners and of the Royal College of Obstetricians and Gynaecologists revised oral contraceptive prescribing recommendations. According to the new recommendations 1) women, who are under 30 years of age, can continue to use the pill but if they smoke they should be advised to quit smoking; 2) women, between 30-35 years of age, can continue to use the pill but if they have taken the pill for 5 or more years and if they smoke they should be advised to switch to other contraceptive methods; and 3) women, over 35 years of age, should be advised to use other contraceptive methods. The British Committee on Safety of Medicines did not issue new prescribing instructions. The International Planned Parenthood Federation, noting the findings of both U.S. and British studies, said that physicians should be aware that the risk of death from cardiovascular disease may be enhanced for oral contraceptive users over the age of 40. The Federation also recommended that couples with completed families should consider sterilization or other alternative forms of contraception.