Unanswered questions in contraceptive management: what do the experts do?

Context: Several areas exist in the practice of contraception where evidence for practice is deficient, yet clinical decisions need to be made.

Objectives: The aim of the study was to find the practice habits of lead practitioners in the area of contraception in specific clinical scenarios where the published evidence is inadequate to provide clear guidance to clinicians. Results can provide 'Level V' evidence for practice for the 'nonexpert' practitioner.

Design: Descriptive study.

Participants: The study was conducted as a postal questionnaire mailed to the 205 lead practitioners whose contact details were known through the Society of Consultants in Reproductive Health (hereafter referred to as 'consultants') working in reproductive health in the National Health Service.

Results: A total of 138 consultants returned completed questionnaires (67% response rate). Important results included 100% of respondents being prepared to prescribe progestogen-only emergency contraception more than once in a cycle (contrary to product labelling) and 71% recommending two tablets daily of the progestogen-only pill for women of high body mass.

Conclusions: Some questions had responses that showed clear majorities, providing a clear guide to practice, while other areas remain doubtful. Comments from respondents indicated great interest in all areas covered and a desire for consensus on many of the issues. Certainly the licensing and the advice from pharmaceutical companies is conservative, and in many scenarios a majority of consultants indicated that in order to serve the best interests of their clients they feel constrained to practise outside the Summary of Product Characteristics.