Serfaty D, Wildemeersch D, Verougstraete A, Creatsas G
Centre de Régulation des Naissances, Hôpital Saint-Louis, Paris, France.
Int J Fertil Menopausal Stud. 1995;40 Suppl 2:73-9.
The European Society of Contraception developed a survey to examine birth control methods in the 12 countries++ of the European Community. Responses to those questions relating to prescribing++ practices of oral contraceptives (OCs) are presented herein. The survey was sent to 400 physicians. One hundred two responded, most from France, Belgium, and the United Kingdom. The responses revealed that the most popular OCs are modern combined formulations containing low doses of ethinyl estradiol and progestogens such as norgestimate, desogestrel, gestodene, and levonorgestrel. More than half of physicians prescribe a particular formulation because of its tolerability and 20% because of its hormonal content. More than 90% prescribe OCs to healthy, nonsmoking women over 40. However, three fourths will not prescribe OCs to smokers over 35. Half of physicians recommend mammography for their older OC patients. Half also recommend cholesterol screening, but 8% only for women over 30. Most physicians are no longer reluctant to prescribe OCs to their diabetic patients: 61% prescribe OCs for women with non-insulin-dependent diabetes, 56% for those with insulin-dependent diabetes, and 85% for those with a history of gestational diabetes. Despite recent studies showing no relation between past OC use and cardiovascular disease, 42% of physicians said that their greatest OC-related health concern is cardiovascular disease. One third cited noncompliance as their greatest concern. These results reveal inhomogeneous prescribing practices for OCs among European physicians. ¿Over-screening¿--not prescribing the pill because of perceived (but not necessarily real) health risks--may be depriving many women of the contraceptive and noncontraceptive benefits of OCs. Complete and accurate information--as promoted by the European Society of Contraception--is one way to combat such overscreening.
欧洲避孕协会开展了一项调查,以研究欧洲共同体12个国家++的节育方法。本文展示了对那些与口服避孕药(OCs)处方++做法相关问题的答复。该调查发送给了400名医生。102人做出了回应,大多数来自法国、比利时和英国。答复显示,最受欢迎的口服避孕药是含有低剂量炔雌醇和孕激素(如诺孕酯、去氧孕烯、孕二烯酮和左炔诺孕酮)的现代复方制剂。超过一半的医生因某种特定制剂的耐受性而开这种药,20%的医生因其激素含量而开药。超过90%的医生给40岁以上健康、不吸烟的女性开口服避孕药。然而,四分之三的医生不会给35岁以上的吸烟者开口服避孕药。一半的医生建议为年龄较大的口服避孕药使用者进行乳房X光检查。一半的医生还建议进行胆固醇筛查,但只有8%的医生仅建议30岁以上的女性进行此项检查。大多数医生不再不愿给糖尿病患者开口服避孕药:61%的医生为非胰岛素依赖型糖尿病女性开口服避孕药,56%的医生为胰岛素依赖型糖尿病患者开药,85%的医生为有妊娠糖尿病史的患者开药。尽管最近的研究表明过去使用口服避孕药与心血管疾病之间没有关联,但42%的医生表示,他们最担心的与口服避孕药相关的健康问题是心血管疾病。三分之一的医生认为最大的问题是患者不遵医嘱。这些结果揭示了欧洲医生在口服避孕药处方方面的做法存在差异。“过度筛查”——因感知到(但不一定是实际存在的)健康风险而不开避孕药——可能会使许多女性无法获得口服避孕药的避孕和非避孕益处。欧洲避孕协会所倡导的完整准确的信息是对抗这种过度筛查的一种方式。