Range of qualitative research

Cerazette® licence extension I welcome the extension to the Cerazette® ‘missed pill’ licence up to 12 hours1 as it facilitates concordance by offering a longer therapeutic window and minimises confusion in pill taking as the rule is similar to that of the combined oral contraceptive pill (COC). The extension of the missed pill licence for Cerazette offers better adherence as well as inhibition of ovulation,2 and increases the contraceptive choices available to youngsters who cannot take the COC on account of medical risks or who cannot accept the invasiveness of long-term implants. Young girls worry that their mothers may suspect a pregnancy if they have amenorrhoea or gain weight on implants. Cerazette may also be used when clients are unable to provide their family medical history. I give below an account of a client who changed my prescribing habit. It was at the end of a busy clinic when I saw this young 16-year-old girl, and the underlying message is undeniably imprinted in my memory. She accessed the clinic for emergency contraception and it is my usual practice to talk about future contraception. Her father had suffered from pulmonary embolism. She informed me that he was under 45 years old and gave no risk factors for venous thromboembolism (VTE). I was impressed by the amount of medical information this young girl could give me and wondered whether my children of similar age would remember details of their parents’ medical histories. I offered the patient a thrombophilia screen and with her consent gave her a letter requesting detailed medical information from her general practitioner. She was disappointed that I could not prescribe her pills with a longer therapeutic window similar to the ones her friends were taking. Progestogen-only contraceptive implants were unacceptable because of amenorrhoea and the progestogen-only pill was not acceptable because of concordance and efficacy issues. At the time I was accused of being overcautious and the general consensus was that I should have prescribed a COC. A few months later I learnt that this girl had developed femoral vein thrombosis and was being treated at the local hospital with anticoagulants. This young client was so determined to get the COC that she went to another clinic, concealed the family history of VTE, and was prescribed COC. Surprisingly, she saw the same nurse, a very competent senior family planning nurse, who is very thorough and meticulous with history taking and other details and would not have missed out any relevant family history of clotting disorders. This girl deliberately concealed the facts in order to get a prescription of the COC. I see many adolescents who are in care, or have been adopted, and hence cannot provide the medical history of their families. I am always reminded of this girl when I prescribe COC for the first time. I acknowledge the lack of evidence on the safety profile of Cerazette to prescribe it routinely as the first-line pill or as a replacement pill for the COC, which regulates periods and mimics the natural cycle. Nonetheless, it is possible that as with progestogen-only emergency contraception, we may have enough evidence in future to change the prescribing habits of health professionals offering contraceptives to youngsters.