[The practice guideline 'Hormonal contraception' (second revision) from the Dutch College of General Practitioners; a response from the perspective of obstetrics & gynaecology].
The Dutch College of General Practitioners' (NHG) guideline on hormonal contraception does not follow the WHO criteria for the use of oral contraceptives in contrast to the guideline of the Dutch Society of Obstetrics and Gynaecology. Contrary to the WHO criteria, the NHG guideline considers a blood-pressure measurement before starting with an oral contraceptive to be unnecessary. It also considers no form of migraine to be a contraindication for oral contraceptives. The NHG guideline further disclaims the (slightly) increased risk of developing breast cancer in women using oral contraceptives. It advises initiation of oral-contraceptive use two weeks postpartum in non-breastfeeding women and six weeks postpartum in breastfeeding women, instead of the three weeks and six months, respectively, indicated in the WHO guideline. Lastly, the NHG guideline is too optimistic as to the reliability of oral-contraceptive use, as no distinction is made between efficacy and effectiveness. Such discrepancies between two Dutch guidelines can be detrimental to women's health care. The WHO criteria for contraceptive use may be a valuable tool to overcome differences of opinion so as to achieve a badly needed full consensus.
Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Verloskunde/Gynaecologie, Postbus 22.700, 1100 DE Amsterdam. m.knuist@amc.uva.nl
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D003267:Contraception / Q000379:methods / Q000592:standards; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006176:Gynecology / Q000592:standards*; D006801:Humans; D009426:Netherlands; D009774:Obstetrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D016896:Treatment Outcome; D014944:World Health Organization
D003278:Contraceptives, Oral, Hormonal