Canadian Contraception Consensus (Part 2 of 4).

Abstract

Abstract Objective To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. Outcomes Guidance for Canadian practitioners on overall effectiveness, mechanism of action, indications, contraindications, non-contraceptive benefits, side effects and risks, and initiation of cited contraceptive methods; family planning in the context of sexual health and general wellbeing; contraceptive counselling methods; and access to, and availability of, cited contraceptive methods in Canada Evidence Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e g , contraception, sexuality, sexual health) and key words (e g , contraception, family planning, hormonal contraception, emergency contraception) Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis and incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies Values The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table).Key to evidence statements and grading of recommendations, using the ranking of the Canadian Task Force on Preventive Health CareQuality of evidence assessment*Classification of recommendations † I:Evidence obtained from at least one properly randomized controlled trial II-1:Evidence from well-designed controlled trials without randomization II-2:Evidence from well-designed cohort (prospective or retrospective) or case-control studies, preferably from more than one centre or research group II-3:Evidence obtained from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category III:Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees A.There is good evidence to recommend the clinical preventive action B.There is fair evidence to recommend the clinical preventive action C.The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making D.There is fair evidence to recommend against the clinical preventive action E.There is good evidence to recommend against the clinical preventive action L.There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision-making Wbolf SH, Battista RN, Angerson GM, Logan AG, Eel W. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2003;169:207-8.*The quality of evidence reported in these guidelines has been adapted from The Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care.†Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force on Preventive Health Care