IUS as emergency contraception.

I was interested to read the commentary by Anne Szarewksi describing how to individually tailor a woman’s combined oral contraceptive (COC) regimen to minimise the amount of breakthrough bleeding she has to experience each year.1 However, in view of the article on repeat abortion (Das et al.) in the same issue of the journal, should we not be more concerned in preventing pregnancy in COC users?2 Das et al. state that 35% of first attenders were using COC and 55% at repeat abortion. It is not uncommon to see patients who have become pregnant on the COC pill despite taking it without fault, some patients unfortunately on more than one occasion, having been restarted on their original COC following the end of their pregnancy. These failures of the method could be attributed to the individual woman ovulating as a 7-day pill-free interval is too long for her ovaries to remain quiescent. In view of this, a 24/4 regimen should be the norm but the drug companies seem slow to change their products. Several alternative formulations such as 24/4 or continuous-use pill regimens are available in other countries including the USA and Australia, but none are currently available in the UK, although one has been granted a licence here with a launch date awaited.3 This will no doubt come at a price. Surely all the COC manufacturers should provide a product that is more effective? However, I am sure that the need for a further licence to enable a change to a 24/4 formulation for the cheaper generic COCs would make drug companies reluctant. We can never be certain which patients fall pregnant despite full compliance with the COC taking ‘rules’ – what is certain is that there will be some women whom this affects each year, and they are likely to be young, new pill starters. This seems awfully unfair on them when in this day and age we have the knowledge to prevent these unwanted pregnancies.