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Contraceptive methods have social images or social stereotypes which may vary over time and may be strongly influenced by single events like a serious complication in a young woman. Wishes regarding the role and/or involvement of the partner vary largely. The knowledge and understanding of what the individual woman wants is an important part of contraceptive counselling. Healthcare professionals seem to be very focused on the objective characteristics of the woman seeking advice, rather than what the woman actually wants and is comfortable with. One way of assessing the subjectivity of the woman is asking, either during the dialogue in the consultation room or by using a questionnaire in the waiting room, about her expectations and experiences regarding the criteria, like efficacy, safety, side effects, relation to sexual activity, duration of action, control, cost, involvement of partner or other family members and additional health benefits.
Reproductive ageing in women is caused by declining number and quality of oocytes. The Royal College of Obstetricians and Gynaecologists (RCOG) should promote the view of a shared responsibility in addressing the problems associated with reproductive ageing and encourage an acknowledgement that personal and social circumstances play a role rather than placing blame on individuals. The RCOG should urge greater transparency and accuracy in depicting assisted reproductive technology success rates, including the cost and clinical efficiency of full cycles (full cycle implies cryopreservation of embryos). There are no contraceptive methods contraindicated by age alone. Older women may use combined hormonal contraception unless they have co-existing diseases or risk factors. Further research is needed into characterisation of existing and novel ovarian biomarkers to provide clinically useful prediction of current and future fertility. National data collection covers live births and terminations of pregnancy but should be expanded to include information about miscarriage.
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