Posted ,
Reading 3 mins.
in collaboration with
Dr Laure Martinat (Anesthesiologist-resuscitator, Naturopath, graduate in Phytotherapy and Aromatherapy)
Anesthetics could have an effect on the effectiveness of hormonal contraception, with the consequence of increasing the risk of unplanned pregnancy. In any case, this is what a British study reveals.
The link between contraception and anesthesia is little explored. And we can only regret it, judging by the British study presented at the annual meeting of the European Society of Anaesthesiology and Intensive Care (ESAIC), Euroanaesthesia, held in Milan ( Italy) from June 4 to 6.
“It is worrying that we so rarely inform patients of the risk of contraceptive failure after the use of an anaesthetic”denounces one of the researchers and co-authors of the study in question.
Contraception should be discussed before anesthesia
Prior to surgery, patients benefit from a consultation with an anesthesiologist. The specialist then fills out a file containing “systematically and obligatory various elements, including the list of the patient’s usual treatments”describes Dr Laure Martinat, anesthetist-resuscitator, phyto-aromatherapist and author of the book Immunity, infectious diseases and convalescence: strengthening your health naturally (ed.. Quintessence).
In this section, the patient must specify whether she usually or temporarily takes any treatments. “We evaluate the taking or not of a contraceptive with the collection of the name of the contraceptive drug and its methods of taking”, she adds.
At the end of the consultation, the anesthesiologist is supposed to give “oral and written instructions” to the patient, in particular concerning the management of her treatments, if any.
“In the case of contraception, as a general rule, and with some exceptions, the instruction is to continue taking your contraceptive treatment according to the usual pattern, without modification”says Dr. Laure Martinat.
However, the British study shows a completely different reality. Of the 150 healthcare professionals surveyed – including anesthesiologists, but also medical assistants – 70% said they did not systematically discuss the effect of anesthetics on contraception with patients.
Sugammadex implicated
Administered towards the end of the operation, before the patient wakes up, sugammadex is a “decurarizing agent”, specifies the Martinat. It reverses the action of curares, drugs used in anesthesia, which allow the patient’s muscles to relax. The sugammadex is “the antidote to two curares: rocuronium and vecuronium”the second no longer being marketed in France.
This decurarizing product is used if, and only if, the patient’s muscles are still relaxed at the end of the procedure.
According to the study, sugammadex is the only anesthetic drug that reduces the effectiveness of contraception. “It is a phenomenon of drug interaction, which is not linked exclusively to the drugs used in anesthesiasays Dr. Martinat. Here, there is a drug interaction between sugammadex and hormonal contraceptives, especially progestin-only contraceptives and, to a lesser extent, estrogen-progestogen contraceptives”.
Sugammadex may therefore reduce the effectiveness of the progesterone-only pill (minipill), the combined pill, vaginal rings, implants and intrauterine devices, among others.
Under what terms? “For progestogen contraceptives, it is generally said that the administration of a dose of 4 mg/kg of sugammadex results in a reduction in the effectiveness of the contraceptive equivalent to a delay in taking the contraceptive by 12 hours. The effect is less in the case of estrogen-progestogen pills because the interaction is less important with estrogens”answers Laure Martinat.
In the British study conducted over six weeks, 234 patients received sugammadex: 48 of them should have received advice on its inhibitory effects on contraception. However, the medical records of these 48 women did not mention it.
“While it is true that most operating theaters in France have access to sugammadex, its use is still moderate due to its high price in France”, notes Dr. Martinat. But there are also hospitals that use it regularly.
What precautions against inhibitory effects?
For Laure Martinat, obtaining information about the patient must be “systematic and repeated, then traced in his file”. Furthermore, she adds, “the patient must be informed of the potential risk of reduced effectiveness of her contraception when using sugammadex and of the potential risk of unwanted pregnancy”.
“In the majority of cases, it is necessary to explain to the patient that she must continue her contraception normally, while associating it with another contraceptive method, such as the condom, during sexual intercourse, and this until the resumption of the next plate”says the practitioner.
For patients taking oral hormonal contraceptives, they should follow the advice on missing a pill. “If the patient has hormonal contraception not taken by mouth, she should use another method of contraception for seven days after the administration of sugammadex”adds Laure Martinat.
If you have the slightest doubt, do not hesitate to ask a health professional (anesthetist, gynecologist or midwife) for more information.
Finally, a solution to consider lies in the choice of the decurarizing agent. “If we have the choice, then we can avoid using rocuronium and use another curare, which will avoid the potential use of sugammadex at the end of the procedure”emphasizes Dr. Martinat.