Long Term Contraception

General Comments and Directions

• These criteria assume that the couple/patient is having intercourse or would be in the near future. If they were not then they would not be eligible for publicly-funded long-term contraception.
• These criteria are intended to determine the priority of the couple for publicly funded long-term contraception (i.e., female sterilisation, male sterilisation and Mirena IUS). The specific treatment will be determined subsequently after informed discussion with the couple. (See Modality of Treatment below.)
• The score should be calculated during the consultation, and the patient informed whether they will be accepted for publicly funded treatment.
• If there is a conflict between generally accepted clinical practice and the decision made by comparing a patient’s criteria score to the threshold, then generally accepted clinical practice should prevail. If there are exceptional factors in a particular case which are outside those covered in the criteria, the booking status may be overridden and the reason for the exception provided.

Consideration of Regret

Once eligibility for a publicly-funded procedure has been determined, the particular treatment is considered with the patient / couple. In considering the most appropriate form of treatment, risk of regret is a very important factor to consider. Factors associated with an increased risk of regret are:

• Age < 30 years
• Either party giving reasons for long-term contraception other than enough children
• Time since last pregnancy – particularly if < 1 year
• Risk of relationship breakdown
• Inadequate consideration of alternative options
• Emotional instability.

If any of these factors are present then Mirena IUS may well be the preferred option.