BACKGROUND: Long-acting reversible contraceptive (LARC) methods are highly effective in preventing unintended pregnancies. However, their uptake is low in much of the developed world. This study aimed at assessing the cost-effectiveness of LARC methods from the British National Health Service (NHS) perspective.
METHODS: A decision-analytic model was constructed to estimate the relative cost-effectiveness of the copper intrauterine device (IUD), the levonorgestrel intrauterine system (LNG-IUS), the etonogestrel subdermal implant and the depot medroxyprogesterone acetate injection (DMPA). Comparisons with the combined oral contraceptive pill (COC) and female sterilization were also performed. Effectiveness data were derived from a systematic literature review. Costs were based on UK national sources and expert opinion.
RESULTS: LARC methods dominated COC (i.e. they were more effective and less costly). Female sterilization dominated LARC methods beyond 5 years of contraceptive protection. DMPA and LNG-IUS were the least cost-effective LARC methods. The incremental cost-effectiveness ratio of implant (most effective LARC method) versus IUD (cheapest LARC method) was pound13 206 per unintended pregnancy averted for 1 year of use and decreased until implant dominated IUD in 15 years. Discontinuation was a key determinant of the cost-effectiveness of LARC methods.
CONCLUSIONS: LARC methods are cost-effective from the British NHS perspective. Practices improving user satisfaction and continuation of LARC method use should be identified and promoted.

OBJECTIVE: To reach a consensus on the role of add-back therapy for patients with endometriosis administered GnRH agonists (GnRH-a).
METHODS: Results of consensus conference reviewing MEDLINE search of English language abstracts of both prospective and retrospective series.
METHODS: Consensus conference of 31 specialists in gynecologic surgery and reproductive endocrinology.
METHODS: Patients with symptomatic endometriosis who were candidates for GnRH-a therapy in treatment courses ranging in duration from 6 to 12 months.
METHODS: Oral steroidal and nonsteroidal add-back regimens.
METHODS: Alteration in painful symptoms, extent of disease, vasomotor symptoms, bone mineral density, and serum lipid profile.
RESULTS: When added to GnRH-a for 6 months, both 2.5 mg of norethindrone and 0.625 mg of conjugated equine estrogens with 5 mg/d of medroxyprogesterone acetate provide effective relief of vasomotor symptoms and decrease but do not eliminate bone mineral density loss. During 12 months of GnRH-a therapy, bone mineral density loss is eliminated effectively with an add-back of 5 mg of norethindrone acetate alone or in conjunction with low-dose conjugated equine estrogens. Organic bisphosphonates also may play a role.
CONCLUSIONS: In patients with symptomatic endometriosis, the efficacy of GnRH agonists may be preserved and therapy prolonged while overcoming hypoestrogenic side effects with the use of appropriate add-back regimens.

Paraphilic syndromes, of which there are at least 40, are known legally as perversions and on the street as kinky and bizarre sex. Paraphilia accounts for a very high proportion of sex-offending that is prosecuted as criminal. A new treatment which combines a hormonal antiandrogen with sexological counseling therapy is becoming widely adopted in America and Europe. The treatment is available also to noncriminal paraphiliacs whose syndrome is a source of interpersonal suffering and crisis.