Contraception

Aka: Contraception, Birth Control, Provision of Contraception, Family Planning, Contraceptive Services

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II. Efficacy: First year failure rates of Contraception

  1. Most effective methods: Permanent (<1 pregnancy per year in 100 women)
    1. Vasectomy: 0.15% failure rate
    2. Tubal Ligation: 0.5% failure rate
    3. Hysteroscopic Sterilization: 0.5% failure rate
  2. Most effective methods: Reversible (<1 pregnancy per year in 100 women)
    1. Implantable Contraception (e.g. Nexplanon): 0.05% failure rate
    2. Levonorgestrel IUD (e.g. Mirena): 0.2% failure rate
    3. Copper-T IUD: 0.8% failure rate
  3. Effective methods (6-12 pregnancies per year in 100 women)
    1. Depo Provera Injection: 6% failure rate
    2. Oral Contraceptives: 9% failure rate
    3. Contraceptive Patch (e.g. Ortho Evra): 9% failure rate
    4. Vaginal Contraceptive Ring (NuvaRing): 9% failure rate
    5. Contraceptive Diaphragm: 12% failure rate
  4. Least effective methods (>18 pregnancies per year in 100 women)
    1. Male Condom: 18%
    2. Female Condom: 21%
    3. Withdrawal Method: 22%
    4. Contraceptive Sponge: 12% (nullip) to 24% (parous) failure rate
    5. Natural Family Planning: 24% failure rate
    6. Vaginal Spermicide: 28% failure rate
  5. References
    1. (2013) MMWR Recomm Rep 62(RR-05):1-60 +PMID:23784109 [PubMed]
      1. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6205a1.htm

III. Preparations: Non-Hormonal Options

  1. Male Condom
  2. Female Condom
  3. Contraceptive Diaphragm
  4. Contraceptive Sponge (no longer available in U.S.)
  5. Cervical Cap
  6. Vaginal Spermicide
  7. Natural Family Planning and Fertility awareness
  8. Contraceptive Sponge (returns to U.S. market in 2005)

IV. Preparations: Hormonal Contraception

  1. Oral Contraceptive
  2. Depo Provera Injectable (repeated every 3 months)
  3. Intrauterine Device
    1. Copper T-380A (Paragard) IUD: 10 years
    2. Mirena (5 year device)
    3. Skyla (3 year device)
    4. Older devices included the one year Progestasert IUD (discontinued)
  4. Vaginal Contraceptive Ring (NuvaRing)
  5. Contraceptive Patch (Ortho Evra)
  6. Implantable Progesterone Rods
    1. Nexplanon (single rod system approved for 3 years of Contraception)
    2. Older devices included Implanon (lasted 2 years) and Norplant (lasted 5 years)

V. History

  1. Confirmation of Non-Pregnant State
    1. Menstrual history
      1. Last Menstrual Period
      2. Menstrual period regularity
    2. Pregnancy history
    3. Lactation history
    4. Most recent intercourse
  2. Chronic medical problems (directs contraceptive selection as in management below)
    1. Diabetes Mellitus
    2. Cardiovascular Disease
    3. Seizure Disorders
    4. Bariatric Surgery
    5. Venous Thromboembolism or Thrombophilia
    6. Migraine Headache with aura
    7. Hypertension
    8. Tobacco Abuse
    9. Chronic Corticosteroid use
    10. Systemic Lupus Erythematosus
    11. Antiphospholipid Antibody Syndrome
  3. Sexual history (and risks for STI)
    1. Current and recent sexual partners
    2. Condom use
    3. Prior Sexually Transmitted Infection (STI)
  4. Other history related to contraceptive selection
    1. Contraceptive use in the past and preferences
    2. Intention for future pregnancy

VI. Exam

  1. Blood Pressure
    1. Avoid combination Oral Contraceptives in Uncontrolled Hypertension
  2. Body weight and BMI
    1. Consider avoiding Depo Provera in low BMI patients (increased Osteoporosis risk)
    2. Monitor weight for methods that may be associated with significant weight gain (e.g. Depo Provera)
  3. Pelvic Examination
    1. Not required for extra-pelvic forms of Contraception (e.g. OCP, Depo Provera, Nexplanon, Contraceptive Patch)
    2. Indicated when placing Intrauterine Device, Cervical Cap, Contraceptive Diaphragm
    3. STD Testing may be performed at time of IUD Placement in asymptomatic patients (to avoid delays)
    4. Avoid requiring Pap Smear or well woman physical exam prior to starting Contraception

VII. Labs

  1. Pregnancy Test
    1. Confirmation of Non-Pregnant State by history may also suffice

VIII. Management: General

  1. Initiation: Avoid barriers and delays
    1. Start Contraception at time of visit (unless not able to reliably confirm Non-Pregnant State)
    2. Bridge to longterm method if unable to confirm Non-Pregnant State
      1. Use non-intrauterine Contraception until repeat Pregnancy Test in 2-4 weeks
  2. Compliance
    1. Prescribe one year supply of Contraception
    2. Help facilitate compliance (reminder systems, longterm Contraception)
    3. Reassess Contraception compliance and method satisfaction at routine visits
    4. Discuss permanent methods (e.g. Vasectomy, Tubal Ligation) if completed intended child bearing
  3. Sexually Transmitted Infection prevention
    1. Make Condoms readily available as part of dual protection for those at risk of STI
  4. Specific cohorts
    1. Postpartum counseling on Contraception after delivery
    2. Perimenopause continuation of Contraception until Menopause or age 50 to 55 years old
    3. Adolescent Health counseling on Contraception and Sexually Transmitted Infection prevention
      1. Consider Long-Acting Reversible Contraception are preferred (e.g. IUD, dermal implants)
      2. Diedrich (2015) Am J Obstet Gynecol 213(5): 662 [PubMed]
      3. Schmidt (2015) J Adolesc Health 57(4): 381-6 [PubMed]

IX. Management: Contraceptive Selection in comorbid conditions

  1. See Contraceptive Selection in Diabetes Mellitus
  2. See Contraceptive Selection in Underlying Cardiovascular Disease
  3. See Contraceptive Selection in Seizure Disorder
  4. History of Bariatric Surgery (only roux-en-Y affected due to malabsorption)
    1. Avoid Oral Contraceptives
  5. History of Venous Thromboembolism
    1. Avoid all Estrogen products (Oral Contraceptives, NuvaRing, Ortho Evra)
  6. Migraine Headache with aura
    1. Avoid all Estrogen products (Oral Contraceptives, NuvaRing, Ortho Evra)
  7. Poorly controlled Hypertension
    1. Avoid all Estrogen products (Oral Contraceptives, NuvaRing, Ortho Evra)
  8. Corticosteroids chronically
    1. Avoid Depo Provera (risk of Osteoporosis)
  9. Tobacco Abuse over age 35 years
    1. Avoid all Estrogen products (Oral Contraceptives, NuvaRing, Ortho Evra)
  10. Cerebrovascular Accident
    1. Avoid all Estrogen products (Oral Contraceptives, NuvaRing, Ortho Evra)
  11. Systemic Lupus Erythematosus, Antiphospholipid Antibodies
    1. Avoid all Estrogen products (Oral Contraceptives, NuvaRing, Ortho Evra)
  12. References
    1. (2006) Obstet Gynecol 107(6): 1453-72 [PubMed]

X. References

  1. Klein (2015) Am Fam Physician 91(9): 625-33 [PubMed]

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Related Studies

Ontology: Family Planning (C0009861)

Definition (OMS) Practices designed to plan and space pregnancy within the context of values, attitudes, and beliefs.
Definition (MSH) Health care programs or services designed to assist individuals in the planning of family size. Various methods of CONTRACEPTION can be used to control the number and timing of childbirths.
Definition (CSP) programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility; planning intended to determine the number and spacing of one's children through birth control or methods which promote reproduction.
Concepts Health Care Activity (T058)
MSH D005193
SnomedCT 73285008, 310031001
English Family Planning, FP - Family planning, Family planning, family planning, family planning services, family plan service, family planning service, Family Planning Services, Family Planning Service, Planning Service, Family, Service, Family Planning, Services, Family Planning, Planning Services, Family, Family planning service, Family planning service (qualifier value), Family planning and/or genetic counseling
Swedish Familjeplanering
Czech plánování rodičovství - služby
Finnish Perhesuunnittelupalvelut
Russian SEM'I PLANIROVANIE, SEM'I PLANIROVANIIA SLUZHBY, СЕМЬИ ПЛАНИРОВАНИЕ, СЕМЬИ ПЛАНИРОВАНИЯ СЛУЖБЫ
Japanese 産児制限, 家族計画, 計画出産
French Services de planification de la famille, Services de planification familiale, Services d'orthogénie, Planification familiale, Planning familial, Service de planning familial
Italian Pianificazione familiare, Servizi di pianificazione familiare
Croatian PLANIRANJE OBITELJI, SAVJETOVALIŠTA, PLANIRANJE OBITELJI
Polish Planowanie rodziny, Świadczenia związane z planowaniem rodziny, Usługi z zakresu planowania rodziny
Norwegian Familieplanlegging
Spanish Centros de Planificación Familiar, servicio de planificación familiar (calificador), servicio de planificación familiar, Servicios de Planificación Familiar
Portuguese Centros de Planejamento Familiar, Clínicas de Planejamento Familiar, Agências de Planejamento Familiar, Serviços de Planejamento Familiar
German Familienplanung
Dutch Gezinsplanning, Adviesbureau gezinsplanning
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Contraceptive methods (C0700589)

Definition (MEDLINEPLUS)

Birth control, also known as contraception, is designed to prevent pregnancy. Birth control methods may work in a number of different ways. These include

  • Preventing sperm from getting to the eggs - condoms, diaphragms and intrauterine devices (IUDs) work this way
  • Keeping the woman's ovaries from releasing eggs that could be fertilized - birth control pills work this way
  • Sterilization, which permanently prevents a woman from getting pregnant or a man from being able to get a woman pregnant

Your choice of birth control should depend on several factors. These include your health, frequency of sexual activity, number of sexual partners and desire to have children in the future. Your health care provider can help you select the best form of birth control for you.

NIH: National Institute of Child Health and Human Development
Definition (NCI) The prevention of conception or impregnation by the use of devices or drugs or surgery.
Definition (MSH) Prevention of CONCEPTION by blocking fertility temporarily, or permanently (STERILIZATION, REPRODUCTIVE). Common means of reversible contraception include NATURAL FAMILY PLANNING METHODS; CONTRACEPTIVE AGENTS; or CONTRACEPTIVE DEVICES.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D003267
SnomedCT 146680009, 146788008, 169558006, 13197004, 73285008
LNC MTHU024530
English Contraception, Contraceptive Method, Contraceptive Methods, Fertility Control, Fertilization Inhibition, Inhibition of Fertilization, Contraception NOS, INHIB OF FERTILIZATION, method birth control, contraceptive method, control fertility, birth control, contraceptives methods, birth control method, birth controls, contraception, fertility control, birth control methods, contraceptions, contraceptive methods, Contraception NOS (finding), Birth control method, Birth Control, Birth control, Contraception (finding), Contraceptive methods, Contraception, NOS, Birth control, NOS
Dutch geboorteregeling, contraceptie NAO, contraceptie, Anticonceptie, Contraceptie, Geboortebeperking
French Contraception SAI, Contrôle de la fécondité, Contrôle des naissances, Méthodes contraceptives, Contraception
German Geburtenkontrolle, Kontrazeption NNB, Verhuetung, Kontrazeption, Empfängnisverhütung, Schwangerschaftsverhütung
Italian Contraccezione NAS, Controllo della fertilità, Inibizione della fertilità, Controllo delle nascite, Metodi contraccettivi, Contraccezione
Portuguese Controlo dos nascimentos, Contracepção NE, Métodos Contraceptivos, Controle da Fecundidade, Limitação da Fecundidade, Contracepção, Controle da Natalidade, Métodos Anticoncepcionais, Anticoncepção, Controle de Natalidade
Spanish Control de la natalidad, Anticoncepción NEOM, anticoncepción, SAI, anticoncepción, SAI (hallazgo), Contraception NOS, Control de Natalidad, Métodos de Control de la Natalidad, Regulación de la Fecundidad, anticoncepción (hallazgo), anticoncepción, control de la natalidad, Control de la Natalidad, Anticoncepción
Japanese 避妊ＮＯＳ, ﾋﾆﾝ, ｼﾞｭﾀｲﾁｮｳｾﾂ, ﾋﾆﾝNOS, 避妊法, 避妊, 受胎調節
Swedish Födelsekontroll
Czech antikoncepce, Antikoncepce NOS, Prevence početí, Antikoncepce, antikoncepční metody, zamezení početí
Finnish Raskauden ehkäisy
Russian KONTRATSEPTSIIA, КОНТРАЦЕПЦИЯ
Croatian KONTRACEPCIJA
Polish Antykoncepcja
Hungarian Fogamzásgátlás, Fogamzásgátlás k.m.n.
Norwegian Befruktningshemming, Fertilitetskontroll, Fruktbarhetskontroll, Fødselskontroll, Prevensjon, Prevensjonsmetoder
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Contraception Management

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