Contraception
Contraception
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Contraception
, Birth Control, Provision of Contraception, Family Planning, Contraceptive Services
See Also
Contraceptive Selection in Diabetes Mellitus
Contraceptive Selection in Underlying Cardiovascular Disease
Contraceptive Selection in Seizure Disorder
Unintended Pregnancy
Confirmation of Non-Pregnant State
Emergency Contraception
Efficacy
First year failure rates of Contraception
Most effective methods: Permanent (<1 pregnancy per year in 100 women)
Vasectomy
: 0.15% failure rate
Tubal Ligation
: 0.5% failure rate
Hysteroscopic Sterilization
: 0.5% failure rate
Most effective methods: Reversible (<1 pregnancy per year in 100 women)
Implantable Contraception (e.g.
Nexplanon
): 0.05% failure rate
Levonorgestrel
IUD (e.g.
Mirena
): 0.2% failure rate
Copper-T IUD: 0.8% failure rate
Effective methods (6-12 pregnancies per year in 100 women)
Depo Provera
Injection: 6% failure rate
Oral Contraceptive
s: 9% failure rate
Contraceptive Patch
(e.g.
Ortho Evra
): 9% failure rate
Vaginal Contraceptive Ring
(
NuvaRing
): 9% failure rate
Contraceptive Diaphragm
: 12% failure rate
Least effective methods (>18 pregnancies per year in 100 women)
Male Condom
: 18%
Female Condom
: 21%
Withdrawal Method: 22%
Contraceptive Sponge
: 12% (nullip) to 24% (parous) failure rate
Natural Family Planning
: 24% failure rate
Vaginal Spermicide
: 28% failure rate
References
(2013) MMWR Recomm Rep 62(RR-05):1-60 +PMID:23784109 [PubMed]
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6205a1.htm
Preparations
Non-Hormonal Options
Male Condom
Female Condom
Contraceptive Diaphragm
Contraceptive Sponge
(no longer available in U.S.)
Cervical Cap
Vaginal Spermicide
Natural Family Planning
and Fertility awareness
Contraceptive Sponge
(returns to U.S. market in 2005)
Preparations
Hormonal Contraception
Oral Contraceptive
Depo Provera
Injectable (repeated every 3 months)
Intrauterine Device
Copper T-380A (
Paragard
) IUD: 10 years
Mirena
(5 year device)
Skyla
(3 year device)
Older devices included the one year
Progestasert
IUD (discontinued)
Vaginal Contraceptive Ring
(
NuvaRing
)
Contraceptive Patch
(
Ortho Evra
)
Implantable
Progesterone
Rods
Nexplanon
(single rod system approved for 3 years of Contraception)
Older devices included
Implanon
(lasted 2 years) and Norplant (lasted 5 years)
History
Confirmation of Non-Pregnant State
Menstrual history
Last Menstrual Period
Menstrual period regularity
Pregnancy history
Lactation
history
Most recent intercourse
Chronic medical problems (directs contraceptive selection as in management below)
Diabetes Mellitus
Cardiovascular Disease
Seizure
Disorders
Bariatric Surgery
Venous Thromboembolism
or
Thrombophilia
Migraine Headache
with aura
Hypertension
Tobacco Abuse
Chronic
Corticosteroid
use
Systemic Lupus Erythematosus
Antiphospholipid Antibody Syndrome
Sexual History
(and risks for STI)
Current and recent sexual partners
Condom
use
Prior
Sexually Transmitted Infection
(STI)
Other history related to contraceptive selection
Contraceptive use in the past and preferences
Intention for future pregnancy
Exam
Blood Pressure
Avoid combination
Oral Contraceptive
s in
Uncontrolled Hypertension
Body weight and BMI
Consider avoiding
Depo Provera
in low BMI patients (increased
Osteoporosis
risk)
Monitor weight for methods that may be associated with significant weight gain (e.g.
Depo Provera
)
Pelvic Examination
Not required for extra-pelvic forms of Contraception (e.g. OCP,
Depo Provera
,
Nexplanon
,
Contraceptive Patch
)
Indicated when placing
Intrauterine Device
,
Cervical Cap
,
Contraceptive Diaphragm
STD Testing may be performed at time of
IUD Placement
in asymptomatic patients (to avoid delays)
Avoid requiring
Pap Smear
or well woman physical exam prior to starting Contraception
Labs
Pregnancy Test
Confirmation of Non-Pregnant State
by history may also suffice
Management
Gene
ral
Initiation: Avoid barriers and delays
Start Contraception at time of visit (unless not able to reliably confirm
Non-Pregnant State
)
Bridge to longterm method if unable to confirm
Non-Pregnant State
Use non-intrauterine Contraception until repeat
Pregnancy Test
in 2-4 weeks
Compliance
Prescribe one year supply of Contraception
Help facilitate compliance (reminder systems, longterm Contraception)
Reassess Contraception compliance and method satisfaction at routine visits
Discuss permanent methods (e.g.
Vasectomy
,
Tubal Ligation
) if completed intended child bearing
Sexually Transmitted Infection
prevention
Make
Condom
s readily available as part of dual protection for those at risk of STI
Specific cohorts
Postpartum counseling on Contraception after delivery
Perimenopause
continuation of Contraception until
Menopause
or age 50 to 55 years old
Adolescent Health
counseling on Contraception and
Sexually Transmitted Infection
prevention
Consider
Long-Acting Reversible Contraception
are preferred (e.g. IUD, dermal implants)
Diedrich (2015) Am J Obstet Gynecol 213(5): 662 [PubMed]
Schmidt (2015) J Adolesc Health 57(4): 381-6 [PubMed]
Management
Contraceptive Selection in comorbid conditions
See
Contraceptive Selection in Diabetes Mellitus
See
Contraceptive Selection in Underlying Cardiovascular Disease
See
Contraceptive Selection in Seizure Disorder
History of
Bariatric Surgery
(only roux-en-Y affected due to malabsorption)
Avoid
Oral Contraceptive
s
History of
Venous Thromboembolism
Avoid all
Estrogen
products (
Oral Contraceptive
s,
NuvaRing
,
Ortho Evra
)
Migraine Headache
with aura
Avoid all
Estrogen
products (
Oral Contraceptive
s,
NuvaRing
,
Ortho Evra
)
Poorly controlled
Hypertension
Avoid all
Estrogen
products (
Oral Contraceptive
s,
NuvaRing
,
Ortho Evra
)
Corticosteroid
s chronically
Avoid
Depo Provera
(risk of
Osteoporosis
)
Tobacco Abuse
over age 35 years
Avoid all
Estrogen
products (
Oral Contraceptive
s,
NuvaRing
,
Ortho Evra
)
Cerebrovascular Accident
Avoid all
Estrogen
products (
Oral Contraceptive
s,
NuvaRing
,
Ortho Evra
)
Systemic Lupus Erythematosus
,
Antiphospholipid Antibodies
Avoid all
Estrogen
products (
Oral Contraceptive
s,
NuvaRing
,
Ortho Evra
)
References
(2006) Obstet Gynecol 107(6): 1453-72 [PubMed]
References
Klein (2015) Am Fam Physician 91(9): 625-33 [PubMed]
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