Table of contents
Absolute Contraindications to Contraception
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- Away to remember:
Think 3 things: pregnancy, undiagnosed vaginal bleeding, cancer
Then think of 5 cardinal risk factors of heart disease (smoking, hypercholesterolemia, hypertension, family hx (thromboembolism), diabetes (proliferative retinopathy).
Contraception Options and Stats
| Unintended pregnancies within first year of use (%)26 | ||||||||
|---|---|---|---|---|---|---|---|---|
| Method | Typical use* | Perfect use † | Women continuing use at one year (%)26 | Frequency of use | Protection against STDs8 | Use while breastfeeding8 | Cost‡ | |
| None | 85 | 85 | — | — | — | — | — | |
| Spermicide | 29 | 15 | 42 | Each time | No § | Yes | $ 0.35 to 12 | |
| Withdrawal | 27 | 4 | 43 | Each time | No | Yes | None | |
| Periodic abstinence | ||||||||
| Calendar method | 25 | 9 | ∼ 50 | Each time | No | Yes | None | |
| Ovulation method | 25 | 3 | ∼ 50 | Each time | No | Yes | None | |
| Symptothermal method‖ | 25 | 2 | ∼ 50 | Each time | No | Yes | None | |
| Postovulation method | 25 | 1 | ∼ 50 | Each time | No | Yes | None | |
| Cervical cap: parous women∥ | 32 | 26 | 46 | Each time | No | Yes | 30 to 40 | |
| Cervical cap: nulliparous women∥ | 16 | 9 | 57 | Each time | No | Yes | 30 to 40 | |
| Diaphragm∥ | 16 | 6 | 57 | Each time | Yes# | Yes | 30 to 40 | |
| Female condom | 21 | 5 | 49 | Each time | Yes | Yes | 2 to 3 each | |
| Male condom | 15 | 2 | 53 | Each time | Yes | Yes | 0.50 to 2 each | |
| OCPs | 8 | 0.3 | 68 | Taken daily | No | ** † † | 20 to 50 per cycle | |
| Contraceptive patch | Unknown | 0.3 | 68 | Applied weekly | No | ** | 36 per month | |
| Vaginal ring | Unknown | 0.3 | 68 | Inserted every 4 weeks | No | ** | 43 per month | |
| Progestin-only OCPs | 3 | 0.3 | 56 | Given every 12 weeks | No | Yes | 30 to 35 every 3 months‡ ‡ | |
| Copper-containing IUD | 0.8 | 0.6 | 78 | Inserted every 10 years | No | Yes | 250 to 300 every 10 years§ § | |
| Levonorgestrel intrauterine system | 0.1 | 0.1 | 81 | Inserted every 5 years | No | Yes | 300 to 400 every 5 years§ § | |
| Female sterilization | 0.5 | 0.5 | 100 | Done once | No | Yes | 1,200 to 2,500 ∥ ∥ | |
| Male sterilization | 0.15 | 0.10 | 100 | Done once | No | Yes | 250 to 1,000 | |
"
"Calendar Method"
- Cycle starts on the FIRST day of their menstrual period
- Ovulation happens 10-14 day of cycle.
- Egg survives maximum 12-24 hours before breaking up.
- Sperm survive up to 4 days in the uterus post-ejaculation.
- Theory behind method (lets say your ovulation happens on day 14)
- Can "in theory" have sex from day 1-10 (after this sperm will survive long enough to fertilize the egg on day 14). (Keep in mind that this includes the period).
- Then egg released for 2 days max
- Then can resume having sex after day 16 (after egg dies).
- These numbers need to be adjusted based on the woman's cycle. You calculate the numbers based on principles:
- After ovulation, woman CONSISTENTLY has 14 days before start of next cycle (bleeding). (Luteal phase length)
- Therefore, adjust time of ovulation based on cycle length. (Follicular phase length).
- Many methods exist to calculate these dates and determine "safe dates" to have sex.
- Luteal phase (after egg released) CONSISTENTLY lasts 14 days. However, can be different.
- Generally cannot use this method if cycle is <26d
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- Find the shortest cycle in your record.
- Subtract 18 from the total number of days.
- Count that number of days from day one of your current cycle, and mark that day with an X. Include day one when you count.
- The day marked X is your first fertile day.
To predict the last fertile day in your current cycle
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- Find the longest cycle in your record.
- Subtract 11 days from the total number of days.
- Count that number of days from day one of your current cycle, and mark that day with an X. Include day one when you count.
- The day marked X is the last fertile day.
Patch
- Only one that's approved by FDA
- Same efficacy as pill with perfect use.
- IN theory less side effects because no first-pass metabolism by liver.
- Apply weekly, "change patch day", and after 3 patches, leave it off for 7 days for period.
- designed to release: 20 µg/day of ethinyl estradiol and 150 µg/day of norelgestromin
- S/E:
- Reasons for stopping: nausea and/or vomiting (2.4%), application site reaction (1.9%), breast discomfort, engorgement or pain (1.9%), headache (1.1%), and emotional lability (1.0%)
- Adverse events: breast discomfort, engorgement or pain (22%), headache (21%), application site reaction (17%), nausea (17%), upper respiratory tract infection (10%), menstrual cramps (10%), and abdominal pain (9%)
Intrauterine System
- 20mcg of lenovogestrel per day
- lasts 5 years.
- costs $400
- As effective as copper IUD - comparable to surgical sterilization
- Less bleeding and dysmenorrhea (unlike copper).
- May have irregular bleeding x6mo when starting followed by light menses.
- 20% amenorrhea at one year of use.
- local progesterone atrophies the endometrial lining, and Estradiol levels maintained - no osteopenia.
- Maybe slight increase in headaches and acne
- When stops, may take up to 12mo for period to return.
- Effectiveness similar to surgical sterilization
- costs $200
- Side effects:
- Heavy bleeding.
- High risk of ectopic if pregnancy does occur.
- lower risk of PID
- Risk of expulsion
Side Effects
- Controversial: in some women increases libido, in some women decreases it (studies aren't consistent). However it appears that there is a CHANGE in libido using OCP.
- apparently monophasic are the worst at this
- The non-oral forms (such as patch), do not have an effect on libido.
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