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Contraception
Effectiveness for contraception is measured by the technique's ability to prevent pregnancy in one year of use. Rates for perfect adherence differ from actual rates due to imperfect use.
We need to know indications, complications, etc.
- male condoms
- female condoms
- diaphragm
- hormonal contraception
- IUDs
- permanent contraception
- emergency contraception
Male Condoms
benefits
limitations
success rates
costs
Female Condoms
benefits
limitations
- doesn't protect against HPV or herpes
success rates
costs
Fertility Predictor
post-ovulation, symptothermal method, cervical mucous, calendar - require a woman to know her body really well and pay close attention. There is maybe a 10 day window of safety
benefits
limitations
success rates
costs
Diaphragm
- two step process: need contraceptive jelly
- must be left in for 6 hours after
- difficult to use in women who have had children
- can become damaged
- 94%/84%
Hormonal Contraception
normally a combination of estrogen and progesterone, generally 20-35 mcg ethinyl estradiol
no apparent long term fertility concerns, though it can take a while before things get going again
- 21 or 28 day cycles
- cyproterone acetate - antiandrogen
- drospirenone - antimineralocorticoid
- progesterone only
- 92% success
- taken continuously, and little allowance if a pill is missed
Evra: an estrogen/progesterone patch that is worn 3 weeks out of 4
- some controversy around DVT/PE
Vaginal Ring (Nuva Ring)
- estrogen and progesterone
- placed in vagina for 3 weeks out of 4
Depo Provera
- progesterone only injection every 12 weeks
- popular among younger women due to ease of use
- 99.7% if injections are received in time
- recent warnings about bone loss, perhaps more of a problem in younger people with long time use
Lunelle
- 99.9% once a month injection of estrogen and progesterone
- only in US
Implanon
- two implantable rods
- only in US
- potential problems getting them out
- 99.7%/ 97%
- many failures are due to missing pills or starting late
Intra Uterine Devices
copper-containing
- Nova T, slimline
- 99% effective
- can be left in from 30 months up to years
Mirena - progesterone-containing ; makes bleeding lighter
- small amounts of progesterone
- 99.9%
- lasts up to 5 years
- can cause infections in women with multiple partners
- difficult to insert in nulliparous women
Permanent Contraception
- male: 99.85% vasectomy
- female: 99.5% tubal ligation
- Essure: intra-fallopian tube coils that are inserted trans-cervically and induce scarring/closure
- not covered by MSI
- not possible for all patients
- requires dye test to confirm
Emergency Contraception
- pills taken within 72 hours of intercourse
- 'Yuzpe' regimen originally used with both estrogen and levonogestrel (synthetic progestin)
- OTC now
- "Plan B" - levonorgestrel: 85% success with less nausea
- IUCD can be inserted within 5 days of intercourse