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contraception

Indication: - prevention of pregnancy - offer to all women of child-bearing potential [2] * discuss contraception with teens at every visit regardless of their sexual history [29] * 1st discussions should occur between ages 13-15 * stress information on the most effective contraceptive methods, i.e. intrauterine devices or contraceptive implant [29] Epidemiology: 1) 1/2 of all pregnancies in the US are unintended [2] 2) 1/5 of pregnancies occur while using some form of contraception 3) most pregnancies occur because of user failure, not method failure Methods: Contraceptive methods: 1) natural methods: a) basal body temperature changes to time of ovulation b) cervical mucus examination c) effectiveness of use of combined methods is 80-98%/year 2) barrier methods 3) hormonal contraceptives 4) sterilization 5) long-acting contraceptives* [20] a) intrauterine device (IUD) b) subdermal implants - subdermal etonogestrel-releasing implants are the most effective contraceptives available [26] c) transdermal contraceptive patch d) 20 times more effective in preventing pregnancy than shorter-acting methods (birth control pills, contraceptive patch, NuvaRing) [9] 6) male contraception a) condom b) coitus interruptus c) vasectomy d) androgens [6] investigational 7) post-coital contraception * recommended 1st line for sexually-active girls & women [18,21] * pelvic examinations are not necessary to prescribe contraceptive or refer patients for IUD placement [18] Complications: - estrogen exposure: a) lowest (estrogen-containing) with Nuva Ring [4] b) risk of thromboembolism c) see estrogen adverse effects - copper IUD & levonorgestrel IUD safest for women at risk for venous thromboembolism [2] Management: - pregnancy test prior to initiation of contraception if > 1 week since last menstrual period [2] - avoid estrogen-containing contraceptives with warfarin anticoagulation (see anticoagulation) - avoid estrogen-containing contraceptives in women with - migraine with aura (further increases risk of stroke) [2] - hypertriglyceridemia [27] - contraception safe for women with HIV1 [10] - use barrier method (condom) in addition to hormonal contraception for women at risk of STD [2,11] - condoms alone one of the least effective forms of contraction [31] Notes: - free contraception - associated with increased frequency of sexual intercourse - does not increase number of sex partners or incidence of sexually-transmitted disease - free, long-acting contraception lowers preganacy rate in teenage girls [19] - highest rates of highly effective reversible contraception (intrauterine devices or subdermal progestin implants) in low-income women eligible for free contraception after abortion [28] - companies exempt from ACA's requirement to pay for contraception

Related

contraceptive family planning

Specific

hormonal contraception long-acting reversible contraception (LARC) Natural cycles; fertility awareness post coital contraception (Plan B, morning after)

General

clinical procedure

References

  1. Journal Watch, Mass Med Soc 19(23):182 (Dec) 1999
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2022 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Journal Watch 25(10):83, 2005 Grimes DA, Gallo MF, Grigorieva V, Nanda K, Schulz KF. Steroid hormones for contraception in men: systematic review of randomized controlled trials. Contraception. 2005 Feb;71(2):89-94. PMID: 15707556
  4. van den Heuvel MW, van Bragt AJ, Alnabawy AK, Kaptein MC. Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations: the vaginal ring, the transdermal patch and an oral contraceptive. Contraception. 2005 Sep;72(3):168-74. PMID: 16102549
  5. Long-acting reversible contraception National Institute for Health and Clinical Excellence (NICE) http://www.nice.org.uk/page.aspx?o=275481
  6. Liu PY, Swerdloff RS, Christenson PD, Handelsman DJ, Wang C; Hormonal Male Contraception Summit group. Rate, extent, and modifiers of spermatogenic recovery after hormonal male contraception: an integrated analysis. Lancet. 2006 Apr 29;367(9520):1412-20. Review. PMID: 16650651
  7. Prescriber's Letter 13(8): 2006 Hormonal Contraception to Existing Drugs Detail-Document#: 220809 (subscription needed) http://www.prescribersletter.com
  8. Centers for Disease Control and Prevention (CDC) Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion Morbidity and Mortality Weekly Report (MMWR) May 28, 2010 / Vol. 59 U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf - World Health Organization Medical eligibility criteria for contraceptive use http://whqlibdoc.who.int/publications/2009/9789241563888_eng.pdf
  9. Winner B et al Effectiveness of Long-Acting Reversible Contraception N Engl J Med 2012; 366:1998-2007 PMID: 22621627 http://www.nejm.org/doi/full/10.1056/NEJMoa1110855
  10. Centers for Disease Control and Prevention Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised Recommendations for the Use of Hormonal Contraception Among Women at High Risk for HIV Infection or Infected with HIV MMWR June 22, 2012 / 61(24);449-452 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6124a4.htm
  11. Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17;59(RR-12):1-110. PMID: 21160459 many of these guidelines withdrawn from NGC Jan 2016
  12. Centers for Disease Control and Prevention U.S. Selected Practice Recommendations for Contraceptive Use, 2013. Adapted from the World Health Organization Selected Practice Recommendations for Contraceptive Use, 2nd Edition. MMWR. vol 62. June 14, 2013 http://www.cdc.gov/mmwr/pdf/rr/rr62e0614.pdf
  13. Amy JJ, Tripathi V. Contraception for women: an evidence based overview. BMJ. 2009 Aug 7;339:b2895. PMID: 19666684
  14. Patel A, Schwarz EB; Society of Family Planning. Cancer and contraception. Release date May 2012. SFP Guideline #20121. Contraception. 2012 Sep;86(3):191-8 PMID: 22682881 (corresponding NGC guideline withdrawn Feb 2018)
  15. Secura GM et al. Change in sexual behavior with provision of no-cost contraception. Obstet Gynecol 2014 Apr; 123:771 PMID: 24785603 http://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=2014&issue=04000&article=00007&type=abstract
  16. Fairchild DG and Sofair A Supreme Court Says Companies Exempt from ACA's Contraception Coverage Requirement Physician's First Watch, July 1 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  17. American Congress of Obstetricians and Gynecologists ACOG Statement on OTC Access to Contraception September 9, 2014 http://www.acog.org/About-ACOG/News-Room/News-Releases/2014/ACOG-Statement-on-OTC-Access-to-Contraception
  18. Orciari Herman A, Fairchild DG Long-Acting Contraceptives Recommended as First Choice for Teens. Physician's First Watch, Sept 30, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - COMMITTEE ON ADOLESCENCE. Contraception for Adolescents. Pediatrics. September 29, 2014 PMID: 25266430 http://pediatrics.aappublications.org/content/early/2014/09/24/peds.2014-2299.full.pdf+html - Ott MA et al Contraception for Adolescents. Pediatrics. September 29, 2014 PMID: 25266435 http://pediatrics.aappublications.org/content/early/2014/09/24/peds.2014-2300.full.pdf+html
  19. Schwarz EB Free, Long-Acting Contraception Dramatically Lowers Pregnancy Rate Among Teens. Physician's First Watch, Oct 2, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org cites NEJM
  20. Harper CC et al Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial. Lancet. June 16, 2015 PMID: 26091743 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2962460-0/abstract
  21. Committee on Gynecologic Practice Long-Acting Reversible Contraception Working Group Number 642, October 2015 Increasing Access to Contraceptive Implants and Intrauterine Devices to Reduce Unintended Pregnancy. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Increasing-Access-to-Contraceptive-Implants-and-Intrauterine-Devices-to-Reduce-Unintended-Pregnancy
  22. MacGregor EA Contraception and headache. Headache. 2013 Feb;53(2):247-76 PMID: 23432442
  23. Champaloux SW, Tepper NK, Curtis KM et al. Contraceptive use among women with medical conditions in a nationwide privately insured population. Obstet Gynecol 2015 Dec; 126:1151 PMID: 26551183
  24. Curtis KM, Tepper NK, Jamieson DJ, Marchbanks PA. Adaptation of the World Health Organization's Selected Practice Recommendations for Contraceptive Use for the United States. Contraception. 2013 May;87(5):513-6. PMID: 23040134
  25. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC). U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep. 2013 Jun 21;62(RR-05):1-60. PMID: 23784109 Free full text
  26. Bimla Schwarz E The Etonogestrel-Releasing Contraceptive Implant: Why Stop at 3 Years? NEJM Journal Watch. Oct 20, 2016 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Ali M, Akin A, Bahamondes L et al. Extended use up to 5 years of the etonogestrel-releasing subdermal contraceptive implant: Comparison to levonorgestrel- releasing subdermal implant. Hum Reprod 2016 Sep 26 PMID: 27671673 Free Article
  27. NEJM Knowledge+. Question of the Week. Jan 24, 2017 http://knowledgeplus.nejm.org/question-of-week/835/ - Berenson AB, Rahman M, Wilkinson G. Effect of injectable and oral contraceptives on serum lipids. Obstet Gynecol. 2009 Oct;114(4):786-94. PMID: 19888036 Free PMC Article - World Health Organization. Medical eligibility criteria for contraceptive use. Fifth edition, 2015. http://who.int/reproductivehealth/publications/family_planning/en/
  28. Goyal V, Canfield C, Aiken AR, Dermish A, Potter JE. Postabortion contraceptive use and continuation when long-acting reversible contraception is free. Obstet Gynecol 2017 Apr; 129:655. PMID: 28277358 http://insights.ovid.com/crossref?an=00006250-900000000-98459
  29. American College of Obstetricians and Gynecologists (ACOG) Counseling Adolescents About Contraception Committee Opinion Number 710, August 2017 https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Counseling-Adolescents-About-Contraception
  30. Tepper NK, Krashin JW, Curtis KM, Cox S, Whiteman MK. Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2016: Revised Recommendations for the Use of Hormonal Contraception Among Women at High Risk for HIV Infection. MMWR Morb Mortal Wkly Rep 2017;66:990-994 https://www.cdc.gov/mmwr/volumes/66/wr/mm6637a6.htm
  31. Woodhams EJ, Gilliam M. Contraception. Ann Intern Med. 2019;170:ITC18-ITC32. PMID: 30716758
  32. The Faculty of Family Planning and Reproductive Health Care http://www.ffprhc.org.uk/