Contraception defined as an intervention that reduces the chance of pregnancy after sexual intercourse.
It is estimated that at least 99% of women who ever had sexual intercourse used at least one contraceptive method in their lifetime.
Approximately 88% of sexually active women not seeking pregnancy use contraception at any given time.
All non-barrier contraceptive methods require a prescription by clinician.
Contraception is, therefore, a common reason for women ages 15-50 years of age to seek healthcare.
Reversible contraceptive methods are typically grouped as hormonal or non-hormonal and long acting or short acting.
Except for behavioral methods, condoms and spermatocyte, contraceptive methods are only available by prescription in the US.
Hormonal contraceptives include progestins and estrogen are steroid or lipid hormones.
Hormonal contraception contains of progesterone with or without an estrogen.
Progesterone is the only naturally occurring progestin; most contraceptive progestins, such as levonorgestrel and norethindrone, are synthesized from testosterone.
Progestins provide contraception by suppressing gonadotropin releasing hormone from the hypothalamus, resulting in lower luteinizing hormone from the pituitary, which in turn prevents ovulation.
Progestin only contraceptive pill benefits include ease of initiation and discontinuation, fertility returns within one cycle, and has a good safety profile, and minimal effects on hemostatic parameters.
Progestins also have a direct negative affect on cervical mucus permeability.
Progestins reduce endometrial receptively and sperm survival and transport to the Fallopian tube
Estrogens suppress gonatropins and follicle stimulating hormone, preventing development of a dominant follicle all enhancing contraceptive effectiveness.
Estrogen and progesterone’s most important contribution in contraception is the reduction of irregular bleeding.
In most combined hormonal contraceptives ethinylestradiol is the estrogen component.
Progesterone only contraceptive pills include norethindrone and drospirenone containing formulations.
Combine hormonal methods that contain both estrogen and progesterone include a daily oral pill, a monthly vaginal ring, and weekly transdermal patch.
The effectiveness of these methods is two pregnancies per 100 users per year, but because there is not full adherence, typical effectiveness is 4to 7;pregnancies per hundred women per year.
Includes intrauterine devices and subdermal implants.
Long-acting reversible contraception (LARC) is efficacious and associated with high rates of continued contraception.
Majority of patients are eligible for the LARC use.
LARC is underutilized, accounting for only 14.3% of all contraceptive use.
Hormonal contraception requiring user involvement makes up 31,8%of contraceptives, while sterilization contraception accounts for 28.2%.
Medroxyprogesterone acetate depot is an injectable progesterone is available and is administered at 12 to 14 week intervals.
Medroxyprogesterone acetate depot is associated with irregular uterine bleeding, and it is the only contraceptive method that can delay return to fertility.
The effectiveness of depot medroxyprogesterone and progesterone only contraceptive pills is 4 to 7 pregnancies per hundred women in a year.
Progestin only long acting methods of IUD and subdermal implants have effective rates of less than one pregnancy per 100 women per year similar to permanent methods such as tubal ligation or vasectomy.
Combined hormonal methods that contain both estrogen and progesterone include a daily oral pill, a monthly vaginal ring, and weekly transdermal patch.
The effectiveness of these methods is two pregnancies per 100 users per year, but because there is not full adherence, typical effectiveness is 4to 7;pregnancies per hundred women per year.
The greatest advantage of combined hormonal control contraceptives over progestin only methods is their ability to produce a consistent, regular bleeding pattern.
The most significant risk of combined hormonal contraception is estrogen mediated increases in thrombotic events.
Large studies have identified the risk of deep vein thrombosis at baseline in reproductive age do women to be approximately 2 to 10 per 10,000 women years.
The risk associated with combined hormonal contraception is approximately 7 to 10 venous thrombotic events per 10,000 women years.
The absolute risk of ischemic stroke in reproductive aged women not taking combined hormonal contraception is 5 per 100,000 women years and combined hormonal contraception is associated with additional absolute risk of approximately two per hundred thousand with an overall risk of 7 per 100,000.
The risk of venous thromboembolism is substantially greater in pregnancy.
Nonhormonal behavioral contraceptive methods include penile withdrawal before ejaculation and fertility awareness based methods, such as natural family planning, the rhythm method.
The effectiveness of such methods depend on patient education, cycle regularity, patient commitment, and the patient’s ability to avoid intercourse or ejaculation during the time of peak fertility.
Metaanalysis show that women at risk for undesired pregnancy report failure rates of 22 pregnancies for 100 women-years for fertility awareness methods.
Additional non-hormonal methods to prevent sperm from entering the upper reproductive track through a physical barrier include condoms in diaphragms, or through agents that kill sperm or impair the motility
First year use of these above methods is 13 pregnancies per 100 women in a year.
The use of copper bearing IUDs is associated with pregnancy rate of 1% per year.
Copper bearing IUDs mechanism of action is spermicidal with effects of copper salts and endometrial inflammatory changes.
Copper bearing IUDs major difficulties is the increase in the amount, duration, and discomfort related to mencies mostly during the first 3 to 6 months of use.
Copper bearing IUDs do not increase risk of tubal infertility.
Emergency contraceptives that reduce pregnancy risk when used after unprotected intercourse, and is most effectively achieved with a copper IUD, which reduces pregnancy risk to 0.1% when placed within five days of unprotected intercourse.