Contraceptives

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Table Of Contents
1 Contraceptives
2 COMBINED HORMONES
3 PROGESTERONE ONLY
4 BARRIER METHODS
5 Intrauterine Device (IUDs)
6 NATURAL FAMILY PLANNING
7 STERILIZATION
8 Popular Sections

Contraceptives

  • 80% of women who have unprotected sex will get pregnant w/in one year.
  • Permanent → sterilization
  • Not permanent
    • Hormonal options: combo pill, progestin pill, norplant, depo provera, transdermal, ring
      1. CI’ed in smokers > 35 y/o
    • Barrier: spermacide, condoms, sponge, diaphragm, cervical cap
    • IUD: progesterone or copper
    • Post coital contraception:
      1. Can take high doses of combined OCPs for 72 hours after – decrease pregnancy by 74%.
      2. Plan B (levonorgestrel) is more effective than combined OCPs and does not cause nausea.
  • After 72 hours, must use mifepristone.
  • OCPs generally: effects decreased w/ abx, antifungals, and some barbituates.
  • May prolong theophylline, benzodiazepine, caffeine.

COMBINED HORMONES

  • OCP combined estrogen + progesterone:
    • Suppresses ovulation, alters cervical mucus, retards sperm entry, and discourages implantation. 1-2% failure.
    • Additional benefits: Protects against
      • Ovarian cancer, endometrial cancer, colorectal cancer
      • Uterine leiomyomata, ovarian cysts
      • Iron-deficiency anemia,
      • PID – thickens cervical mucus
      • Fibrocystic breast disease
      • Acne
      • Good for bone mineral density
    • Absolute contraindications:
      • Known thrombogenic mutations or previous events,
      • CAD or cerebrovascular disease,
      • Cigarette smoking and > 35 y/o
      • Uncontrolled HTN
      • Diabetes w/ complications,
      • Breast or endometrial cancer, or undiagnosed vaginal bleeding
      • Liver disease
      • Congenital hyperlipidemia
    • Relative contraindications:
      • Diabetes in general
      • Obstructive jaundice in pregnancy
      • Epilepsy – drugs may decrease the effectiveness
      • Migraines with aura – not just headaches alone.
      • Breastfeeding
      • Morbid obesity
  • Transdermal patch:
    • combined norelgestromin and estradiol, similar to OCPs except the increased risk of blood clots – remember the Williams sisters.
  • Ring:
    • etonogestrel (progesterone) and estradiol. Wear it for three weeks.

PROGESTERONE ONLY

  • Benefits:
    • Lower risk of blood clots than combined estrogen + progesterone.
  • Minipill w/ progesterone only:
    • Decreases and thickens cervical mucus, prevents uterine lining from thickening. 1-3% failure.
    • Best for breastfeeding!
  • Depo-Provera:
    • Injectable progestin, given every 3 months and lasts for 14 weeks.
    • Side effects: weight gain, irregular menses (50% have amenorrhea), hirsutism, prolonged return to fertility
  • Implanon:
    • progesterone only, effective for 3 years. The failure rate is < 1% for women who weigh less than 150 lbs.

BARRIER METHODS

  • Female condom
    • failure rate = 21 to 26%
  • Sponge
    • failure = 18 to 28%. Rare risk of toxic shock.
  • Diaphragm
    • – should leave in for 6 hours after intercourse.
    • With spermicide, failure rate is 6-18%
  • Cervical cap
    • – can leave for up to 48 hours. Rare risk of TSS.
    • Failure = 18%
  • Spermicides alone:
    • failure rate is 20-30%
  • Spermicide + condom
    • = very effective, like OCPs

Intrauterine Device (IUDs)

  • About:
    • All IUDs alter uterine and tubal fluids, inhibiting sperm entry through cervix.
    • Copper does so via an inflammatory process.
    • Progesterone will also thin uterine lining.
  • Recommended for:
    • women in monogamous relationships because of risk of PID.
  • Contra-Indicated:
    • if endometritis w/in 3 months or recurrent endometritis, PID, STD, pregnancy, anatomic distortions, HIV.
  • Relative CI’s
    • – many are obvious, also known or suspected malignancy, previous problems with an IUD
  • Copper:
    • 4-5% failure rate;
    • Mirena: failure rate < 1%

NATURAL FAMILY PLANNING

  • Abstain during the 10 days of greatest fertility.
  • Can monitor temp before out of bed in the morning – will drop by several tenths of a degree before ovulation, then return to normal after ovulation.
  • Can also monitor cervical mucus.
  • Failure is 14-47% per year.

STERILIZATION

  • Vasectomy is considered safer than tubal ligation – can be done as an outpatient.

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