Contraception

Introduction

The rationale of contraception is to prevent an unintended pregnancy.

  • According to 2011 data, about 45% of pregnancies are unintended in the United States, with about 42% of those resulting in abortions.

NOTE: Contraception should generally be continued for 1 year after the last period if >50 years (for 2 years if <50).



Contraceptive Methods

Effectiveness of Family Planning Methods

There are many factors in selecting contraception.

  • Effectiveness
  • Importance of not being pregnant
  • Likelihood and ability to adhere
  • Frequency of intercourse
  • Age
  • Cost and ability to pay
  • Adverse effects
  • Perceptions, misperceptions, risk-benefit
  • Concomitant drug use
  • Health status and habits
  • Patients' preference

Women with comorbid medical conditions (e.g. thromboembolic disease, hypertension, diabetes, HIV infection, obesity, pelvic infection and seizure disorders) should be offered contraceptive methods in accordance with the WHO Medical Eligibility Criteria for Contraceptive Use or other relevant guidelines (e.g. The United States Medical Eligibility Criteria for Contraceptive Use, 2016 (US MEC)).

NOTE: Condoms should always be used to reduce the risk of sexually transmitted infections.



Postabortion

Ovulation postabortion (induced or spontaneous) occurs between a mean of 21 to 29 days after the procedure with a reported range of 8 to 103 days. Thus, women can become pregnant before their first period.



Postpartum

After a live birth, World Health Organization advises of at least 24 months before attempting the next pregnancy to reduce the risk of adverse maternal, perinatal and infant outcomes. Hence, the postpartum is an ideal timing to counsel on contraception methods.

In an overview, contraception is not necessary in the first 21 days after delivery.

Progestin-only implants and intrauterine devices (both copper and LNG-releasing IUDs) can be inserted after delivery.

Progestogen-only contraceptives may be used at any time after delivery; if depot medroxyprogesterone is used before 6 weeks postpartum, it may cause heavy, irregular heavy bleeding.

Combined oral contraceptives (COC) is not recommended until 3 to 6 weeks postpartum as there may be increased risk of thrombosis before this time.

In women <6 months postpartum who are amenorrhoeic and full breastfeeding, the lactational amenorrhoea method can be >98% effective in preventing pregnancy.



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