Contraception (medical methods)

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disclaimer. [edit intro] Contents 1 Human fertility 2 Sex can cause
other conditions besides pregnancy 3 Success and failure rates in
contraception 4 Clinical practice guidelines 5 Methods 5.1 Natural
family planning methods 5.2 Spermicides 5.3 Barrier methods 5.3.1
Condoms for men 5.3.1.1 Latex allergy 5.3.1.2 Effectiveness of male
condoms 5.3.2 Female barriers: diaphragm, and others 5.3.2.1 Condoms
for women 5.3.2.2 Cervical cap 5.3.2.3 Diaphragm 5.4 Intrauterine
devices (IUD) 5.5 Hormonal medications (systemic) 5.5.1
'Morning-after' pill (emergency contraception) 5.5.2 Induced abortion
5.5.3 Oral contraceptive pills for birth control 5.5.3.1 Oral
contraceptive pills for other purposes 5.5.4 Long-acting hormonal
contraceptives 5.5.4.1 Hormonal patch 5.5.4.2 Vaginal ring 5.5.4.3
Intramuscular injections 5.6 Surgical methods (reproductive
sterilization) 6 Ethics of using medical contraceptives 7 References
This article is about Contraception (medical methods). For other uses
of the term Contraception, please see Contraception (disambiguation).
Medical methods of contraception are forms of pregnancy prevention
that include barrier contraceptives (condoms, cervical caps, etc.),
birth control pills or patches (i.e, hormonal contraceptives), and
IUD's (intrauterine devices). Medical contraceptive methods are all
far more effective at preventing pregnancy than natural family
planning. Unlike surgical sterilization, medical methods of pregnancy
prevention do not usually result in permanent sterility. No method of
birth control (medical or natural) is guaranteed to prevent all
pregnancies, other than complete abstinence from sexual intercourse.
Each medical method has potentially adverse physical effects,
including failure to work as intended with the result being pregnancy.
Human fertility[edit] When an egg and sperm merge, the stage is set
for pregnancy. Normally, fertilization occurs in the fallopian tube
where the egg will begin dividing as it travels toward the uterus,
where it will become implanted. Some methods of contraception try to
prevent fertilization by: (1) stopping the release of eggs (birth
control pills, injections, and patches); (2) shielding the egg from
sperm cells (barrier methods including condoms and diaphragms); and/or
(3) impairing the sperm cells' ability to merge with the egg
(spermicides in foams and sponges, copper in copper-containing IUDs).
Another major strategy for contraception is to (4) prevent the
implantation of a newly fertilized egg into the womb (intrauterine
device (IUD)). Because the production of gametes (the ovum and
spermatazoon that are capable of uniting to produce a zygote, the very
first stage of a baby) is different in women and men, the strategies
for stopping their production or release by hormonal methods are also
different. Women release egg cells (ovulation) periodically —
usually about every 28 days, from puberty (menarche) to menopause; by
contrast, men produce sperm cells (spermatogenesis) continuously after
puberty. For these and other reasons, hormonal treatments to prevent
production of mature gametes are only available for women at this
time. None of the medical methods of contraception, even when used in
combination, is completely effective in preventing pregnancy when a
woman of child-bearing age and a fertile man have sexual intercourse.
Each medical contraception method has some health risks for women, and
the most effective methods also pose the greatest health risk. That
said, the overall risk of using the more effective methods, hormonal
contraceptives (birth control pills and patches) and IUDs (once they
are already implanted) is quite low, and the risk of using barrier
methods such as condoms and chemical spermicides is much lower. Sex
can cause other conditions besides pregnancy[edit] Besides the risk of
pregnancy, sexual activity increases the transmission of some diseases
and increased in incidence of certain conditions. Except for condoms,
medical contraception methods offer little or no protection against
sexually transmitted diseases, and might even increase the risk of
contracting an infection. Insertion of the IUD, in particular, is
associated with a high risk of pelvic inflammatory disease if a
sexually transmitted infection is present when the device is inserted
into the uterus. Pelvic inflammatory disease is a chronic bacterial
infection of the female reproductive tract that is an important cause
of infertility. Some chemical spermicides irritate the genital tract
and have been shown to increase the rate of HIV transmission in both
male and female partners. Success and failure rates in
contraception[edit] Medical methods of contraception are usually
described as having a particular success rate. These are summarized
and tabulated by the United States Centers for Disease Control and
Prevention.[1] This is the percentage of sexually active heterosexual
women of childbearing age using the method over the course of a year
who do not become pregnant. For example, used properly, condoms are
usually described as being 98% effective. Conversely, the failure rate
of contraceptives is the percentage of women who become pregnant over
the course of a year despite using the method. For a hundred women
whose mates used condoms, a failure rate of 2% means that two of them
will become pregnant in that year. Another way that this 2% rate is
expressed in the medical literature is as "two pregnancies per hundred
woman-years". A given method (such as male condoms) might be accepted
as 98% effective, but real effective rates are often lower because of
improper or inconsistent use of the contraceptive; for women under age
25 in the USA, male condoms are closer to 90% effective as
contraceptives. It is easy to assume that the percentage used to
describe effectiveness relates to a comparison with a control group
who are not using contraception. This is not accurate. When no attempt
at birth control is used by sexually active couples who desire
children, the rate of pregnancy is not 100%. Instead, after one year,
about 85% of women will have become pregnant. The remaining couples
are called infertile, and are considered candidates for medical
evaluation of infertility or subfertility, should they so desire. Even
without this evaluation, and without any treatment, some will go on to
establish pregnancies. Other methods (such as an IUD) have a success
rate that is independent of the users' compliance. In other words,
some methods have one level of effectiveness for 'perfect-use' and
another level for 'actual-use', but others, such as the IUD, have an
effectiveness that is completely independent of conscious motivational
acts by the user. Because these attributes are important when
discussing birth control, more detailed information on effectiveness
than the overall pregnancy rate is included for each of the methods
presented here. Similarly, the incidence of side effects and
complications of each method differ according to the individual
characteristics of the women and men using them, and these relative
risks are also discussed. In medicine, the choice of medical
contraceptives is tailored to the individual characteristics of the
user. Clinical practice guidelines[edit] Clinical practice guidelines
are available: Centers for Disease Control and Prevention[1] World
Health Organization[2] Methods[edit] Long acting methods have been
reviewed.[3] Natural family planning methods[edit] For more
information, see: Natural family planning. Natural family planning,
based on abstinence during the days of the month when the female is
ovulating, is the least reliable form of birth control, whereby one in
five women will likely become pregnant if sexually active and using
only this method.[4] Spermicides[edit] The word 'spermicide' is
usually used to refer to a product that is applied specifically for
its spermicidal qualities. Spermicides are often used with, or
incorporated into, other medical means of contraception. Technically,
a spermicide is any material that is toxic to sperm, and, despite the
"-cide" suffix, may not kill sperm so much as disable them
sufficiently to halt their mobility. Some chemical spermicides are
applied to condoms, or locally applied inside the vagina. However, the
action of some medical contraceptives that are not ordinarily
considered to be spermicides is, in fact, spermicidal. For example,
the copper-containing IUDs primarily prevent fertilization by their
toxic actions on sperm. Spermicides change the cell membrane of sperm
and therefore make sperm inactive. Nonoxynol-9, a widely used
spermicide, can cause epithelial damage to the lining of the vagina
and rectum, and this damage can increase the risk of transmission of
HIV. Nonoxynol-9 is the only spermicide approved for use in the USA.
"In general, when used alone, spermicides have a failure rate of
approximately 15% per year with perfect use but double that rate with
typical use." [5] Since the increased risk of HIV transmission was
reported by the World Health Organization in 2001, spermicides have
been considered potentially problematic as contraceptives for
monogomous women whose partners may be bisexual or using intravenous
drugs, and for women who have many sexual partners, especially if not
used in conjunction with male condoms, which offer some protection
from the virus. Barrier methods[edit] Barrier methods try to
physically prevent egg and sperm from coming into contact. Basically,
this is attempted by either putting up a physical barrier to semen in
the female tract, or by disabling the sperm so that it has poor
mobility and a poor chance of fertilizing the egg, or both physically
blocking the ejaculate and disabling the motility of sperm cells. The
human sperm cell is normally able to swim, propelled by a long tail
called a flagellum. When sperm cannot swim properly, they are much
less likely to reach the egg. Further, when sperm are not normally
motile, that is not swimming strongly, it is often a sign of being
more generally impaired, and overall less likely to accomplish
fertilization even if they do reach the egg. Condoms for men[edit] A
condom is a thin, strong, non-porous sheath of material that fits over
the glans and shaft of the erect penis. Historically, condoms were
made from natural materials, such as sheep intestines. However,
synthetic materials, such as latex, are more effective for containing
semen and also offer some protection against infective agents, such as
viruses, that are much smaller than sperm cells. Condoms have become
increasingly available to the public in most parts of the world since
the AIDS crisis, and are the only form of contraception that (when
used correctly) can reduce both the risk of pregnancy and the
transmission of sexually transmitted infections. The effectiveness of
condoms varies according to the individual product, and only good
quality condoms are effective. Sperm cells are so small that a visible
hole in a condom renders it useless. In some parts of the world,
condoms are not of high enough quality to prevent sperm (or viruses)
from being transmitted into the female genital tract, and these
function as sham medical devices rather than true condoms. [6] The
effectiveness of a condom of good quality depends on exactly how it is
used. By placing a male condom over an erect penis, semen and
pre-ejaculate can be prevented from entering the vagina, stopping
pregnancy from occurring; a condom can also prevent transmission of
some sexually transmitted infections, including HIV, the virus that
causes AIDS. When used correctly, the efficacy rate for the prevention
of both pregnancy and sexually transmitted infections is 98%.[7]
Water-based lubricants increase the effectiveness of condoms by
reducing the chance of a tear, but oil-based products degrade latex
condoms and must never be used with them latex. Polyurethane condoms
or non-latex condoms are not affected by oil-based products. Even when
high quality condoms containing spermicide are used appropriately,
pregnancy sometimes occurs and sexually transmitted diseases,
including HIV, may be transmitted. Latex allergy[edit] Latex allergy
causes symptoms which can be very severe for people who are allergic
to latex materials. Latex condoms cannot be used safely if either
partner is allergic to latex. Since the 1990s, an alternative to latex
condoms has been marketed. Polyurethane condoms and synthetic
elastomer condoms are not allergenic to individuals with sensitivities
to latex, and, because they resist oxidation, they have a long shelf
life and are compatible with oil-based lubricants. However, non-latex
condoms break more easily than latex condoms and there are no good
data, at present, to show whether or not they are as effective for
contraception. Some non-latex condoms are not formfitting, and have
been shown to be ineffective contraceptives. [8]. Effectiveness of
male condoms[edit] Failure rates vary according to relative risk of
users While condoms, when used appropriately, are said to be 98%
effective in preventing both pregnancy and the spread of sexually
transmitted infections, these statistics consider all users, and not
just the highest risk users. If a woman is having vaginal sexual
intercourse (coitus) with a fertile man while ovulating, this 98%
statistic may not apply even if the condom is used perfectly;
similarly, if, over a year, a hundred HIV-negative women had
intercourse solely with men who were not only HIV-positive, but who
also had high concentrations of HIV antibodies and were actively
shedding virus, it can not be concluded that only two of them would
become HIV-positive. This 98% effectiveness rate involves the
statistical realities that women sometimes have coitus when they are
not fertile, and that people sometimes have sex with men who do not
have any sexually transmittable diseases. For these reasons, most
physicians advise discretion in choosing sexual partners for both men
and women as part of the practice of 'safer sex', and awareness of the
days of maximal fertility for women using barrier methods for
contraception to reduce their chances of an unwanted pregnancy.
Protection varies according to compliance: typical use is less
effective than perfect use The Effectiveness rating of male condoms
has been estimated from retrospective studies in which participants
were asked about their birth control methods. Although condoms are
effective for contraception, and the rates quoted here have been
derived from this evidence, the actual rate of effectivenesss among
groups of users is not precisely known. Male condoms, like some other
barrier methods, require a deliberate act by those who use them in
every instance of sexual intercourse. Further, if pregnancy and
sexually transmitted disease are to be prevented, the penis cannot
touch a woman's genital area unless properly covered by a condom.
Using a condom, but only after such touching, or allowing such
touching after the removing the condom, markedly reduces protection.
For these reasons, experts caution that male condoms are most
effective only when used by a motivated couple. In other
circumstances, the failure rate of condoms is certainly not as low as
2%. In one study in the USA, the first-year failure rates for male
condom use were between 3% and 6% when the woman was over age 30 but
between 8% and 10% when the woman was under age 25.[9] According to a
current obstetrics textbook, "Pregnancy rates for the condom are
reported to be from 1.6 to 21 per 100 woman-years, depending on the
age and motivation of the population studied." [10] Female barriers:
diaphragm, and others[edit] Some of the female barrier methods have
been in use for decades, and rates of effectiveness are fairly well
known. Others, such as the female condom, are much newer and there is
relatively little clinical evidence for how effective these methods
are in actual use. Condoms for women[edit] The female condom has
theoretical advanatages. However, it has not been used widely enough
or long enough to have its clinical efficacy tested. It may or may not
offer as much protection as the male condom. The female condom is a
loose tube of thin material (polyethelene) that extends between two
rings, one which fits in the vagina and the other which fits over the
external genitalia. It is not made out of latex, and therefore is not
a problem for those with latex allergy. Since it completely covers the
genital contact area between men and women during coitus, it should
help reduce the transmission of some sexually transmitted infections,
particularly genital herpes, as well as the rate of pregnancy, and —
unlike the male condom, which is worn over the penis — is more
completely controlled by the woman who uses it. However, the female
condom is not nearly as well studied as the male condom, and the
actual failure rates and effectiveness in preventing disease
transmission are not known. There are other differences which may be
helpful in some circumstances: the female condom is inserted before
beginning sexual activity and can be left in place for a longer time
after ejaculation. Cervical cap[edit] The cervical cap requires skill
for proper use. Even in skilled hands, and with good compliance
reported, it is at best only 95% effective as a contraceptive. The
cervical cap is a flexible rubber (or plastic) cup-like dome placed
over the cervix, that has been in use for several decades — mostly
in Europe. A spermicide is placed in the cap before use and is an
important component for effectiveness. The flexible cap is depressed
while being positioned over the cervix by the user and is then held in
place by suction, once released. Cervical caps are not sold over the
counter but must be carefully sized by health care providers. Caps
require office or clinic visits for fitting, and personal instruction
for use. Proper technique involves considerable skill on the part of
the user. Even with consistent use, technical errors lead to pregnancy
in 5% or more of women using this method. Failure rates with the
cervical cap are similar to those with the diaphragm. In one large,
randomized clinical trial, 1-year pregnancy rates were 17.4% for the
cap and 16.7% for the diaphragm.[9] There has been speculation that
the cap may help reduce sexually transmitted infections, but this
device still allows the kind of genital contact that ordinarily
transmits herpes simplex and genital warts, and there have been no
studies that prove any reduction in sexually transmitted infections.
Diaphragm[edit] Diaphragms are circles of synthetic material held by a
flexible ring. These are folded and placed in the vagina by the user.
When inserted properly, the device unfolds when released, covering the
cervix. Diaphrams must be carefully fitted by a health care provider
in the office or clinic in order for a woman to receive the correct
size. The proper size is the largest size that fits without putting
pressure on the surrounding vaginal mucosa (the lining of the vagina).
Devices that are too large, or which are left in place for too long,
can ulcerate the vaginal mucosa. A woman whose uterus makes a sharp
angle with the vagina, or who has a short vagina, cannot usually use a
diaphragm effectively. Spermicides are recommended for use with the
diaphragm. Before it is inserted, spermicial jellies or creams are
placed on the side of the device that will face the cervix. The
diaphragm should be left in place for at least eight hours after the
last episode of sexual intercourse. If there is more than one episode,
then more spermicide should be placed in the vagina before each,
leaving the diaphragm in place. There are some variations in the
details of recommended use depending on individual experts. Diaphragms
have been used for decades, predating the AIDS era. There is no good
evidence that diaphragms prevent sexually transmitted disease.
Although in some cases the diaphragm may act as a barrier that reduces
infection, the use of spermicides and the possibility of ulceration
with poorly fitting devices make the overall benefit doubtful. As with
the cervical cap, using this device allows (essentially) full contact
between the penis and vaginal mucosa, and offers no protection of
surrounding areas, so there is no reason to expect protection from
transmission of venereal warts or herpes. Failure rates with the
diaphragm (as a contraceptive) range from about 5% for experienced,
long-time users who are part of a motivated couple, to 20% for general
use.[9] Diaphragm use is associated with an increased number of
urinary tract infections in the women who use them. Intrauterine
devices (IUD)[edit] For more information, see: Intrauterine device. An
intrauterine device (IUD) is more than 99% effective in preventing
pregnancy, so that only 1 out of 100 sexually active women who use an
IUD will get pregnant in a year, and if inserted within five days of
unprotected sex, it still works[4]. An IUD is a 1- to 2-inch piece of
flexible plastic shaped like a T that is installed by a doctor into a
woman's uterus, where it remains until removed (possibly years later)
and prevents implantation of a fertilized egg. An IUD can be used by a
woman even if she cannot tolerate the side effects of birth control
pills. Hormonal medications (systemic)[edit] Hormonal medications used
for birth control are generally aimed at the female ovulatory
cycle.[11] Since hormonal contraceptives affect the menstrual cycle,
they have been prescribed for several decades for women who have
problems with excessive or irregular menstrual bleeding — even if
the women are celibate. More recently, some physicians have been
willing to prescribe their use for elective changing of the normal
menstrual cycle to decrease the number of periods. However, oral
contraceptive drugs are not without significant side effects, and not
all women can tolerate them. Even when women can tolerate the drug,
taking it at the correct intervals requires a great deal of discipline
and planning. Systemic hormonal preparations are used for ordinary
contraception in two basic forms: those that rely on progestin alone,
and those that incorporate both estrogen and progestin. Ovulation is
triggered in mid cycle by a surge of secretion of luteinizing hormone
from the anterior pituitary gland. Progestin prevents ovulation by
suppressing this secretion of luteinizing hormone. Progestins also
thicken cervical mucus, thereby retarding the passage of sperm, and
they make the endometrium unfavorable to implantation. Estrogen, on
the other hand, prevents ovulation by suppressing the secretion of
follicle-stimulating hormone (FSH), which is necessary to begin the
ovarian cycle. A second effect of estrogen that is important in the
contraceptives is to stabilize the endometrium, which inhibits
breakthrough bleeding. Although this effect does not itself prevent
pregnancy, it offers an advantage in the combination hormonal
contraceptives that is not present in the progestin-only kind. Another
variation in these hormonal birth control medications is in the route
of administration. If given in transdermal patches, intramuscular
shots, or appliances that are inserted into the vagina, these
preparations are released slowly over time (time-released) and, after
administration, continue working for weeks or months. Oral
contraceptives, on the other hand, are short-acting preparations that
are taken daily. The difference between these medications is mainly
the reduced number of acts of compliance required over a given time
period in the longer-acting forms. The various preparations also have
different side effects. In some cases, antibiotics can reduce the
effectiveness of oral contraception and may lead to unwanted
pregnancies. In certain situations, additional contraceptive methods
are recommended. [12] 'Morning-after' pill (emergency
contraception)[edit] It is possible to use hormonal oral
contraceptives and IUDs for emergency contraception from just after
unprotected intercourse up to 120 hours later; the sooner it is begun,
the more effective it is. Combined oral contraceptives are given as an
initial dose followed by a second dose 12 hours later, and these large
doses sometimes have the side effect of inducing nausea and vomiting.
'Plan B' (levonorgestrel) is a two-dose, progestin-only hormone that
causes much less nausea and vomiting, and is available over the
counter in the USA.[13] "Current evidence suggests that single 1.5 mg
dose of levonorgestrel, (or) mifepristone at doses ranging from 10 mg
to 50 mg should be offered."..."Women receiving mifepristone should be
warned that there may be a few days' delay in onset of menses.
Emergency contraception should be started as soon as possible to
obtain the highest efficacy"[14] There is generally less delay in
menses when levonorgestrel is administered. These hormones reduce the
rate of pregnancy compared to controls who had unprotected sex and
used no contraception, but the mechanism of that reduction is likely
to vary from case to case. In some cases, ovulation may be inhibited,
in others, sperm motility impaired, and in others, implantation of the
fertilized egg may be stopped. However, the primary means of
contraception seems to be prevention of fertilization. Dr Vivian
Dickerson, then president-elect of the American College of
Obstetricians and Gynecologists, stated in testimony to the FDA in
December 2003: “Clinical research data demonstrate that Plan B
primarily prevents pregnancy by inhibiting or preventing ovulation and
secondarily perhaps by impairing the migration and function of sperm.
In other words, it prevents pregnancy before fertilization
occurs.”[15] Induced abortion[edit] Abortion has never been intended
to be a method of birth control. However, it is the last resort for
women whose method of birth control has failed to prevent pregnancy.
From 1973 until 2022, women in the U.S. had the legal right to
terminate a pregnancy within three months of impregnation, three
months being a de facto standard set by the medical community.
Abortions later than three months generally required doctors to
certify that the woman's life would be in danger by carrying the fetus
to term. But in 2022, the U.S. Supreme Court ruled, in Dobbs V.
Jackson, that the question of whether abortions are legal was no
longer considered a federal matter and would be left to individual
states. As of 2023, nearly half the states have affirmed a woman's
human right to choose whether to bear a child or not, and in the
remaining states there exist a variety of levels of bans, about half
of those severe bans that may rule out abortion in cases of rape,
incest, or when a woman's own life is endangered by the fetus. The
point is, that induced abortion is now only legal in some states. Two
pharmaceuticals used in combination provide an often-preferred medical
method of terminating a pregnancy within three months of impregnation.
The first drug, mifepristone, blocks the reproductive hormone
progesterone, and the second, misoprostol, is taken one or two days
later to prompt contractions and help the uterus expel its
contents.[16] As of 2023, more than half of all pregnancies
terminations in the U.S. are done using these drugs rather than by
surgical methods. The Cleveland Clinic has a web page which provides a
complete description of how these pharmaceuticals can be used,
including procedural details, risks and benefits, recovery and
outlook, and when to call the doctor.[17] The two drugs have been
available for combined use since 2000, but in 2016, the U.S. Food and
Drug Administration (FDA), deeming the two drugs proven safe by
hundreds of medical studies and long use, took a series of steps to
increase the availability of distribution of mifepristone. In 2023,
this means that, in states where terminating a pregnancy is legal,
people can obtain the two prescription drugs at a local drug store or
by a mail-order, similar to any other medicine.[18] Women may take
them at home, while remaining in touch with a nurse or doctor via
phone or internet throughout the process[19], and thus avoid the risk
of harrassment and threats of violence that have frequently been
encountered by women who visit a birth control clinic and also,
sometimes, to avoid involving family members or friends who might
raise objections. As such, abortion opponents were particularly
incensed that these drugs might make it easier for a woman to
terminate a pregnancy without their family knowing about it. In 2023,
a lawsuit brought before a Texas judge (a state that is vehemently
against pregnancy terminations) resulted in a ruling that would make
the drug mifepristone illegal in all of the U.S. by classifying
mifepristone as unsafe. The decision was immediately appealed, and
stays against banning the drug were put in place. Removing
mifepristone from the market would mean that medically induced
abortion, the safest, most convenient and most affordable method of
pregnancy termination, would be unavailable to anyone. The claim was
made that the FDA had made mifepristone available without proof that
it is safe, and that the court, which is not made of medical experts,
should overrule a decision made by a federal agency of medical
experts. This attack, if allowed to stand, could have far-reaching
implications weakening the authority of the FDA in matters relating to
many other drugs. In April, the case was appealed to the U.S. Supreme
Court, and that court ordered that the drug would remain widely
available for now in a statement that did not include any reasoning as
to how it might eventually rule on the case.[20] It seems likely to
many observers that the Supreme Court might be reluctant to overturn a
medical decision by the FDA, and it might also fail to accept the
"standing" of the people who filed the lawsuit in the beginning, since
none of them can claim to have been harmed in any way by the drug.
That the lawsuit made it as far as it did is deemed by many observers
to be a function of judges overriding their legal opinion with their
personal political views. As a result of the unresolved lawsuit, many
states in which pregnancy termination is legal are now stockpiling the
drug that is under threat of being banned. At least one state is
looking into agreements for the manufacture of the drug locally within
their state in the future. Oral contraceptive pills for birth
control[edit] © Photo: Matthew Bowden Once a day monthly dose pack-
with "dummy" pills, the placebo placeholders that will allow
menstruation. With perfect use, the protection that birth control
pills provide against pregnancy is nearly 100%. However, because of
inconsistent or incorrect use, there is a surprisingly high annual
failure rate of 8% in typical users.[21] Pregnancy while taking these
pills is almost always because of a failure to remember to take them
every day (failure of compliance). Because a sudden drop in progestin
can result in the release of an egg and proliferation of the uterine
endometrium in preparation for implantation, missing progestagen-only
pills at any time of the cycle can result in pregnancy if unprotected
intercourse occurs. Missing combined pills, in particular at the
beginning or at the end of the pack such that the pill-free interval
is more than seven days, can also result in pregnancy.[22] Although
the protection rate from unwanted pregnancy is similar in both types
of pills (if used correctly), the side effects differ in incidence and
type. Estrogen taken in the combined pill has a safety profile that is
dose-related. A dose of 50 μg or less of the hormone has been
considered safe for healthy women over age 35 years, and is also
somewhat protective of bone mineralization. Estrogen administration
increases the risk of thromboembolism, the creation of abnormal blood
clots that can cause heart attacks, leg problems, and stroke. In women
who have other risk factors for producing blood clots, such as
obesity, combination birth control pills are usually not an optimal
choice. Smoking, another high risk factor for thromboembolism, is
generally considered to be forbidden while using oral contraceptives
for this reason. The use of oral contraceptives, including newer
agents, increases blood pressure by as much as 8 mm Hg systolic and 6
mm Hg diastolic. Women with hypertension, particularly if poorly
controlled, are usually advised to use a different method of
contraception because of the increased risk of stroke and other
adverse effects related to high blood pressure. In 2006, the American
College of Obstetrics and Gynecology released guidelines suggesting
that "In women with well-controlled and monitored hypertension who are
35 years or younger, a trial of combination contraceptives may be
appropriate as long as the patient is otherwise healthy, shows no
signs of end-organ vascular disease, and does not smoke. If blood
pressure remains well controlled several months after the trial is
started, combination contraceptives may be continued. Progestin-only
contraceptives and the levonorgestrel-releasing intrauterine system
(Mirena) are appropriate options in women with hypertension."
Combination birth control pills have been advocated as the best
contraceptive for sexually active teenage girls. "As a method, these
agents are the best choice for adolescents because they provide
effective contraception, increase bone density, and can be used to
improve acne and regulate irregular menses. The obvious disadvantage
is the daily requirement of taking a pill.[23] Oral contraceptive
pills for other purposes[edit] Oral contraceptives are sometimes
prescribed for purposes other than contraception. When a woman has a
condition that is treatable by oral contraceptives, then sometimes
this becomes her preferred method for contraception, because of 'side
benefits'. Very irregular menstruation or heavy bleeding, or
dysmennorhea are some of these conditions. Long-acting hormonal
contraceptives[edit] Long-acting hormonal contraceptives deliver the
same kinds of medications as do both oral contraceptives (birth
control pills) and some post-coital emergency contraceptives (such as
Plan B). In the long-acting contraceptives, it is mainly the method of
administration that is different from that of these short-acting
preparations. Unlike oral contraceptive pills, daily doses are not
needed. The advantage of long-acting contraceptives is that compliance
for a period of weeks or months requires only one motivational act,
whereas short-acting contraceptives require many (daily) acts by the
individual using them to give the same level of protection. If each is
used properly, however, the side effects of the long-acting
preparations are potentially greater than those of the short-acting
preparations, with some exceptions. Decrease in bone-mineral density
may occur.[24] Hormonal patch[edit] The backing of this transdermal
patch has not yet been removed. Transdermal patches are drug delivery
devices that administer medication through the skin. These patches
have been used to administer many different kinds of drugs, and in
recent years a combination contraceptive has been formulated: Ortho
Evra (Ortho McNeil). They are designed to deliver 150 µg of
norelgestromin and 20 µg of ethinylestradiol every day for seven days
[25]. Their primary advantage was hoped to be to eliminate the need
for the daily act of compliance required to take oral contraceptives
properly. The patch is changed each week for three weeks, followed by
a week with no patch. Thus the need for daily compliance is replaced
by a need for weekly action by the woman using this medication.
Although the 'motivational act' required with this method is reduced
from daily to weekly, the patch is not any more effective than
combination oral contraceptive pills in studies of actual use. Vaginal
ring[edit] Vaginal rings are soft polymer devices that contain
hormones. Basically the vaginal ring is a drug delivery system. The
vaginal mucosa can absorb the medication, which is usually
self-adminstered by the patient, who inserts and removes the device.
Complications have included the very rare misplacement of a vaginal
ring into the bladder by insertion into the urethra. Otherwise, the
adverse effects are very similar to those of oral combination
contraceptives. Manufactured in the USA and France by Organon,
NuvaRing is a monthly combination hormonal contraceptive that supplies
a progestin (etonogestrel) and an estrogen (ethinyl estradiol). The
ring is used intravaginally for 21 days followed by a seven-day
hormone-free interval. When placed in the vagina, each ring releases
on average 0.12 mg/day of etonogestrel and 0.015 mg/day of
ethinylestradiol over a three-week period of use. [26] "The need for
compliance is restricted to the day of insertion and the day of
removal, although FDA labeling allows use for up to 28 days. Patients
choosing the ring were given a NuvaRing starter kit, and counseled
regarding the previously mentioned hormonal side-effects. Specific
mention was given to side-effects unique to the ring, including
expulsion (2.6%), and increased vaginal secretions (4.8%)".[27] Like
other forms of combination hormonal contraceptives for women, the
vaginal ring acts primarily by preventing ovulation through
suppressing the body's production of the gonadotropins that are
required for the maturation of follicles in the ovary. In two large
clinical trials, pregnancy rates were between one and two pregnancies
per 100 women-years for women who used this vaginal ring. [28]
Intramuscular injections[edit] Medroxyprogesterone acetate 150 mg is
administered intramuscularly every three months as Depo-provera. To
help ensure that the injection is not given to a pregnant women,
health care providers are advised to give the first shot in the first
five days of the menstrual cycle. The next injection must be given
within 14 weeks, or else a pregnancy test must be performed before
this next injection is given. When injections are given properly, no
more than 14 weeks apart, the effectiveness is 99%. As with all
prolonged administration of progestins in doses that prevent
ovulation, these injections reduce serum estrogen levels, and this can
lead to reductions in bone mineral density. [29][24] Surgical methods
(reproductive sterilization)[edit] For more information, see:
Sterilization (human, elective procedures). Surgical methods, also
called reproductive sterilization, are the most reliable means of
preventing pregnancy and are very safe. However, none of them are
reliably reversible and are, therefore, chosen only by those who
accept the probability that no future biological children can be
conceived. These methods, include tubal ligation and vasectomy. Ethics
of using medical contraceptives[edit] For the majority of people, sex
and pregnancy involve some of the most important aspects of adult
life. Since medical contraceptives are effective in preventing
pregnancy, and (to some extent) in uncoupling the 'act of procreation'
from procreation itself, many ethical issues are raised by their use.
At a most fundamental level, there are strongly held beliefs by some
people that interfering with the establishment of pregnancy in any way
other than not having sex is immoral and against the laws of God (see
the article natural family planning). However, the ethical issues
associated with using these methods of contraception are not
restricted to religious considerations. There are many instances where
sexual intercourse resulting in pregnancy is violently forced upon
women against their will, or upon young women by incest or abuse from
an adult male. The rights of violated women vs. the rights of an
unborn fetus are not clear to everyone. When one member of a couple is
dishonest about using or not using a method, in an attempt to either
establish or prevent a pregnancy without the knowledge of the other,
the core of their relationship may be threatened on the basis of an
ethical violation. The use of contraceptives by sexually active
adolescents brings up another set of ethical issues – and in some
countries, even legal issues – if parental consent is not obtained.
In such circumstances either withholding or providing access to
contraceptives can raise ethical concerns for health care providers
over their actions. Overall, the ethics of using the methods of
contraception described here is too large a topic to also be included.
Yet no article on medical methods of contraception would be complete
without at least mentioning the fact that these issues exist.
References[edit] ↑ 1.0 1.1 Anonymous (2010). www.cdc.gov (English).
Centers for Disease Control and Prevention. Retrieved on 2010-06-02.
↑ Anonymous (2009). WHO | Family planning. World Health
Organization. Retrieved on 2010-06-02. ↑ Peterson HB, Curtis KM
(2005). "Clinical practice. Long-acting methods of contraception.". N
Engl J Med 353 (20): 2169-75. DOI:10.1056/NEJMcp044148. PMID 16291986.
Research Blogging. ↑ 4.0 4.1 How Effective are IUDs from Planned
Parenthood. ↑ Burkman RT (2007) Chapter 36: 'Contraception and
family planning.' In DeCherney AH, Nathan L (eds) Current Diagnosis &
Treatment Obstetrics & Gynecology 10th Edn, ISBN 9780071439008 ↑
Sullivan TM et al. (2006) Skewed contraceptive method mix: why it
happens, why it matters. J Biosocial Sci 38:501-21 PMID 16762087 ↑
Flannigan J (2007) Promoting sexual health: practical guidance on male
condom use. Nursing Standard 21:51-7 PMID 17288318 ↑ Gallo MF et al.
(2003) Non-latex versus latex male condoms for contraception. Cochrane
Database Syst Rev CD003550 PMID 12804475 ↑ 9.0 9.1 9.2 Chapter 13:
'Family planning' in Stenchever MA et al. (2001) Comprehensive
Gynecology 4th Edn, Mosby, ISBN 032301402X ↑ 'Pregnancy prevention
and birth control' in Gabbe SG et al. (2002) Obstetrics - Normal and
Problem Pregnancies 4th Edn, Churchill Livingstone ISBN 0443065721 ↑
Kaunitz AM (2008). "Clinical practice. Hormonal contraception in women
of older reproductive age.". N Engl J Med 358 (12): 1262-70.
DOI:10.1056/NEJMcp0708481. PMID 18354104. Research Blogging. ↑
Weaver, Kate and Anna Glasier, 1999.
[http://phclweb.wo.utoledo.edu/4720/antibiotics-contraceptives.pdf
Interaction Between Broad-Spectrum Antibiotics and the Combined Oral
Contraceptive Pill]. Contraception. 59 71-78. ↑ Hansen LB et al.
(2007) Levonorgestrel-only dosing strategies for emergency
contraception. Pharmacotherapy 27:278-84 PMID 17253917 Dirubbo NE
(2006) Counsel your patients about contraceptive options. Nurse
Practitioner 31:40-4 PMID 16607211 ↑ Cheng, Cochrane reference. ↑
Aschenbrenner DS (2006) Over-the-counter access to emergency
contraception. Am J Nursing 106:34-6 PMID 17068428 ↑ Opponents of
the right to terminate a pregnancy call the combined use of the drugs
mifepristone and misoprostol "the abortion pill". ↑ Medical Abortion
on the Cleveland Clinic website, last accessed 4/23/2023. This website
provides a complete description of how pregnancies may be terminated
by taking two drugs a day or two apart, along with risks and benefits,
recovery and outlook, and when to call a doctor. ↑ In the years
before 2016, a prescription for mifepristone first required an
in-person doctor visit. ↑ Can you get abortion pills at a pharmacy
now instead of directly from a nurse or doctor? And what if abortion
is illegal in my state? at Planned Parenthood online, Jan. 13, 2023
↑ Supreme Court Ensures, for Now, Broad Access to Abortion Pill in
the New York Times, April 21, 2023 ↑ Kaunitz AM (2005) Beyond the
pill: new data and options in hormonal and intrauterine contraception.
Am J Obstet Gynecol 192:998-1004 PMID 15846172 ↑ Chapter 17:
'Fertility Control: Current Approaches and Global Aspects' in Larsen
PR (2003) Williams Textbook of Endocrinology 10th Edn, Saunders & Co
ISBN 0721691846 ↑ Chapter 32: 'Contraception' in Cunningham G et
al.(2005) Williams Obstetrics 22nd Edn, McGraw-Hill ISBN 0-07-141315-4
↑ 24.0 24.1 Lopez LM, Grimes DA, Schulz KF, Curtis KM (2011).
"Steroidal contraceptives: effect on bone fractures in women.".
Cochrane Database Syst Rev (7): CD006033.
DOI:10.1002/14651858.CD006033.pub4. PMID 21735401. Research Blogging.
↑ Chapter 17: 'Fertility Control: Current Approaches and Global
Aspects' in Larsen PR (2003) Williams Textbook of Endocrinology 10th
Edn, Saunders & Co ISBN 0721691846 ↑ Maheswaran AM (2006) Mosby's
Drug Consult 16th Edn, ISBN 0323040624 ↑ Victor I, Fink RA (2006)
Comparing patient telephone callback rates for different hormonal
birth control delivery systems. Am J Therap 13:507-12 PMID 17122531
↑ Maheswaran AM (2006) Mosby's Drug Consult 16th Edn, ISBN
0323040624 ↑ Chapter 119: 'Approach to fertility control' in Goroll,
AH, Mulley AG (eds) (2007) Primary Care Medicine 5th Edn, Lippincott
Williams & Wilkins ISBN 078174878 Retrieved from
"https://citizendium.org/wiki/index.php?title=Contraception_(medical_methods)&oldid=890727"
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