Birth control Resident Survival Guide Microchapters |
---|
Overview |
Birth Control Options |
Female Options |
Male Options |
Indications |
Contraindications |
Emergency Contraception |
Side Effects |
Eligibility Criteria |
Dos |
Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Huda A. Karman, M.D.
Synonyms and keywords: Contraception options, Birth control options, Planned parenthood, Birth prevention, Family planning, Conception prevention
Contraception or birth control is mainly used for the prevention of unwanted pregnancy intentionally by using one of many different methods including devices, sexual practices, chemicals, drugs or surgical procedures. Contraception methods can also be used for other purposes such as prevention of sexual transmitted infection, treatment of different conditions such as acne, polycystic ovary syndrome, endometriosis, amenorrhea, dysmenorrhea, premenstrual syndrome, primary ovarian insufficiency, and heavy menstrual periods. Health care providers should consider the important elements when choosing the most appropriate contraceptive method for women, men, or couples such as safety, effectiveness, availability (including accessibility and affordability), and acceptability. CDC has created recommendations and categories for the use of birth control based on the element of safety.
Long-acting reversible contraception (LARC): is 99% effective, has a high rate of satisfaction, long-term use, quick return to fertility when discontinued and includes the following:[1]
Injectable contraception[4]
Combined hormonal contraceptives[5]
Barrier and chemical methods[6][7]
Traditional options/Natural contraception[9]
Surgical options
Male contraception includes the following:[15]
Male Sterilization
Coitus Interruptus or Withdrawal (75% effective)[19]
Hormonal contraceptive injectable regimes using testosterone combined with other molecules
Contracetion option | Hours after intercourse | Efficacy |
---|---|---|
Copper containing IUD | 0 to 120 hour/5 days | >99% |
Ulipristal | 0 to 120 hour/5 days | 98-99% |
Levonorgestril | 0 to 72 hour/3 days | 59-94% |
Oral contraceptive pills | 0 to 72 hour/3 days | 47-89% |
Contraceptive method | Side effects |
---|---|
Combined hormonal contraceptives
(OCPs, patch, ring) |
Breakthrough menstrual bleeding
Breast Tenderness Nausea Weight gain Rare side effects: Cardiovascular events (heavy smoker, over age 35 years)
|
Subdermal implant | Unscheduled bleeding,
Weight gain Headache Ovulation and fertility occur within one month after removal |
DMPA | Amenorrheah
Initial irregular bleeding Reversible bone loss, delayed return to fertility, +/- weight gain |
Progestin IUD | Amenorrhea
Irregular bleeding |
Copper IUD | Heavy menses
Menestrual and intermenestrual pain Dysmenorrhea |
Spermicide | May damage the genital epithelium and increase risk of acquiring SDIs |
Abbreviations: BMI: body mass index; CHC: combined hormonal contraceptive; COC: combined oral contraceptive; Cu-IUD: copper-containing intrauterine device; ECP: emergency contraceptive pill; IUD: intrauterine device; LNG: levonorgestrel; POC: progestin-only contraceptive; STD: sexually transmitted disease; UPA: ulipristal acetate
Women, men, or couples should consider the following elements when choosing the most appropriate contraceptive method:
Category | Characteristics |
---|---|
1 | A condition for which there is no restriction for the use of the contraceptive method |
2 | A condition for which the advantages of using the method generally outweigh the theoretical or proven risks |
3 | A condition for which the theoretical or proven risks usually outweigh the advantages of using the method |
4 | A condition that represents an unacceptable health risk if the contraceptive method is used |
The following table focuses on the safety of the use of the contraceptive method for a person with a particular characteristic based on CDC guidelines and recommendations:
Condition | Category | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | ||||||||
Breastfeeding
<21 days postpartum |
Implants
DMPA POP |
CHCs | |||||||||
21 to <30 days postpartum
With other risk factors for VTE |
Implants
DMPA POP |
CHCs | |||||||||
21 to <30 days postpartum
Without other risk factors for VTE |
Implants
DMPA POP |
CHCs | |||||||||
30–42 days postpartum
With other risk factors for VTE |
Implants
DMPA POP |
CHCs | |||||||||
30–42 days postpartum
Without other risk factors for VTE |
Implants
DMPA POP |
CHCs | |||||||||
>42 days postpartum | Implants
DMPA POP |
CHCs | |||||||||
Postpartum (non-breastfeeding women)
<21 days postpartum |
Implants
DMPA POP |
CHCs | |||||||||
Postpartum (non-breastfeeding women)
21–42 days postpartum With other risk factors for VTE |
Implants
DMPA POP |
CHCs | |||||||||
Postpartum (non-breastfeeding women)
21–42 days postpartum Without other risk factors for VTE |
Implants
DMPA POP |
CHCs | |||||||||
Postpartum (non-breastfeeding women)
>42 days postpartum |
CHCs
Implants DMPA POP |
||||||||||
Postpartum (including cesarean delivery)
<10 minutes after delivery of the placenta Breastfeeding |
Cu-IUD | LNG-IUD | |||||||||
Postpartum (including cesarean delivery)
a. <10 minutes after delivery of the placenta Non-breastfeeding |
Cu-IUD
LNG-IUD |
||||||||||
10 minutes after delivery of the placenta to <4 weeks
(breastfeeding or non-breastfeeding) |
Cu-IUD
LNG-IUD |
||||||||||
≥4 weeks (breastfeeding or non-breastfeeding) | Cu-IUD
LNG-IUD |
||||||||||
Postpartum sepsis | Cu-IUD
LNG-IUD | ||||||||||
Multiple risk factors
for atherosclerotic cardiovascular disease |
Cu-IUD | LNG-IUD
Implants POP |
CHCs
DMPA
|
CHCs | |||||||
Superficial venous disorders
Varicose veins |
Cu-IUD
LNG-IUD Implants DMPA POP CHCs |
CHCs | |||||||||
Superficial venous disorders
Superficial venous thrombosis (acute or history) |
Cu-IUD
LNG-IUD Implants DMPA POP |
CHCs | |||||||||
Headaches
Non-migraine (mild or severe) |
Cu-IUD
LNG-IUD Implants DMPA POP CHCs |
||||||||||
Migraine
Without aura (includes menstrual migraine)
|
Cu-IUD
LNG-IUD Implants DMPA POP
|
CHCs | |||||||||
Migraine with aura | Cu-IUD
LNG-IUD Implants DMPA POP |
CHCs | |||||||||
Multiple sclerosis
With prolonged immobility |
Cu-IUD
LNG-IUD Implants POP |
DMPA | CHCs | ||||||||
Multiple sclerosis
Without prolonged immobility |
Cu-IUD
LNG-IUD Implants POP |
DMPA | |||||||||
Suspected Gestational trophoblastic disease
(immediate post-evacuation) Uterine size first trimester |
Cu-IUD
LNG-IUD Implants DMPA POP CHCs |
||||||||||
Suspected Gestational trophoblastic disease
(immediate post-evacuation) Uterine size second trimester |
Implants
DMPA POP CHCs |
Cu-IUD
LNG-IUD |
|||||||||
Confirmed gestational trophoblastic disease
(after the initial evacuation and during monitoring) Undetectable/nonpregnant β-hCG levels
|
Cu-IUD
LNG-IUD Implants DMPA POP CHCs |
||||||||||
Decreasing β-hCG levels
|
Cu-IUD (continuation)
LNG-IUD (continuation) Implants DMPA POP CHCs |
Cu-IUD (initiation)
LNG-IUD (initiation) |
|||||||||
Persistently elevated β-hCG levels or malignant disease,
with no evidence or suspicion of intrauterine disease
|
Cu-IUD (continuation)
LNG-IUD (continuation) Implants DMPA POP CHCs |
Cu-IUD (initiation)
LNG-IUD (initiation) |
|||||||||
Persistently elevated β-hCG levels or malignant disease,
with evidence or suspicion of intrauterine disease |
Implants
DMPA POP CHCs |
Cu-IUD (continuation)
LNG-IUD (continuation) |
Cu-IUD (initiation)
LNG-IUD (initiation) | ||||||||
Sexually transmitted diseases
or chlamydial infection or gonococcal infection
|
Implants
DMPA POP CHCs |
Cu-IUD (continuation)
LNG-IUD (continuation) |
Cu-IUD (initiation)
LNG-IUD (initiation) | ||||||||
Vaginitis
(including Trichomonas vaginalis and bacterial vaginosis) |
Implants
DMPA POP CHCs |
Cu-IUD (initiation)
LNG-IUD (initiation)
LNG-IUD (continuation) |
|||||||||
High risk for HIV | Implants
DMPA POP CHCs |
Cu-IUD (initiation)
LNG-IUD (initiation)
LNG-IUD (continuation) |
|||||||||
HIV infection | Implants
DMPA POP CHCs |
||||||||||
Clinically well receiving ARV therapy |
Cu-IUD (initiation)
LNG-IUD (initiation)
LNG-IUD (continuation) |
||||||||||
HIV infection
Not clinically well or not receiving ARV therapy |
Cu-IUD (continuation)
LNG-IUD (continuation) |
Cu-IUD (initiation)
LNG-IUD (initiation) |
|||||||||
Cystic fibrosis | Cu-IUD
LNG-IUD Implants POP CHCs |
DMPA | |||||||||
Antiretroviral therapy
Nucleoside reverse transcriptase inhibitors (NRTIs) |
Cu-IUD (initiation)
Cu-IUD (continuation) LNG-IUD (initiation) |
Cu-IUD (initiation)
LNG-IUD (initiation) LNG-IUD (continuation) |
|||||||||
Nonnucleoside reverse transcriptase inhibitors (NNRTIs) | Cu-IUD (initiation)
Cu-IUD (continuation) LNG-IUD (initiation) DMPA |
Cu-IUD (initiation)
LNG-IUD (initiation) LNG-IUD (continuation) Implants POP CHCs |
|||||||||
Ritonavir-boosted protease inhibitors | Cu-IUD (initiation)
Cu-IUD (continuation) LNG-IUD (initiation) DMPA |
Cu-IUD (initiation)
LNG-IUD (initiation) LNG-IUD (continuation) Implants POP CHCs
|
|||||||||
Protease inhibitors without ritonavir | Cu-IUD (initiation)
Cu-IUD (continuation) LNG-IUD (initiation) LNG-IUD (continuation) DMPA Implants POP CHCs |
Cu-IUD (initiation)
LNG-IUD (initiation) |
|||||||||
CCR5 co-receptor antagonists | Cu-IUD (initiation)
Cu-IUD (continuation) LNG-IUD (initiation) LNG-IUD (continuation) DMPA Implants POP CHCs |
Cu-IUD (initiation)
LNG-IUD (initiation) |
|||||||||
HIV integrase strand transfer inhibitors | Cu-IUD (initiation)
Cu-IUD (continuation) LNG-IUD (initiation) LNG-IUD (continuation) DMPA Implants POP CHCs |
Cu-IUD (initiation)
LNG-IUD (initiation) |
|||||||||
Fusion inhibitors | Cu-IUD (initiation)
Cu-IUD (continuation) LNG-IUD (initiation) LNG-IUD (continuation) DMPA Implants POP CHCs |
Cu-IUD (initiation)
LNG-IUD (initiation) |
|||||||||
Psychotropic medications a. SSRIs | Cu-IUD
LNG-IUD DMPA Implants POP CHCs |
||||||||||
St. John’s wort | Cu-IUD
LNG-IUD DMPA |
Implants
POP CHCs |
|||||||||
|pmc=
value (help). PMID 26457821.