Children

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Contraception

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Updated on: 4/18/2017
Updated by: Dr. Seema Menon

Abstinence

  • Effectiveness:
    • If ALL sexual activity avoided (including skin to skin contact) 100% effective at preventing pregnancy and STDs
  • Pros:
    • No side effects
    • Free
  • Cons:
    • No protection if sexual activity is forced
  • Contraindications:
    • None 

Combined Oral Contraceptive Pills

  • Effectiveness:
    • Perfect use: 99% effective
    • Actual use: 92-95% effective
  • Pros:
    • Menstrual cycles become lighter and are regular
    • Can be used for extended cycling
    • Can help with dysmenorrheal and other symptoms of PMS
    • Decreases incidence of physiologic ovarian cysts, ovarian cancer and endometrial cancer
    • Does not interrupt sexual activity
    • Protects against pregnancy if sexual activity is forced
  • Cons:
    • Needs to be taken every day at the same time
    • Does not protect against STDs
    • Certain medications may interact with the pill:
      • Decrease the efficacy of the OCP: carbamazepine, Phenobarbital, phenytoin, rifampin, griseofulvin, barbiturates, felbamate, topiramate, ethosuximide
      • Decrease the efficacy of the medication: warfarin, lorazepam, salicylates
      • Decreases clearance of medication: cyclosporine, dantrolene
      • Drugs potentiated by OCP: benzodiazepines, beta blockers, caffeine, corticosteroids, TCA
        • Increases the risk of thrombotic events
        • Potential side effects include nausea and headaches
  • Contraindications:
    • Absolute: Pregnancy, hypercoagulable states, history of DVT/PE/stroke, active liver disease, vaginal bleeding of unknown etiology, estrogen-dependent malignancy
      (breast cancer), prolonged immobilization, complicated congenital heart disease, severe hypertension, migraine with aura or focal neurological defects
    • Relative: high blood pressure, gall bladder disease, smoking, hyperlipidemia

Condoms

  • Effectiveness
    • Perfect use: 97% effective
    • Actual use: 86% effective
  • Pros:
    • Protects against STDs
    • Inexpensive
    • No hormones involved
  • Cons:
    • Need to interrupt sexual activity to use
    • Possibility that condom can break
    • Must be placed correctly
    • Need to use a new one with each episode of intercourse
    • Latex can be weakened by oil based lubricants (always use water based), extreme heat or cold, humidity, sunlight, age (always check the expiration date)
  • Contraindications:
    • Latex allergy (instruct patients to use polyurethane condoms instead)

Depo-Provera

  • Effectiveness:
    • Perfect use: 99.7% effective
    • Actual use: 97% effective
  • Pros:
    • Each injection prevents pregnancy for 3 months (12 weeks)
    • Does not contain estrogen, so appropriate to use in those with contraindications to estrogen
    • Protection even if sexual activity is forced
    • Many girls stop getting their periods while receiving injections
      • Periods return on average 6-12 months after discontinuation of injections
  • Cons:
    • Does not protect against STDs
    • Need to see health care provider every 3 months for the injection
    • Common to see irregular bleeding during the first 3 months after initiating injections
    • Side effects include weight gain, depression, hair loss
    • May see decrease in bone density
      • This decrease has not been shown to cause increase in fractures
      • Decreased bone density has been shown to reverse on discontinuation of injections
  • Contraindications:
    • Caution in girls with history of/high risk of bone fractures

Emergency Contraception

(Note: Emergency contraception (EC) does not work if a woman is already pregnant. EC will NOT cause an abortion.)

  • Effectiveness
    • Perfect use: lowers risk of pregnancy 75-89%
  • Pros
    • Can be taken 5 days (120 hours) after unprotected sex
    • Girls 17 and over can get over the counter (do not need a prescription)
    • Can be taken if sexual activity is forced
  • Cons
    • Does not protect against STDs
    • Girls 16 and under need a prescription
      • Side effects include nausea, headache

Hormonal Implants (Implanon)

  • Effectiveness:
    • Perfect use: 99.95%
    • Actual use: 99.95%
  • Pros:
    • Prevents pregnancy for 3 years
    • Can have it removed at any time
    • Pregnancy protection even if sexual activity is forced
    • Does not contain estrogen, so appropriate to use in those with contraindications to estrogen
  • Cons:
    • No protection against STDs
    • Requires minor procedure for both insertion and removal of the rod
    • Need to have a health care provider trained in insertion/removal
    • Side effects including irregular bleeding, depression, hair loss, weight gain
  • Contraindications:
    • Pregnancy, active liver disease, vaginal bleeding of unknown etiology
  • Lactational
    • Effectiveness

Amenorrhea Method (LAM)

  • Effectiveness: 
    • Perfect use: 98% effective
    • Actual use: 98% effective
  • Pros
    • Does not interrupt sexual activity
    • Can prevent pregnancy in forced sexual activity
  • Cons
    • Only can be used within 6 months of delivery in a woman who has not had menstrual period since delivery and is breast feeding baby at least 6-10 times per day
    • Does not protect against STDs
  • Contraindications:
    • Not breast feeding

Levonorgestrel IUD (Mirena)

  • Effectiveness:
    • Perfect use: 99.8%
    • Actual use: 99.8%
  • Pros:
    • Prevents pregnancy for up to 5 years
    • Does not need daily attention – just need to check the strings once a month
    • Will likely have much lighter periods or none at all (Also a treatment for menorrhagia)
    • Pregnancy protection even if sexual activity is forced
    • Does not contain estrogen, so appropriate to use in those with contraindications to estrogen
  • Cons:
    • Does not protect against STDs
    • Need to have health care provider trained in insertion/removal
    • Increased risk of PID during the first few weeks after insertion in patients with STDs
    • Small risk of spontaneous expelling
    • Small risk of uterine perforation during placement
    • Moderate to severe uterine cramping during placement
    • Irregular, light bleeding for approximately 2 months after placement
  • Contraindications:
    • Pregnancy, abnormal uterus (mullerian anomaly), recent PID, cervical/endometrial/ovarian cancer

Ortho-evra patch, Nuva Ring

  • Effectiveness
    • Perfect use: 99.7% (patch and ring)
    • Actual use: 99% (patch); 95% (ring)
  • Pros:
    • Does not need to be taken every day (the patch lasts 1 week and the ring lasts 3 weeks)
    • Makes menstrual periods more regular and lighter
    • Can use extended cycling
    • Can help with dysmenorrhea and other PMS symptoms
    • Decreases incidence of ovarian cysts, ovarian cancer and endometrial cancer
    • Does not interrupt sexual activity
    • The ring can be left in during sex or removed for maximum of 3 hours
    • Protection from pregnancy even if sexual activity is forced
  • Cons:
    • Does not protect against STDs
    • The patch may not be as effective in people over 200 lbs
    • Potential side effects include irregular bleeding, breast tenderness, nausea, headaches
    • Patch is associated with slightly higher risk of thrombotic event (but lower than thrombotic risk associated with pregnancy).
    • Patch may cause skin irritation or change in skin pigment
    • Vaginal ring may cause leukorrhea, foreign body sensation
  • Contraindications:
    • Absolute: Pregnancy, hypercoagulable states, history of DVT/PE/stroke, active liver disease, vaginal bleeding of unknown etiology, estrogen-dependent malignancy
      (breast cancer), prolonged immobilization, complicated congenital heart disease, severe hypertension, migraine with aura or focal neurological defects
    • Relative: high blood pressure, gall bladder disease, smoking, hyperlipidemia

Progestin-only Pills

  • Effectiveness
    • Perfect use: 98% effective
    • Actual use: 95% effective
  • Pros
    • Does not contain estrogen, so appropriate to use in those with contraindications to estrogen
    • Protection even if sexual activity is forced
  • Cons:
    • Needs to be taken every day at the same time
    • Does not protect against STDs
    • Associated with breakthrough bleeding

Rhythm Method

  • Effectiveness:
    • Perfect use: 91-98% (average 94%) effective
    • Actual use: 76% effective
  • Pros:
    • Free
    • Do not need to interrupt sexual activity
  • Cons:
    • Woman needs to know when she is ovulating and avoid sex few days before and few days after
    • Does not protect against STDs
    • Does not protect against forced sexual activity
  • Contraindications:
    • Irregular periods

Withdrawal

  • Effectiveness:
    • Perfect use: 96% effective
    • Actual use: 77-81% effective
  • Pros:
    • Free
    • No hormones needed
  • Cons:
    • Perfect use rarely happens: Pre-ejaculate may contain sperm
    • Does not prevent STDs
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