CSD | Contraception Methods

Contraception

• Contraception aims to prevent pregnancy through medications, medical devices, or behaviors
• Many contraceptive options are available, both hormonal and non-hormonal

Non-Hormonal Contraceptives

• Tubal ligation is a permanent method of contraception
• Vasectomy is a surgical procedure for male sterilization
• Copper IUDs prevent fertilization without hormones
• Diaphragms are barrier devices used with spermicide
• Male and female condoms prevent sperm from reaching the egg

Hormonal Contraceptives

• Vaginal rings release hormones vaginally
• Patches deliver hormones through the skin
• Oral contraceptives contain synthetic hormones
• Injectable progestin is an administered hormone shot
• Mirena IUD is an intrauterine device that releases progestin
• Progestin implants are surgically implanted

Permanent Sterilization

• Vasectomy is a permanent sterilization procedure for males
• Bilateral tubal ligation is a permanent sterilization procedure for females

Long-Acting Reversible Contraception (LARC)

• Progestin implants can provide long-term contraception
• Copper IUDs are effective for several years
• Hormonal methods include vaginal rings and patches
• Barrier methods such as condoms are used during intercourse

Male Condom

• Most condoms are made from latex rubber
• Condoms made from lamb intestines, polyurethane, or synthetic elastomers are available
• Acts as a barrier to prevent sperm from reaching the egg
• Provides protection against sexually transmitted infections (STIs)
• Polyurethane condoms are effective against STDs but have a breakage and slippage risk
• Lamb intestine condoms provide STD protection but not infection protection
• With perfect use, the failure rate is 2% and with typical use, it's 18%

Female Condom

• The female condom contains a nitrile sheath, a flexible polyurethane inner ring, and an outer ring
• The open ring remains outside the vagina
• The closed internal ring is fitted behind the symphysis
• Prevents sperm from reaching the egg and provides protection against STIs
• Can be inserted before intercourse and prevent pregnancy and STDs
• Pregnancy rate is higher compared to a male condom
• With perfect use, the failure rate is 5% while typical use has a 25% failure rate

Spermicides

• Spermicides contain a chemical (usually nonoxynol-9)
• Inserted in the vagina prior to sexual intercourse
• Damages sperm cells
• Available over the counter, gels, creams, foams, films, and suppositories
• Contraindicated in individuals with HIV or at risk for HIV infection
• Perfect use failure rate is 18%, typical use failure rate is 28%

Diaphragm

• A large dome-shaped device made of latex or plastic
• Used with spermicide or contraceptive gel
• The diaphragm is not removed for at least 6 hours after intercourse
• The device is not left in place for longer than 24 hours to prevent toxic shock syndrome
• If the patient is nulliparous, there is a perfect use failure rate of 9% and typical use of 16%
• If the patient is parous, there is perfect use failure rate is 26% and typical use of 32%

Cervical Cap

• A small cap that fits over the cervix and must be used with spermicide
• A reusable, washable, silicone barrier device surrounds the cervix to block sperm passage
• May be inserted any time prior to intercourse and must be left in place for at least 8 hours after
• Spermicide dosing and redosing mirrors that with a diaphragm
• For nulliparous women, failure rates are 9% with perfect use and 16% with typical use
• For parous women, perfect use 26% and typical use 32%

Copper Intrauterine Device

• Hormone-free copper-containing intrauterine device
• Is a Longest-lasting reversible method of contraception, FDA-approved for up to 10 years
• Effective for up to 12 years
• Copper ions create localized inflammation that decreases sperm viability and prevents fertilization
• Can decrease the chance of implantation
• Failure rates are 0.6% with perfect use and 0.6% with typical use

Copper IUD Contraindications

• Pregnancy
• Uterine abnormality with distorted uterine cavity
• PID
• Postpartum or postabortal endometritis in the past 3 months
• Known or suspected uterine or cervical malignancy
• Genital bleeding of unknown etiology
• Mucopurulent cervicitis
• Wilson disease
• Allergy to ParaGard
• A previously placed IUD that has not been removed

Hormonal Methods

• Combined hormonal contraceptives contain both an estrogen and a progestin
• Progestin-only contraceptives only contain progestin
• Oral contraceptive pills, transdermal patches, and intravaginal contraceptive rings are included in combined hormonal contraceptives
• Progestin-only pills (POPS), injections, intrauterine devices (IUDs), and subdermal implants are included in progestin-only contraceptives

Hormonal Contraceptive

• CHCs provide short-acting, reversible contraception when taken as prescribed
• Consist of a combination of estrogen and progestins and suppresses ovulation via systemic estrogen
• CHCs are taken daily, weekly, or monthly
• CHC efficacy is often affected by adherence
• Progestin-only contraceptives are effective, with reversible durations ranging from short-acting daily tablets to long-acting IUDs
• Progestin-only can manage abnormal uterine bleeding, dysmenorrhea, and endometriosis

Combined Oral Contraceptive Pills

• An oral pill that contains estrogen and progestin
• There's no consensus on preferred COCs
• Initiate a low-dose (i.e., 30 mcg of ethinyl estradiol) monophasic pill with levonorgestrel without preference of the patient
• With perfect use, the failure rate is 0.3%, and with typical use 9%

Progestin-Only Contraceptive Pills

• Highly effective, short-acting, reversible, low-dose progestin pill
• Options include continuously taken pills such as norethindrone or norgestrel, and monthly pause pills such as drospirenone
• Perfect use failure rate: 0.3%, typical use 9%

Combined Oral Contraceptive Pills Benefits and Disadvantages

• CHCs provide effective, short-acting, reversible contraception when taken perfectly
• Suppress ovulation via systemic estrogen and have more contraindications than other methods
• CHCs contain both estrogen and a progestin
• CHCs can be used to treat Polycystic ovary syndrome, Endometriosis, and Abnormal uterine bleeding

Minipills

• Norethindroneonly provides 0.35 mg of hormone and is taken daily
• Drospirenoneonly is marketed as Slynd and delivers 4mg of hormone
• Slynd is taken for 24 consecutive days during a 28-day cycle
• Slynd offers a 24-hour missed pill window
• Progestin-only pills are contraindicated in patients with renal or adrenal insufficiency

Transdermal Patch

• Delivers daily a dose of 150 µg of the progestin norelgestromin and 20 µg of ethinyl estradiol
• A new patch is applied each week for 3 weeks, followed by a patch-free week to allow withdrawal bleeding.
• The transdermal patch may have a low quality and limited use for women with a BMI ≥25
• Provides weekly applications to daily dosing
• Perfect use, 0.3% failure rate and typical use is 9 %

Vaginal Ring

• NuvaRing is a flexible polymer ring with a 54mm outer diameter and a 50 mm inner diameter
• Its core releases a daily dose of 15 µg ethinyl estradiol and 120 µg of the progestin etonogestrel
• Suitable for three weeks of continuous vaginal use
• Failure rate: perfect use 0.3%, typical use 9%

Progestin Implant

• Progestin-containing cylinders implanted in the upper arm release contraceptive hormone
• These single-rod etonogestrel implants release 30 µg of hormone daily and may be used for three years
• The inserter assists with positioning while averting placement too deep
• Nerve injury is a risk if insertion is too deep or during removal
• With nonpalpable devices, imaging is required for localization before removal
• Contraindications include pregnancy, thrombosis, liver tumors, abnormal genital bleeding, and breast cancer

Progestin Injections

• Injections of DMPA 150 mg may be administered every three months
• DMPA, marketed as DepoProvera, is injected into the deltoid or gluteus muscle
• DeposubQ provera 104 version is injected into the anterior thigh or abdomen
• Initial injection is given within the first five days following menses onset
• The effect lasts ~ 3 months and some may not return to fertility for up to 18 months
• Bone density loss is greater with long-term use

Levonorgestrel Releasing Intrauterine System

• Intended to be a Long-term, reversible levonorgestrel-releasing intrauterine device.
• approved by the FDA for 3–8 years
• Prevents fertilization, decreases likelihood of implantation, and decreases sperm function
• Cervical mucous changes block the sperm from reaching an oocyte

Levonorgestrel

• Four types of levonorgestrel-releasing intrauterine systems are approved by the Food and Drug Administration (FDA)
• These contraceptive systems are T shaped polyethylene structures with the stem encased by a cylinder containing polydimethylsiloxane and levonorgestrel

Levonorgestrel Releasing Intrauterine System Contraindications

• Pregnancy or suspicion of pregnancy
• Uterine abnormality with distorted uterine cavity
• Acute PID or history of unless there has been a subsequent intrauterine pregnancy
• Postpartum endometritis or infected abortion in the past 3 months
• Known or suspected uterine or cervical neoplasia
• Uterine bleeding of unknown etiology
• Untreated acute cervicitis or vaginitis or other lower genital tract infections
• Acute liver disease or liver tumor
• A previously placed IUD that has not been removed
• Hypersensitivity to any component of Mirena
• Known or suspected breast cancer or other progestin sensitive cancer

Adverse Effects

• Combined Hormonal include headaches, breast tenderness, GI symptoms, Irregular bleeding, moods
• Progrestin also includes Irregular periods, mood changes, follicular Cysts

Contraindications

• Combined Hormonal include high blood pressure or uncontrolled, Smokers over 35 and pregnancy
• Progrestin Only includes Current Pregnancy and undiagnosed bleeding

Vasectomy

• The office procedure is done with local analgesia and usually takes ≤20 minutes to complete
• A small incision is made in the scrotum, and the lumen of the vas deferens is disrupted to block sperm traveling from the testes
• Postprocedure counseling: Backup contraception is required until azospermia post surgery
• Complications that may result include Hematoma, Surgical site infection and Sperm granuloma with chronic pain

Bilateral Tubal Ligation

• A surgical procedure in which both fallopian tubes are permanently blocked or severed
• Prevents fertilizartion by removing the connection between the utetus and ovaries
• Complications that may result includes Hemorrhage and infections
• Should pregnancy occur, ectopic risk is elevated but risk is considered extremely low
• Failure rates are about 0.5 %

Overview of contraception, including hormonal and non-hormonal methods. Covers tubal ligation, vasectomy, IUDs, diaphragms, condoms, vaginal rings, patches, oral contraceptives, injectable progestin, and progestin implants. Permanent sterilization options are also discussed.