Birth control resident survival guide

Jump to navigation Jump to search


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Contraception or birth control is 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 as acne, polycystic ovary syndrome, endometriosis, amenorrhea, dysmenorrhea, premenstrual syndrome, primary ovarian insufficiency, and heavy menstrual periods.


Birth Control Options

Female birth control options

Long acting reversible contraception (LARC): are 99% effective, high rate of satisfaction, long-term use, quick return to fertility when discontinued and include the following:[1]

  • Intrauterine device (IUDs) (> 99% effective)[2]
    • Copper IUD: Effective for up to 10 years, used for patients with light menstrual periods, patients who desire long-term contraception without using hormonal contraception
    • Progestin-releasing IUD: Effective for up to 5 years, used for patients with heavy menstrual bleeding and dysmenorrhea
  • Subdermal implant (> 99% effective): Effective for up to 3 years[3]

Injectable contraception[4]

  • Depot Medroxyprogesterone: (94% effective), IM injection is given every 3 months

Combined hormonal contraceptives[5]

  • Oral contraceptive (estrogen/progestin pills) (OCPs) (91% effective)
  • Birth Control Patch (91% effective)
  • Vaginal Ring (91% effective)

Barrier and chemical Methods[6][7]

  • Female Condom
  • Diaphragm
  • Cervical Cap
  • Sponge
  • Spermicide (80% failure rate if used alone). Should be used with cervical cap or diaphragm, may damage the genital epithelium and increase risk of acquiring SDIs[8]

Traditional options/Natural contraception[9]

  • Fertility awareness[10]
  • Lactational Amenorrhea Method (LAM) (Breastfeeding can help with child spacing)[11]
  • Abstinence
  • Rhythm Method

Surgical options

  • Permanent Sterilization (Tubectomy/tubal ligation)[12][13]

Emergency contraception

  • Copper IUD
  • Emergency contraceptive pills[14]


Note:

  • You can use IUD in a nulliparous female
  • Progestin subdermal implant is more effective that IUD (failure rate .2-.8%) and female fertilization (.5% failure rate)


Male birth control options

Male contraception includes the following:[15]

Barrier contraception

  • Condoms (80% effective), the only type of contraception that prevent sexual transmitted infections[16]

Male Sterilization

Coitus Interruptus or Withdrawal (75% effective)[19]

Hormonal Contraception[20]

  • Testosterone in combination with other hormones under research and development[21]
  • Testosterone enanthate: intramuscular short-acting testosterone formulations suppresses sperm concentration to very low levels[22]
  • Long-acting intramuscular testosterone undecanoate[23]

Hormonal contraceptive injectable regimes using testosterone combined with other molecules

  • Testosterone plus progestin[24]
  • Testosterone plus Gonadotropin Releasing Hormone (GnRH) antagonists[25]
  • Hormonal contraceptive transdermal regimes using testosterone and Nestorone: gel-gel combination[26]


Indications

  • Prevention of unwanted pregnancy
  • Treatment of different conditions such as:
    • Acne
    • Amenorrhea
    • Dysmenorrhea
    • Endometriosis
    • Heavy Menstrual Periods
    • Premenstrual Syndrome (PMS)
    • Primary Ovarian Insufficiency (POI)
    • Polycystic Ovary Syndrome (PCOS): OCPs are used for menstrual regulation


Contraindications

Combined hormonal contraceptives

Absolute contraindications[5]

  • Pregnancy
  • Less than 6 wks postpartum
  • Smoking (age ≥ 35, and ≥15 cigarettes per day)
  • Hypertension (systolic ≥ 160mmHg or diastolic ≥100mmHg)
  • Venous thromboembolism (VTE) (current of past history)
  • Prior history of throboembolic event or stroke
  • Thrombophilia (factor V Leiden, APLS)
  • Ischemic heart disease
  • Cerebrovascular accident history
  • Complicated valvular heart disease (pulmonary hypertension, atrial fibrillation, history of subacute bacterial endocarditis)
  • Migraine headache with aura or focal neurological symptoms
  • Breast cancer (Active)
  • History of an estrogen-dependent tumor
  • Diabetes with retinopathy/nephropathy/neuropathy
  • Severe cirrhosis (active or severe decompensated liver disease) (impair steroid metabolism)
  • Liver tumor (adenoma or hepatoma)
  • Hypertriglyceredemia

Relative contraindication

  • Age ≥ 35 and smoking < 15 cigarettes per day
  • Adequately controlled mild hypertension
  • Hypertension (systolic 140 - 159mmHg or diastolic 90 - 99mmHg)
  • Migrain headache over the age of 35
  • Currently symptomatic gallbladder disease
  • Mild cirrhosis
  • History of combined OCP-related cholestasis
  • Medications that interfere with OCPs: Lamotrigine, Rifampine
  • Inhirited thrombophilia carrier and family member with thrmbophilia plus thromboembolism

IUDs

  • Uterine anomalies or severe distortion
  • Active pelvic infection
  • Wilson disease
  • Complicated organ transplant failure

Subdermal implant

  • Progesterone receptor-positive breast cancer

Emergency contraception

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%

Side effects

[27][28]

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)

  • Deep venous thrombosis
  • Ischemic stroke
  • Myocardial infarction
  • Hypertension (patients with a history of hypertension in pregnancy or with a family history of hypertension)
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

Do's

  • Increase the levothyroxine dose in patients with hypothyroidism who started taking OCPs. OCPs (estrogen) increases the liver synthesis of thyroxin-binding globulin (TBG) and hence decreases the effect of levothyroxine. Oral contraceptives (estrogen) alter the transport and tissue delivery of thyroid hormone by increasing the synthesis of throxine-binding globulin , relative hypothyroid state in patients with hypothyroidism. Increase the dose of levothyroxine when starting OCPs.
  • Consider increasing the dose of warfarin when the patient use OCPs
  • Give two forms of contraceptives and take monthly pregnancy tests for sexually active women who use Isotretinoin for acne
  • Give non-oral form of contraception (IUD, implant) for one year to patients who underwent bariatric surgery to achieve weight loss goals and stabilize nutritional status

Don'ts


References

  1. ↑ Stoddard A, McNicholas C, Peipert JF (2011). "Efficacy and safety of long-acting reversible contraception". Drugs. 71 (8): 969–80. doi:10.2165/11591290-000000000-00000. PMC 3662967. PMID 21668037.
  2. ↑ Blumenthal PD, Voedisch A, Gemzell-Danielsson K (2011). "Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception". Hum Reprod Update. 17 (1): 121–37. doi:10.1093/humupd/dmq026. PMID 20634208.
  3. ↑ Jacobstein R, Stanley H (2013). "Contraceptive implants: providing better choice to meet growing family planning demand". Glob Health Sci Pract. 1 (1): 11–7. doi:10.9745/GHSP-D-12-00003. PMC 4168562. PMID 25276512.
  4. ↑ Kaunitz AM (1992). "Injectable contraception: the USA perspective". IPPF Med Bull. 26 (6): 1–3. PMID 12346920.
  5. ↑ 5.0 5.1 Rager KM, Omar HA (2005). "Hormonal contraception: noncontraceptive benefits and medical contraindications". Adolesc Med Clin. 16 (3): 539–51. doi:10.1016/j.admecli.2005.05.003. PMID 16183538.
  6. ↑ Gilliam ML, Derman RJ (2000). "Barrier methods of contraception". Obstet Gynecol Clin North Am. 27 (4): 841–58. doi:10.1016/s0889-8545(05)70174-1. PMID 11091990.
  7. ↑ Craig S, Hepburn S (1982). "The effectiveness of barrier methods of contraception with and without spermicide". Contraception. 26 (4): 347–59. doi:10.1016/0010-7824(82)90102-0. PMID 6759027.
  8. ↑ Harwood B, Meyn LA, Ballagh SA, Raymond EG, Archer DF, Creinin MD (2008). "Cervicovaginal colposcopic lesions associated with 5 nonoxynol-9 vaginal spermicide formulations". Am J Obstet Gynecol. 198 (1): 32.e1–7. doi:10.1016/j.ajog.2007.05.020. PMC 4332520. PMID 18166301.
  9. ↑ Ajayi AI, Adeniyi OV, Akpan W (2018). "Use of traditional and modern contraceptives among childbearing women: findings from a mixed methods study in two southwestern Nigerian states". BMC Public Health. 18 (1): 604. doi:10.1186/s12889-018-5522-6. PMC 5941455. PMID 29739372.
  10. ↑ Peragallo Urrutia R, Polis CB, Jensen ET, Greene ME, Kennedy E, Stanford JB (2018). "Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review". Obstet Gynecol. 132 (3): 591–604. doi:10.1097/AOG.0000000000002784. PMID 30095777.
  11. ↑ Van der Wijden C, Manion C (2015). "Lactational amenorrhoea method for family planning". Cochrane Database Syst Rev (10): CD001329. doi:10.1002/14651858.CD001329.pub2. PMC 6823189 Check |pmc= value (help). PMID 26457821.
  12. ↑ Patil E, Jensen JT (2015). "Update on permanent contraception options for women". Curr Opin Obstet Gynecol. 27 (6): 465–70. doi:10.1097/GCO.0000000000000213. PMC 4678034. PMID 26406934.
  13. ↑ Bartz D, Greenberg JA (2008). "Sterilization in the United States". Rev Obstet Gynecol. 1 (1): 23–32. PMC 2492586. PMID 18701927.
  14. ↑ Schiavon R, Jiménez-Villanueva CH, Ellertson C, Langer A (2000). "[Emergency contraception: a simple, safe, effective and economical method for preventing undesired pregnancy]". Rev Invest Clin. 52 (2): 168–76. PMID 10846441.
  15. ↑ Mathew V, Bantwal G (2012). "Male contraception". Indian J Endocrinol Metab. 16 (6): 910–7. doi:10.4103/2230-8210.102991. PMC 3510960. PMID 23226635.
  16. ↑ Gallo MF, Grimes DA, Schulz KF (2003). "Non-latex versus latex male condoms for contraception". Cochrane Database Syst Rev (2): CD003550. doi:10.1002/14651858.CD003550. PMID 12804475.
  17. ↑ Kumar V, Kaza RM, Singh I, Singhal S, Kumaran V (1999). "An evaluation of the no-scalpel vasectomy technique". BJU Int. 83 (3): 283–4. doi:10.1046/j.1464-410x.1999.00934.x. PMID 10233495.
  18. ↑ Dassow P, Bennett JM (2006). "Vasectomy: an update". Am Fam Physician. 74 (12): 2069–74. PMID 17186713.
  19. ↑ Horner JR, Salazar LF, Romer D, Vanable PA, DiClemente R, Carey MP; et al. (2009). "Withdrawal (coitus interruptus) as a sexual risk reduction strategy: perspectives from African-American adolescents". Arch Sex Behav. 38 (5): 779–87. doi:10.1007/s10508-007-9304-y. PMC 4218729. PMID 18293076.
  20. ↑ Gava G, Meriggiola MC (2019). "Update on male hormonal contraception". Ther Adv Endocrinol Metab. 10: 2042018819834846. doi:10.1177/2042018819834846. PMC 6419257. PMID 30899448.
  21. ↑ Cheng CY, Mruk DD (2010). "New frontiers in nonhormonal male contraception". Contraception. 82 (5): 476–82. doi:10.1016/j.contraception.2010.03.017. PMC 4381878. PMID 20933122.
  22. ↑ Steinberger E, Smith KD (1977). "Testosterone enanthate a possible reversible male contraceptive". Contraception. 16 (3): 261–8. doi:10.1016/0010-7824(77)90025-7. PMID 913115.
  23. ↑ Gu YQ, Wang XH, Xu D, Peng L, Cheng LF, Huang MK; et al. (2003). "A multicenter contraceptive efficacy study of injectable testosterone undecanoate in healthy Chinese men". J Clin Endocrinol Metab. 88 (2): 562–8. doi:10.1210/jc.2002-020447. PMID 12574181.
  24. ↑ Meriggiola MC, Farley TM, Mbizvo MT (2003). "A review of androgen-progestin regimens for male contraception". J Androl. 24 (4): 466–83. doi:10.1002/j.1939-4640.2003.tb02695.x. PMID 12826683.
  25. ↑ Pavlou SN, Brewer K, Farley MG, Lindner J, Bastias MC, Rogers BJ; et al. (1991). "Combined administration of a gonadotropin-releasing hormone antagonist and testosterone in men induces reversible azoospermia without loss of libido". J Clin Endocrinol Metab. 73 (6): 1360–9. doi:10.1210/jcem-73-6-1360. PMID 1955518.
  26. ↑ Sitruk-Ware R, Nath A (2010). "The use of newer progestins for contraception". Contraception. 82 (5): 410–7. doi:10.1016/j.contraception.2010.04.004. PMID 20933114.
  27. ↑ Hubacher D, Chen PL, Park S (2009). "Side effects from the copper IUD: do they decrease over time?". Contraception. 79 (5): 356–62. doi:10.1016/j.contraception.2008.11.012. PMC 2702765. PMID 19341847.
  28. ↑ Sanders JN, Adkins DE, Kaur S, Storck K, Gawron LM, Turok DK (2018). "Bleeding, cramping, and satisfaction among new copper IUD users: A prospective study". PLoS One. 13 (11): e0199724. doi:10.1371/journal.pone.0199724. PMC 6221252. PMID 30403671.


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Birth_control_resident_survival_guide&oldid=1658736"