Birth control resident survival guide

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

Overview

Long acting reversible contraception(LARC): 99% effective, high rate of satisfaction, long-term use, quick return to fertility when discontinued

IUDs (> 99% effective)
- Copper IUD: effective for up to 10 years, used for patients with light menstrual periods, desire long-term contraception, not prefer using hormonal contraception
- Progestin-releasing IUD, effective for up to 5 years, for patients with heavy menstrual bleeding and dysmenorrhea
Subdermal implant (> 99% effective), effective for up to 3 years, SE: unscheduled bleeding, weight gain, headache. Ovulation and fertility occur within one month after removal
Depot Medroxyprogesterone, IM injection given every 3 months (94% effective),
Combined hormonal contraceptives
- Oral contraceptive (estrogen/progestin pills) (OCPs) (91% effective)
- Birth Control Patch (91% effective)
- Vaginal Ring (91% effective)
Barrier Methods
- 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
Natural contraception (Natural Family Planning and Fertility Awareness)
- Lactational Amenorrhea Method (LAM) (Breastfeeding can help with child spacing)
Abstinence
Permanent Sterilization

Barrier contraception (Condoms) (80% effective), the only type of contraception that prevent sexual transmitted infections

Vasectomy

Withdrawal (coitus interruptus) (75% effective)

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)

Absolute contraindications

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)
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

Increase the levothyroxine dose in patients with hypothyroidism who started taking OCPs. OCPs (estrogen) increases the liver synthesis of thyroxin-binding globulin (TBG)
OCPs also decrease the effect of Warfarin, so consider increasing the dose
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.