Birth control resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Birth Control Options
Female birth control options
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
Emergency contraception
Male birth control options
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)
Indications
- Pregnancy prevention
- Treatment of different conditions such as:
- Polycystic Ovary Syndrome (PCOS): OCPs are used for menstrual regulation
- Endometriosis
- Amenorrhea
- Dysmenorrhea
- Premenstrual Syndrome (PMS)
- Primary Ovarian Insufficiency (POI)
- Heavy Menstrual Periods
- Acne
Contraindications
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.
Combined hormonal contraceptives
Absolute contraindications
- 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)
- 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 (current)
- Diabetes with retinopathy/nephropathy/neuropathy
- Severe cirrhosis
- Liver tumor (adenoma or hepatoma)
IUDs
- Uterine anomalies
- Active pelvic infection
Relative contraindications
- Smoker over the age of 35 (< 15 cigarettes per day)
- Adequately controlled 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:
Subdermal implant
- Progesterone receptor-positive breast cancer
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)
- OCPs also decrease the effect of Warfarin, so consider increasing the dose
Don'ts
- The content in this section is in bullet points.