Birth control resident survival guide
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
- Depot Medroxyprogesterone: (94% effective), IM injection is given every 3 months
Combined hormonal contraceptives[4]
- Oral contraceptive (estrogen/progestin pills) (OCPs) (91% effective)
- Birth Control Patch (91% effective)
- Vaginal Ring (91% effective)
Barrier and chemical Methods
- 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
Traditional options/Natural contraception
- Fertility awareness[5]
- Lactational Amenorrhea Method (LAM) (Breastfeeding can help with child spacing)
- Abstinence
- Rhythm Method
Surgical options
- Permanent Sterilization (Tubectomy/tubal ligation)
Emergency contraception
- Copper IUD
- Emergency contraceptive pills
Male birth control options
Barrier contraception
- Condoms (80% effective), the only type of contraception that prevent sexual transmitted infections
Male Sterilization
- Vasectomy
Coitus Interruptus or Withdrawal (75% effective)
Hormonal Contraception
- Testosterone in combination with other hormones under research and development[6]
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
- 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
- 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
| 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)
|
| 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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.