Birth control resident survival guide

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

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]

Injectable contraception[4]

Combined hormonal contraceptives[5]

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]

Surgical options

Emergency contraception


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

Male Sterilization

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

Hormonal Contraception[20]

Hormonal contraceptive injectable regimes using testosterone combined with other molecules


Indications


Contraindications

Combined hormonal contraceptives

Absolute contraindications[5]

Relative contraindication

IUDs

Subdermal implant

Emergency contraception

[30]

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

[31][32]

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



U.S. Medical Eligibility Criteria for Contraceptive Use (MEC), 2016 [33]

Abbreviations: BMI: body mass index; CHC: combined hormonal contraceptive; COC: combined oral contraceptive; Cu-IUD: copper-containing intrauterine device; ECP: emergency contraceptive pill; IUD: intrauterine device; LNG: levonorgestrel; POC: progestin-only contraceptive; STD: sexually transmitted disease; UPA: ulipristal acetate


Women, men, or couples should consider the following elements when choosing the most appropriate contraceptive method:

  • Safety
  • Effectiveness
  • Availability (including accessibility and affordability)
  • Acceptability
  • Categories of medical eligibility criteria for contraceptive use


Catgory Characterestics
1 A condition for which there is no restriction for the use of the contraceptive method
2 A condition for which the advantages of using the method generally outweigh the theoretical or proven risks
3 A condition for which the theoretical or proven risks usually outweigh the advantages of using the method
4 A condition that represents an unacceptable health risk if the contraceptive method is used


The following table focuses on the safety of the use of contraceptive method for a person with a particular characteristic based on CDC guidance and recommendations:

Condition Best option Contraindication 1 2 3 4
Breastfeeding

<21 days postpartum

CHCs Implants

DMPA

POP

CHCs
21 to <30 days postpartum

With other risk factors for VTE  

Implants

DMPA

POP

CHCs
21 to <30 days postpartum

Without other risk factors for VTE

Implants

DMPA

POP

CHCs

Do's

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. Ilani N, Roth MY, Amory JK, Swerdloff RS, Dart C, Page ST; et al. (2012). "A new combination of testosterone and nestorone transdermal gels for male hormonal contraception". J Clin Endocrinol Metab. 97 (10): 3476–86. doi:10.1210/jc.2012-1384. PMC 3462927. PMID 22791756.
  28. Meriggiola MC, Bremner WJ, Costantino A, Pavani A, Capelli M, Flamigni C (1997). "An oral regimen of cyproterone acetate and testosterone undecanoate for spermatogenic suppression in men". Fertil Steril. 68 (5): 844–50. doi:10.1016/s0015-0282(97)00363-4. PMID 9389813.
  29. Fraser IS (2010). "Non-contraceptive health benefits of intrauterine hormonal systems". Contraception. 82 (5): 396–403. doi:10.1016/j.contraception.2010.05.005. PMID 20933112.
  30. "Emergency contraception". Paediatr Child Health. 8 (3): 181–92. 2003. doi:10.1093/pch/8.3.181. PMC 2792670. PMID 20020019.
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