Contraception

With increasing globalization and lifestyle changes, even general practitioners are getting more and more young patients willing to adopt contraceptive measures. An optimum clinical choice of contraceptive can only be done through a mutual discussion between the physician and patient taking into consideration both clinical aspects and patient's choice. This article gives a brief general summary of the methods of contraception.

Contraception is the process of taking steps to ensure about not becoming pregnant after having sex. There are different types of contraceptive measures. They all have pros and cons. Different methods will be right for different couples, or right at different times in life.

Types of contraceptives:

Hormonal (2-3%)
Intrauterine (5%)
Barrier (10-15%)
Chemical (15-20%)
Physiologic
Sterilization (4%)
* percentages mentioned within brackets are failure rates

Hormonal contraception

It involves the use of estrogen and progesterone to prevent fertilization; associated with a 2-3% failure rate.
Oral contraceptive pills suppress the action of fsh/lh from the pituitary gland, they also suppress the lh surge, alter the cervical mucosa to inhibit penetration by spermatozoa, and they inhibit atrophic change in the endometrium.
Complications: venous thrombosis, pulmonary embolism, cva, mi, htn, amenorrhea, cholelithiasis, hepatocellular adenoma. Risks increase with smoking.

Contraindications: dvt, pe, cvd, cva, pregnancy, cancer, abnormal lfts

Classification

Monophasic (fixed combination: take estrogen and progesterone on days 1-21 and placebo on days 22-28. Increased estrogen increases the side effects of a headache, weight gain, nausea, and edema decreased estrogen and progesterone increase the risk of breakthrough bleeding and increases the failure rate.
Multiphasic: low-dose estrogen with varying doses of progesterone on days 1-21.
Progestin-only pills: not as effective and can cause breakthrough bleeding.
Levonorgestrel: lasts up to five years.
Medroxyprogesterone: lasts three months.
Benefits:

Decreases the risk of ovarian and endometrial cancer and decreased the risk of ectopic pregnancy.

Intrauterine contraception

It involves the insertion of a small device into the uterus with the hopes of inhibiting implantation, altering tubal motility, or inflaming the endometrium.
Intrauterine contraceptive devices are associated with a relatively low failure rate (2-4% pregnancy rate) but do suffer from a higher rate of complications (e. G, four times increased the risk of ectopic pregnancy).

Types:

Intrauterine device (iud) with progestogen: it releases progesterone and must be replaced annually.
Iud with copper-t: it contains copper and can last up to 4-6 years.
Side effects:

Increased blood loss and duration of menses, increased dysmenorrhea

Complications:

Expulsion of iud, pregnancy, perforation of the uterine wall when inserted, increased risk of tubo-ovarian abscess (esp. Among younger nulliparous females with greater than ;1 sex partner). Pid is not as common with the newer iuds but still a significant risk factor.

Indicated for: multiparous women greater than 35 years who smoke.

Concerns about pelvic infections and subsequent fertility often limit the use of iucds to women who are at low risk for sexually transmitted disease and to those less likely to desire further children, i. E, monogamous multigravid patients.

Barrier methods

It involves the use of an artificial device to inserted into the vagina or fitted to the penis with the intent to retain the products of intercourse.

Types:

Condoms: condoms have a 2% failure rate in consistent couples and a 10% failure rate in occasional users. They are best indicated for std prevention.
Vaginal diaphragms: they have a 15-20% failure rate, but when combined with a spermicidal jelly and left in for 6-8 hours post-coitus failure rate declines to 2%. Diaphragms are associated with side effects of bladder irritation and cystitis, also colonization with s. Aureus if left in too long.
Cervical caps: they must be properly fitted and can be left in for a longer time than the diaphragm.
Chemical contraception

It has a 15- 20% failure rate and involves the use of sponges and spermicides.
Spermicides contain surfactants to disrupt cervical membranes; placed in the vagina up to 30 minutes before intercourse.
Physiologic contraception

It involves the avoidance of intercourse from an onset of menses to 2-days post ovulation.

Sterilization

This method involves manipulation of parts of male and female anatomy such that conception is prevented by failure and gametes to combine.

Types:

Vasectomy: lesser than 1% failure and can be successfully reversed in some cases.
Tubal ligation: lesser than 1% failure rate. Increase risk of ectopic.
Emergency contraception pills - emergency contraception can be used if one had sex without using contraception; or if someone had sex but there was a mistake with contraception.

Emergency contraception options are usually very effective if started within 3-5 days of unprotected sex. The earlier you take this pill, the more effective it is. It works either by preventing or postponing ovulation or by preventing the fertilized egg from settling in the womb (uterus).

A proper patient counseling informing the success rate and complication of contraception should be an integral part of the treatment regime.