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 mainly used for 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. Health care providers should consider the important elements when choosing the most appropriate contraceptive method for women, men, or couples such as safety, effectiveness, availability (including accessibility and affordability), and acceptability. CDC has created recommendations for the and categories for the use of birth control based on the element of safety.

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

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[5]

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 Category
1 2 3 4
Breastfeeding

<21 days postpartum

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
30–42 days postpartum

With other risk factors for VTE

Implants

DMPA

POP

CHCs
30–42 days postpartum

Without other risk factors for VTE

Implants

DMPA

POP

CHCs
>42 days postpartum Implants

DMPA

POP

CHCs
Postpartum (nonbreastfeeding women)

<21 days postpartum

Implants

DMPA

POP

CHCs
Postpartum (nonbreastfeeding women)

21–42 days postpartum

With other risk factors for VTE

Implants

DMPA

POP

CHCs
Postpartum (nonbreastfeeding women)

21–42 days postpartum

Without other risk factors for VTE

Implants

DMPA

POP

CHCs
Postpartum (nonbreastfeeding women)

>42 days postpartum

CHCs

Implants

DMPA

POP

Postpartum (including cesarean delivery)

<10 minutes after delivery of the placenta

Breastfeeding

Cu-IUD LNG-IUD
Postpartum (including cesarean delivery)

a. <10 minutes after delivery of the placenta

Nonbreastfeeding

Cu-IUD

LNG-IUD

10 minutes after delivery of the placenta to <4 weeks

(breastfeeding or nonbreastfeeding)

Cu-IUD

LNG-IUD

≥4 weeks (breastfeeding or nonbreastfeeding) Cu-IUD

LNG-IUD

Postpartum sepsis Cu-IUD

LNG-IUD

Multiple risk factors

for atherosclerotic cardiovascular disease  

Cu-IUD LNG-IUD

Implants

POP

CHCs

DMPA

CHCs
Superficial venous disorders

Varicose veins

Cu-IUD

LNG-IUD

Implants

DMPA

POP

CHCs

CHCs
Superficial venous disorders

Superficial venous thrombosis (acute or history)

Cu-IUD

LNG-IUD

Implants

DMPA

POP

CHCs
Headaches

Nonmigraine (mild or severe)

Cu-IUD

LNG-IUD

Implants

DMPA

POP

CHCs

Migraine

Without aura (includes menstrual migraine)

Cu-IUD

LNG-IUD

Implants

DMPA

POP


CHCs
Migraine With aura Cu-IUD

LNG-IUD

Implants

DMPA

POP

CHCs
Multiple sclerosis

With prolonged immobility

Cu-IUD

LNG-IUD

Implants

POP

DMPA CHCs
Multiple sclerosis

Without prolonged

immobility

Cu-IUD

LNG-IUD

Implants

POP

DMPA
Suspected Gestational trophoblastic disease

(immediate postevacuation)

Uterine size first trimester

Cu-IUD

LNG-IUD

Implants

DMPA

POP

CHCs

Suspected Gestational trophoblastic disease

(immediate postevacuation)

Uterine size second trimester

Implants

DMPA

POP

CHCs

Cu-IUD

LNG-IUD

Confirmed gestational trophoblastic disease

(after initial evacuation and during monitoring)

Undetectable/nonpregnant β-hCG levels

Cu-IUD

LNG-IUD

Implants

DMPA

POP

CHCs

Decreasing β-hCG levels


Cu-IUD (continuation)

LNG-IUD (continuation)

Implants

DMPA

POP

CHCs

Cu-IUD (initiation)

LNG-IUD (initiation)

Persistently elevated β-hCG levels or malignant disease,

with no evidence or suspicion of intrauterine disease

Cu-IUD (continuation)

LNG-IUD (continuation)

Implants

DMPA

POP

CHCs

Cu-IUD (initiation)

LNG-IUD (initiation)

Persistently elevated β-hCG levels or malignant disease,

with evidence or suspicion of intrauterine disease

Implants

DMPA

POP

CHCs

Cu-IUD (continuation)

LNG-IUD (continuation)

Cu-IUD (initiation)

LNG-IUD (initiation)

Sexually transmitted diseases


Current purulent cervicitis

or chlamydial infection or gonococcal infection

Implants

DMPA

POP

CHCs

Cu-IUD (continuation)

LNG-IUD (continuation)

Cu-IUD (initiation)

LNG-IUD (initiation)

Vaginitis

(including Trichomonas vaginalis and bacterial vaginosis)

Implants

DMPA

POP

CHCs

Cu-IUD (initiation)

LNG-IUD (initiation)


Cu-IUD (continuation)

LNG-IUD (continuation)

High risk for HIV Implants

DMPA

POP

CHCs

Cu-IUD (initiation)

LNG-IUD (initiation)


Cu-IUD (continuation)

LNG-IUD (continuation)

HIV infection Implants

DMPA

POP

CHCs


HIV infection

Clinically well receiving ARV therapy

Cu-IUD (initiation)

LNG-IUD (initiation)


Cu-IUD (continuation)

LNG-IUD (continuation)

HIV infection

Not clinically well or not receiving ARV therapy

Cu-IUD (continuation)

LNG-IUD (continuation)

Cu-IUD (initiation)

LNG-IUD (initiation)

Cystic fibrosis Cu-IUD

LNG-IUD

Implants

POP

CHCs

DMPA
Antiretroviral therapy

Nucleoside reverse transcriptase inhibitors (NRTIs)

Cu-IUD (initiation)

Cu-IUD (continuation)

LNG-IUD (initiation)

Cu-IUD (initiation)

LNG-IUD (initiation)

LNG-IUD (continuation)

Nonnucleoside reverse transcriptase inhibitors (NNRTIs) Cu-IUD (initiation)

Cu-IUD (continuation)

LNG-IUD (initiation)

DMPA

Cu-IUD (initiation)

LNG-IUD (initiation)

LNG-IUD (continuation)

Implants

POP

CHCs

Ritonavir-boosted protease inhibitors Cu-IUD (initiation)

Cu-IUD (continuation)

LNG-IUD (initiation)

DMPA

Cu-IUD (initiation)

LNG-IUD (initiation)

LNG-IUD (continuation)

Implants

POP

CHCs


Protease inhibitors without ritonavir Cu-IUD (initiation)

Cu-IUD (continuation)

LNG-IUD (initiation)

LNG-IUD (continuation)

DMPA

Implants

POP

CHCs

Cu-IUD (initiation)

LNG-IUD (initiation)

CCR5 co-receptor antagonists Cu-IUD (initiation)

Cu-IUD (continuation)

LNG-IUD (initiation)

LNG-IUD (continuation)

DMPA

Implants

POP

CHCs

Cu-IUD (initiation)

LNG-IUD (initiation)

HIV integrase strand transfer inhibitors Cu-IUD (initiation)

Cu-IUD (continuation)

LNG-IUD (initiation)

LNG-IUD (continuation)

DMPA

Implants

POP

CHCs

Cu-IUD (initiation)

LNG-IUD (initiation)

Fusion inhibitors Cu-IUD (initiation)

Cu-IUD (continuation)

LNG-IUD (initiation)

LNG-IUD (continuation)

DMPA

Implants

POP

CHCs

Cu-IUD (initiation)

LNG-IUD (initiation)

Psychotropic medications a. SSRIs Cu-IUD

LNG-IUD

DMPA

Implants

POP

CHCs

St. John’s wort Cu-IUD

LNG-IUD

DMPA

Implants

POP

CHCs

Do's

Don'ts

References

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