Transcript Contraceptive Methods

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Contraceptive Methods
Alison Pittman
PGY2 Family Medicine
Civic Family Health Team
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Outline
 Introduction
 Choosing
a Method of
Contraception
 Natural
Methods
 Non-Hormonal
 Hormonal
Methods
Methods
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Contraception
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Patients often have questions about contraception but aren’t sure which
type they want
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Some reasons why patients will ask about contraception:
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Control over timing of pregnancy
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Avoidance of unintended pregnancy
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Protection from STI infection
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Noncontraceptive health benefits (hormonal options)
Discuss all forms with patients to find which method will fit their needs
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Choosing a Method
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Convenience
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Duration
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Reversibility
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Efficacy
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Cost
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Side effects

Accessibility
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STI protection
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Effect on uterine bleeding
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Noncontraceptive benefits
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Contraindications
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Natural Methods
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Abstinence
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Fertility Awareness/Natural Family Planning
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Rhythm (Calendar) Method
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Withdrawal
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Non-Hormonal Methods
 Surgery
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Tubal Ligation
Vasectomy
 Barriers
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Male Condom
 Intrauterine
Contraceptive Device (Copper IUD)
 Others
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Spermicide
Contraceptive sponge
Lea contraceptive
Cervical Cap
Diaphragm
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Copper IUD
T-shaped
device with copper wire that is
inserted into the uterus
Changes
intrauterine chemistry, prevents
fertilization and destroys sperm
Efficacy
Fails
in <1 in 100 users per year
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Copper IUD
Benefits:
 Up
to 5 years of contraception
 No
need to remember pills
 Can
 No
use while breast feeding
hormone exposure
 Decreased
risk of endometrial ca
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Copper IUD
 Absolute
Contraindications
 Pregnancy
 Current or recent PID or
STI
 Distorted uterine cavity
 Unexplained vaginal
bleeding
 Cervical or endometrial
cancer
 Copper allergy
 Relative
Contraindications
 High risk for STIs
 Immunocompromised
 Ovarian cancer
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Copper IUD
 Side
effects
 Increased
bleeding
 Dysmenorrhea
 Risks
 Uterine
perforation
 Infection
 Expulsion
 Failure
 Risk
of ectopic pregnancy
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Copper IUD
Who
could benefit?
Postpartum
and
breastfeeding
Hormone
concerns
Difficulty
remembering pills
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Hormonal Methods
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Combined oral contraceptive
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Contraceptive patch
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Vaginal ring
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Progestin-only oral
contraceptive

Injection
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Hormonal IUD
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Combined Oral Contraceptive Pills
Combined
OCPs
contain estrogen and
progestin
Multiple
mechanisms
of action
Efficacy
 99.9%
with perfect use
 User failure rates 3-8%
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OCP – Non-Contraceptive Benefits
 Cycle
regulation

endometrial cancer
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menstrual flow

risk of fibroids

BMD
 Fewer
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dysmenorrhea
perimenopausal
symptoms
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
acne
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hirsutism

ovarian cancer
ovarian cysts
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OCP – Absolute contraindications
 Pregnancy
 <6
weeks postpartum (if
breastfeeding)
 Smokers >35y/o (>15
cig/day)
 Hypertension (>160/100)
 History of VTE
 IHD
 Previous CVA
 Valvular heart disease
 Migraine
headache with
neurologic symptoms
 Breast cancer (current)
 Severe cirrhosis
 Liver tumour
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OCP – Relative Contraindications
 Smokers
>35y/o (<15 cig/day)
 Controlled
 Migraines
hypertension
>35y/o
 Symptomatic
gallbladder
disease
 Mild
cirrhosis
 Contraindicated
medications
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OCP – Side Effects and Risks
 Side
Effects
 Irregular
 Breast
bleeding
tenderness
 Nausea
 Weight
 Mood
gain
changes
 Risks
 VTE
 MI
 CVA
 Gallbladder
 Breast
disease
cancer
 Cervical
cancer
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OCP - Disadvantages
 Compliance
 No
issues
STI protection
 Effectiveness
may be affected by other medications
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OCP – Who could benefit?
 Irregular
 Heavy
cycles
bleeding
 Dysmenorrhea
 Acne
 Otherwise
 Good
healthy
compliance
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Contraceptive Patch
 Transdermal
patch that continuously
releases estrogen and progestin into
the bloodstream
 Each
patch is worn for 7 days. Week
4 is patch-free
 99.7%
 91%
effectiveness with perfect use
effectiveness with typical use
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Contraceptive Patch
 Advantages
 Improved
adherence
 Serum
hormone levels
remain in contraceptive
range for up to 9 days
 Reversible
 Disadvantages
 Not
as effective >90kg
 Possible
skin irritation
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Vaginal Ring
 Flexible, transparent
ring
placed in the vagina that
delivers estrogen and progestin
over a 3 week period
 99.7%
 91%
effective with perfect use
effective with typical use
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Vaginal Ring
Advantages
 Convenient
 Compliance
 Reversible
 Disadvantages
 Vaginal
irritation
 Breakthrough
bleeding
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Patch and Ring
 Who
could benefit?
 Difficulty
remembering pills
 No
contraindications
 Not
interested in IUD
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Progestin-only oral contraceptive
 Daily
pill that does not contain any estrogen, just
progestin
 Thickens
cervical mucous and changes the
lining of the uterus, affecting implantation
 40%
of women continue to ovulate
 99.5%
effective with perfect use
 90-95%
effective with typical use
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Progestin-only oral contraceptive
 Absolute
contraindications
 Pregnancy
 Current
 Relative
 Active
 Liver
breast cancer
contraindications
viral hepatitis
tumours
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Progestin-only oral contraceptive
 Non-contraceptive
benefits
 May decrease menstrual flow
 May decrease menstrual
cramping and PMS
 Advantages
 Use
in women who can’t take
estrogen
 Women >35 who smoke
 Breastfeeding
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Progestin-only oral contraceptive
 Side
effects
 Irregular
bleeding
 Hormonal
side effects
 Headache/bloating/acne/
breast tenderness
 Disadvantages
 Must
be taken at the same
time every day
 No
STI protection
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Injection
 Injectable
progestin (Depo-Provera) inhibits
secretion of pituitary gonadotropins, suppressing
ovulation
 99.7%
effective
 Absolute
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Pregnancy
Current breast cancer
 Relative
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
contraindications
contraindications
Severe cirrhosis
Active viral hepatitis
Benign hepatic adenoma
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Injection
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Non-contraceptive benefits
 Amenorrhea (in 50%) with decreased dysmenorrhea
 Decreased risk of endometrial cancer, endometriosis
symptoms, PMS, chronic pelvic pain
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Advantages
 Injection only needed every 12-13 weeks
 Can be used while breastfeeding
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Injection
 Side
effects
 Weight gain
 Mood effects
 Hormonal side effects
 Risks
 Delayed
return to fertility
 ~9 months
 Decreased BMD
 VTE; CAD; CVA
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Hormonal IUD
 Intrauterine
small T-shaped frame
with levonorgestrel
 No
estrogen
 Slowly
releases hormone
 Endometrial
decidualization,
glandular atrophy, thickened
cervical mucous
 99.9%
5
effective
years (Mirena) or 3 years (Jaydess)
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Hormonal IUD
Side effects
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Reduction in menstrual blood loss
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More bleeding soon after insertion, which
decreases
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Some hormonal effects
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Depression, acne, headache, tenderness
Functional ovarian cysts
Advantages
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Effective
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Compliance
Disadvantages
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Requires trained clinician for insertion and
removal
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In conclusion…
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There are many contraceptive options available to our patients
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Take a patient’s health, lifestyle, cultural beliefs and compliance
habits into account when discussing their options
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Be familiar with side effects and contraindications
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Questions?
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References
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The Society of Obstetricians and Gynaecologists of Canada (SOGC)
(2012) Birth Control http://www.sexualityandu.ca/
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Association of Reproductive Health Professionals ( June 2014) Choosing
a Birth Control Method https://www.arhp.org/publications-andresources/quick-reference-guide-for-clinicians/choosing
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Black, A., Francoeur, D., Rowe, T. et al. (2004) Canadian Contraception
Consensus. JOGC, Volume 143 (part 1 of 3; February 2004) 143 - 156
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Black, A., Francoeur, D., Rowe, T. et al. (2004) Canadian Contraception
Consensus. JOGC, Volume 143 (part 2 of 3; March 2004) 219 – 254
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Trussell, J., Wynn, L. Reducing unintended pregnancy in the United
States. Contraception. 2008;77(1):1
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Tubal Ligation
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Surgical disconnection of the fallopian tubes
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Considered permanent
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Reversal is costly, difficult, and not guaranteed
Benefits
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Most effective method for women
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Can be done at same time of c-section
Risks
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Surgical risk
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Ectopic pregnancy more likely
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No STI protection
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Vasectomy
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Surgical disconnection of the vas deferens
 Prevents sperm from entering the
ejaculate
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Benefits
 Most effective male method
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Risks
 Surgical risks
 Possible sperm in ejaculate for up to 3
months
 No STI protection
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Male Condom
97% effective
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When used properly and consistently
Benefits
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Cheap
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Easy to use
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Some STI protection
Disadvantages
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Latex allergies
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Breakage/slip off
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Poor use technique