Contraception

Objectives

The student will have a working knowledge of current contraceptive methods, including indications and contraindications for each type.

 

Oral Contraceptives

General Statements

Absolute Contraindications Relative Contraindications Requiring Clinical Judgment
and Informed Consent Prescription of OCs to a Patient
Other areas of concern commonly arising in the Comprehensive Care Clinic:
If intolerable to the patient, decreased bleeding due to low-dose OCs may be corrected by increasing the estrogen dosage or changing the estrogen/progestogen ratio.
Implantable and Injectable Progestins: Norplant and Depo-Provera

Mechanism of Action: thickened cervical mucus, atrophic endometrium, and suppression of ovulation (not complete); good contraception, but poor cycle control.

Norplant

Depo-Provera
Intrauterine Device

The most popular method of reversible contraception worldwide, it is now used by only 1% of women in the U.S. Previously popular in this country in the 60s and 70s, problems with the Dalkon Shield caused public concern about all IUDs.

Copper-containing IUDs were the safest and most effective. However, the Cu-7 was taken off the market in 1986 (litigation had made it unprofit-able), and none were available in the U.S. until the Paragard T380A was approved in 1990. It is approved for up to 10 years of use.

Postcoital Contraception
Suggested Reading

Speroff L, Glass RH, Kase NG, Clinical Gynecologic Endocrinology and Infertility, 5th ed. Baltimore: Williams and Wilkins, 1994: 687-806.


M. Harper, MD
updated 8/30/05


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