Effectiveness for contraception is measured by the technique's ability to prevent pregnancy in one year of use. Rates for perfect adherence differ from actual rates due to imperfect use.
We need to know indications, complications, etc.
good nomenclature: HER-C highly effective reversible contraception
post-ovulation, symptothermal method, cervical mucous, calendar - require a woman to know her body really well and pay close attention. There is maybe a 10 day window of safety
Mirena - progesterone-containing ; makes bleeding lighter
Oral contraceptives (OCs) are very effective, with a risk of pregnancy of 6-8% with typical use and of about 1% with perfect use (Petitti, 2003). Normally a combination of estrogen and progesterone.
Combined OCs contain two hormones - estrogen and progestin. Estrogen is usually ethinyl estradiol (EE) at a dose of 20-50 ug. Nausea or breast tenderness may be reduced by using a low-dose EE pill.
Progestins may be monophasic, biphasic, or triphasic, describing weekly variations in dose. Selective progestins have little or no androgenic activity, and these may be helpful for patients with acne, oily skin, hirsuitism, mood swings, or premenstrual symptoms. Progestins include:
Progestin-only contraceptives contain norethindrone. They are useful when estrogen is
contraindicated, for example in smokers over 35, in
breastfeeding women, or in women with hypertension,
migraine + aura, or a history of DVT.
A monophasic pill us helpful if the cycle is heavy.
There are a number of ways of beginning OC. It may be started immediately in the office after ruling out pregnancy, on the first day of the cycle, or the fifth day of the cycle. If the pill is started after the fifth day, alternative contraception must be used for 7 days.
A recheck should be done within 3 months to assess, especi
Pills may be taken on 21 or 28 day cycles. In the case
of 28 day cycles, the last 7 days are sugar or 'dummy'
pills, used to maintain consistency in a woman's
Continuous use is also feasible, and is often done for
women who have dysmenorrhea, mood swings, or would like
to avoid periods. Breakthrough bleeding often occurs,
but decreased over time.
Progestin only pills need to be taken at the same time daily, are taken consistently, and often are accompanied by irregular bleeding.
If a woman misses one pill, it should be taken as soon as possible, and the next pill taken at the normal time. If two consecutive days are missed during the 1st or 2nd week, take 2 pills daily for 2 days, then return to one pill daily. Use back-up contraception for one week.
If two consecutive days are missed during the third week, or if three or more pills are missed at any time, discard the pack and immediately start a new pack. Use back-up contraception for one week.
Make it a routine; put the pack by your toothbrush.
While OC is very safe, there are a number of adverse effects that may result. These are described below.
common side effects
stroke, myocardial infarction
There are many relative contraindications, and a number of absolutes.
Some of the significant contraindications include:
progesterone-only pill (POP)
good for patients who cannot take estrogen
immediate return to fertility; 10% amenorrhea
increases cervical mucous; can cause endometrial atrophy and inhibit
Evra: an estrogen/progesterone patch that is worn 3 weeks out of 4
RESPOND project - videos on LA/PMs