Contraception

Article Author:
Oshin Bansode
Article Author (Archived):
Manbeer Sarao
Article Editor:
Danielle Cooper
Updated:
1/30/2019 10:32:01 PM
PubMed Link:
Contraception

Definition/Introduction

Contraception is a product or medical procedure that prevents reproduction from acts of sexual intercourse. As the contraceptives came into being, couples could act on natural incitement and desires with decreased risks of pregnancy. Contraceptive methods are technological advances intended to overcome biology.

The most appropriate contraceptive methods include efficiency, safety, acceptability and availability (including accessibility and affordability). Voluntarily informing the choice of contraceptive methods is an important guiding principle, and contraceptive counseling, when associable, is a marked contributor to the successful use of contraceptive methods.

Birth control methods are designed to prevent conception or interrupt or nullify implantation and growth. Conception can be prevented by hormonally disrupting the menstrual cycle (oral contraceptive (OC) pills), by physically blocking the passageway (barrier methods or sterilization), or less successfully, by abstinence during fertile periods or withdrawal method. Implantation impairment is the mechanism via the use of a foreign body (intrauterine device {IUD}) or surgical removal (tubectomy or vasectomy).[1]

Intrauterine Contraception

  • Copper T intrauterine device (IUD) 
  • Levonorgestrel intrauterine system (LNG IUD)

Hormonal Methods

  • Implant
  • Injection or “shot”
  • Combined oral contraceptives
  • Progestin-only pill
  • Patch
  • Hormonal vaginal contraceptive ring

Barrier Methods

  • Diaphragm or cervical cap
  • Sponge
  • Male condom
  • Female condom
  • Spermicides

Fertility awareness-based methods

Lactational Amenorrhea Methods

Emergency Contraception

  • Copper IUD
  • Emergency contraceptive pills.

Permanent Methods of Birth Control

  • Female - Tubal ligation or “tying tubes”
  • Male - Sterilization–Vasectomy

Issues of Concern

Concerns arise in women who take hormone-based birth control as they have an increased incidence of breast cancer, making the contraceptives a significant public health priority. In a recent study, Mørch et al. showed that hormonal contraception had a 20% higher risk of breast cancer, regardless of the dose of estrogen, than women who never used any birth control methods.[2]

Irregular bleeding is of particular concern and can occur to younger women so good counseling is important before advising either implant or depot injections. Contraceptive-induced menstrual bleeding changes (CIMBCs) should be recognized as a critical concern in contraceptive counseling and usage.[3]

Clinicians are increasingly considering intrauterine devices in nulliparous women and those less than 25 years. Among the contraceptives, IUD for women is one of the better options due to fewer complications. There is a concern if pelvic infection and menorrhagia persist. The key to minimizing problems in contraceptive practice is the consideration of sustainability (efficiency, cost, duration of action and suitability), making a careful and correct choice, and then counseling the patient well.[4]

Venous thromboembolism (VTE) and arterial thrombosis (AT) are the most concerning side effects of the OC pill. The rate of VTE in non-pregnant women is 4 to 5 per 10000, in OC pill users is 9 to 10 in 10000, while in a normal pregnancy it is approximately 30 in 10000.[5] Lowering the dose of estrogen may be better for preventing myocardial infarction and possibly thrombotic stroke. The decision to use hormonal contraceptives and the choice of the formulation should be individualized based on the known risk factors and the patient's age.[6]

The number of children desired per family averages around two in the United States. Despite the number of available options, close to 50% of pregnancies in the United States are not planned, and approximately 25% of babies born are unwanted at the time of birth.[1]

Clinical Significance

Effective contraception provides social and health benefits to mothers and their children by reducing unintended pregnancies and abortions and facilitating family planning. Effective contraception indirectly helps in improving the overall health status of infants and children.

In addition to preventing pregnancy, the correct and consistent use of male condoms (a barrier method) reduces the risk of HIV and other STDs including infections like chlamydia, gonococcus, and trichomoniasis. It acts as double protection. Although hormonal contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect against STDs, including HIV.

Contraceptives like OC pills are used clinically to treat [7]:

  • Primary dysmenorrhea
  • Endometriosis
  • Amenorrhea due to low weight, stress or exercise
  • Menstrual cramps
  • Premenstrual syndrome
  • Primary ovarian insufficiency
  • Menorrhagia
  • Acne
  • Polycystic ovary syndrome