In this section
Contraception
Updated by: Dr. Seema Menon
Updated on: 4/2017
Abstinence
- Effectiveness:
- If ALL sexual activity is avoided (including skin to skin contact) 100% effective at preventing pregnancy and STDs
- Pros:
- No side effects
- Free
- Cons:
- No protection if sexual activity is forced
- Contraindications:
- None
Combined oral contraceptive pills
- Effectiveness:
- Perfect use: 99% effective
- Actual use: 92-95% effective
- Pros:
- Menstrual cycles become lighter and are regular
- Can be used for extended cycling
- Can help with dysmenorrheal and other symptoms of PMS
- Decreases incidence of physiologic ovarian cysts, ovarian cancer, and endometrial cancer
- Does not interrupt sexual activity
- Protects against pregnancy if sexual activity is forced
- Cons:
- Needs to be taken every day at the same time
- Does not protect against STDs
- Certain medications may interact with the pill:
- Decrease the efficacy of the OCP: carbamazepine, Phenobarbital, phenytoin, rifampin, griseofulvin, barbiturates, felbamate, topiramate, ethosuximide
- Decrease the efficacy of the medication: warfarin, lorazepam, salicylates
- Decreases clearance of medication: cyclosporine, dantrolene
- Drugs potentiated by OCP: benzodiazepines, beta blockers, caffeine, corticosteroids, TCA
- Increases the risk of thrombotic events
- Potential side effects include nausea and headaches
- Contraindications:
- Absolute: Pregnancy, hypercoagulable states, history of DVT/PE/stroke, active liver disease, vaginal bleeding of unknown etiology, estrogen-dependent malignancy (breast cancer), prolonged immobilization, complicated congenital heart disease, severe hypertension, migraine with aura or focal neurological defects
- Relative: high blood pressure, gall bladder disease, smoking, hyperlipidemia
Condoms
- Effectiveness:
- Perfect use: 97% effective
- Actual use: 86% effective
- Pros:
- Protects against STDs
- Inexpensive
- No hormones involved
- Cons:
- Need to interrupt sexual activity to use
- Possibility that condom can break
- Must be placed correctly
- Need to use a new one with each episode of intercourse
- Latex can be weakened by oil based lubricants (always use water based), extreme heat or cold, humidity, sunlight, age (always check the expiration date)
- Contraindications:
- Latex allergy (instruct patients to use polyurethane condoms instead)
Depo-Provera
- Effectiveness:
- Perfect use: 99.7% effective
- Actual use: 97% effective
- Pros:
- Each injection prevents pregnancy for 3 months (12 weeks)
- Does not contain estrogen, so appropriate to use in those with contraindications to estrogen
- Protection even if sexual activity is forced
- Many girls stop getting their periods while receiving injections
- Periods return on average 6-12 months after discontinuation of injections
- Cons:
- Does not protect against STDs
- Need to see health care provider every 3 months for the injection
- Common to see irregular bleeding during the first 3 months after initiating injections
- Side effects include weight gain, depression, hair loss
- May see decrease in bone density
- This decrease has not been shown to cause increase in fractures
- Decreased bone density has been shown to reverse on discontinuation of injections
- Contraindications:
- Caution in girls with history of/high risk of bone fractures
Emergency contraception
(Note: Emergency contraception (EC) does not work if a woman is already pregnant. EC will NOT cause an abortion.)
- Effectiveness:
- Perfect use: lowers risk of pregnancy 75-89%
- Pros:
- Can be taken 5 days (120 hours) after unprotected sex
- Girls 17 and over can get over the counter (do not need a prescription)
- Can be taken if sexual activity is forced
- Cons:
- Does not protect against STDs
- Girls 16 and under need a prescription
- Side effects include nausea, headache
Hormonal implants (Implanon)
- Effectiveness:
- Perfect use: 99.95%
- Actual use: 99.95%
- Pros:
- Prevents pregnancy for 3 years
- Can have it removed at any time
- Pregnancy protection even if sexual activity is forced
- Does not contain estrogen, so appropriate to use in those with contraindications to estrogen
- Cons:
- No protection against STDs
- Requires minor procedure for both insertion and removal of the rod
- Need to have a health care provider trained in insertion/removal
- Side effects including irregular bleeding, depression, hair loss, weight gain
- Contraindications:
- Pregnancy, active liver disease, vaginal bleeding of unknown etiology
- Lactational:
- Effectiveness
Amenorrhea Method (LAM)
- Effectiveness:
- Perfect use: 98% effective
- Actual use: 98% effective
- Pros:
- Does not interrupt sexual activity
- Can prevent pregnancy in forced sexual activity
- Cons:
- Only can be used within 6 months of delivery in a woman who has not had menstrual period since delivery and is breast feeding baby at least 6-10 times per day
- Does not protect against STDs
- Contraindications:
- Not breast feeding
Levonorgestrel IUD (Mirena)
- Effectiveness:
- Perfect use: 99.8%
- Actual use: 99.8%
- Pros:
- Prevents pregnancy for up to 5 years
- Does not need daily attention - just need to check the strings once a month
- Will likely have much lighter periods or none at all (Also a treatment for menorrhagia)
- Pregnancy protection even if sexual activity is forced
- Does not contain estrogen, so appropriate to use in those with contraindications to estrogen
- Cons:
- Does not protect against STDs
- Need to have health care provider trained in insertion/removal
- Increased risk of PID during the first few weeks after insertion in patients with STDs
- Small risk of spontaneous expelling
- Small risk of uterine perforation during placement
- Moderate to severe uterine cramping during placement
- Irregular, light bleeding for approximately 2 months after placement
- Contraindications:
- Pregnancy, abnormal uterus (mullerian anomaly), recent PID, cervical/endometrial/ovarian cancer
Ortho-evra patch, Nuva Ring
- Effectiveness:
- Perfect use: 99.7% (patch and ring)
- Actual use: 99% (patch); 95% (ring)
- Pros:
- Does not need to be taken every day (the patch lasts 1 week and the ring lasts 3 weeks)
- Makes menstrual periods more regular and lighter
- Can use extended cycling
- Can help with dysmenorrhea and other PMS symptoms
- Decreases incidence of ovarian cysts, ovarian cancer and endometrial cancer
- Does not interrupt sexual activity
- The ring can be left in during sex or removed for maximum of 3 hours
- Protection from pregnancy even if sexual activity is forced
- Cons:
- Does not protect against STDs
- The patch may not be as effective in people over 200 lbs
- Potential side effects include irregular bleeding, breast tenderness, nausea, headaches
- Patch is associated with slightly higher risk of thrombotic event (but lower than thrombotic risk associated with pregnancy).
- Patch may cause skin irritation or change in skin pigment
- Vaginal ring may cause leukorrhea, foreign body sensation
- Contraindications:
- Absolute: Pregnancy, hypercoagulable states, history of DVT/PE/stroke, active liver disease, vaginal bleeding of unknown etiology, estrogen-dependent malignancy (breast cancer), prolonged immobilization, complicated congenital heart disease, severe hypertension, migraine with aura or focal neurological defects
- Relative: high blood pressure, gall bladder disease, smoking, hyperlipidemia
Progestin-only pills
- Effectiveness:
- Perfect use: 98% effective
- Actual use: 95% effective
- Pros:
- Does not contain estrogen, so appropriate to use in those with contraindications to estrogen
- Protection even if sexual activity is forced
- Cons:
- Needs to be taken every day at the same time
- Does not protect against STDs
- Associated with breakthrough bleeding
Rhythm method
- Effectiveness:
- Perfect use: 91-98% (average 94%) effective
- Actual use: 76% effective
- Pros:
- Free
- Do not need to interrupt sexual activity
- Cons:
- Woman needs to know when she is ovulating and avoid sex few days before and few days after
- Does not protect against STDs
- Does not protect against forced sexual activity
- Contraindications:
- Irregular periods
Withdrawal
- Effectiveness:
- Perfect use: 96% effective
- Actual use: 77-81% effective
- Pros:
- Free
- No hormones needed
- Cons:
- Perfect use rarely happens: Pre-ejaculate may contain sperm
- Does not prevent STDs