Contraceptive methods

Summary:
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Oral contraceptives:
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combined oral contraceptive (COC), progesterone only pill
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vaginal ring works in similar way
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1 in 10 women taking the pill may get pregnant
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Injectable contraceptives - Depo-Provera
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Implants - Implanon
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Emergency contraception
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Intra-uterine Contraceptive Devices (IUCDs)
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Copper IUD
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progesterone IUD
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affects sperm movement and survival
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changes lining of womb (endometrium)
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Barrier Devices: condoms, diaphragm,
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Natural Methods
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Sterilisation

* only condoms can protect from sexually transmitted infections

Oral Contraceptives
Combined Oral Contraception: 99.7% effective if taken correctly (with perfect use)
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effectiveness reduced when: taken ineffectively, absorption affected (vomiting, diarrhoea,
medication)
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low-dose oestrogen, moderate dose progesterone
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inhibition of hypothalamic and pituitary function > an anovulation
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prevents ovulation and thickens cervical mucus to prevent sperm from entering the uterus
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monophasic/ biphasic or tri-phasic (incremental dose increase)
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common side effects: acne, amenorrhea, breakthrough bleeding, breast tenderness/ mastalgia,
chloasma, depression, dysmenorrhoea/ menorrhagia, libido loss, headache/ focal migraine,
nausea/vomiting, weight gain (constant or cyclic), loss of libido
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serious side effects:
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cardiovascular: deep vein thrombosis, pulmonary embolism, myocardial infarction, thrombotic
stroke, haemorrhagic stroke
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cancer: no overall incidence of cancer in women using COC
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possible effect: cervix, breast
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possible protective: endometrial, epithelial ovarian
- advantages: regular bleed with reduced blood loss, acne often improves, improvement or
absence of PMS (premenstrual syndrome),
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advice to patient:
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periods tend to become shorter, regular and lighter
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no break from the pill is necessary
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drug interactions: antacids, putgatives, vitamin C, antibiotics (especially griseofulvin,
rifampicin), anti convulsants (except sodium valproate), requirements may change for those
on warfarin or oral hypoglycaemics
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diarrhoea and vomiting may reduce the effect of the pill
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advice on what to do if a pill is missed (essentially, keep going)
Progesterone only pill (mini pill): 99.7% effective (with perfect use)
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levonorgestrel 30 mcg/day
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norethisterone 350 mcg/day
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cervical mucus thickens, acting as a plug to sperm
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indications: age " 45, contraindications/ intolerances to oestrogens, diabetes mellitus, migraine,
chloasma, lactation and well-controlled hypertension
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it is important not to be more than 3 hours late with the mini pill
Vaginal Ring (e.g. Nuva Ring): 99.7% effective (with perfect use)
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exible polymer ring with 15mcg ethinyloestradiol and 120 mcg etonogestrel released per 24
hours
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inserted into vagina once a month, in rst 5 days after period, and removed after 21 days, with a
break of 7 days
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not listed on PBS scheme

Injectable contraceptives
Depo-Provera (only injectable available in Australia): 99.8% effective
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suppression of hormone production, also used to treat endometriosis
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medroxyprogesterone acetate
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150mg by deep IM injection in rst 5 days of menstrual cycle
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every 12 weeks
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side effects: disrupted menstrual cycle, excessive weight gain, breast tenderness, depression,
delay in return to fertility (6 months), loss of libido,
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no CVS or cancer risk, long term use associated with accelerated bone loss (> osteoporosis)
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advantages: highly effective, relief of symptoms of PMT and period pain, every 12 weeks
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possible reduction of risk of ovarian cancer, endometrial cancer, endometriosis and possible
pelvic infection
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disadvanatages: doctor visit every 3 months, side effects, irreversible for 3 months and may take
up to 6 - 12 months for periods to start again

Etonogesterel Implant (Implanon): 99.8% effective
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sub dermal, inhibits ovulation and has an anti-mucous effect
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3 year system, requires minor surgical procedure for implanting and removal
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4cm plastic under skin on inside of arm
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1 in 20 women may still get pregnant
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side effects: most women have less bleeding, but some have more frequent and longer periods;
headaches, acne
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periods return to normal usually after a month of removal

Emergency Contraception
oral:
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stopping or delaying ovulation, preventing fertilisation, stopping fertilised egg attaching
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estimated to prevent 85% of expected pregnancies
copper IUD:
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interfere with sperm movement, prevent fertilisation and implantation
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estimated to prevent 98% of expected pregnancies
types:
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Postinor 2
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72 hour limit
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1 750 mcg levonorgestrel tablet, followed by another 12 hr later
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Yuzpe method
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high oestrogen COC
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2 pills initially, repeat 12 hours later
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Danazol 200mg tablets
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2 initially, repeated 12 hours later
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copper IUCD
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within 5 days

Intra-uterine Contraceptive Devices (IUCDs): 99.8% effective
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small devices of inert material with bioactive substance
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copper (e.g. Multiload-cu375): 6 - 10 years
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progestogen (e.g. Mirena): 5 years
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affects sperm motility and transport
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96 - 99% protection against pregnancy
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advantages: long term contraception, easy to maintain/ dont forget, cheaper over the long term,
progesterone IUD also reduces menstrual bleeding
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disadvantages: may expel itself, increases risk of miscarriage (if contraception fails), small risk
of infection in the 3 weeks after insertion, rarely may perforate wall of uterus, very rarely ectopic
pregnancy

Barrier Methods
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condoms (also protects against STI): 98% effective (82% effective if not used properly)
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vaginal diaphragms
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soft silicon cap worn inside vagina to cover the cervix
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94% effective
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cervical caps
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vaginal vault caps

Spermicides
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adjunct to barrier methods
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creams, jellies, foams, pessaries, containing nonoxynol 9 or octixinol

Natural methods: 95 - 99.6% effective
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basal body temperature methods
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calendar or rhythm method
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Billings ovulation method
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coitus interruptus (withdrawal): 96% effective

Sterilisation
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Vasectomy
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Tubal ligation
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time clips (Filshie or Hulka) or rings (Falope) are applied to each fallopian tube
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Essure procedure
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procedure for permanent female birth control involves the placement of a exible titanium
micro-insert into each fallopian tube with a hysteroscope. The insert expands and over time
(usually 3 months) reactive tissue growth occludes the tubes.

References:
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Murtagh, John. John Murtagh's General Practice, 5th Edition. McGraw-Hill Medical
Publishing/Australia, 2010-10-01. VitalBook le. p. 941
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https://www.thewomens.org.au/patients-visitors/clinics-and-services/sexual-health-sexuality/
contraception/
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https://thewomens.r.worldssl.net/images/uploads/fact-sheets/Contraception-Your-Choices.pdf