Table 7-2: Contraceptive Methods
| Method |
Failure Rates
(% Pregnancies) in First Year of Typical and Perfect Use |
Contraindications |
Benefits |
Potential Side Effects |
Convenience |
Disadvantages |
| Typical |
Perfect |
| Hormonal |
| Combined oral contraceptive pill (OC) |
3 |
0.1 |
History of CVD, DVT, stroke; Hypertension; High LDL/HDL ratio; >35 and heavy smoker; Markedly impaired liver function; Hepatocellular adenoma; Headache with focal neurologic symptoms; Diabetes with nephropathy, retinopathy, neuropathy, or vascular disease; Breast cancer; Major surgery with immobilization |
Decreased menstrual pain, PMS, and blood loss; May reduce acne; Decreased benign breast disease; Decreased functional ovarian cysts; Decreased ovarian and endometrial cancers; Decreased PID |
Nausea; Headache; Weight gain; Dizziness; Breast tenderness; Vaginal spotting; Chloasma; Depression |
Use independent from sexual intercourse |
No STI protection; May increase susceptibility to some STIs; Must remember to take pill daily |
| Combined estrogen-progestin injection (Lunelle) |
0.03-0.1 |
0.03-0.1 |
Same as for OCs |
Same as for OCs |
Similar to OCs; more spotting/ irregular bleeding than with OCs |
Use independent from sexual intercourse; Daily action not required |
No STI protection; May increase susceptibility for some STIs; Must have IM injection monthly in medical office (5 day “grace” period) |
| Combined estrogen-progestin vaginal ring (Nuva Ring) |
N/A |
0.6 |
Same as for OCs |
Same as for OCs |
Similar to OCs; possible increased vaginal discharge |
Use independent from sexual intercourse; Vaginal ring inserted for 3 wks out of every mo – precise placement not required |
No STI protection; May increase susceptibility for some STIs |
| Combined estrogen-progestin patch (Ortho Evra) |
0.6–0.8 (may be higher with wt > 90kg) |
0.6 |
Same as for OCs |
Same as for OCs; improved user compliance |
Similar to OCs; Skin irritation |
Use independent from sexual intercourse; Patch applied weekly 3 of 4 weeks |
No STI protection; May increase susceptibility for some STIs |
| Depo-medroxyprogesterone acetate (DMPA) |
0.3 |
0.3 |
Unexplained vaginal bleeding; Breast cancer |
Decreased risk of seizures; May have protective effects against PID, ovarian and endometrial cancer; Decreased blood loss, anemia Amenorrhea |
Menstrual changes (spotting, irregular bleeding, amenorrhea); Weight gain; Breast tenderness; Headache; Adverse effect on lipids; Depression |
Often causes amenorrhea; Requires only 4 injections/yr; Requires no ongoing action by user; Use independent from sexual intercourse |
No STI protection |
| Norplant |
0.9 |
0.9 |
Same as above |
Same as above |
Tenderness or infection at site; Menstrual changes; Hair loss; Weight gain; Breast tenderness; Depression |
Provides 5 yr of contraception; Requires no ongoing action by user; Use independent from sexual intercourse |
No STI protection |
| Progestin-only pill |
1.1–13.8 |
0.5 |
Same as above |
Same as above |
Menstrual changes (spotting, irregular bleeding, amenorrhea); Breast tenderness; Depression; Weight gain |
Use independent from sexual intercourse |
No STI protection; Ectopic pregnancy more likely among progestin-only pills than other forms of hormonal contraception; Must remember to take pill daily |
| Barrier Methods |
| Condom, male (latex, polyurethane, natural membrane) |
12 |
3 |
Allergy to condom material |
Protects against STIs, including HIV (except for natural memberane). Delays premature ejaculation |
Allergy or sensitivity to condom material; Decreased sensitivity |
Inexpensive and readily available; Does not require a prescription |
Requires partner possible cooperation; Possible loss of spontaneity during sex |
| Condom, female |
21 |
5 |
Polyurethane allergy |
Protects against STIs, including HIV |
Allergy or sensitivity to polyurethane; Possible decreased sensitivity |
Woman controlled; Less likelihood of breakage; Can be inserted up to 8 hr before intercourse; Does not require a prescription |
May be awkward to use; Aesthetically unappealing to some |
limited data |
| Cervical cap — parous/nonparous |
36/18 |
26/9 |
Latex allergy; Abnormal cervical/ vaginal anatomy; History of TSS or recurrent UTIs; Known or suspected cervical/uterine malignancy; Abnormal Pap; Vaginal or cervical infection; Recent delivery or spontaneous/induced abortion |
Limited STI protection |
Pelvic pressure; Vaginal irritation; Allergy or sensitivity to latex; Vaginal or urinary tract infections |
Woman controlled; Can be inserted ahead of time |
Efficacy based on high motivation; Spermicide re-application required with each act of coitus; Should not be used during menses |
| Diaphragm |
18 |
6 |
Latex allergy; Abnormal vaginal anatomy; History of TSS or recurrent UTIs |
Limited STI protection; Reduces risk of PID |
Same as above |
Woman controlled; Can be inserted up to 6 hr before intercourse |
Same as above, except may be used during menses |
| Spermicides |
21 |
6 |
Allergy to
nonoxynol-9 |
Protection against some STIs, significant against gonorrhea/chlamydia;
In vitro activity against HIV |
Vaginal irritation; Allergy; Vaginal and urinary tract infection |
Woman controlled; Does not require a prescription; Easily available and inexpensive |
Efficacy reduced when used without a barrier method; May increase susceptibility to HIV with frequent sexual activity; No protection against HIV |
| IUD (Copper-Paragard) |
0.8 |
0.6 |
Recent (within 3 mo) or recurrent pelvic infection; Postpartum, postabortion endometritis; Active STI; Women at increased risk for STIs; Severely distorted uterine cavity |
None |
Menstrual cramping; Increased bleeding; Risk of PID and uterine perforation following insertion; Anemia |
Provides contraception for 10 yrs; Requires no ongoing user action |
No STI protection; Increased risk of PID |
| Levonorgestrel intrauterine system (Mirena) |
0.1–0.3 |
0.1 |
Same as for Copper IUD |
Overall reduction in menstrual blood loss (20% amenorrhea after 1 yr); Possible decreased rates of anemia, PID |
Increased incidence of irregular bleeding in 1st 6 mo (compared to Copper IUD); Risk of PID and uterine perforation following insertion |
Provides contraception for 5 yr; Requires no ongoing user action |
No STI protection |
| Female surgical sterilization |
0.4 |
0.4 |
Desire for future fertility; Active pelvic infection |
Possible decreased risk of ovarian cancer; Decreased risk of salpingitis |
Pain at surgical site; Subsequent regret; Increased risk of ectopic pregnancy if failure |
Provides permanent contraception; Requires no ongoing user action |
Permanent; No STI protection |
| Nonsurgical female sterilization (Essure) |
0.2–0.4 |
0.2–0.4 |
Desire for future fertility; Active pelvic infection |
Probably similar to surgical sterilization (experience limited) |
Subsequent regret; Increased risk of ectopic pregnancy if failure; Cramping, nausea/vomiting with placement; Expulsion or uterine perforation (<3%) |
Provides permanent contraception; Requires no ongoing user action; Lower cost, does not require surgery or general anesthesia as compared to surgical sterilization |
Permanent; No STI protection; Requires office procedure for insertion, use of alternate contraception for 3 mo, and hysterosalpingographic confirmation of tubal occlusion |
| Male sterilization |
0.15 |
0.10 |
Desire for future fertility |
None |
Pain at surgical site; Subsequent regret |
Provides permanent sterilization for the man |
Same as above, except sterility not immediate |
| |
Pregnancy Rate |
|
|
|
|
|
Emergency contraception -
Levonorgestrel 0.25mg/ Ethinylestradiol 50μg (Preven)
Levonorgestrel 0.75mg (Plan B) |
3.2% (57% expected pregnancies prevented)
1.1% (85% expected pregnancies prevented)
|
Established pregnancy |
None |
Nausea and vomiting (less with Plan B); Changes in next menses (generally minor) |
Can be used after unprotected intercourse or with other contraceptive “failure” (e.g. condom breakage) |
Should be used within 72 hrs of intercourse; No STI protection; Failure rate higher if intercourse during fertile phase of cycle |