Pregnancies often are unintended. Currently, 45-62% of pregnancies are unintended. These pregnancies often result in increased preterm delivery, low birth weight, and abortion. Thus, contraceptive methods are available for pregnancy prevention. These methods include spermicide, condoms, withdrawal, sponge, combined hormonal contraceptives, intrauterine devices, implants, and sterilization.
COMBINED HORMONAL CONTRACEPTIVES
Combined hormonal contraceptives include birth control pills and patches. These formulations provide both estrogen and progesterone. Estrogen inhibits ovulation and progesterone thickens cervical mucus. As a result, only 6-12 pregnancies per 100 in a year are expected with the usage of combined hormonal contraceptives. CHC are available in multiple formulations and dosage amounts. Each regimen is unique to the individual, whether estrogenic, progesterone, or androgenic effect is necessary. It is always significant to ask about back-up protection upon other drug usage as well as any non-compliance. These medications can result in severe and non-severe side effects. Some of the most common initial side effects include bloating, nausea, headache, and weight gain. More severe effects potentiating the need for healthcare attention are unexplainable or excessive bleeding, abdominal cramping, elevated blood pressure, and leg pain.
Combined hormonal tablets, progestin only, and anti-progestins are available as emergency contraceptives. Progestin only tablets contain levonorgestrel formulated as one tablet taken once or two tablets administered twelve hours apart and most effective within 72 hours of sexual intercourse. Anti-progestins of mifesprostone and ulipestel are effective within 120 hours. These therapies have an 86% efficacy rate and depending on formulation are over the counter. For example, levonorgestrel 1.5 mg is formulated as Plan B one step and approved over the counter for all women of child bearing age.
Long-acting reversible contraceptives include copper IUD, levonorgestrel 52 mg-releasing IUD (Mirena), levonorgestrel 13.5 mg (Skyla), and levonorgestrel 52 mg (Liletta). Copper IUD has the longest duration of action of 10 years. Mirena provides protection for 5 years. Skyla and Liletta provide protection for 3 years. It is important to consider pain upon administration which is often alleviated by topical application of lidocaine. In addition, duration awareness is applicable for contraceptive timing.
Diaphragm: Caya is single-size silicone diaphragm not requiring healthcare fitting. It is non-hormonal and easy to use. It is to remain in place for 6 hours after intercourse and with a spermicide. Diaphragm efficacy is rated as 18 pregnancies prevented out of 100 in a year.
Sterilization methods such as hysteroscopy and vasectomy result in less than 1 in 100 women per year experiencing an unintended pregnancy. However, it is best to use back-up for 3 months following the procedure.
Pharm D, BCPS, BCACP, CDE, MSMTM