Contraceptive Options

There are many available contraceptive options.  Their effectiveness in preventing pregnancy has improved with the Long Acting Reversible Contraception (LARC).

The contraceptives categorized as LARC have the lowest failure rates of all the methods available including combined birth control pills, barrier methods, and natural family planning. These types of contraceptives either have a progesterone  only agent or “no”  hormones (Paragard IUD). They are administered via injection, insertion under the skin, or insertion inside the uterus. The failure rate of Long Acting Reversible Contraception is less than 1%. The failure rate for birth control pills for all users is 9% which is improved with consistent use and condom failure rate is 12%.

In any given year 5% of unintended pregnancies among women of all ages occured  while using contraception consistently and 95% occur in women who were either not using contraception at all or using it inconsistently. The most recent data for North Carolina reveals that the rate of teen pregnancy  (ages 15-19) was 53 per 1000 in 2011. This represents a 57% decrease since 1988.  Some evidence suggest that the decrease in the teen pregnancy rate is due in part to the use of Long Acting Reversible Contraception (LARC).

 

Nexplanon® (etonogestrel) Subdermal Implant

Nexplanon® is a progestin-only, soft flexible implant pre-loaded in a sterile, disposable applicator. It measures 4 cm (about 1.6 inches) in length and 2 mm (7/100^th of an inch) in diameter.  It releases progesterone for 3 years .It is inserted and removed in an office setting. 

Nexplanon® does not contain latex.

Side Effects

The most common side effect with Nexplanon® is changes in menstrual cycles, causing irregular periods.

Mechanism of action is achieved by suppression of ovulation, increase thickness of cervical mucus and changes in the endometrium. 

Efficacy: 0.05% failure rate

 

Mirena® IUD (levonorgetrel)  Intrauterine device

 

 Mirena® is a progestin-only IUD which is inserted into the uterus. It is T-shaped and latex free.   It measures 32 mm (about 1.26 inches) horizontal and 32mm vertical. Mirena® prevents pregnancy by thickening the cervical mucus and thereby preventing sperm from reaching the egg and thins the lining of the uterus and partially suppresses ovulation. It is effective for 5 years after insertion. 

Mirena® is recommended for women who have had a child.

 

You should not have the Mirena® IUD inserted until 6 weeks postpartum, or if:

• you have an untreated pelvic infection,
• you have unexplained bleeding,
• you have problems with your immune system,
• you have multiple sexual partners or your partner has multiple partners,
• you have allergies to silicone, polyethylene, silver, silica, barium sulfate and iron oxide.

Side effects

The most common side effect is irregular cycles.

There is a risk of perforation which may require surgery for removal.

There is a risk of expulsion as well.

Efficacy: 0.2% failure rate.

 

Skyla® (levonorgestrel) Intrauterine device

 

Skyla® is a progestin-only IUD which is inserted into the uterus. It is T-shaped and latex free. It measures 28 mm (1.1 inches) horizontal and 30 mm (about 1.2 inches) vertical. It has less hormone and is smaller than the Mirena®. It is designed for women who have not had a baby. It is effective for 3 years after insertion.  Skyla® prevents pregnancy by thickening the cervical mucus preventing and thereby sperm from reaching the egg and thins the lining of the uterus and partially suppresses ovulation 

Side Effects

It causes irregular periods and may cause menstrual cycles to stop after one year.

There is a risk of perforation which may require surgery for removal. There is a risk of expulsion as well.

You should not use Skyla® or any IUD if:

• you have an untreated pelvic infection,
• you have unexplained bleeding,
• you have problems with your immune system,
• you have multiple sexual partners or your partner has multiple partners,
• you have allergies to silicone, polyethylene, silver, silica, barium sulfate and iron oxide.

 

Efficacy: 0.2% failure rate.

 

Depo-Provera (medroxyprogesterone acetate) Injection

 

Depo-Provera Injection is administered every 3 months.

Depo-Provera is a progestin-only injection. It works by preventing ovulation and by thickening cervical mucus making it hard for the sperm to reach the uterus.

 

Side Effects

Depo-Provera causes irregular cycles.

You should not use Depo-Provera for more than 2 years. It can potentially cause bone loss if used for more than 2 years.

Efficacy: 1% failure rate

 

Paragard® (copper) Intrauterine device

Paragard® is a T-shaped device that contains copper which is inserted into the uterus. Size measures 32 mm  (1.26 inches) horizontal 36 mm (about 1.42 inches) vertically.  Paragard® prevents pregnancy by releasing copper which produces an inflammatory reaction in the uterus that is toxic to sperm and which prevents fertilization. It can be used for up to 10 years. 

 

Side Effects

The Paragard® typically causes menstrual cycles to last longer and to be more painful and heavier. There is a risk of perforation which may require surgery for removal. There is a risk of expulsion as well.

Efficacy: 0.8% failure rate

 

Combined Estrogen and Progesterone Contraception

Most combined hormonal contraception have the same estrogen (ethinyl estradiol) at different doses and combined with a variety of progesterones.

Side effects

Combined estrogen and progesterone contraception taken regularly tend to improve menstrual cycle pain and flow. The birth control pills generally improve complexion and used to treat heavy menstrual flow. Taking birth control pills may increase your risk for blood clot, stroke or heart attack if there are risk factors in your medical history or your families.

Contraindications

Migraines with aura, previous DVT, smoker over 35 yrs old, uncontrolled hypertension under 35, hypertension over 35 yrs of age

If taken consistently the efficacy is 1-2 % failure while if taken inconsistently would be closer to 9% failure rate.

 

Pills  

Most birth control pills contain a combination of ethinyl estradiol with a number of progesterones including but not exclusive to levonorgesterol, norethindrone, ethynodiol acetate, drospertenone, and norgestimate. There are a variety of oral contraceptives which are well tolerated.

 

Nuvaring® (etonogestrel/ethinyl estradiol)

 

Nuvaring is a combination contraception which the individual can insert in the vagina and remove and insert new Nuvaring on a monthly basis.  This is ideal for women who have trouble remembering to take their birth control pills daily. It is low dose and by passes the liver.

 

Side effects

Combined estrogen and progesterone contraception taken regularly tend to improve menstrual cycle pain and flow. The birth control pills generally improve complexion and used to treat heavy menstrual flow. Taking birth control pills may increase your risk for blood clot, stroke or heart attack if there are risk factors in your medical history or your families.

Contraindications

Migraines with aura, previous DVT, smoker over 35 yrs old, uncontrolled hypertension under 35, hypertension over 35 yrs of age.

Efficacy: If taken consistently the efficacy is 1-2 % failure while if taken inconsistently would be closer to 9% failure rate.

 

Othro Evra® patch (norelgestromin/ ethinyl estradiol)

 

 

Ortho Evra patch is a patch that is applied to the skin and changed weekly.  It is a combination contraception.

 

Side effects

Combined estrogen and progesterone contraception taken regularly tend to improve menstrual cycle pain and flow. The birth control pills generally improve complexion and used to treat heavy menstrual flow. Taking birth control pills may increase your risk for blood clot, stroke or heart attack if there are risk factors in your medical history or your families.

Contraindications

Migraines with aura, previous DVT, smoker over 35 yrs old, uncontrolled hypertension under 35, hypertension over 35 yrs of age

Efficacy: If taken consistently the efficacy is 1-2 % failure while if taken inconsistently would be closer to 9% failure rate.

 

Barrier Methods

• Diaphragm (holds spermicide close to cervix) 12 % failure rate
• Male condoms 18 % failure rate (according to CDC data)
• Female condom 21% failure rate
• Withdrawal 22% failure rate
• Fertility awareness 24 % failure rate

 

Permanent methods

Permanent methods of contraception are appropriate options when a woman or couplele has no further desire to have children. These methods are essentially  irreversible.

• Vasectomy  0.15% failure rate
• Tubal ligation  0.5% failure rate  IVF could be done after tubal ligation
• Essure®  1% failure rate  IVF cannot be done with Essure®

Conclusion

Today there are many available methods for preventing pregnancy. This guide provides basic information about numerous options, their effectiveness, and the associated risks. You are encouraged to talk to your provider to determine what option might be best for you.