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contraception

contraception

introduction

  • unintended pregnancies have a high psychosocial and often financial cost
  • most women and their partners, do not consider termination of these pregnancies without enormous psychologic stress at the time or the pregnancy, and later in life in often still raises psychologic issues.
  • unintended pregnancy rates in Australia are ~20 per 1000 women aged 15-44 years compared with 17 per 1000 in northern Europe 1) 2)
  • ~50% of unintended pregnancies in the US are due to failure of methods which require women to make a decision to use them each day
  • adolescents and young adult women are at their most fertile stages of life and at a stage of life when they tend to be less reliable at taking daily contraception or using coital contraceptive methods
  • these women in particular should have good access to reliable long acting reversible contraceptive methods (LARC) but uptake in Australia is slow 3)
    • a study suggests that if 5% of women in the UK change from using the combined OCP to one of the LARC methods, there would be 7500 fewer unintended pregnancies each year, resulting in a annual net saving cost of almost £10m! 4)
    • modern methods of LARC are not associated with infertility and are suitable for use in young women, while continuity rates and satisfaction rates are much higher than other methods which suggests lower side effect rates.

long acting reversible contraception (LARC)

copper intra-uterine contraceptive device (IUCD)

levonorgestrel intrauterine system

  • unintended pregnancy rate in 1st year of use 0.2% 7)
  • usually active for 5 years
  • 1yr “very satisfied” rate 70% and 1 year continuation rate 88% 8)

progestogen-only implant

  • unintended pregnancy rate in 1st year of use 0.05% 9)
  • etonergestrel subdermal implants last up to 3 years
  • 1yr “very satisfied” rate 55% and 1 year continuation rate 83% 10)

depot medroxyprogesterone acetate injection

  • unintended pregnancy rate in 1st year of use 6% typical use, 0.2% perfect use 11)
  • duration of action usually 3 months
  • 1yr “very satisfied” rate 42% and 1 year continuation rate 57% 12)

"short acting" contraception

oral contraceptive pill (OCP)

  • unintended pregnancy rate in 1st year of use 9% typical use, 0.3% perfect use 13)
  • 1yr “very satisfied” rate 41% and 1 year continuation rate 55% 14)

"minipill" progestogen only tablets

combined hormonal patch

  • unintended pregnancy rate in 1st year of use 9% typical use, 0.3% perfect use 15)
  • 1yr “very satisfied” rate 35% and 1 year continuation rate 49% 16)

combined hormonal vaginal ring

  • unintended pregnancy rate in 1st year of use 9% typical use, 0.3% perfect use 17)
  • 1yr “very satisfied” rate 47% and 1 year continuation rate 54% 18)

post-coital emergency contraception

barrier methods

diaphragm

  • unintended pregnancy rate in 1st year of use 12% typical use, 6% perfect use 19)

male condom

  • unintended pregnancy rate in 1st year of use 18% typical use, 2% perfect use 20)

female condom

  • unintended pregnancy rate in 1st year of use 21% typical use, 5% perfect use 21)

other methods

withdrawal

  • unintended pregnancy rate in 1st year of use 22% typical use, 4% perfect use 22)

fertility awareness methods (timing)

  • unintended pregnancy rate in 1st year of use 24% typical use, 0.4-5% perfect use 23)

References:

  • The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices. AmJObGyn. Volume 181(5, Part 1) November 1999  pp 1263-1269
  • Female sexual health. Sheila Bryan (RWH). Em. Med. 2003 vol 15: 223-6
1)
Lancet 2012; 379:625-632
2)
Med J Aust 2005; 182:447-452
3)
Kirsten Black et al. Med J Aust 2013; 199(5):317-318
4)
Hum Reprod 2008; 23:1338-1345
5) , 7) , 9) , 11) , 13) , 15) , 17) , 19) , 20) , 21) , 22) , 23)
J. Contraception 2011; 83:397-404, Table 1
6) , 8) , 10) , 12) , 14) , 16) , 18)
Obstet Gynecol 2011; 117: 1105-1113
contraception.txt · Last modified: 2013/09/18 12:30 (external edit)