Contraception

Question 1

How is contraceptive effectiveness tested?

Answer 1

Effectiveness measured by “perfect use” vs. “typical use.”
Failure rates per 100 women per year

Question 2

What are the failure rates per 100 women annually for each contraception?

Answer 2

1. Highly effective methods (<1 pregnancy/year):
   Implants, IUDs, vasectomy, female sterilization, injectables.
2. Moderately effective methods (4–7 pregnancies/year):
   Combined oral contraceptives, vaginal rings, patches.
3. Less effective methods (≥13 pregnancies/year):
   Male/female condoms, fertility awareness methods, withdrawal.

Question 3

What are some permanent contraceptive methods?

Answer 3

• Female sterilization (tubal ligation): Most common permanent method; 19% of reproductive-age women use it.
• Vasectomy: Less common globally (<3%), shorter procedure than female sterilization.

-More than half of U.S. sterilizations occur post-partum (~340,000/year).

Question 4

What are some Long-Acting Reversible Contraceptives (LARCs)?

Answer 4

Copper IUD:
- Creates a chemical reaction that damages sperm and egg.
- Effective for up to 12 years.

Levonorgestrel IUD:
- Thickens cervical mucus, preventing sperm from reaching the egg.
- Effective for 5 years.

Hormonal Implants:
- Prevent ovulation and thicken cervical mucus.
- Effective for 3–5 years.

Question 5

What are the injectable/hormonal contraceptives?

Answer 5

• Progestin-only injectables (DMPA, NET-EN): Prevent ovulation; suitable for breastfeeding women.
• Combined injectables (CICs): Contain estrogen and progestin, require monthly administration.
• Oral Contraceptives (COCs & Progestin-only pills): Work by delaying ovulation.
• Hormonal Patch & Vaginal Ring: Used for three weeks with a one-week break.

Question 6

What are some examples of emergency contraceptives?

Answer 6

• Copper IUD (most effective).
• Ulipristal acetate (UPA) 30 mg.
• Levonorgestrel (LNG) 1.5 mg.
• Yuzpe method (high-dose combined oral contraceptive).

**Must be taken as soon as possible after unprotected intercourse.
**Not effective after implantation has occurred.

Question 7

What are fertility-awareness based methods (FABMs)

Answer 7

-Based on identifying fertile vs. infertile days.
-Requires strict adherence to cycle tracking and abstinence or barrier methods during fertile periods.
-Standard Days Method (SDM) is one of the most effective.

Question 8

What are two other natural methods?

Answer 8

Lactational Amenorrhea Method (LAM):
- Works by suppressing ovulation through high prolactin levels.
- Requires exclusive or nearly exclusive breastfeeding.
- Effective only for 6 months postpartum.

Progesterone Vaginal Ring: Prolongs lactational amenorrhea, used up to 12 months.

Question 9

What is being studied regarding male contraception?

Answer 9

Still in development (testosterone + progestin to suppress sperm production).
GnRH inhibitors also being studied.

Question 10

How does contraception vary worldwide?

Answer 10

• Less availability on contraceptives in Africa, most go without
• Sterilisation in females very common in north and south America
• Withdrawal method heavily relies on in Europe

Question 11

How does contraception vary with age?

Answer 11

• Young Females in UK majorly use pill, implants and patches
• Older women tend to use no method
• As age progresses, condom use decreases

Question 12

How is the HPG axis relevant in contraception?

Answer 12

• Most common approach: mimic natural negative feedback on hypothalamus on pituitary via excess hormones so FSH and LH are low so there is no follicle development
• Very effective at preventing follicular development and ovulation
• Modified versions of natural hormones could potentially minimise side effects