Contraception (Birth Control)

Contraception refers to methods of preventing pregnancy, ranging from natural methods to surgical procedures. Each method has its own advantages and disadvantages. Some contraceptive methods also offer protection against sexually transmitted infections (STIs). The effectiveness of contraception depends on user compliance, individual health conditions, and consistency of use. No method guarantees 100% prevention, so choosing the right method should involve consultation with a healthcare provider and one's partner.

Patient Advice

• Multiple contraceptive methods may be used together to increase effectiveness.
• Emergency contraception should be used within 72 hours after unprotected intercourse or condom failure. All pills must be taken as directed to maximize efficacy.
• Always check the expiration date on contraceptive products or medication before use.
• Consult a gynecologist or family planning specialist to determine the most suitable method.
• Women should undergo a preliminary screening before starting oral contraceptive pills.
• If a pill is missed:
  • For 1 missed pill: Take it immediately and resume the regular schedule.
  • If >1 pill is missed during week 1: Take one as soon as remembered, continue the rest as normal, and use backup contraception for 7 days.
  • If >1 pill is missed during week 2–3: Take one immediately, continue normal schedule, skip placebo pills (if using a 28-pill pack), and start a new pack. Use backup for 7 days.
• Some medications, such as antibiotics or anticonvulsants, may reduce the effectiveness of oral contraceptives. Always inform your doctor or pharmacist.
• Lactational Amenorrhea Method (LAM) can be used if all of the following apply:
  • No menstruation or spotting within 2 months postpartum
  • Breastfeeding every 4 hours during the day and every 6 hours at night
  • Infant is younger than 6 months

If any of the above criteria are not met, LAM is no longer effective.

When to See a Doctor

• Inability to use or intolerance to contraceptive methods
• Use of medications that interfere with contraceptive effectiveness (e.g., anticonvulsants, antibiotics)

Treatment Options

1. Oral Contraceptive Pills (OCPs)

• Combined pills contain estrogen (e.g., ethinyl estradiol, mestranol) and progestin (e.g., levonorgestrel, drospirenone)
• Available in monophasic (same dose daily) or multiphasic (varying doses) formulations
• Suppress ovulation and thicken cervical mucus
• Progestin-only pills (POPs) are suitable for women who are breastfeeding, smoke, have migraines, or are contraindicated for estrogen
• Must be taken daily
• Side effects: weight gain, nausea, vomiting, acne, breakthrough bleeding
• Long-term use may increase risk of clotting disorders or breast cancer (especially in high-risk populations)
• May interact with other medications—always inform your healthcare provider

2. Injectable and Implantable Contraceptives

• Long-acting progestin-based methods (e.g., medroxyprogesterone, norethisterone, levonorgestrel)
• Injections: medroxyprogesterone lasts 3 months; norethisterone 8 weeks
• Implants: (e.g., etonogestrel) subdermal rods effective for up to 3 years
• Intrauterine devices (IUDs):
  • Hormonal (e.g., levonorgestrel): up to 5 years
  • Copper-based: toxic to sperm/eggs; lasts 5–10 years
  • Avoid IUDs if: suspected pregnancy, uterine abnormalities, recent postpartum infections, hormone-sensitive cancers, liver disease

3. Other Contraceptive Forms

• Transdermal patch: contains estrogen and progestin, applied weekly for 3 weeks followed by 1 patch-free week. May be less effective in women >90 kg.
• Barrier methods:
  • Male condoms (latex, polyurethane)
  • Female condoms (polyurethane)
  • Diaphragm or cervical cap—used with spermicide, inserted 30 minutes before and left for at least 6 hours post-intercourse
  • Contraceptive sponge—impregnated with spermicide; left for at least 6 hours after intercourse
• Spermicides: typically nonoxynol-9, not effective alone and may not prevent STIs