Contraception
James M. Rippe in Lifestyle Medicine, 2019
There is a wide range of contraceptive efficacy between different methods of contraception. Injectable contraceptives are considered effective methods with very low pregnancy rates and high actual efficacy, but they do require periodic follow-ups for reinjection. Methods that require user control and rely on more frequent adherence include oral contraceptives, transdermal contraceptive systems, and the vaginal ring. These methods are also associated with a very low pregnancy rate if utilized consistently in an optimal fashion. Because of frequent misuse by women, actual pregnancy rates are significantly higher than theoretical or perfect use rates. Condoms, diaphragms, cervical caps, spermicides, and natural family planning methods, including withdrawal and abstinence, are considered least effective. The overall actual efficacy rates of these methods have varied among studies but commonly are quoted at about 30 pregnancies per 100 women in one year.7
Maternal and child health
Liam J. Donaldson, Paul D. Rutter in Donaldsons' Essential Public Health, 2017
The efficacy of the various methods of contraception varies. Typically, the proportion of women experiencing an unintended pregnancy within the first year of use of contraceptive pill is 8%, and 15% for the male condom. These are higher figures than many people realize, and reflect a significant degree of user failure. Used correctly, the failure rate falls to less than 1% for the pill and 2% for the condom. Failure rates fall as user experience increases. Some methods, such as sterilization and implants, have much lower failure rates and, by their nature, little variation between users: 0.05% for the long-acting implant and 0.5% for female sterilization. Risks related to the combined pill include breast cancer, thrombosis and stroke. However, the benefits include a reduction in endometrial and ovarian cancer risk. Media stories about the safety of hormonal contraception have stopped women from using it at different times, and rises in abortion rates in the years that followed have been attributed to the concerns. Women’s health advocates argue that side effects of hormonal treatments, such as emotional well-being, weight gain, menstrual bleeding and headaches, are often ignored by researchers. All women, providing they are not at risk of acquiring an infection, can use intrauterine devices. Sterilization involves a one-time risk associated with surgery.
Postpartum Care
Vincenzo Berghella in Obstetric Evidence Based Guidelines, 2022
IUDs are highly effective methods of contraception. Unfortunately, less than 50% of women who express interest in an IUD postpartum actually receive one [216]. Immediate postpartum placement has been shown to be safe and allows women to access contraception during the maternity hospitalization, though it is associated with an increased risk of expulsion compared with delayed insertion [217, 218]. In an RCT of postplacental versus delayed insertion, women randomized to postplacental insertion were more likely to have a device inserted (98% versus 90.2%, p = 0.20). There were no differences between groups in IUD use at 6 months postpartum (84.3% versus 76.5%). However, among women who were ineligible for the study and were advised to follow up for IUD placement as part of routine postpartum care, only 26.8% were using an IUD at 6 months postpartum [219]. These results were confirmed in a more recent Cochrane review, with IUD use at 6 months twice as likely, though expulsion was four times more likely [220]. These results suggest that women undergoing postplacental placement are more likely to use an IUD than those advised to follow up for placement during routine postpartum care. Immediate postplacental IUD placement has been classified as category 1 or 2 by the Centers for Disease Control and Prevention’s U.S. Medical Eligibility Criteria for Contraceptive Use [221].
Women’s sexual experiences as a side effect of contraception in low- and middle-income countries: evidence from a systematic scoping review
Published in Sexual and Reproductive Health Matters, 2020
Shannon N. Wood, Celia Karp, Linnea Zimmerman
Nearly half of all pregnancies worldwide are mistimed or unwanted.1 Unintended pregnancy rates differ substantially between developing and developed regions, varying from 127 to 28 unintended pregnancies per 1000 women in East Africa vs. Western Europe, respectively.1 While contraception is an effective means to prevent unintended pregnancy, many women living in developing countries who want to prevent or delay a pregnancy are not using contraception.2 Among women who are using contraception, discontinuing use while still in need of pregnancy prevention methods remains common.3,4 Family Planning 2020 (FP2020) estimates that one-third of women who start using contraception will stop use within one year and more than half of women will stop within two years.5 The majority of women who discontinue contraception while still in need of family planning do so for method-related concerns, such as side effects.2,5 Concerns about side effects, both those that are clinically recognized and those that are myths or misconceptions, are well-documented as one of the primary deterrents to contraceptive use.6–11
A retrospective study comparing the efficiency of recurrent LSIL cytology to high-grade cytology as predictors of high-grade cervical intraepithelial neoplasia or worse (CIN2+)
Published in Southern African Journal of Gynaecological Oncology, 2021
The categorical variables were categorised into three modalities (Yes/No/Unknown). Contraception use was further detailed into seven categories, namely, oral, injectables, intrauterine contraceptive devices (IUCD), barrier methods (condoms, diaphragm and cervical cap), implants, tubal ligation or others. Biopsy types were categorised into cervical punch biopsy, cone biopsy (conization) or large loop excision of the transformation zone (LLETZ). The standard list of descriptive colposcopy observations listed were acetowhite lesions, metaplasia, leukoplakia, mosaicism, punctation, abnormal blood vessels (ABN) and warty atypia. The outcome categories referred to the confirmed histopathology results, separated into four categories, namely, normal, CIN1 (LSIL), CIN2-3 (HSIL) or CC. The treatment types were separated into excisional (i.e. LLETZ, cold knife conization and hysterectomy) and ablative (i.e. cryotherapy and laser therapy).
Current and future contraceptive options for women living with HIV
Published in Expert Opinion on Pharmacotherapy, 2018
Rena C. Patel, Elizabeth A. Bukusi, Jared M. Baeten
Several aspects often play into a woman’s choice of her contraceptive method, such as anticipated side effects, delivery mechanism, or ability to use covertly. In addition, contraceptive effectiveness can be highlighted as another aspect (Figure 1). Depending on a woman’s needs, more effective contraceptive methods (surgical, intrauterine contraception [IUC; which includes intrauterine devices or systems], and implants) may be more appealing over less effective contraceptive methods (injectables, oral, or other hormonal contraceptives) or least effective contraceptive methods (barrier or natural methods; Figure 2). Generally, implants are the most effective form of contraception, followed by surgical methods and then IUC [6,11]. Contraceptive effectiveness with injectables and oral contraceptives varies markedly depending on the setting. While many of the least effective contraceptive methods are used by people living with HIV, including in combination with more effective methods at times, their relative effectiveness is not specifically influenced by factors related to HIV.
Related Knowledge Centers
- Combined Oral Contraceptive Pill
- Contraceptive Implant
- Contraceptive Patch
- Sterilization
- Tubal Ligation
- Vasectomy
- Intrauterine Device
- Hormonal Contraception
- Vaginal Ring
- Injectable Birth Control