Sarah George - Reproductive Health Department Senior Editor
Date Published: February, 2020
A 2020 National Institute of Health article entitled Evidence-Based Update on Contraception sets out to increase transparency of contraception. Contraception is a term that refers to alternate/artificial mechanisms that prevent pregnancy that occurs from sexual intercourse. The first mentioned contraceptives are hormonal methods that interfere with the reproductive cycle (combined hormonal contraceptives or CHC). CHC pills should be taken at the same time period daily for accurate ovarian suppression. This is a major disadvantage of taking CHC pills: even missing one dosage can lead to an ineffective ovarian suppression. For example, progestins (prevent pregnancy by inhibiting luteinizing hormone) and estrogens (prevent pregnancy by inhibiting follicle-stimulating hormone). Common side effects can include a 40% reduction in blood flow during a woman’s period, nausea, breast tenderness, and amenorrhea (absence of period). Contraindications include but are not limited to being above the age of 35, smoking, having a systolic blood pressure of 160 or higher, or elevated risk of deep vein thromboembolism. Moreover, CHC can also be found in alternate forms for those who don’t prefer to take medications: a CHC transdermal patch (replaced weekly) can be placed on the back or stomach, which can yield the same overall result as the CHC pills. In addition, there are CHC vaginal rings (placed in the vagina internally) that are around 2 inches in diameter and replaced monthly. These rings ensure steady hormone levels of estrogen and progestogen in a woman to prevent pregnancy. IUD’s (intrauterine devices) can be hormonal and non-hormonal methods of birth control as women have two options to pick from: one that has progesterone called Mirena and a hormone-free copper IUD called Paragard. Patients may choose Mirena due to an increased effectiveness rate, and patients may choose Paragard due to a 10 year lifespan compared to Mirena’s 5 years.
Planning a family is multifactorial and contraceptives often play a supporting role in the episodes leading up to a planned pregnancy. However, choosing the correct contraceptive varies upon female to female. As there are more and more contraceptive options, women should prioritize three main considerations: methods of safety, failure risk, and contraindications. For example, there are three main hormonal contraceptives, but each have their downfall or tailored side effects. CHC medications need to be taken daily and can decrease in effectivity if not, CHC patches can increase vaginal irritation in 20% of users, and CHC vaginal rings can yield vaginal dryness. In addition, when opting to choose the IUD route, women should be aware of the often reported painful, uncomfortable process it takes to insert this T-shaped ring inside a woman’s uterus. Essentially, this device helps to prevent pregnancy in two main ways: it can increase inflammation near the woman’s uterine wall (nonsymptomatic to women) and occupies space along the uterine wall to prevent sperm binding.
References
Britton LE, Alspaugh A, Greene MZ, McLemore MR. CE: An Evidence-Based Update on Contraception. Am J Nurs. 2020 Feb;120(2):22-33. doi: 10.1097/01.NAJ.0000654304.29632.a7. PMID: 31977414; PMCID: PMC7533104.
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