For sexually active fertile women who do not use contraception, pregnancy rates approach 90 percent at 1 year. For those who do not desire pregnancy, fertility regulation is now possible, and a variety of effective contraceptive methods are shown in Table 32-1. None is completely without side effects or categorically without danger. One tenet emphasized throughout this chapter is that contraception usually poses less risk than does pregnancy.
Table 32-1. Contraceptive Methods Currently Used in the United States |Favorite Table|Download (.pdf)
Table 32-1. Contraceptive Methods Currently Used in the United States
Combination estrogen and progestin contraceptives
Injectable (intramuscular, subcutaneous)
Copper intrauterine device
Physical, chemical, or barrier techniques
Sexual abstinence around the time of ovulation
Nationally representative data concerning contraceptive use are shown in Figure 32-1. With use during the first year, wide variations can be seen between estimated failure rates of perfect and typical use (Table 32-2). Many of these rates can be appreciably reduced with effective motivation and education (Gilliam and co-workers, 2004). The World Health Organization has crafted four evidence-based guides for family planning, which encompass topics of contraceptive selection, patient counseling, and method use. These are available at the World Health Organization website: http://www.who.int/reproductive-health/publications/family_planning.html.
Contraceptive use in the United States, 2002, for users aged 15 to 44. DMPA = depot medroxyprogesterone acetate; FAB = fertility awareness-based method; IUD = intrauterine device. (Data from Chandra and co-workers, 2005.)
Table 32-2. Contraceptive Failure Rates during the First Year of Use |Favorite Table|Download (.pdf)
Table 32-2. Contraceptive Failure Rates during the First Year of Use
Percent of Women with Pregnancy
Progestin-only pill (“mini-pill”)
Mirena levonorgestrel device
ParaGard T 380A
NuvaRing vaginal ring
Diaphragm and spermicides
These are currently available in oral, injectable, transdermal-patch, and transvaginal-ring forms. Oral contraceptive pills are a combination of estrogen and progestin—“the pill”—are or progestin only. Other forms contain progestins alone or a combination of estrogen and progestin. Male hormonal contraceptive options have been evaluated in ...