hormonal%20contraception
HORMONAL CONTRACEPTION
Contraceptive methods are used to prevent pregnancy and sexually transmitted infections (STIs).
Contraception allows women/couples to explore plan on childbearing and family planning.
Hormonal contraception is a method with high rate of effectiveness & ease of administration. It is the widely used method of reversible contraception.
It does not protect against STIs/HIV.

Principles

  • Contraceptive methods are used to prevent pregnancy and sexually transmitted infections (STIs)
  • Contraception allows women/couples to explore plans on childbearing and family planning
  • Contraceptive care and access are parts of the reproductive and sexual health care that the World Health Organization (WHO) recognizes as a fundamental human right
  • The Platform for Action of the 1995 Beijing Conference stated:

 “The basic right of all couples and individuals to decide freely and responsibly the number and spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health”

Determinants of Effective Contraceptive Method

Information Provided by Health Care Providers

  • Birth control options and their effectiveness
  • Specific characteristics of the contraceptive method
  • Common adverse effects
  • Balance between risks and benefits of the method
  • Instructions on the correct use of the chosen method
  • Actions to be taken in case problems arise
  • Strategies to help with consistent use of a specific method over time
  • Information to avoid STIs

Woman’s Attitude Towards Specific Method

  • Openness in discussing contraception with the physician and partner on personal perception or matters concerning sexuality
  • The woman’s perception on what method is accepted or rejected by partner, relatives, or society as a whole, greatly influences her choice and compliance

Specific Behavioral Skills

  • Formulation of contraceptive health agenda

Environmental Factors

  • Healthcare worker should consider factors that may lessen the ability of the woman to use method effectively
    • Eg women in abusive or disempowered relationships, cost of contraception, those who are chemically dependent, etc

Definition

Characteristics

  • A method with high rate of effectiveness and ease of administration
  • Widely used method of reversible contraception
  • Does not protect against sexually transmitted infections/human immunodeficiency virus (STIs/HIV)
    • For high-risk individuals, the correct and consistent use of condoms is recommended, either alone or with another contraceptive method

Combined Hormonal Contraception

  • Refers to methods that contain both Estrogen and Progestin
  • Progestin component inhibits ovulation and thickens the cervical mucus
  • Estrogen component inhibits follicular development, maintains the endometrium and prevents unscheduled bleeding
  • Initiation of combined hormonal contraception should be done immediately

Progestin-only Hormonal Contraception

  • May be used in women who require Estrogen-free method of contraception and/or in those who may benefit from the non-contraceptive activity of Progestin
  • May be used with caution in women with proven thrombophilia
  • Can be used in women with current, previous history or family history of venous thromboembolism (VTE), on anticoagulants, known thrombogenic mutations, or in those who underwent minor or major surgery with or without prolonged immobilization
  • Can be initiated in women with history of stroke or myocardial infarction (MI) as no causal association has been observed, however, should be discontinued once patient develops new symptoms of stroke or heart disease
  • May be given to women regardless of weight [eg body mass index (BMI) ≥30 kg/m2]
  • Women who may benefit from Estrogen-free contraception:
    • Women >35 years who smoke, have migraines, are recently postpartum and those who are breastfeeding
  • Counsel patient regarding disturbances in menstrual cycle before starting progestin-only hormonal contraception

Types of Contraceptive Failure

  • User failure: Pregnancy occurs due to incorrect use or non-use of hormonal contraception
  • Method failure: Pregnancy occurs despite the method of contraception being used correctly and consistently

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