Your patient is a 25-year-old married woman who wants to postpone having children for another 2 years while she finishes graduate school. She and her husband are currently using condoms, but would like to change to something different. She is in good health and does not smoke. You take this opportunity to discuss with her all the methods available to prevent pregnancy. First, you determine what she knows about the methods and if she has any preferences. She tells you that she is specifically interested in either the hormonal vaginal ring (NuvaRing) (Figure 3-1) or an intrauterine device that releases a hormone (Figure 3-2). You participate in shared decision-making as she comes up with the method that best fits her lifestyle and health issues.
NuvaRing is a combined hormonal intravaginal contraceptive ring. The flexible material of the ring allows for easy insertion and removal. Note the size in comparison to a quarter. (Reproduced with permission from Richard P. Usatine, MD.)
Mirena (levonorgestrel-releasing intrauterine system) provides effective contraception for at least 5 years. (Reproduced with permission from Bayer HealthCare Pharmaceuticals Inc.)
Contraception, like most other medical interventions, requires informed decision-making for best outcomes. Each birth control method has its inherent risks and benefits. Each method has its barriers to use, such as compliance, cost, and social stigmas. By educating patients appropriately and letting them know beforehand of potential side effects, we can greatly increase adherence and satisfaction.
An unintended pregnancy may be either unwanted (occurred when no children or no more children were desired) or mistimed. Unintended pregnancy most often results from nonuse, inconsistent use, or incorrect use of effective contraceptive methods. Unintended pregnancy is associated with an increased risk of adverse outcomes for the mother and baby. For instance, a woman may not be in optimal health for childbearing or have missed the opportunity for preconception or early prenatal care such as taking folic acid, quitting tobacco use, and abstaining from alcohol and drugs.1 Good communication and shared decision-making between providers and patients may minimize these risks.
In 2011, 45% of pregnancies were unintended, which is a decline from 51% in 2008. During this period, the rate of unintended pregnancies decreased 18% from 54 to 45 unintended pregnancies per 1000 women for ages 15–44 years.2 Approximately half of these occurred in women using reversible contraception.3
Large declines (44%) also occurred among teenagers ages 15–17 years. However, unintended pregnancy rates per 1000 women were highest among women ages 18–24 years, had incomes <100% of the federal poverty level, had not graduated from high school, or who were cohabiting women and had never been married. Among teenagers 15–19 years of age, 3 of every 4 pregnancies were unintended.2
The most commonly used contraceptive methods in the United States are oral contraceptive pills (OCPs), ...