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GENERAL CONSIDERATIONS

According to the 2015–2017 National Survey of Family Growth (NSFG), changes in contraceptive method use among married, non-Hispanic white women have contributed to a significant decline in the proportion of unintended births among this group. Sixty-five percent of women of reproductive age are currently using contraception. Contraceptive use has been shown to increase with age; 37% of women age 15–19 compared to 74% of women age 40–49 are using contraceptive methods. Of women age 15–49, the most common methods of contraception are female sterilizations (18.6%), oral contraceptive pills (12.6%), and long-acting reversible contraceptives (10.3%). Use of long-acting reversible contraceptives has increased, whereas fewer women report that their partners are using condoms as their current most effective means of contraception. Addressing family planning and contraception is an important issue for providers of care to reproductive-age women. Because of the wide range of contraceptive options available, it is important that healthcare providers remain current with the recent advances concerning counseling, efficacy, safety, and side effects.

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Curtis  KM, Jatlaoui  TC, Tepper  NK,  et al. U.S. selected practice recommendations for contraceptive use, 2016. MMWR Recomm Rep. 2016;65(4):1–66.
[PubMed: 27467319]
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Curtis  KM, Tepper  NK, Jatlaoui  TC,  et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep. 2016;65(3):1–103.
[PubMed: 27467196]
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Daniels  K, Abma  JC. Current Contraceptive Status Among Women Aged 15-49: United States 2015-2017. NCHS Data Brief, No 327. Hyattsville, MD: National Center for Health Statistics, 2018.

COMBINED ORAL CONTRACEPTIVES

According to the 2015–2017 NSFG, usage rate of the combined oral contraceptive (COC) pill has decreased to 12.6% for women between the ages of 15 and 44 from a rate of 28% in the 2006–2010 report. The availability of lower-dose COCs (<50 µg ethinyl estradiol) has provided many women a highly effective, safe, and tolerable method of contraception.

COCs suppress ovulation by diminishing the frequency of gonodotropin-releasing hormone pulses and halting the luteinizing hormone surge. They also alter the consistency of cervical mucus, affect the endometrial lining, and alter tubal transport. Most of the antiovulatory effects of COCs derive from the action of the progestin component. The estrogen doses are not sufficient to produce a consistent antiovulatory effect. The estrogenic component of COCs potentiates the action of the progestin and stabilizes the endometrium so that breakthrough bleeding is minimized. When administered correctly and consistently, they are >99% effective at preventing pregnancy. However, failure rates are as high as 9% during the first year of typical use. Noncompliance is the primary reason cited for the difference between these rates, frequently secondary to side effects such as abnormal bleeding and nausea. When appropriate contraceptive counseling is provided, women have higher rates of successful contraceptive use.

Hormonal Content

The estrogenic agent most commonly used in COCs is ethinyl estradiol, in doses ranging from ...

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