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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. It is now your 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 the newest intrauterine device that releases a hormone (Figure 3-2). Then you participate in shared decision making as she comes up with the method that best fits her lifestyle and health issues.

Figure 3-1

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. (Courtesy of Richard P. Usatine, MD.)

Figure 3-2

Mirena (levonorgestrel-releasing intrauterine system) provides effective contraception for at least 5 years. (Printed with permission from Bayer HealthCare Pharmaceuticals Inc.)

Contraception is like many other treatments in medicine. Each method has its 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 compliance and satisfaction.

  • Approximately one-half of pregnancies in the United States are unintended.1 Approximately one-half of these occurred in women using reversible contraception.2
  • The most commonly used contraceptive methods in the United States are oral contraceptive pills (OCPs), male condoms, and female sterilization.3
  • Long-acting reversible forms of contraception are increasingly popular. Encouraging these methods may help lower the unintended pregnancy rate. Gaps or discontinuation of use of short-acting methods lead to unintended pregnancy.4
  • Newer contraceptives often have improved side-effect profiles or have more convenient delivery systems that may not require daily patient adherence. Having a wide range of contraceptive options helps patients find a method that will work best for them.
  • This chapter focuses on contraceptive methods available in the United States and the considerations one must address when counseling patients on their choice of method.

  • No contraception method is perfect. Each individual or couple must balance the advantages and disadvantages of each method and decide which offers the best choice. As the physician, one must help the patient make the appropriate decision based on many factors that are unrelated to their medical history or to the side-effect profile of the method, such as the likelihood of compliance and access to follow up.
  • Some important considerations in choosing a contraceptive method are its potential side effects, failure ...

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