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  • Image not available. The attitude of the patient and sexual partner toward contraceptive methods, efficacy rate, the reliability of the patient in using the method correctly (which may affect the effectiveness of the method), noncontraceptive benefits, and the patient’s ability to pay must be considered when selecting a contraceptive method.
  • Image not available. Patient-specific factors (e.g., frequency of intercourse, age, smoking status, and concomitant diseases or medications) must be evaluated when selecting a contraceptive method.
  • Image not available. Adverse effects or difficulties using the chosen method should be monitored carefully and managed in consideration of patient-specific factors.
  • Image not available. Accurate and timely counseling on the optimal use of the contraceptive method and strategies for minimizing sexually transmitted diseases must be provided to all patients when contraceptives are initiated and on an ongoing basis.
  • Image not available. Emergency contraception may prevent pregnancy after unprotected intercourse or when regular contraceptive methods have failed.

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On completion of the chapter, the reader will be able to:

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  1. Discuss the advantages and disadvantages to barrier methods of contraception.

  2. Explain the mechanism of action of hormonal methods of contraception.

  3. Compare and contrast monophasic, multiphasic, extended-cycle, continuous, and progestin-only oral contraceptives.

  4. Explain the differences in hormonal activity between the newer progestins (e.g., desogestrel, drospirenone) and the older progestins (e.g., levonorgestrel).

  5. List the contraindications and precautions that can preclude the use of combined hormonal contraception.

  6. Identify the risks and benefits (contraceptive and noncontraceptive) of all hormonal contraception.

  7. Compare and contrast the progestin-only methods of contraception, and identify appropriate candidates for their use.

  8. Describe the benefits and risks of long-acting reversible contraception methods.

  9. Explain initiation methods for combined hormonal contraception.

  10. Identify common combined hormonal contraceptive-related side effects and provide suggestions for their management.

  11. List medications that can potentially interact with hormonal contraceptives.

  12. Explain the role of emergency contraception and list the available products, dosing, and usage considerations.

  13. Counsel patients on the effective use of hormonal and emergency contraception.

  14. Explain the return of fertility after stopping hormonal contraception.

  15. Describe clinical controversies surrounding use of hormonal contraception.

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Unintended pregnancy is a significant public health problem. In the United States, approximately 6 million females become pregnant each year.1 The most recent data reveal that 37% of pregnancies are unintended, with the highest rates occurring in women aged 20 to 34 years.1 However, teen pregnancy rates are still an issue and slow to decline; teen births account for 11% of all the births in the United States.1 About half of all unintended pregnancies end in abortion, and 40% occur in sexually active couples who claim they used some method of contraception.1 If the goal of contraception—for pregnancies to be planned and desired—is to be realized, education on the use and efficacy of contraceptive methods must be improved.

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Comprehension of the hormonal regulation of the normal menstrual cycle is essential to understanding contraception in women (Fig. 62-1). The cycle of menstruation begins with menarche, usually around age 12 years, and continues to occur in nonpregnant women until ...

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