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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.

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

  • 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 precautions that can preclude the use of combined hormonal contraception.
  • 6. Identify the risks and benefits (contraceptive and noncontraceptive) of all hormonal contraception.
  • 7. Describe a patient who may be well suited for progestin-only contraception.
  • 8. Explain initiation methods for combined hormonal contraception.
  • 9. Identify common combined hormonal contraceptive related side effects, and provide suggestions for their management.
  • 10. List medications that can potentially interact with hormonal contraceptives.
  • 11. Explain the role of emergency contraception, list the available products, dosing, and usage considerations.
  • 12. Counsel patients on the effective use of hormonal and emergency contraception.
  • 13. Explain the return of fertility after stopping hormonal contraception.
  • 14. Describe clinical controversies surrounding use of hormonal contraception.
  • 15. Describe factors that should be evaluated when assessing therapeutic outcomes in women using contraception.

Unintended pregnancy is a significant public health problem. In the United States, approximately 62 million women are of childbearing age, and approximately 6 million become pregnant each year.1 The most recent data reveal that 31% of pregnancies are unintended, with the highest rates occurring in women aged 25 to 44 years (38%).1 About half of all unintended pregnancies end in abortion, and half also occurred in sexually active couples who claimed they used some method of contraception.2 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.

Comprehension of the hormonal regulation of the normal menstrual cycle is essential to understanding contraception in women (Fig. 88–1). The cycle of menstruation begins with menarche, usually around age 12 ...

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