18 - Contraception in Patients with Medical Disorders

Abstract

This chapter discusses contraception in patients with medical disorders. Contraception for someone who is already ill and who may well have a reduced life expectancy can be a difficult problem. The risks of pregnancy if contraception is not used, the risks inherent in the contraceptive method itself, and the risks of pregnancy as a result of failure of the method must all be considered within the context of the patient's social and medical state. Consideration of the appropriate contraceptive involves deciding whether it is merely desirable to postpone pregnancy or whether it would be disastrous should the patient become pregnant again. The main problems with intra-uterine devices are linked with relative lack of long-term efficacy as a contraceptive, with local effects on the uterus and with creation of a portal of entry for infection. Their use may be acceptable in the presence of some medical conditions, for temporary postponement of pregnancy. Of the other methods, the condom and the diaphragm have a much lower failure rate than is generally appreciated, and they can be an excellent method for spacing pregnancies.