18 - Hormonal Contraception

Abstract

For all couples, access to contraception is critical to be able to plan the timing and spacing of their childbearing for social, economic, and health reasons. The U.S. Selected Practice Recommendations for Contraceptive Use and the U.S. Medical Eligibility Criteria for Contraceptive Use from the Centers for Disease Control and Prevention offer evidence-based guidelines to assist providers in caring for women who need contraception. Long-acting reversible contraceptive methods, which include the copper intrauterine device, the levonorgestrel intrauterine device, and the etonogestrel subdermal implant, provide superior contraceptive effectiveness, equivalent to sterilization, and higher continuation and satisfaction rates compared with shorter-acting methods. These methods should be offered to all women, including adolescents. Using a process of shared decision making, clinicians can help patients choose a contraceptive considering factors such as the patient’s age, values, lifestyle, and other relevant circumstances, including the recognition that contraceptive needs are likely to change during different phases of reproductive life and that the risks and benefits may alter according to age and background health factors. Hormonal contraceptives are most effectively used by individuals who are well informed about the advantages and common side effects of the method, and who have actively participated in selecting the method. Reducing health care system barriers to contraceptive initiation and continuation is important to reduce unintended pregnancy rates. Such barriers include requiring unnecessary health screenings, waiting until the subsequent menstruation cycle to begin methods, inappropriate contraindications, and failure to provide adequate refills for prescription-based methods.