Hormonal Contraception Drug Summary

Ring should be placed in the vagina during the first 5 days of the menstrual cycle and remains in place x 3 weeks followed by 1 week of vaginal ring-free period. After a 1-week ring-free interval, a new ring is inserted 

Adverse Reactions

• Minor side effects occur during the first 3 cycles (nausea, breast tenderness, headache); Irregular menstrual bleeding (breakthrough bleeding or spotting most likely, amenorrhea in 2% to 3% of cycles); Other effects (acne, mood changes, increased weight and BP)
• Patient should be made aware that side effects generally improve with time
• Relative risk of VTE can increase with combination oral contraceptives (COCs) use but risk is still low and considerably lower than VTE risk associated with pregnancy
• COC users with hypertension or those who smoke ≥15 cigarettes/day have an increased relative risk of MI and stroke
• Considered to have less irregular bleeding when compared to COCs; vaginitis, vaginal discomfort, expulsion

• COCs should not be used in women with known contraindication to the component/s or where the risks usually outweigh the benefits
• Dual protection with condoms to reduce risk of STIs should be discussed with patient
• Follow-up visit should be scheduled to monitor the BP and review the user’s experience, satisfaction, and compliance; pelvic exam can also be performed

Ring should be placed in the vagina between days 2 and 5 of the menstrual cycle and remains in place x 3 weeks followed by 1 week of vaginal ring-free period. After a 1-week ring-free interval, the same ring is washed and inserted. One ring provides contraception for 1 year (28-day cycles x 13) 

Adverse Reactions

• GI effects (nausea/vomiting, abdominal pain, diarrhea); GU effects (UTI, genital pruritus, vulvovaginal mycotic infection/candidiasis, vag discharge); Other effects (headache, breast tenderness, dysmenorrhea, bleeding irregularities including metrorrhagia)

• COCs should not be used in women with known contraindication to the component/s or where the risks usually outweigh the benefits
• Dual protection with condoms to reduce risk of STIs should be discussed with patient
• Follow-up visit should be scheduled to monitor the BP and review the user’s experience, satisfaction, and compliance; pelvic exam can also be performed
• Contraindicated in women with estrogen- or progestin-sensitive cancer, undiagnosed abnormal uterine bleeding, or concomitant use of hepatitis C drug combinations containing Ombitasvir/Paritaprevir/Ritonavir, with or without Dasabuvir

• CNS effects (headache, asthenia, nervousness); GI effects (abdominal pain, nausea); Gynecological effects (amenorrhea, breast pain, menorrhagia, metrorrhagia, vaginal moniliasis, vulvovaginal abnormalities); Other effects (acne, alopecia, emotional lability, weight gain)

• Avoid in patients with breast cancer or suspected breast malignancy, undiagnosed vaginal/genital bleeding, thromboembolic disease, cerebrovascular disease, CV or liver disease, diabetes with vascular involvement, known or suspected pregnancy
• Use with caution in patients with history or family history of breast cancer or breast tumor, diabetes or prediabetes, depression, dyslipidemia, liver dysfunction, smokers

Adverse Reactions

• CNS effects (headaches, asthenia, nervousness); GI effects (gastric upset, weight changes); Gynecological effects (changes in libido, menstrual irregularities, feeling of tension in breasts, irregular bleeding)

Special Instructions

• Avoid in patients with breast malignancy, undiagnosed vaginal bleeding, moderate to severe HTN, present or history of arterial thrombosis, severe liver disease, cholestatic jaundice or hepatitis, pregnancy
• Do not give further injection due to increased risk of thrombosis in case of occurrence for the first time of migrainous headaches or more frequent occurrence of unusually severe headaches, sudden perceptual disorders, signs of thrombophlebitis or thromboembolic symptoms, chest pain and tightness, impending operations (6 weeks beforehand), immobilization

• Minor side effects occur during the first 3 cycles (nausea, breast tenderness, headache); Irregular menstrual bleeding (breakthrough bleeding or spotting most likely, amenorrhea in 2% to 3% of cycles); Other effects (acne, mood changes, increased weight and BP)
• Patient should be made aware that side effects generally improve with time
• Relative risk of VTE can increase with COC use but risk is still low and considerably lower than VTE risk associated with pregnancy
• COC users with hypertension or those who smoke ≥15 cigarettes/day have an increased relative risk of MI and stroke

• COCs should not be used in women with known contraindication to the component/s or where the risks usually outweigh the benefits
• Dual protection with condoms to reduce risk of STIs should be discussed with patient 
• Follow-up visit should be scheduled to monitor the BP and review the user’s experience, satisfaction, and compliance; pelvic exam can also be performed
• Emergency contraception regimens are administered for 2 doses 12 hours apart not later than 5 days after unprotected sexual intercourse or contraceptive failure (Yuzpe method) 

Apply 1 patch weekly x 3 weeks followed by 1 week of patch-free period starting on day 22 

Adverse Reactions

• Minor side effects occur during the first 3 cycles (nausea, breast tenderness, headache); Irregular menstrual bleeding (breakthrough bleeding or spotting most likely, amenorrhea in 2% to 3% of cycles); Other effects (acne, mood changes, increased weight and BP)
• Patient should be made aware that side effects generally improve with time
• Relative risk of VTE can increase with combination oral contraceptives (COCs) use but risk is still low and considerably lower than VTE risk associated with pregnancy
• COC users with hypertension or those who smoke ≥15 cigarettes/day have an increased relative risk of MI and stroke
• Application site reaction

• COCs should not be used in women with known contraindication to the component/s or where the risks usually outweigh the benefits
• Dual protection with condoms to reduce risk of STIs should be discussed with patient
• Follow-up visit should be scheduled to monitor the BP and review the user’s experience, satisfaction, and compliance; pelvic exam can also be performed

Insert 1 implant subdermally within the first 5 days of the menstrual cycle
Effective x 3 years

Adverse Reactions

• Irregular bleeding which tends to decrease with time; headache, bloating, acne and breast tenderness
• Insertion and removal may cause bruising, irritation, pain and occasionally scarring

• Contraceptive doses of progestins do not appear to increase the risk of VTE, MI or stroke 
• Do not leave any one system in place longer than its effectivity

Insert 52 mg IUD into the uterine cavity within the first 7 days of the menstrual cycle 
Effective x 5 years 

Adverse Reactions

• CNS effects (mood changes, headache); GI effects (abdominal pain, nausea, weight gain); Dermatologic effect (acne); Other effects (edema, back pain, pelvic pain, dysmenorrhea, vaginal discharge, cervicitis, breast tenderness, expulsion)

• May insert immediately after first trimester abortion; postpartum insertion should be postponed until 6 weeks after delivery
• Re-examine patient 4-12 weeks after insertion and once yearly thereafter
• Do not leave any one system in place for >5 years

• Irregular bleeding which tends to decrease with time; headache, bloating, acne and breast tenderness

• Contraceptive doses of progestins do not appear to increase the risk of VTE, MI or stroke
• Drospirenone: Use with caution in patients with hyperkalemia
• Levonorgestrel: If vomiting occurs within 3 hours of drug intake, consider this dose missed. Repeat dose and administer 2nd dose 12-24 hours later, if 0.75 mg is used
• Back-up contraceptive method is recommended for 48 hours if there is >3-hour delay in pill intake for traditional POPs and >12-hour delay in pill intake for Desogestrel

• Menstrual cycle disturbance (irregular bleeding, amenorrhea); Unpredictable bleeding may be common during the first month of use and many patients become amenorrheic with continued use; headache, acne, decreased libido, breast tenderness, weight gain
• Delay in the return of fertility may be encountered but no evidence of infertility
• Reversible reduction in BMD has been reported

• Injectable progestins do not appear to increase the risk of VTE, CVD, stroke or MI

• Gynecological effects (excessive vaginal bleeding, uterine hemorrhage, uterine infections); GI effects (diarrhea, nausea/vomiting, abdominal cramps); Other effects (UTI, fatigue, back pain, headache)

• Avoid use in patients with suspected or confirmed ectopic pregnancy, chronic adrenal failure, concurrent long-term corticosteroid therapy or anticoagulant therapy, hemorrhagic disorders, hepatic or renal impairment
• Use with caution in patients with asthma, COPD, CVD, history of infective endocarditis, or in female smokers >35 years old, alcoholic drinkers

• CNS effects (headache, dizziness); GI effects (nausea/vomiting, abdominal pain/discomfort, upper abdominal pain); Gynecologic effects (dysmenorrhea, pelvic pain); Other effects (mood disorders, myalgia, back pain, fatigue, breast tenderness) 

• Avoid use in pregnant patients, in patients with galactose intolerance, glucose-galactose malabsorption
• Use with caution in patients with hepatic impairment, asthma not sufficiently controlled by oral glucocorticoid, in women concomitantly taking Levonorgestrel-containing emergency contraceptive
  • Repeat administration within the same menstrual cycle is not advised