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Introduction
Contraceptive methods are used to prevent pregnancy and STIs. Contraception allows women/couples to explore plans on childbearing and family planning. Contraceptive care and access are parts of the reproductive and sexual healthcare that the World Health Organization (WHO) recognizes as fundamental human right.
The Platform for Action of the 1995 Beijing Conference stated: “The basic right of all couples and individuals to decide freely and responsibly the number and spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health.”
The characteristics of hormonal contraception include: A method with high rate of effectiveness and ease of administration, widely used method of reversible contraception, does not protect against sexually transmitted infections (STIs) or human immunodeficiency virus (HIV), and they do not cause infertility. For high-risk individuals, the correct and consistent use of condoms is recommended, either alone or with another contraceptive method.
Classification
Combined Hormonal Contraception
Combined hormonal contraception refers to methods that contain both
estrogen and progestin. The progestin component inhibits ovulation, prevents
endometrial over-proliferation in response to estrogen, and thickens the
cervical mucus. While the estrogen component inhibits follicular development,
maintains endometrium, and prevents unscheduled bleeding. Initiation of
combined hormonal contraception should be done immediately. The risks,
benefits, side effects and contraindications of combined hormonal
contraceptives are generally considered to be similar regardless of the method
of delivery.
Progestin-only Hormonal Contraception
Progestin-only hormonal contraception may be used in women who require
estrogen-free method of contraception and/or in those who may benefit from the
non-contraceptive activity of progestin. It can be used in women w/ current,
previous history or family history of venous thromboembolism (VTE), on
anticoagulants, known thrombogenic mutations, or in those who underwent minor
or major surgery with or without prolonged immobilization. It can also be
initiated in women with history of stroke or myocardial infarction (MI) as no
causal association has been observed, but should be discontinued once patient
develops new symptoms of stroke or heart disease. It may be used with caution in women with
proven thrombophilia and may be given to women regardless of weight (eg body
mass index [BMI] ≥30 kg/m2). Women who may benefit from
estrogen-free contraception include women >35 years who smoke, have
migraines, and are recently postpartum whether breastfeeding or not. Patient is
counseled regarding disturbances in menstrual cycle before starting
progestin-only hormonal contraception.
Types of Contraceptive Use
- Typical use: Measure of a method’s effectiveness as used by individuals who use it
- Perfect use: Measure of a method’s maximum possible efficacy; refers to the use of a method as intended and covers all acts of exposure to pregnancy
Types of Contraceptive Failure
- User failure: Pregnancy occurs due to incorrect use or non-use of hormonal contraception
- Method failure: Pregnancy occurs despite the method of contraception being used correctly and consistently