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Choosing the Right Contraceptive

Matching Users with a Best Method: Healthy Reproductive Age, Obesity, Androgen Excess, Excess Bleeding, Adolescents, Perimenopausal, and Postpartum

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The Handbook of Contraception

Part of the book series: Current Clinical Practice ((CCP))

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Abstract

Healthcare providers must choose from the wide variety of options when addressing contraceptive needs of their patients. Most women are looking for a method that is effective and easy to use with few side effects. While oral contraceptive pills along with rings and patches have traditionally been the most popular methods in the United States, the highly effective long-acting reversible contraceptives (LARCs), the intrauterine devices and subdermal implants, are quickly gaining increased popularity and are now recommended as first-line options. New options include a new progestin-only pill (POP) containing drospirenone, a new vaginal ring [used for 3 cycles] and a new lower-dose contraceptive patch. This chapter recommends best options in various populations and problem groups, identifies areas of concern, emphasizes safety issues, and provides counseling tips.

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References

  1. Secura G, Allsworth JE, Madden T, Mullersman JL, Pipert J. The Contraception CHOICE Project: reducing barrier to long-acting reversible contraception. Am J Obstet Gynecol. 2010;203(2):115e1–7.

    Google Scholar 

  2. Contraceptive use in the United States. Fact sheet. Guttmacher Institute; 2014.

    Google Scholar 

  3. Kavanaugh ML, Jerma J, Finer LB. Changes in use of long-acting reversible contraceptive methods among US women, 2009–2012. Obstet Gynecol. 2015;126(5):917–27.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Luo Z, Gao O, Anguzu R, Ahao J. Long-acting reversible contraceptive use in the post-abortion period among women seeking abortion in mainland China: intentions and barriers. Reprod Health. 2018;15(1):85.

    PubMed  PubMed Central  Google Scholar 

  5. Hurskainen R, Teperi J, Rissanen P, et al. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet. 2001;357:273–7.

    CAS  PubMed  Google Scholar 

  6. Marchbanks PA, McDonald JA, Wilson HG, et al. Oral contraceptives and risk of breast cancer. N Engl J Med. 2002;346:2025–32.

    CAS  PubMed  Google Scholar 

  7. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative breast cancer reanalysis of individual data on 53,297 women with breast cancer and 100,239 women without breast cancer from 54 epidemiological studies. Lancet. 1996;347:1713–27.

    Google Scholar 

  8. Strom BL, Berlin JA, Weber AL, et al. Absence of an effect of injectable and implantable progestin-only contraceptives on subsequent risk of breast cancer. Contraception. 2004;69:353–60.

    CAS  PubMed  Google Scholar 

  9. Skegg DC, Noonan EA, Paul C, et al. Depot medroxyprogesterone and breast cancer: a pooled analysis of the World Health Organization and New Zealand studies. JAMA. 1995;273:799–804.

    CAS  PubMed  Google Scholar 

  10. Schlesselman JJ. Risk of endometrial cancer in relation to use of combined oral contraceptives: a practitioner’s guide to meta-analysis. Hum Reprod. 1997;12:1851–63.

    CAS  PubMed  Google Scholar 

  11. Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. Combination oral contraceptive use and the risk of endometrial cancer. JAMA. 1987;257:796–800.

    Google Scholar 

  12. World Health Organization. Collaborative study of neoplasia and steroid contraceptives. Depot-medroxyprogesterone acetate (DMPA) and risk of endometrial cancer. Int J Cancer. 1991;49:186–90.

    Google Scholar 

  13. Gardner FJ, Konje JC, Abrams KR, et al. Endometrial protection from tamoxifen-stimulated changes by a levonorgestrel-releasing intrauterine system: a randomised controlled trial. Lancet. 2000;356:1711–7.

    CAS  PubMed  Google Scholar 

  14. Parazzini F, La Vecchia C, Moroni S. Intrauterine device use and risk of endometrial cancer. Br J Cancer. 1994;70:672–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Hill DA, Weiss NS, Voigt LF, Beresford SA. Endometrial cancer in relation to intrauterine device use. Int J Cancer. 1997;70:278–81.

    CAS  PubMed  Google Scholar 

  16. Suvanto-Luukkonen E, Kauppila A. The levonorgestrel intrauterine system in menopausal hormone replacement therapy; five-year experience. Fertil Steril. 1999;72:161–3.

    CAS  PubMed  Google Scholar 

  17. Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. The reduction in risk of ovarian cancer associated with oral-contraceptive use. N Engl J Med. 1987;316:650–5.

    Google Scholar 

  18. Ness RB, Grisso JA, Klapper J, The SHARE Study Group. Risk of ovarian cancer in relation to estrogen and progestin dose and use characteristics of oral contraceptives. Am J Epidemiol. 2000;152:233–41.

    CAS  PubMed  Google Scholar 

  19. Hankinson SE, Colditz GA, Hunter DJ, Spencer TL, Rosner B, Stampfer MJ. A quantitative assessment of oral contraceptive use and risk of ovarian cancer. Obstet Gynecol. 1992;80:708–14.

    CAS  PubMed  Google Scholar 

  20. Martinez ME, Grodstein F, Giovannucci E, et al. A prospective study of reproductive factors, oral contraceptive use, and risk of colorectal cancer. Cancer Epidemiol Biomark Prev. 1997;6:1–5.

    CAS  Google Scholar 

  21. Pomp DR, LeCessie S, Rosendaal FR, CJM D. Risk of venous thrombosis: obesity and its joint effect with oral contraceptive use and prothrombotic mutations. Br J Haematol. 2007;139:289–96.

    PubMed  Google Scholar 

  22. Robinson JA, Burke AE. Obesity and hormonal contraceptive efficacy. Womens Health [Lon Eng]. 2013;9(5):453–66.

    CAS  Google Scholar 

  23. Jurema M, Zacur H. Menorrhagia. Up to date. Available at http://bit.ly/fHJVtw. Assessed 25 Aug 2019.

  24. Andersson JK, Rybo G. Levonorgestrel-releasing intrauterine device in the treatment of menorrhagia. Br J Obstet Gyaecol. 1990;97(8):690–4.

    CAS  Google Scholar 

  25. Kaunitz AM, Bissonnette F, Monteiro I, Lukkari-Lax E, Muysers C, Jensen JT. Levonorgestrel-releasing intrauterine system or medroxyprogesterone for heavy menstrual bleeding: a randomized controlled trial. Obstet Gynecol. 2010;116(3):625–32.

    CAS  PubMed  Google Scholar 

  26. FDA approves intrauterine device for heavy menstrual bleeding PR Newswire. Available at http://bit.ly/ekovjr. Last assessed 01 Oct 2009.

  27. Rauramo I, Elo I, Istre O. Long-term treatment of menorrhagia with levonorgestrel intrauterine system versus endometrial resection. Obstet Gynecol. 2004;104(6):1314–21.

    CAS  PubMed  Google Scholar 

  28. Cochrane review; www.cochrane.org/CD000154/MENSTRU_combined-hormonal-contraceptvies-heavy.

  29. Munro MG, Mainor N, Basu R, Brisinger M, Barreda L. Oral medroxyprogesterone acetate and combination oral contraceptives for acute uterine bleeding: a randomized controlled trial. Obstet Gynecol. 2006;108(4):924–9.

    CAS  PubMed  Google Scholar 

  30. Ammenrman SR, Nelson AL. A new progestogen-only medical therapy for outpatient management of acute abnormal uterine bleeding: a pilot study. Am J Obstet Gynecol. 2013;208:499e1–5.

    Google Scholar 

  31. Healthjade.com/menorrhagia/. Last assessed 23 Aug 2019.

  32. Secura GM, Madden T, McNicholas C, Mullersman J, Buckel C, Quihong Z, Peipert J. Provision of no-cost, long-acting contraception and teenage pregnancy. N Engl J Med. 2014;371:1316–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, Allsworth JE, Secura GM. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366:1998–2007.

    CAS  PubMed  Google Scholar 

  34. Abma JC, Martinez GM, Mosher WD, Dawson BS. Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2002. Vital Health Stat. 2004;24:1–48.

    Google Scholar 

  35. CDC.gov/nchs/data/series/sr23_031.pdf.

  36. Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004;36:6–10.

    PubMed  Google Scholar 

  37. Jacobson DL, Womack SD, Peralta L, et al. Concordance of human papillomavirus in the cervix and urine among inner city adolescents. Pediatr Infect Dis J. 2000;19:423–8.

    Google Scholar 

  38. Disaia PJ, Creasman WT. Clinical gynecologic oncology. 5th ed. St Louis: Mosby; 1997.

    Google Scholar 

  39. Centers of Disease Control and Prevention. HIV/AIDS surveillance report. 2002;14:1–48. www.cdc.gov/hiv/stats/hasr1402.htm. Accessed 11 Mar 2006.

  40. Sulak PJ, Herbelin S. Teenagers and sex: delaying sexual debut. Female Patient. 2005;30:29–38.

    Google Scholar 

  41. Manlove J, Ryan S, Franzetta K. Contraceptive use and consistency in US teenagers’ most recent sexual relationship. Persp Sex Reprod Health. 2004;36:265–75.

    Google Scholar 

  42. Bleakley A, Hennessy M, Fishbein M. Public opinion on sex education in US schools. Arch Pediatr Adolesc Med. 2006;160(11):1151–6. https://doi.org/10.1001/archpedi.160.11.1151.

    Article  PubMed  Google Scholar 

  43. American College of Obstetrics and Gynecology (ACOG). ACOG patient education pamphlet, frequently asked questions especially for teens ACOG Patient Education. 2018.

    Google Scholar 

  44. Akers AY, Steinway C, Sonalkar S, Perriera LK, Schreiber C, Harding J, Garcia-Espana JF. Reducing pain during intrauterine device insertion: a randomized controlled trial in adolescents and young women. Obstet Gynecol. 2017 Oct;130(4):795–802.

    PubMed  Google Scholar 

  45. National Institutes of Health. Workshop summary: scientific evidence on condom effectiveness for sexually transmitted disease (STD) prevention. 2001.

    Google Scholar 

  46. Holmes KK, Levein R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ. 2004;82:454–61.

    PubMed  PubMed Central  Google Scholar 

  47. http://www.cdc.gov/condomeffectiveness/latex.htm.

  48. Archer DF, Cullinhs V, Creasy GW, Fisher AC. The impact of improved compliance with a weekly contraceptive transdermal system (Ortho Evra™) on contraceptive efficacy. Contraception. 2004;69:189–95.

    CAS  PubMed  Google Scholar 

  49. Cromer VE, Smith RD, Blair JM, Dwyer J, Brown RT. A prospective study of adolescents who choose among levonorgestrel implants, medroxyprogesterone acetate, or the combined oral contraceptive pill as contraception. Pediatrics. 1994;94:687–94.

    CAS  PubMed  Google Scholar 

  50. Scholes D, LaCroix AZ, Ichikawa LF, Barlow WE, Ott SM. Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception. Arch Pediatr Adolesc Med. 2004;159:139–44.

    Google Scholar 

  51. Cromer BA, Lazebnik R, Rome E, et al. Double-blinded randomized controlled trial of estrogen supplementation in adolescent girls who receive depot medroxyprogesterone acetate for contraception. Am J Obstet Gynecol. 2005;192:42–7.

    CAS  PubMed  Google Scholar 

  52. Sowers M, Corton G, Shapiro B, Jannausch ML, Crutchfield M, Smith ML, Randolph JF, Hollis B. Changes in bone density with lactation. JAMA. 1993;269(24):3130–5.

    CAS  PubMed  Google Scholar 

  53. Kaunitz AM. Injectable long-acting contraceptives. Clin Obstet Gynecol. 2001;44:73–91.

    CAS  PubMed  Google Scholar 

  54. Kaunitz AM. Oral contraceptive use in perimenopause. Am J Obstet Gynecol. 1859;2001:S32–7.

    Google Scholar 

  55. Santoro N, Brown JR, Adel T, Skjurnick JH. Characterization of reproductive hormonal dynamics in the perimenopause. J Clin Endocrinol Metab. 1996;81:1495–501.

    CAS  PubMed  Google Scholar 

  56. Strauss LT, Herndon J, Chang J, et al. Abortion surveillance – United States, 2001. MMWR Surveill Summ. 2004;53:1–32.

    PubMed  Google Scholar 

  57. Gold EB, Block G, Crawford S, et al. Lifestyle and demographic factors in relation to vasomotor symptoms; baseline results from the Study of Women’s Health Across the Nation. Am J Epidemiol. 2004;159:1189–99.

    PubMed  Google Scholar 

  58. Freeman EW, Sammel MD, Grisso JA, Battistini M, Garcia-Espagna B, Hollander L. Hot flashes in the late reproductive years: risk factors for African American and Caucasian women. J Womens Health Gend Based Med. 2001;10:67–76.

    CAS  PubMed  Google Scholar 

  59. Casper R, Dodin S, Reid RL. Study Investigators. The effect of a 20 μg ethinyl estradiol/1 mg norethindrone acetate (Minastrin®), a low-dose contraceptive, on vaginal bleeding patterns, hot flashes, and quality of life in symptomatic perimenopausal women. Menopause. 1997;4:139–47.

    Google Scholar 

  60. Kuohung W, Borgatta L, Stubblefield P. Low-dose oral contraceptives and bone mineral density an evidence-based analysis. Contraception. 2000;61:77–82.

    CAS  PubMed  Google Scholar 

  61. Gambacciani M, Spinetti A, Cappagli B, et al. Hormone replacement therapy in perimenopausal women with a low dose oral contraceptive preparation: effects on bone mineral density and metabolism. Maturitas. 1994;19:125–76.

    CAS  PubMed  Google Scholar 

  62. Michaelsson K, Baron JA, Farahmand BY, Persson I, Ljunghall S. Oral-contraceptive use and risk of hip fracture: a case-control study. Lancet. 1999;353:1481–4.

    CAS  PubMed  Google Scholar 

  63. Pettiti DB, Sidney S, Bernstein A, Wolf S, Quesenberry C, Ziel HK. Stroke in users of low-dose oral contraceptives. N Engl J Med. 1996;335:8–15.

    Google Scholar 

  64. Sidney S, Siscovick DS, Petitti DB, et al. Myocardial infarction and use of low-dose oral contraceptive: a pooled analysis of 2 US studies. Circulation. 1998;98:1058–63.

    CAS  PubMed  Google Scholar 

  65. Hannaford PC, Kay CR. The risk of serious illness among oral contraceptive users: evidence from the RCGP’s oral contraceptive study. Br J Gen Pract. 1998;48:1657–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Gebbie A. Contraception in the perimenopause. J Br Menopause Soc. 2003;9:123–8.

    PubMed  Google Scholar 

  67. American College of Obstetricians and Gynecologists (ACOG). ACOG technical bulletin. Health maintenance for perimenopausal women. Number 210-Aug 1995. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 1995;51:171–81.

    Google Scholar 

  68. Nguyen BT, Jensen JT. Evaluating the efficacy and safety of a progestin- and estrogen-releasing ethylene vinyl acetate copolymer contraceptive vaginal ring. Expert Opin Drug Saf. 2014;13(10):1423–30.

    CAS  PubMed  Google Scholar 

  69. Dinger J, Mohner S, Heinemann K. Cardiovascular risk associated with the use of a etonogestrel-containing vaginal ring. Obstet Gynecol. 2013;122(4):800–8.

    PubMed  Google Scholar 

  70. Bergendal A, et al. Limited knowledge on progestogen-only contraception and risk of venous thromboembolism. Acta Obstet Gynecol Scand. 2009;88:261–6.

    CAS  PubMed  Google Scholar 

  71. van Hylckama-Vlieg A, et al. The risk of deep vein thrombosis associated with injectable depot-medroxyprogesterone acetate contraceptives or a levonorgestrel intrauterine device. Arterioscler Thromb Vasc Biol. 2010;30(11):2297–300.

    PubMed  Google Scholar 

  72. Barsoum MK, et al. Is progestin an independent risk factor for incident venous thromboembolism? A population-based case-control study. Throm Res. 2010;126:373–8.

    CAS  Google Scholar 

  73. Shargil AA. Hormone replacement therapy in perimenopausal women with a triphasic contraceptive compound: a three-year prospective study. Int J Fertil. 1985;30:15–28.

    CAS  PubMed  Google Scholar 

  74. Trussel J. Contraceptive failure in the United States. Contraception. 2004;70:89–96.

    Google Scholar 

  75. Fu H, Darrouch JE, Haas T, Ranjit N. Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth. Fam Plan Perspect. 1999;31:56–63.

    CAS  Google Scholar 

  76. Awwad JT, Toth TL, Schiff I. Abnormal uterine bleeding in the perimenopause. Int J Fertil Menopausal Stud. 1993;38:261–9.

    CAS  PubMed  Google Scholar 

  77. Larsson G, Milsom I, Lindstedt G, Rybo G. The influence of a low-dose combined oral contraceptive on menstrual blood loss and iron status. Contraception. 1992;46:327–34.

    CAS  PubMed  Google Scholar 

  78. Crosignani PG, Vercellini P, Mosconi P, Oldani S, Cortesi I, De Giorgi O. Levonorgestrel-releasing intrauterine device versus hysteroscopic endometrial resection in the treatment of dysfunctional uterine bleeding. Obstet Gynecol. 1997;90:257–63.

    CAS  PubMed  Google Scholar 

  79. Andersson J, Rybo G. Levonorgestrel-releasing intrauterine device in the treatment of menorrhagia. Br J Obstet Gynaecol. 1990;97:690–4.

    CAS  PubMed  Google Scholar 

  80. Parazzini F, La Vecchia C, Moroni S. Intrauterine device use and risk of endometrial cancer. Br J Cancer. 1984;70:672–3.

    Google Scholar 

  81. Lobo RA, McCormick W, Singer F, Roy S. Depo-medroxyprogesterone acetate compared with conjugated estrogens for the treatment of postmenopausal women. Obstet Gynecol. 1984;63:1–5.

    CAS  PubMed  Google Scholar 

  82. Cundy T, Cornish J, Roberts H, Reid IR. Menopausal bone loss in long-term users of depot medroxyprogesterone acetate contraception. Am J Obstet Gynecol. 2002;186:978–83.

    CAS  PubMed  Google Scholar 

  83. Castracane VD, Gimpel T, Goldzieher JW. When is it safe to switch from oral contraceptives to hormonal replacement therapy? Contraception. 1995;52:371–6.

    CAS  PubMed  Google Scholar 

  84. U.S. Medical Eligibility Criteria ofr Contraceptive use, updated 2012 http://www.cdc.gov/reproductivehealth/unintendedpregnancy/USMEC.htm. Last assessed 27 Aug 2019.

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  1. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck Medical School at the University of Southern California, Los Angeles, CA, USA

    Donna Shoupe

  2. Department of Family Medicine, Keck School of Medicine at USC, Los Angeles, CA, USA

    Donna Shoupe

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  1. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Donna Shoupe

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Shoupe, D. (2020). Choosing the Right Contraceptive. In: Shoupe, D. (eds) The Handbook of Contraception. Current Clinical Practice. Humana, Cham. https://doi.org/10.1007/978-3-030-46391-5_14

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  • DOI: https://doi.org/10.1007/978-3-030-46391-5_14

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