Overview Snapshot A 24-year-old, G0P0, woman presesnts to her gynecologist for a scheduled routine visit. She denies any acute complaints and reports to be in excellent health. She is sexually active with only one male partner and uses condoms consistently, which is her only method of contraception. Both her and her partner were recently tested for sexually transmitted infections and results were negative. She reports concern because approximately 2 days ago, she had intercourse and the condom broke. She feels that she is not prepared to care for a child and inquires about the "morning after pill." After a discussion, she requests the copper intrauterine device as emergency contraception and as a contraceptive method to decrease the risk of future pregnancy. Barrier Contraceptives Male condom creates a barrier that prevents contact with genital lesions, penile, vaginal, and anal discharges if used correctly and consistently, condoms may reduce the risk of pregnancy and acquiring or transmitting sexually transmitted infections (STIs) effectiveness with typical use, there is an 18% pregnancy rate advantages reversible accessible protection against STI cost disadvantages reduced sensitivity during intercourse latex sensitivity Female condom another barrier mode of contraception that may reduce the risk of pregnancy and STIs effectivness with typical use, there is a 21% pregnancy rate Contraceptive Pills Estrogen-progestin contraceptive can also be a ring and patch mechanism of action inhibition of the midcycle luteinizing hormone (LH) surge login to view 1 more bullet effectiveness with typical use, there is a 9% pregnancy rate side effects include hypercoagulability (DVT and PE) elevated triglycerides hypertension cholelithiasis and cholecystitis login to view 1 more bullet depression nausea drug interactions login to view 1 more bullet hepatic adenoma contraindications ≥ 35 years of age and smoking ≥15 cigarettes/day venous thromboembolism ischemic heart disease stroke history breast cancer cirrhosis migraine with aura non-contraceptive benefits reduce the risk of ovarian and endometrial cancer can treat acne and hirsutism first-line for endometriosis-related pain Progestin-only contraceptive can also be injected and implanted subcutaneously mechanism of action endometrial decidualization and eventual atrophy leads to login to view 1 more bullet thickening of cervical mucous leading to login to view 1 more bullet impairs tubal peristalsis and motility effectiveness with typical use, there is a 9% pregnancy rate benefits can serve as an alternative contraceptive in women with contraindications to estrogen or if estrogen causes additional health risks can be used immediately post-partum protective against the development of endometrial cancer side effects menstrual irregularity amenorrhea weight gain headache nausea abdominal pain vomiting reduction in bone density bloating dizziness Etonogestrel implant A small progestin rod that is a reversible mode of contraception placed subdermally in the upper arm to provide long-acting (three years) contraception Efficacy with typical use, there is a <1% pregnancy rate Intrauterine Device (IUD) Types of IUDs copper IUD mechanism of action login to view 5 more bullets efficacy login to view 1 more bullet provides contraception for up to 10-years also has post-fertilization contraceptive effects levonorgestrel IUD mechanism of action login to view 4 more bullets efficacy login to view 1 more bullet provides contraception for up to 5-years Contraindications uterine cavity distortions e.g., bicornuate uterus and cervical stenosis pelvic infection of acute onset e.g., pelvic inflammatory disease, mucopurulent cervicitis, and endometritis pregnancy Wilson's disease also in patients with a copper allergy hormone releasing IUD would be preferred in these cases unexplained uterine bleeding current breast cancer it is contraindicated to use the levonorgestrel IUD Emergency Contraception (EC) EC involves the use of drugs or a device to prevent pregnancy EC is also known as "postcoital contraception" and "morning-after pill" Indications recent unprotected intercourse recent possible failure of a different mode of contraception (e.g., condom breakage) Options copper IUD the most effective method of emergency contraception must be inserted within 5-7 days of unprotected intercourse requires office visit for placement ulipristal a progestin receptor modulator and delays ovulation must be taken within 120 hours after intercourse login to view 1 more bullet the most effective oral EC requires a prescription for adolescents requesting emergency contraception with ulipristal, parental consent is not necessary levonorgestrel recommended to be taken within 72 hours after intercourse login to view 2 more bullets available over-the-counter preferred over the estrogen-progestin regimen for adolescents requesting emergency contraception with levonorgestrel, parental consent is not necessary Efficacy trend copper IUD > ulipristal > levonorgestrel