Contraceptive Options for Contraindicated Patients
In 2015-2017, it was estimated 64.9% of women in the United States between the ages of 15-49 were using some form of contraception.1 The National Survey of Family Growth (NSFG) reported female sterilization (18.6%), oral contraceptive pills (12.6%), long-acting reversible contraceptives (10.3%) and male condoms (8.7%) were the most popular and common options, however, the degree of usage for each varied largely by age.1 Although some methods of contraception are far more efficacious than others, it is important to also take into consideration other factors such as demographics, side effects, duration, reversibility, and contraindications when offering contraceptive counseling. Likewise, dual protection should always be considered to prevent risks from HIV and STIs since even highly effective methods of contraception such as Intrauterine Device (IUDs) or surgical sterilization do not protect against these infections.2
Contraceptives can be grouped into hormonal and non-hormonal categories. See the interactive diagrams above which compare typical effectiveness per contraceptive method alongside their degree of hormonal properties. Although there are many options to choose from, some patients may find themselves contraindicated for hormonal contraceptives, specifically estrogen. The CDC provides a helpful summary chart (U.S. Medical Eligibility Criteria for Contraceptive Use) which outlines a comprehensive medical eligibility criteria across four categories of severity for several potential conditions and sub conditions.3 For women who find themselves in category 3, it would be wise to consider alternative birth control methods.
Women who find themselves in category 4 are completely contraindicated, typically due to hormonal therapy associated with estrogen releasing products. Patients contraindicated to hormone birth control methods can consider the above options which either circumvent hormones altogether or rely on progestin alone. Note when considering birth control methods, it is important to tailor the best option to the patient. For example, if a patient is looking to space their children out evenly across 3 years, a Nexplanon implant might be a good option. Likewise, a patient who is no longer interested in having children may be better suited for more permanent methods such as sterilization or a long-term IUD.
- Centers for Disease Control and Prevention. Current Contraceptive Status Among Women Aged 15–49: United States, 2015–2017. Accessed March 1, 2021. https://www.cdc.gov/nchs/products/databriefs/db327.htm.
- Centers for Disease Control and Prevention. Contraception. Accessed March 1, 2021. https://www.cdc.gov/reproductivehealth/contraception/index.htm.
- Centers for Disease Control and Prevention. US Medical Eligibility Criteria (US MEC) for Contraceptive Use, 2016. Accessed March 1, 2021. https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/summary.html.