Contraceptive Options for Contraindicated Patients

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 contraception1. 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%) as the most popular and common options but the degree of usage for each varied largely by age1. Although some methods of contraception are far more efficacious than others, it is important to take into consideration other factors too. These include demographics, side effects, duration, reversibility and contraindications when offering contraceptive counseling, and assisting patients in deciding on the most appropriate form of birth control for their specific needs. Likewise, dual protection should always be considered to prevent risks from HIV and STIs as even highly effective methods of contraception such as Intrauterine Device (IUDs) or surgical sterilization do not protect against these infections2

As a whole, contraceptives can be grouped into hormonal and non-hormonal categories. See the interactive diagram which compares typical effectiveness per contraceptive method below alongside their degree of hormonal properties to get a feel for what options are available on the market and how they compare to one another.

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. I have put together a more condensed version of the legend below:

For women who find themselves in category 3, it would be wise to consider alternative birth control methods whereas women who find themselves in category 4 are completely contraindicated. Most commonly, this contraindication is due to hormonal therapy associated with estrogen releasing products. Patients contraindicated to hormone birth control methods can consider the following options which either circumvent hormones altogether or rely on progestin alone:

When considering the above 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 options such as sterilization or a long term IUD. I hope our dive into contraceptives has been helpful and as always I wish you all the best of luck with your studies. 

Sincerely,

Jean Hanna

References:

  1. Products – Data Briefs – Number 327 – December 2018. (2018, December). Retrieved from https://www.cdc.gov/nchs/products/databriefs/db327.htm
  2. Contraception. (2020, August 13). Retrieved from https://www.cdc.gov/reproductivehealth/contraception/index.htm
  3. Contraception. (2020, August 13). Retrieved from https://www.cdc.gov/reproductivehealth/contraception/index.htm