When baby brain ain't your thang...contraceptives in a nutshell

After broaching this topic with patients many times, I have learned that the most appropriate line to open with is probably,  "There are way more options out there than you may think!"

SO, you may be wondering,  "What do I need to know in order to choose the right contraceptive for me?"

The options differ in the many categories: efficacy, cost, duration of action, convenience, side effects/benefits, reversibility and ability to protect against sexually transmitted infections.

You need to choose what is best for YOU.

Let's look at the options individually (in order of most efficacious to least)...

Intrauterine devices (ex. Copper T) or systems (ex. Mirena):
- less than 1% failure rate in first year with typical use
- copper IUDs can last up to 10 years; Levonorgestrel releasing (progestin) IUS's last up to 5 years
- copper IUDs can cause heavier periods, while Levonorgestrel releasing IUS's usually result in lighter periods (occasionally heavier at first), which are more irregular (usually less frequent)
- insertion and removal must be done by a physician
- risks include infection (for 20 days post insertion), uterine perforation and expulsion

Depot provera (injection)
- 6% failure rate in the first year with typical use
- lasts for 12 weeks
- hormone type is progestin
- results in lighter, more irregular periods
- injection must be administered by a clinician
- may cause mood swings or weight gain

Contraceptive pill/patch/ring
- 9% failure rate in the first year with typical use
- the pill requires daily use, the patch is weekly and the ring is monthly
- hormone types are ESTROGEN and progestin
- periods are typically lighter and more predictable (withdrawal bleeds when used regularly)
- contraindicated in women over 35 who smoke, those who are sensitive to estrogen-related side effects, as well as in patients with numerous medical conditions** (see link below for full list)
- may slightly increase risk of blood clots and hepatic adenomas
- may decrease acne and hirsutism, as well as hot flushes during peri menopause

Diaphragms
- 12% failure rate in the first year with typical use
- must be inserted prior to intercourse every time (and used with spermicide)
- access is via prescription
- may increase the risk of urinary tract infections

Male condom
- 18% failure rate in the first year with typical use
- single use
- may be purchased over the counter
- occasionally can break
- best protection against STI's!!!

Well, there you have it! Lots of options and a lot of information to take in. And unfortunately, if none of these options appeal to you, I will suggest what my Catholic school taught me: "Abstinence is the best policy" ;)

References:
UpToDate
**http://www.medscape.com/viewarticle/421497_7