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Upon completion of the chapter, the reader will be able to:

  1. Discuss the physiology of the normal female reproductive system.

  2. Compare the efficacy of oral contraceptives with that of other methods of contraception.

  3. State the mechanism of action of hormonal contraceptives.

  4. Discuss the risks associated with the use of contraceptives, and state absolute and relative contraindications to their use.

  5. List side effects associated with the use of various contraceptives, and recommend strategies for minimizing or eliminating such side effects.

  6. Describe advantages and disadvantages of various contraceptives, including both oral and nonoral formulations.

  7. Cite important drug interactions that may occur with oral contraceptives.

  8. Provide appropriate patient education regarding the important differences between various barrier methods of contraception.

  9. Discuss how emergency contraception (EC) may be employed to prevent accidental pregnancy.

  10. Provide appropriate patient education regarding the use of oral contraceptives, and recommend and discuss the use of nonoral contraceptives when appropriate.




  • Image not available. Heavy smokers (greater than or equal to 15 cigarettes per day) who are 35 years of age or older as well as patients with a history of thromboembolic disease, stroke, coronary artery or ischemic heart disease, peripheral vascular disease, any estrogen-dependent neoplasm, undiagnosed abnormal uterine or vaginal bleeding, or migraine headache disorder with focal neurologic deficits should not take estrogen-containing contraceptives.

  • Image not available.Side effects associated with the use of combination oral contraceptives may be minimized by appropriately adjusting either the total estrogen or progestin content.

  • Image not available. Clinicians should be aware of the many drugs that may potentially interact with contraceptives—especially those that may reduce the effectiveness of contraceptives.

  • Image not available. Nonoral forms of contraceptives, such as the transdermal patch and the transvaginal ring, eliminate the need for daily administration and, as such, may enhance patient convenience and adherence.

  • Image not available. Oral, transdermal, and transvaginal contraceptives, as well as intrauterine devices (IUDs) and most barrier contraceptives, do not protect against sexually transmitted diseases (STDs).

  • Image not available. When a contraceptive dose is missed, the risk of accidental pregnancy may be increased. Depending on how many doses were missed, the contraceptive formulation being used, and the phase of the cycle during which doses were missed, counseling regarding the use of additional methods of contraception may be warranted.


Historically, the 1950s represented an important time in the control of human fertility. It was during that decade that the first combination oral contraceptives (COCs) were developed. Shortly after the discovery that the exogenous administration of hormones such as progesterone successfully blocked ovulation, the use of hormonal steroids quickly became the most popular method of contraception worldwide. Specifically, COCs represent the most commonly used reversible form of contraception today, and it is estimated that nearly 100 million women worldwide take oral contraceptives.1 Of the 62 million women in the United States who are of childbearing age (15 to 44 years), it is estimated that more than 38 million are currently using a contraceptive method.2 Although the choice of contraceptive ...

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