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LEARNING OBJECTIVES

LEARNING OBJECTIVES

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

  1. Discuss the physiology of the 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 adverse effects, risks, and contraindications associated with the use of contraceptives, and recommend strategies for minimizing or eliminating such risks.

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

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

  7. Provide appropriate patient education regarding the use of oral and barrier methods of contraception.

  8. Discuss how emergency contraception may be employed to prevent unintended pregnancy.

INTRODUCTION

Historically, the 1950s was an important time in the control of human fertility. It was during that decade that the first combination hormonal contraceptives (CHCs) 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. CHCs are the most commonly used reversible form of contraception in the United States today, with an estimated 9.7 million women users.1 Studies of women of childbearing age (15–44 years) in the United States estimate that 62% are currently using a contraceptive method.1 Since the introduction of oral contraceptives, many additional contraceptive forms have been developed and are available for use in the United States, including transdermal systems, transvaginal systems, and intrauterine devices (IUDs). These additional forms of contraception offer women effective and potentially more convenient alternatives to oral contraceptives.

EPIDEMIOLOGY

According to the National Survey of Family Growth, approximately 6.37 million pregnancies occur annually in the United States.2 It is estimated that nearly half of all pregnancies that occur each year in the United States are unintended.2,3 A survey of women who had unintended births in the United States between 1998 and 2002 revealed that approximately 60% were not using any form of contraception.1 In addition, many women who do use contraceptives use their chosen method of contraception imperfectly, and this also increases the risk of unintended pregnancy. For patients with certain medical conditions, such as epilepsy, hypertension, ischemic heart disease, sickle cell disease, lupus, or thromboembolic mutations, unintended pregnancy can further increase the risk for adverse health events.4,5 The provision of appropriate and adequate instruction to patients regarding how to use contraceptive methods effectively is essential in order to reduce the risk of unintended pregnancy and, for some women, the associated increase in risk for adverse health-related events.

Exposure to sexually transmitted infections (STIs) is also a concern for women who are sexually active. It is estimated that 20 million people in the United States become newly infected annually with an STI.6 Given that not all methods of contraception protect the user against ...

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