The latest contraceptive options: What you must know

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Applied Evidence

The latest contraceptive options: What you must know

J Fam Pract. 2008 December;57(12):797-805

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References

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IUD can also be used in an emergency

Insertion of a copper IUD provides EC as well as ongoing contraception. It is hormone free and can be used effectively for EC up to 5 days after sexual intercourse, then continued for primary contraception for up to 10 years.⁴⁵ Its estimated failure rate was less than 0.1% in more than 8400 postcoital insertions.⁴⁶ The IUD works by impairing fertilization and implantation and by altering sperm motility and integrity. With a copper IUD, additional primary contraception is unnecessary. The LNG IUS (Mirena) has not been studied as an alternative EC.

Some worry that EC’s availability will encourage unprotected sex

Some authorities have wondered if increased access to EC might paradoxically lead to more pregnancies by encouraging unprotected sex. Researchers are exploring this issue. One study reported that unfettered access to free EC resulted in an increase in EC use, and another study reported that patients with unrestricted EC access had inadequately protected sex more often than those in the control group.^47,48

A systematic review of 23 articles studying the effect of increased access to EC confirmed an increase in EC use,⁴⁹ but no statistically significant differences in pregnancy or abortion rates.

FAST TRACK

Using hormonal contraception does not increase the risk of breast cancer for individuals with a family history of it

So what do you recommend?

For patients like the 35-year-old woman discussed earlier, who do not like taking pills, there are many contraception options to choose from, including the patch, vaginal ring, chewable OC, IUD, depot medroxyprogesterone injection, and subdermal implant.

Hormonal contraception would not be an issue for this patient—even though she has a family history of breast cancer. Using hormonal contraception does not increase the risk of breast cancer for individuals with a family history of breast cancer in a first-or second-degree relative.⁵⁰

Correspondence
Petra M. Casey, MD, Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905; casey.petra@mayo.edu.