Contraceptive Management

Introduction to Contraceptive Options

• Intrauterine devices (IUDs) are a highly effective contraceptive option, with an effectiveness of >99% in preventing pregnancy, as recommended by the Centers for Disease Control and Prevention (CDC) 1, 2, 3, 4, 5
• The effectiveness of different contraceptive methods is summarized in the following table:

3, 2, 5, 4

Bleeding Management

• For users of intrauterine devices (IUDs) experiencing bleeding, the American College of Obstetricians and Gynecologists recommends NSAIDs for 5-7 days to manage symptoms 5
• For implant users with heavy bleeding, the Centers for Disease Control and Prevention (CDC) suggests NSAIDs for 5-7 days, hormonal treatment with low-dose combined oral contraceptives for 10-20 days, or antifibrinolytic agents for 5 days 5
• Extended-cycle regimens can be beneficial for conditions like anemia, severe dysmenorrhea, endometriosis, and migraines without aura, as noted by the American Academy of Pediatrics, offering non-contraceptive benefits including decreased menstrual bleeding and cramping, reduced frequency of menstrual periods, and improvement in conditions exacerbated by menstruation 4

Follow-up Care and Satisfaction

• The CDC recommends scheduling follow-up within 3 months to assess satisfaction with the chosen method, changes in mood or depression symptoms, and management of side effects, although no routine follow-up visit is required for most methods 1
• The CDC advises providing clear instructions about what to do if pills are missed for oral contraceptive users, as part of missed dose management 1

Special Considerations and Contraindications

• Women taking oxcarbazepine can use IUDs, including copper IUD and levonorgestrel-releasing IUD, as first-line contraceptive options due to their high efficacy and lack of interaction with the medication, classified as Category 1 (no restriction) by the CDC 1, 2
• Combined hormonal contraceptives are classified as Category 3 (risks usually outweigh benefits) for women taking oxcarbazepine, due to potential pharmacokinetic interactions 1
• Women with stable systemic lupus erythematosus (SLE) and no antiphospholipid antibodies can use IUDs or subdermal progestin implants due to their high effectiveness and minimal systemic side effects 3
• Contraindications for combined hormonal contraceptives include pregnancy, hypersensitivity to any component, renal dysfunction, adrenal insufficiency, history of thromboembolic disorders, cardiovascular disease, uncontrolled hypertension, migraine with aura, breast cancer, liver disease, or undiagnosed abnormal genital bleeding 6
• The risk of venous thromboembolism (VTE) is a significant concern with combined hormonal contraceptive use, with a baseline VTE risk in non-users of 1 per 10,000 woman-years, and a risk with combined hormonal contraceptives of 3-4 per 10,000 woman-years 6, 7

Emergency Contraception

• The CDC recommends that emergency contraception should be taken as soon as possible within 5 days of unprotected sexual intercourse, with the most effective window being within 72 hours 1
• The American College of Obstetricians and Gynecologists recommends levonorgestrel as a first-line emergency contraception option, as it is effective when used correctly, preventing approximately 75-80% of expected pregnancies 1
• Ulipristal acetate is effective up to 120 hours after unprotected intercourse, but requires a prescription, preventing approximately 85% of expected pregnancies, and is preferred for patients with higher BMI due to its maintained efficacy in this population 1, 8, 9