Contraception Methods to Prevent Ectopic Pregnancy

Introduction to Effective Contraception

The American College of Obstetricians and Gynecologists recommends long-acting reversible contraceptives (LARCs), such as the etonogestrel implant (Nexplanon) or levonorgestrel IUD (Mirena), as the best methods to prevent ectopic pregnancy due to their high effectiveness in preventing all pregnancies, including ectopic ones 1

The Centers for Disease Control and Prevention (CDC) reports that Nexplanon has a typical use failure rate of 0.05%, meaning 99.95% of women will not become pregnant during the first year of use 3, 2, 4, 1
The CDC also states that Mirena has a typical use failure rate of 0.2%, meaning 99.8% of women will not become pregnant during the first year 3, 2, 4, 1
Both Nexplanon and Mirena have continuation rates exceeding 80% at one year, ensuring sustained protection 2, 1

The CDC notes that combined oral contraceptives, patches, and vaginal rings have 9% typical use failure rates (only 91% effectiveness) due to missed pills, late applications, or incorrect use 3, 2, 4, 1
The CDC reports that Depo-Provera injections have a 6% typical use failure rate due to missed appointments 3, 2, 4, 1
Barrier methods like condoms have failure rates of 18-21% with typical use 2, 5

The American College of Obstetricians and Gynecologists recommends offering LARC methods as the first-line option for women at risk of ectopic pregnancy 6, 1
The American College of Obstetricians and Gynecologists suggests that Nexplanon is particularly advantageous for women who cannot use estrogen-containing methods or have contraindications to IUDs 1
The American College of Obstetricians and Gynecologists notes that Mirena provides additional benefits, including reduced menstrual bleeding 7, 1

Women at higher risk for ectopic pregnancy include those with a history of cigarette smoking 7
Women at higher risk for ectopic pregnancy include those with a history of infertility or assisted reproduction 7
Women at higher risk for ectopic pregnancy include those with the presence of an intrauterine device (though modern IUDs are still highly protective overall) 7

While IUDs are extremely effective at preventing all pregnancies, if a pregnancy does occur with an IUD in place, there is a higher relative risk that it will be ectopic, but the absolute risk of ectopic pregnancy is still lower in IUD users compared to women using no contraception 3, 4
The copper IUD (Paragard) has a 0.6-0.8% typical use failure rate 3, 2, 4

The CDC recommends starting contraceptive counseling early in pregnancy or preconception and continuing as an ongoing discussion, presenting the most effective methods first (LARCs) 6, 1
The American College of Obstetricians and Gynecologists suggests using the U.S. Medical Eligibility Criteria (US MEC) to ensure the chosen method is appropriate for any comorbid conditions 6
The American College of Obstetricians and Gynecologists emphasizes that LARCs are easily reversible when pregnancy is desired, allowing for planned conception in a supervised medical setting 6

The American College of Obstetricians and Gynecologists recommends offering immediate postpartum LARC placement to prevent short-interval pregnancy and allow time for medical optimization 6
Immediate postpartum LARC placement reduces the risk of unintended pregnancy before the 6-week postpartum visit 6
Immediate postpartum LARC placement allows adequate interpregnancy interval for recovery 6
Immediate postpartum LARC placement provides highly effective contraception without requiring patient follow-up for initiation 6

The CDC recommends against using spermicides due to their high failure rates (28% typical use) and association with increased HIV transmission risk in certain populations 7, 2
The CDC notes that fertility awareness-based methods have 24% typical use failure rates and are inappropriate for women seeking maximum protection against ectopic pregnancy 2, 5