Contraception Guidelines

Introduction to Contraception

The American College of Physicians recommends conventional combined hormonal contraceptives with synthetic hormones as the standard of care for birth control due to their established safety and efficacy profiles 1
No bioidentical hormone therapy has FDA approval for contraceptive use, and their safety and effectiveness have not been evaluated through the FDA's drug approval process 1

Combined oral contraceptives increase the risk of venous thromboembolism 3-4 fold (up to 4 per 10,000 woman-years) 2
Current combined oral contraceptive use is associated with an increased risk of myocardial infarction (RR 1.7, 95% CI 1.5-1.9) and ischemic stroke (RR 1.6, 95% CI 1.3-1.9) 3
Obesity increases myocardial infarction risk (OR 0.59 to 5.1), hypertension dramatically increases risk (OR 3.1 to 14.5 for myocardial infarction), and dyslipidemia increases myocardial infarction risk (OR 25, 95% CI 6-109) 3
Women with migraines using estrogen-containing contraceptives have an increased ischemic stroke risk (OR 2.08 to 16.9) 3

Combined oral contraceptives have a perfect-use failure rate of 0.3% (typical use: 9%) 2
Estrogen-progestin therapy is beneficial for conditions like anemia, severe dysmenorrhea, endometriosis, abnormal uterine bleeding, and bleeding disorders 2

Pregnancy carries a higher thromboembolism risk (10-20 per 10,000 woman-years) than hormonal contraceptives 2
Women over 35, especially smokers, should carefully weigh the risks and benefits of any estrogen-containing contraceptive (no specific citation, but implied by the context)