Contraceptive Options
Ricci pg. 108 - 130
Method
Abstinence
Long – Acting
Reversible
Contraceptive
(LARC)
Hormonal
Contraception
How the Method Works
No Intercourse
AKA Celibacy
 Most effective reversible method. Provides effective contraception for extended periods of
time.
Intrauterine Device
 This is also known as an IUD
 Typically, a T shaped device inserted into the uterine cavity to prevent pregnancy
 There is a string attached to the IUD and is visible and palpable at the cervical OS
 Two Types – Hormonal and Nonhormonal
 Hormonal release progestin for either 3 years or 5 years
 The nonhormonal IUD is effective up to 10 years
 Advantages include: Effectiveness, reduced client error and is reversible
 Disadvantages include: bleeding, cramps, backache, a slight risk of tubal pregnancy. Slight risk
of pelvic infection on insertion, displacement of the device and rarely perforation of the cervix
and uterus.
Implants
 A single rod subdermal implant, usually inserted inside the upper arm
 Good for 3 years
 Women can experience amenorrhea up to frequent bleeding
 Lactating women may also use the implant
 Oral contraceptives block ovarian stimulation by preventing the release of Follicle Stimulating
Hormone (FSH).
 Without FSH a follicle will not ripen and ovulation does not occur.
 Progestin is the medication used, in addition to preventing ovulation, Progestin makes the
cervix impermeable to sperm.
 Hormonal contraception comes in many forms: intrauterine, implantable, injectable, oral,
transdermal patch or intravaginal ring.
Revised by TMB Fall 22
 Advantages include:
 Prevents unintended pregnancy
 Decreased cramps and bleeding
 Regular bleeding cycle
 Decreased incidence of anemia
 Decreased in acne with some formulations
 Protection from ovarian and uterine cancer
 Decreased incidence of ectopic pregnancy
 Protection from benign breast disease
 Decreased incidence of pelvic infection
 Risks include:
 Rare in healthy women
 Breakthrough bleeding / breast tenderness
 Nausea, weight gain and mood changes
 Small increased risk for developing blood clots, stroke or heart attack – smoking is a huge
factor
 Possible increased incidence of benign liver tumors and gallbladder disorders
 No protection from Sexually transmitted infections
Oral contraceptives = combination
 A pill that suppresses ovulation by combined action of estrogen and progestin.
 Pros
 Easy to use
 High rate of effectiveness
 Protection against ovarian and endometrial cancer
 Cons
 User must remember to take daily
 Possible undesirable side effects
 High cost for some women
 Prescription needed
Patch (Ortho Evra)
 Transdermal patch that releases estrogen and progestin into circulation
 Pros
Revised by TMB Fall 22






Easy system to remember
Very effective
Cons
May cause skin irritation
May fall off without notice
Education – instruct woman to apply patch every week for 3 weeks and then not to wear one
during week 4
Ring (NuvaRing)
 Vaginal contraceptive ring about 2 inches in diameter that is inserted into the vagin and
releases estrogen and progestin
 Pros
 Easy system to remember
 Very effective
 Cons
 May cause a vaginal discharge
 Can be expelled without notice
 Education – if the ring is out for more than 3 hours, woman should use a back -up method
Depo-Provera Injection
 An injectable progestin that inhibits ovulation
 Pros
 Long duration of action (3 months)
 Estrogen free
 May be used by smokers
 May be used by lactating women
 Cons
 Menstrual irregularities
 Return visit needed every 12 weeks for injection
 Weight gain
 Headaches
 Depression
 Return to fertility delayed up to 12 months
Revised by TMB Fall 22
Go to ATI Pharmacology Book and review chapters on Medication Affecting the Reproductive
System
Sterilization
Mechanical Barriers
MEN – Vasectomy
Diaphragm
WOMEN – Tubal Ligation
Refer to table 56-4
The diaphragm is an effective contraceptive device consisting of a
round flexible spring covered with a domelike latex rubber cup. The
diaphragm is used in conjunction with a spermicide, which is used to
coat the diaphragm prior to inserting deep into the vagina, covering
the cervix completely. Prior to use the diaphragm should be inspected
for tiny holes or tears. Post coitus, the diaphragm should be left in
place for 6 hours, but no longer than 12 hours. Disadvantages include:
allergic reactions in those who are sensitive to latex and increased rate
of UTI.
Cervical Cap
A cervical cap is smaller than a diaphragm and only covers the cervix. If
a woman can feel her cervix she is usually able to use a cervical cap
effectively. Major advantage is the cervical cap can be left in place for
2 days after coitus. The cap is used with spermicide. Disadvantage: can
cause cervical irritation. Most PCP will do a PAP Smear and then
repeat it in 3 months after the cervical cap has been used.
Female Condom
The female condom provides protection from STI, HIV and pregnancy.
Refer to Figure 56-6 for a picture or the picture below. Disadvantages
include cost and cannot be used in a standing position.
Spermicides
Spermicides are made from nonoxynol – 9 or octoxynol and are
available over the counter as foams, gels, films, suppositories and also
on condoms. Advantages: this is a nonhormonal option, user
Revised by TMB Fall 22
controlled, does not cause systemic side effects and are immediately
effective. Disadvantage: Do not protect from HIV or STI’s
Male Condom
The male condom is an impermeable, snug – fitting cover applied to
the erect penis before entering the vaginal canal. Space needs to be
left at the end of the condom for ejaculation. Advantages: provides a
barrier against STI. An exception are natural condoms, which do NOT
protect from HIV. Disadvantages: HPV can still be transmitted because
of the skin to skin contact. If abraded skin is exposed to body fluids,
the risk for STI transmission increases.
Sponge
Disk – shaped polyurethane device containing a spermicide that is
activated by wetting with water.
Coitus Interruption
or Withdrawal
Fertility Awareness –
Based Methods
Emergency
Contraception
This is the removal of the
penis from the vagina
before ejaculation.
This method requires the
woman to know when
fertile time occurs during
the menstrual cycle.
This requires a lot of control by the male partner and is considered to
be an unreliable source of birth control.
These are methods that can
be used by women after
unprotected sex to prevent
pregnancy.
Emergency contraceptive pills – need to be taken as soon as possible
and no later than 5 days after unprotected sex. Nausea, breast
tenderness and irregular bleeding are potential side effects.
Contraindicated in pregnancy. If a woman is breast feeding, a
progestin – only formulation is prescribed. To avoid exposing an infant
to hormones, the woman should manually express milk and formula
Revised by TMB Fall 22
If using this method to prevent pregnancy, a couple should not have
sex during fertile days. Up to 18% of couples using this method of birth
control become pregnant within the first year. While using this
method, couples should avoid sex during days 8 to 19 of the menstrual
cycle. Advantages: not hazardous to health, inexpensive and approved
by religions that do not approve of other methods of birth control.
Disadvantage: requires discipline.
feed baby for 24 hours. If no menstrual cycle after 3 weeks a
pregnancy test should be performed.
Postcoital intrauterine
Device
Revised by TMB Fall 22
This is a copper bearing IUD that needs inserted within five days of
unprotected sex. The chemical reaction within the sperm prevent
fertilization. The woman may experience discomfort on insertion, may
have heavier menstrual bleeding and may cramp. Inserting this IUD
into a woman who is already pregnant could cause termination of the
established pregnancy.
Revised by TMB Fall 22