Add a note of two of the the contraceptive techniques used by females.
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Unintended pregnancy is a major women’s health problem. In the United States, the unintended pregnancy rate was 45% in 2011 as compared with 51% in 2008.1,2 Although the rate has declined, it is still unacceptably high given the plethora of safe and effective methods of contraception. The consequences of unscheduled pregnancies include delayed prenatal care; early pregnancy exposure to smoking, drinking, or substance abuse; low birth weight; and decreased chances of breastfeeding after delivery.
Condoms and combined oral contraceptive pills (COCs) remain the most commonly used contraceptives. Guidelines strongly recommend long-acting reversible contraceptive (LARC) methods — intrauterine devices (IUDs) and the progestin-only subdermal implant — as first-line options for most women because of their high efficacy. These LARC methods offer women the advantage of not having to remember to take, apply, or insert their contraceptive (worry-free), and not having to rely on a yearly appointment for refills. The 3-year overall continuation rates for LARC users are significantly higher than for other methods, including combined hormonal contraception.3 This article discusses the available female contraceptive methods, including sterilization and emergency contraception, in terms of efficacy, side effects, convenience, and use in clinical practice.
Contraceptive Use in Clinical Practice
More than 99% of sexually active women have used at least one contraceptive method at some time.4 The choice of contraceptive method is determined by the woman's individual risk factors, age, frequency of sexual activity, number of sexual partners, permanence, and efficacy. (Table 1) shows the effectiveness of the available contraceptives.
Table 1: Effectiveness of Contraceptive Methods
Pregnancies per 100
women in first 12 months
of use
Contraceptive method As commonly used Perfect use
Oral contraceptives
Combined hormonal contraceptives 9 0.3
Progestin-only pills 9 0.3
Transdermal contraceptives
Combined hormonal contraceptives 9 0.3
Vaginal ring
Combined hormonal contraceptives 9 0.3
Injectable contraceptives
Depot medroxyprogesterone acetate 6 0.2
Progestin-only subdermal implant 0.05 0.05
Intrauterine devices
Levonorgestrel IUD 0.2 0.2
Copper IUD 0.8 0.6
Barrier contraceptives
Diaphragm with spermicide 12 6
Cervical cap
Nulliparous women
Parous women
12
24
9
20
Female condoms 21 5
Spermicides 28 18
Contraceptive sponge
Nulliparous women
Parous women
12
24
9
20
Male condoms 18 2
Sterilization
Female sterilization 0.5 0.5
Male sterilization 0.15 0.1
Fertility awareness-based methods
Lactation amenorrhea method 2 0.5
Coitus interruptus 22 4
Symptothermal — 0.4
Ovulation method — 3
Rhythm method — 5
Contraception rate without birth control
No method 85 85
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