Contraception Methods

Choosing a Method

The World Health Organization (WHO) produced guidelines to aid in contraceptive choice. The WHO Medical Eligibility Criteria for Contraceptive Use (WHO MEC) provides evidence-based recommendations to help the healthcare provider to safely select the most appropriate method of contraception. A WHO also provides information on contraception effectiveness to assists in decision making. Table I provides classifications of the four categories used.

Women must realize that popular methods, such as COCs and barrier contraception, that rely on daily or coital administration have “typical” use failure rates (user and method failures) that are higher than the “perfect” use rates (method failures). Their effectiveness is dependent on compliance and correct use. This has resulted in the promotion of “long-acting reversible contraception” (LARC). A LARC is a method that requires administration less than once per cycle or month. These methods include copper IUDs, levonorgestrel-intrauterine systems (LNGIUS), progestogen-only injectable contraceptives (POIC), progestogen-only subdermal implants, and combined hormonal vaginal rings. LARC methods combine reversibility with high effectiveness.

Table 1: World Health Organization Contraceptive Use Classification

Source: World Health Organization. Medical Eligibility Criteria for Contraceptive Use, 4th Ed., 2009.

Natural Methods

Natural family planning methods are practiced in most countries and include fertility-based methods (FAM) and withdrawal. These methods are safe, have no side effects, are inexpensive to practice, and may be easily discontinued.

Disadvantages include meticulous recordkeeping of fertility cycles, involve intensive training, and are dependent on a partner's willingness to abstain from intercourse during the fertile period. Other factors, such as irregular menstrual cycles, medicine that may affect body temperature or cervical mucus, women who are breastfeeding or ill, as well as cervical surgery may influence effectiveness.

...