Contraception

Updated: May 15, 2023

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Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

nonoxynol-9 vaginal 

Gel or foam
Every dose works promptly and remains effective for up to 60 minutes after use
Sponge
Protection starts immediately and endures for 24 hours despite repeated sexual activity
Wait for 6 hours after the last sexual act before taking out the pad
Do not keep the pad inside the vagina for more than 30 hours
Film
Introduce one sheet and position it as deeply as possible near the cervix
Introduce the sheet not less than 15 minutes and not more than 3 hours before sex
Apply one sheet before every sexual act



drospirenone/ethinyl estradiol/levomefolate 

Beyaz
For the first 24 days, take one active tablet (3 mg drospirenone/0.02 mg ethinyl estradiol) orally daily; for the next 4 days, take one inert tablet orally daily.

Safyral, Tydemy
For the first 21 days, take one active tablet (3 mg drospirenone/0.03 mg ethinyl estradiol) orally daily; for the next 7 days, take one inert tablet orally daily.



desogestrel 

Adults: Females: one tablet (75 mcg) taken orally once a day



etonogestrel 

Subdermally insert one implant
If prolonged contraceptive protection is desired, a new implant may be inserted in its place at least three years after the original implant date.

No previous usage of hormonal contraception in the previous month:
Insert between Days 1-5 of the menstruation, even if the patient is bleeding

Change from one contraceptive method to another:
OCP: Within Seven days after the last active medication
Transdermal patch: During a transdermal contraception system's seven-day patch-free time
Vaginal ring: During the 7-day etonogestrel/ethinylestradiol ring-free period

Change from progestin-only contraception:
When changing pills, you can do so on any day of the month. Avoid skipping any days between the final dose and the insertion
On the same day as the removal of the contraceptive implant
Intrauterine device or Implant: On the same day that a progestin-containing IUD is removed
Injection: When the subsequent contraceptive injection is scheduled to be given



etonogestrel/ethinyl estradiol 

It is recommended for use by women of age to become pregnant.
During three weeks, one NuvaRing is inserted into the vagina.
Remove for a week; withdrawal bleeding typically happens; Then, Insert a fresh ring one week after the prior one was removed.



lynestrenol 

When taken alone, 0.5 mg daily is recommended, or administer 0.75 to 2.5 mg daily when combined with an oestrogen.



ethinyl estradiol/levonorgestrel transdermal 

Cycle of 28 days:
Apply one new transdermal system (TDS) and worn for one week for three consecutive weeks
No new transdermal system is worn during week 4 when withdrawal bleeding is expected
Each new new transdermal system should be applied on the same day of the week
When week 4 ends then a new 28-day cycle is started by applying a new TDS
Under no situations should there be more than one week TDS-free interval between dosing cycles
If there are more than one week of TDS-free then women are not protected from nonhormonal back-up contraception and pregnancy, it must be used for one week
Dosing Considerations
Consider the drug’s decreased its effectiveness in women with a body mass index of ≥25 to <30 kg/m2



levonorgestrel oral/ferrous bisglycinate/ ethinylestradiol 

Take one active tablet orally daily for three weeks and then take one ferrous tablet orally daily on Days 22 to 28
Note: Take tablets in the sequence as indicated on blister pack
Dosage Modifications
Stop taking drug if following adverse reactions occurs:
Arterial thrombotic event or venous thromboembolic event, proptosis, diplopia, papilledema, Unexplained loss of vision
Hepatic impairment
Study not performed
Dosing Considerations
Start with transdermal patch of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate on the next scheduled application
After a first-trimester abortion then start levonorgestrel oral/ethinylestradiol/ ferrous bisglycinate instantly
After childbirth, start with contraceptive therapy following instructions for women those are not currently using hormonal contraception



dienogest/estradiol valerate 


Indicated for Contraception
One tablet orally every day, use at the same time every day
It should not delay or skip the intake of tablets by more than 12 hours
Start using the pack on day-1 of the menstrual cycle and also use the non-hormonal method as a backup like condoms, or foam for the nine days
Start following the pregnancy:
An enhanced risk for VTE after delivery with a combination of hormonal contraceptives; the risk decreases instantly following 21 days, yet it does not return to the normal till 42 days following delivery
CDC guidelines suggested for waiting nearly 3 to 6 weeks in the postpartum women without the inclusion of the VTE risks
Start following vaginal birth: It should wait for nearly three weeks
Start following cesarean section (C-section) birth: It should wait for nearly six weeks
Inclusion to postpartum, females who are with other types of risk factors for VTE: It should not use the combination of hormonal contraceptive



etynodiol 

Take a dose of 500 mcg orally daily when used as single dose or dose of 1 to 2 mg when used as a combination drug



promegestone 

125 to 500 mcg in a day on a cyclical basis



gestodene 

Take a dose of 75 mcg orally daily in monophasic preparations
Take a dose of 50 to 100 mcg orally daily in triphasic preparations



norgestimate 

250 mcg/day as usual dosage is given in monophasic preparations; 180-250 mcg/day is given in triphasic preparations



norethisterone 

0.35

mg

Tablet

Orally 

once a day

0.35mg orally one time a day



ethinyl estradiol and ethynodiol diacetate 

Products containing ethylenediol and estradiol ethynodiol come in dosage preparations of 21/ 28 days
Hormonally inert are the final seven tablets in 28-day dose formulations
Take one tablet by oral route at a consistent time daily once
Initiate on the starting day of menstrual cycle
This medication should not be regarded as effective as a contraceptive until the first seven days of continuous administration have passed; if any day other than the first day of the menstrual cycle is the commencement date of the beginning cycle, a non-hormonal contraceptive should be used as a backup during these first seven days



lactic acid/citric acid/potassium bitartrate vaginal 

Indicated in the females of reproductive potential for the prevention of pregnancy
:

Used as a demanding contraceptive method

Apply a prefilled applicator of 5 grams into the vagina immediately before or 1 hour before the vaginal intercourse

After multiple acts of vaginal intercourse within an hour, apply an additional dose



 

drospirenone/ethinyl estradiol/levomefolate 

<14 years: Safety and efficacy not established
≥14 years:
Beyaz
For the first 24 days, take one active tablet (3 mg drospirenone/0.02 mg ethinyl estradiol) orally daily; for the next 4 days, take one inert tablet orally daily.

Safyral, Tydemy
For the first 21 days, take one active tablet (3 mg drospirenone/0.03 mg ethinyl estradiol) orally daily; for the next 7 days, take one inert tablet orally daily.



etonogestrel/ethinyl estradiol 

It is recommended for use by women of age to become pregnant.
During three weeks, one NuvaRing is inserted into the vagina.
Remove for a week; withdrawal bleeding typically happens; Then, Insert a fresh ring one week after the prior one was removed.



ethinyl estradiol/levonorgestrel transdermal 

Cycle of 28 days:
Apply one new transdermal system (TDS) and worn for one week for three consecutive weeks
No new transdermal system is worn during week 4 when withdrawal bleeding is expected
Each new new transdermal system should be applied on the same day of the week
When week 4 ends then a new 28-day cycle is started by applying a new TDS
Under no situations should there be more than one week TDS-free interval between dosing cycles
If there are more than one week of TDS-free then women are not protected from nonhormonal back-up contraception and pregnancy, it must be used for one week
Dosing Considerations
Consider the drug’s decreased its effectiveness in women with a body mass index of ≥25 to <30 kg/m2



dienogest/estradiol valerate 


Indicated for Contraception
Safety and efficacy have been established only in women of reproductive age
Adolescents who require contraception: It is as adults
One tablet orally every day, use at the same time every day
It should not delay or skip the intake of tablets by more than 12 hours
Start using the pack on day-1 of the menstrual cycle and also use the non-hormonal method as a backup like condoms, or foam for the nine days
Start following the pregnancy:
An enhanced risk for VTE after delivery with a combination of hormonal contraceptives; the risk decreases instantly following 21 days, yet it does not return to the normal till 42 days following delivery
CDC guidelines suggested for waiting nearly 3 to 6 weeks in the postpartum women without the inclusion of the VTE risks
Start following vaginal birth: It should wait for nearly three weeks
Start following cesarean section (C-section) birth: It should wait for nearly six weeks
Inclusion to postpartum, females who are with other types of risk factors for VTE: It should not use the combination of hormonal contraceptive



ethinyl estradiol and ethynodiol diacetate 

For adolescents postpubertal
Products containing ethylenediol and estradiol ethynodiol come in dosage preparations of 21/ 28 days
Hormonally inert are the final seven tablets in 28-day dose formulations
Take one tablet by oral route at a consistent time daily once
Initiate on the starting day of menstrual cycle
This medication should not be regarded as effective as a contraceptive until the first seven days of continuous administration have passed;
if any day other than the first day of the menstrual cycle is the commencement date of the beginning cycle, a non-hormonal contraceptive should be used as a backup during these first seven days



 

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Contraception

Updated : May 15, 2023

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