Background

Contraception is the deliberate prevention of conception, and it is also referred to as birth control. When it comes to contraception, there are a lot of methods out there, and each has its advantages and disadvantages. They are most effective when used appropriately and they are the most suitable for preventing pregnancy.

The most suitable means of contraception would be dependent on the age, health status, lifestyle, and personal preference of the individual. 

There are two main categories of contraception: It has further divided into hormonal methods and barrier methods. 

Indications

Prevention of Unintended Pregnancy: The primary use of contraception is to prevent unintended pregnancies. 
 
Spacing of Pregnancies: These include helping couples to plan for children and the time they wish to have them. 
Helps in managing the health of the mother and child by allowing time for recovery between pregnancies. 
 
Medical Indications: Hormonal contraceptives can regulate menstrual cycles, reduce heavy menstrual bleeding (menorrhagia), and alleviate menstrual pain (dysmenorrhea). 

Contraindications

Known or suspected breast cancer 

Pregnancy 

Unexplained vaginal bleeding 

Outcomes

Equipment

Barrier Methods: 

Condoms 

Diaphragms and cervical caps 

Hormonal Methods: 

Birth control pills 

Birth control patch 

Birth control injections 

Long-acting Reversible Contraception (LARC): 

Intrauterine devices (IUDs) 

Implants 

Patient preparation

Discuss various contraceptive methods available (e.g., pills, implants, IUDs, condoms) considering effectiveness, convenience, side effects, and reversibility. 
Assess medical history, including previous contraceptive use, allergies, chronic conditions, and medications that might interact with contraceptives. 
 
Conduct a thorough physical exam, if necessary, especially for methods like intrauterine devices (IUDs) or implants. 
 
Explain how each of the methods is used to avoid conception and the general effectiveness rates of each method in typical and perfect use. 

Technique

Contraception method types 

Barrier Methods:

Barrier methods of birth control include the use of condoms or diaphragms whose mode of action is to prevent sperm from meeting an egg. They include:

Step 1: Condoms: Both male and female condoms are used; the main purpose of these contraceptives is to ensure that sperm does not get into the woman’s vagina. It also has an added advantage of protecting the individual against sexually transmitted infections (STIs). 

Condoms 

Step 2: Diaphragm and Cervical Cap: These are made of silicone or latex that has a dome shape, and they are worn over the cervix to prevent sperm from reaching the uterus.

Step 3: Spermicide: It is the chemical substances in the form of creams, gels, or foams, which inhibits the sperm entry and does not allow it to reach the egg. Spermicides are mostly used in combination with any other barrier contraceptive method such as condoms or diaphragms.

Step 4: Significance:

Barrier methods are easily obtained and do not require a doctor’s prescription.

It has been proved that, they are much effective in preventing the spread of STIs when used in a correct way with the condom.

Non-hormonal contraception and contraception options for women with those who have contraindications to hormonal drugs. 

Hormonal Methods:

Hormonal contraception employs synthetic hormones to prevent pregnancy through suppression of ovulation, immobilization of sperm by making the cervical mucus thick, or by reducing the endometrium lining. Types include:

Step 1: Birth Control Pills: Combinations of estrogen and progestin pills that are used as a contraceptive.

Step 2: Birth Control Patch: A small, thin paper-like substance that can be applied directly to the skin and release hormones into the body.

Step 3: Birth Control Shot: Progestin-only injection every three months.
Step 4: Birth Control Implant: A thin stick which is inserted under the skin to deliver progestin over a few years.

Step 5: Hormonal Intrauterine Device (IUD): A T-shaped object that is inserted in the uterus and secretes hormonal agents.

Step 6: Significance:

When used to the best, outcome is excellent.

It is useful in controlling the menstrual cycle and may also be effective in alleviating the pain that is associated with menstrual cramps.

Some of the methods (such as IUDs) are long-acting and reversible, so they do not require daily use of a contraceptive medication.

May have benefits that are not related to contraception such as clearing of acne or reduced menstrual flow. 

Long-Acting Reversible Contraception (LARC): 

LARC methods are highly effective forms of contraception that do not require daily or monthly attention:  

Step 1: Intrauterine Devices (IUDs): It also comes with hormonal and non-hormonal types and is effective for many years. 

Step 2: Birth Control Implant: A single-rod implant that can provide treatment for up to three years.

Step 3: Significance:

It is very efficient with relatively few factors that may be influenced by the user.

They are rather easy to maintain because they do not need much care.

It is useful for women who want to have long term contraception and do not want to rely on daily use. 

Permanent Methods: 

Permanent contraception (sterilization) involves procedures that permanently prevent pregnancy:
Step 1: Tubal Ligation (for women): The surgical intervention which aims at ligating or excising the fallopian tubes.

Step 2: Vasectomy (for men): Surgical method of either tying or cutting the vas deferens, that is a duct that carries sperm.

Step 3: Significance:

It is among the most popular and effective methods of contraception that is often considered as permanent.

Extremely efficient however the likelihood of it being ineffective is very low.

Gives a sense of assurance to people who are certain that they have no desire to have more children in the future. 

Emergency Contraception:

Emergency contraception (EC) methods can prevent pregnancy after unprotected intercourse: 

Step 1: Emergency Contraceptive Pills (ECPs): These are pills containing hormones that can be taken after unprotected intercourse or a condom has burst to prevent ovulation from taking place.
Step 2: Significance:

This is the last resort option of protecting against conception especially after having unprotected sex or after a contraceptive method has failed. 

Laboratory tests 

Sexually Transmitted Infections (STI) Screening: A test for STIs such as gonorrhea and chlamydia in order to minimize the likelihood of infection during the insertion steps.

Pap Smear: PAP test is used as screening tool to identify cervical cancer cells or precancerous cells in women.

Blood Tests: The doctor might recommend for further blood tests, to evaluate other diseases that might make the process difficult. 

Complications

Hormonal contraceptives: (such as birth control pills, patches, rings, injections):
These can include nausea, headache, breast tenderness, mood changes, and irregular bleeding.

Rare but serious risks include blood clots, stroke, heart attack, and hypertension, especially in women who smoke or have certain medical conditions.

Intrauterine Devices (IUDs): 

Perforation: It is the cases where the IUD can puncture the uterine wall. This is especially common in women that have never been pregnant or have thin endometrial lining.

Expulsion: The IUD can sometimes be expelled from the uterus, reducing its effectiveness.

Infection: There is a small risk of pelvic infection, particularly shortly after insertion.

Barrier methods (such as condoms, diaphragms): 

Allergic reactions: Some individuals may have allergic reactions to latex or spermicides used in these methods.

Breakage or slippage: Improper use can lead to breakage or slippage, reducing effectiveness in preventing pregnancy or STIs.

Sterilization (tubal ligation, vasectomy):

Surgical risks: Any surgical procedure carries risks such as infection, bleeding, and anesthesia complications.

Failure: While rare, sterilization can fail, leading to an unintended pregnancy. 

References

Contraception – StatPearls – NCBI Bookshelf (nih.gov) 

References

Contraception – StatPearls – NCBI Bookshelf (nih.gov)