Contraception and Reproductive Tract Infections
Contraception
Use the US MEC categories (1–4) to guide method choice by medical condition. Category 4 = unacceptable risk (e.g., combined hormonal contraception with migraine with aura, or with smoking and age ≥35). Long-acting reversible contraception (IUD, implant) is first-line for most, including adolescents and nulliparas.
Emergency contraception: copper IUD is most effective, then ulipristal, then levonorgestrel. Know that levonorgestrel EC may be less effective with higher BMI.
Infections
Screen for chlamydia and gonorrhea in at-risk patients; untreated infection causes pelvic inflammatory disease, tubal factor infertility, and ectopic pregnancy. Bacterial vaginosis is treated with metronidazole; trichomoniasis with metronidazole; vulvovaginal candidiasis with azoles. PID regimens must cover gonorrhea and chlamydia.
Traps
- Prescribing combined hormonal contraception in a woman with migraine with aura (stroke risk).
- Forgetting that an IUD can be used in nulliparous and adolescent patients.
- Treating PID without covering anaerobes or without partner treatment.
- Missing that asymptomatic chlamydia is common and screening prevents tubal damage.
Worked example
A 36-year-old smoker requests the pill: combined hormonal contraception is category 4 (age ≥35 + smoking). Offer a progestin-only method, IUD, or implant instead.