Family Planning and Contraception
Contraceptive questions revolve around the WHO Medical Eligibility Criteria, effectiveness and non-contraceptive benefits. Long-acting reversible methods - implants and intrauterine devices - are the most effective reversible options, with typical-use failure rates below 1%. Combined hormonal contraception is avoided in migraine with aura, uncontrolled hypertension, current venous thromboembolism, smoking over 35 years, and breastfeeding under 6 weeks; progestogen-only methods are safer in many of these situations.
Emergency contraception includes the copper IUD, which is the most effective and can be inserted up to 5 days after unprotected intercourse, oral levonorgestrel and ulipristal acetate. Depot medroxyprogesterone acetate is associated with reversible bone mineral density loss and delayed return to fertility. Postpartum contraception can begin immediately for progestogen-only methods, while combined methods are delayed until 6 weeks in breastfeeding women. Sterilisation carries a small failure risk and regret, especially in young women.
Traps: thinking antibiotics other than enzyme inducers reduce combined pill efficacy; forgetting that oral emergency contraception is less effective at higher body weight; misclassifying hypertension or migraine in the eligibility criteria; and missing the need for a pregnancy test before IUD insertion.
Rule of thumb: migraine with aura is a contraindication to combined hormonal contraception but not to progestogen-only methods.