Family Planning and Contraception
What the exam tests
Contraceptive effectiveness, eligibility, emergency contraception, and postpartum contraception.
Core rules
- Typical-use failure: implant and IUD <1%, injectable 4%, pill 7–9%, condom 13–18%. LARC methods are first-line for most women.
- Combined oral contraceptives are contraindicated with migraine with aura, smoking at age ≥35 (≥15 cigarettes/day), uncontrolled hypertension, prior VTE, and breastfeeding under 6 weeks.
- Progestin-only pills are safe in most of these situations but must be taken at the same time daily.
- Emergency contraception: copper IUD is the most effective and can be used up to 5 days; levonorgestrel is best within 72 hours, ulipristal within 120 hours.
- Postpartum: progestin-only methods can start immediately; combined methods after 6 weeks if breastfeeding.
Worked example
A 35-year-old smoker of 20 cigarettes/day requests the combined pill. She has no migraine. The pill is contraindicated because she is ≥35 and smokes ≥15/day, increasing cardiovascular risk. Offer a progestin-only pill, implant, or IUD, and discuss smoking cessation. The reasoning: the risk is venous and arterial thrombosis, not failure of contraception.
Traps
Missing aura; assuming all progestin-only methods cause weight gain; giving levonorgestrel after 120 hours; and forgetting to check blood pressure.