What are the recommended contraceptive methods for individuals?

Recommended Contraceptive Methods for Individuals

Long-acting reversible contraceptives (LARCs), specifically IUDs and implants, are the recommended first-line contraceptive methods for most individuals due to their superior effectiveness (<1% failure rate) and minimal user intervention requirements. 1, 2

Effectiveness Hierarchy of Contraceptive Methods

Tier 1: Most Effective (Failure rate <1%)

• Intrauterine Devices (IUDs)
  • Copper T 380A (Cu-IUD): 0.8% typical failure rate
  • Levonorgestrel IUD (LNG-IUD): 0.1-0.2% typical failure rate
• Contraceptive Implant: 0.05% typical failure rate
• Sterilization
  • Female sterilization: 0.5% typical failure rate
  • Male sterilization: 0.15% typical failure rate

Tier 2: Highly Effective (Failure rate 3-9%)

• Injectable contraception (DMPA): 0.3-6% typical failure rate
• Combined hormonal contraceptives (pills, patch, ring): 5-9% typical failure rate
• Progestin-only pills: 5-9% typical failure rate

Tier 3: Moderately Effective (Failure rate >10%)

• Male condoms: 14% typical failure rate
• Female condoms: 21% typical failure rate
• Withdrawal method: 19% typical failure rate
• Fertility awareness methods: 25% typical failure rate
• Diaphragms with spermicide: 20% typical failure rate

Selection Algorithm

1. Assess medical eligibility:

   • Review medical history for conditions that may contraindicate specific methods
   • For example, smokers over age 35 should avoid combined hormonal methods 2
   • Women with history of thrombosis should avoid estrogen-containing methods 2

2. Consider effectiveness needs:

   • For individuals with high priority on preventing pregnancy, recommend LARCs or sterilization
   • For those who can accept some pregnancy risk, Tier 2 or 3 methods may be acceptable

3. Evaluate user preferences:

   • Need for menstrual cycle control
   • Desire for non-contraceptive benefits (acne treatment, reduced menstrual bleeding)
   • Comfort with insertion procedures
   • Frequency of administration (daily, weekly, monthly, years)
   • Preference for hormonal vs. non-hormonal methods

4. Consider STI protection needs:

   • Recommend condom use in addition to other methods for individuals at risk of STIs 1
   • Remember that hormonal methods and IUDs do not protect against STIs/HIV

Starting Contraceptive Methods

When to Start

• Most contraceptive methods can be started anytime during the menstrual cycle if pregnancy can be reasonably ruled out 1
• For LNG-IUD, implant, DMPA, and CHCs started >5-7 days after menses began, use backup contraception for 7 days 1
• For norethindrone/norgestrel POP, use backup for 2 days if started >5 days after menses 1
• For drospirenone POP, use backup for 7 days if started >1 day after menses 1

Required Examinations Before Initiation

• Cu-IUD/LNG-IUD: Bimanual examination and cervical inspection 1
• Combined hormonal contraceptives: Blood pressure measurement 1
• Implant, DMPA, POPs: No specific examinations required 1

Managing Common Issues

Bleeding Irregularities

• For Cu-IUD users with heavy/prolonged bleeding: NSAIDs for 5-7 days 1, 2
• For LNG-IUD, implant users with spotting/bleeding: NSAIDs for 5-7 days 1, 2
• For implant users with heavy bleeding: Consider NSAIDs, hormonal treatment with low-dose COCs, or tranexamic acid 1, 2

Expected Bleeding Patterns

• LNG-IUD: Initial spotting common, reduces menstrual blood loss by 88-95% after 6-12 months; about half of users experience amenorrhea by 2 years 2
• Implant: Unpredictable bleeding patterns common
• DMPA: Amenorrhea often develops with continued use
• Combined hormonal methods: Regular, predictable bleeding patterns

Special Considerations

Adolescents

• LARCs are appropriate for adolescents and nulliparous women 1
• Consider confidentiality needs and ease of use

Perimenopausal Women

• LNG-IUD particularly beneficial as it can manage heavy bleeding while providing endometrial protection 2
• Consider bone mineral density effects with long-term DMPA use 3

Medication Interactions

• Certain anticonvulsants, rifampin, and rifabutin may reduce effectiveness of hormonal methods 1
• HIV medications may interact with hormonal contraceptives 1

Common Pitfalls to Avoid

1. Overestimating user adherence: Perfect use rates differ significantly from typical use rates for user-dependent methods 4

2. Underutilizing LARCs: Despite being the most effective reversible methods, LARCs are still underutilized compared to oral contraceptives 4

3. Imposing unnecessary medical barriers: Few examinations or tests are needed before starting most contraceptive methods 1

4. Assuming bleeding with LNG-IUD is normal: Heavy bleeding with LNG-IUD is uncommon and warrants evaluation 2

5. Neglecting STI protection: Always counsel on condom use for STI prevention regardless of contraceptive choice 1