Implantable Hormonal Agent

Subcutaneous implantation of six rods containing levonorgestrel (a proges-terol), which lasts about 5 years

Efficacy

Mechanism of Action

■ Suppression of LH surge

■ Thickened mucus

■ Endometrial atrophy

Side Effects

■ Irregular bleeding

■ Decreased libido

■ Adnexal enlargement

■ Possible difficult removal

Indications

■ Oral contraceptives contraindicated/intolerated

■ Smokers over 35 years old

■ Women with diabetes mellitus, HTN, CAD

Contraindications

■ Thrombophlebitis/embolism

■ Known/suspected pregnancy

■ Liver disease/cancer

■ Breast cancer

■ Concomitant anticonvulsant therapy

INTRAUTERINE DEVICE

Insertion of a T-shaped device (Paragard or Progestasert) into the endometrial cavity with a nylon filament extending through the cervix to facilitate removal

Efficacy

Types

■ Paragard—made with copper and lasts 10 years

■ Progestasert—releases progesterone and lasts 1 year

Mechanism of Action

■ Prevents fertilization by creating a hostile environment (a sterile inflammatory reaction) for sperm and for a fertilized ovum

■ Prevents ovulation and causes endometrial atrophy (Progestasert only)

Indications

■ Oral contraceptives contraindicated/intolerated

■ Smokers over 35 years old

Contraindications

■ Multiple sexual partners

■ Immunocompromised (e.g., HIV, sickle cell disease)

■ Known/suspected pregnancy

Complications

■ Uterine perforation

The IUD filament provides an access for bacteria, so it is a high risk for infection.

■ Ectopic pregnancy

■ Menorrhagia and metrorrhagia

■ IUD expulsion

POSTCOITAL/EMERGENCY CONTRACEPTION

Indicated after rape, barrier contraception failure, or any other unprotected intercourse

Efficacy

Most Common Regimen

■ Two tablets of a combination estradiol (50 ^g) and norgestrel (0.5 ^g) at time of examination

■ Two more tablets 12 hours later

Nausea occurs in about one half of cases following regimen.

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