OG21.1 | Contraceptive Methods — Summary & Reflection

KEY TAKEAWAYS

Contraceptive methods are classified as barrier (condom, diaphragm), hormonal (COC, POP, injectable, implant, patch, ring), intrauterine (copper IUCD CuT380A effective 10 years; LNG-IUS effective 5 years), emergency (LNG within 72 h; UPA within 120 h; copper IUCD within 5 days), and permanent (tubectomy, vasectomy). The WHO MEC framework assigns methods to categories 1–4 based on medical conditions; COC is MEC 4 in migraine with aura, breastfeeding <6 weeks postpartum, and smokers ≥35 yr with heavy smoking. Failure rates: the most effective reversible methods are the LNG-IUS and implant (<0.2 per 100 wy). Mechanism of copper IUCD: foreign body + copper spermicidal (non-hormonal). Mechanism of COC: primarily anovulation. Emergency contraception reduces pregnancy risk by ~85% (LNG within 72 h) to >99% (copper IUCD within 5 days). Permanent methods are effective but essentially irreversible — vasectomy is simpler and as effective as tubectomy. Male contraception options: male condom (STI protection) and vasectomy.

REFLECT

Return to the four patients from the opening scenario. You can now explain why each is a COC MEC 4 case: the migraineur with aura (stroke risk), the breastfeeding mother at 4 weeks (lactation suppression and infant oestrogen exposure), the smoker aged 38 (arterial thrombosis risk), and the post-intercourse presentation at 60 hours (not a contraindication to COC per se, but EC is what she needs and LNG remains effective). What would you offer each? Write a one-sentence response for each patient that names the preferred method and the key reason you are choosing it over COC.