Approximately 49 percent of pregnan...

Approximately 49 percent of pregnancies in the United States are unintended. (1) undivided cost analysis (2) found that compared with pregnancy and abortion, contraception saves an estimated $9000 to $14000 by means of woman of childbearing age from one side of to the other a five-year period. Although near methods of contraception have side meanings morbidity and mortality rates are significantly higher for pregnancy and childbirth than for the use of any contraceptive course alone. (3)

Oral contraceptive pills (OCPs) male condoms, and female sterilization are the contraceptive way s most commonly used in the United States. (4) However, approximately 3 million U women at risk for unintended pregnancy are using no form of contraception. (5) not rarely cited reasons for discontinuing a order when contraception is still desired include side results difficulty of use, safety disturbs and lack of access to health care. (5) Furthermore, personal beliefs and selections influence a woman's willingness to use a contraceptive mode correctly.

Family physicians provide contraceptive counseling to a significant number of patients each year. Knowledge of the wide variety of contraceptive modes and barriers to the use of a certain of these methods is important in helping each patient make an appropriate choice.

Traditional systems of Contraception

The benefits, side powers and potential complications of traditional meanss of contraception are reviewed in detail elsewhere. (6-8) A summary of these way s is provided in Table 1 (8-11)

It is important to note certain changes that have occurr in the past several years. For example, no contraceptive wipe s currently are available in the United States, although a of the present day vaginal sponge (Protectaid) is subject to investigation. Likewise, the levonorgestrel implant a whole marketed as Norplant is no longer being manufactured; however, a single-rod implant (Implanon), shortly used outside the United States, may become available in the future

A combination OCP that contains the strange progestogen drospirenone (Yasmin) has been available for several years. Drospirenone has a certain antimineralocorticoid activity and has been shown to decrease the water retention, negative affect, and appetite changes that commonly are associated with menstrual period changes. (12) [Strength of Recommendation (SOR) B descriptive studies and lower quality clinical trials] Serum potassium on a levels should be monitored when women use this OCP in conjunction with other medicines that also raise potassium horizontals because hyperkalemia is a potential side effect

Finally, studies upon the length of time that active pills are given have provided more options and flexibility for OCP users. (13) The U cheer and Drug Administration (FDA) lately approved the use of levonorgestrel- ethinyl estradiol (Seasonale) in an dilateed OCP regimen consisting of 84 days of active pills and seven days of nonhormonal pills.

Newer way s of Contraception

Traditional regularitys of contraception have some drawbacks (Table 1) (8-11) Consequently patient dissatisfaction and inconsistent or incorrect use may be the effect in unintended pregnancy. For example, the succes of OCP the most numerous widely used reversible contraceptive system is highly dependent on daily adherence. In single study, (14) approximately 47 percent of OCP users failed to take single or more pills per period and 22 percent failed to take brace or more pills.

In designing the newer contraceptives, attention has been given to improving the side validity profiles of older methods and to developing delivery combination of parts to form a wholes that do not require daily patient adherence.

VAGINAL CONTRACEPTIVE RING

The combined hormonal vaginal ring (NuvaRing) has a unique delivery order The ring works in a similar manner as OCP on the other hand daily action by the patient is not required. The ring (Figure 1) which releases ethinyl estradiol at a rate of 15 mcg by day and etonogestrel at a rate of 120 mcg for day, is placed in the vagina for three weeks. If for a reason the ring is on the outside of the vagina for more than three hours, back-up contraception should be used until the ring has been back in place for seven days. After three weeks, the ring is remov for the same week, and a new ring is inserted. Withdrawal bleeding arises during the ring-free week.

[FIGURE 1 OMITTED]

In a one-year studious mood (15) the overall failure rate for the vaginal ring was 065 pregnancies through 100 women-years. The majority of women in the reflection considered insertion and removal of the vaginal ring to be easy, and 90 percent used the device correctly. Adverse purports that led to discontinuation of vaginal ring use greatest in number often were related to foreign carcass sensation, coital problems, and expulsion of the device. However, merely 3.6 percent of women in the investigation stopped using the device for these reasons.

In terminuss of cycle control, the vaginal ring is associated with a lower incidence of breakthrough bleeding than levonorgestrel-ethinyl estradiol OCP and with a higher rate of normal withdrawal bleeding. (16) combined hormonal injection