Update on contraception

Hippokratia 2005, 9(1):35-40

A Papanikolaou, G Makedos
4th Dpt Obstetrics & Gynaecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece


Contraception is an important health issue in preventive medicine because it protects women globally from the effects of unwanted pregnancy and allows them to integrate in the society. Uncontrolled childbearing in underdeveloped countries carries a significant risk of maternal death. Available methods are not ideal and are a result of a compromise between efficacy and safety. In assessing risks, the consequences of inadvertent pregnancy should no contraception is used must be taken into consideration. Natural methods have a failure rate of 6-25 %. Condom demands motivation but protects from sexual transmitted diseases and can be used in combination with the pill or alone with a failure rate of 12% (3-15%). Barrier methods have failure rates up to 25%. Hormonal contraception is the most efficacious (above 99%) but questions of safety and minor side effects (nausea, headaches, break through bleeding) result in discontinuation rates of at least 30%. The combined contraceptive pill has been scrutinized and found safe and practical for women under 35 with no significant cardiovascular risk. Thrombosis is slightly increased , with an absolute risk of 1-10 more cases in 100,000 women. Increased age, obesity, smoking and hypertension alone or in combination increase the risks significantly and are the main contraindications for its use. Breast and cervical cancer risks are slightly increased but the absolute risks are small, occur after 5 years of use and are reversible. Other hormonal methods with injectable and implantable progestins are safe and practical but not readily reversible and produce menstrual irregularities and sometimes amenorrhea. Hormonal methods have several benefits on reproductive problems such as dysmenorrhea, menorrhagia and ovarian cysts. Intrauterine contraceptive devices (IUCD) are safe and effective with a failure rate of 0,1-1,5% but demand skill in application and selection of patients (monoga-mous, preferably parous) to avoid infection that is increased only around insertion. Emergency postcoital contraception in the form of high dose combined pill or high dose progestins or insertion of IUD is effective and should be widely available. Teenage pregnancy is a serious health problem of modern societies and contraception in this age group demands special non-didactic counseling, education and parent involvement. The pill or/and condom are the methods used commonly.