Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-26T16:36:03.272Z Has data issue: false hasContentIssue false

Chapter 20 - Hormonal and Non-hormonal Contraceptives

from Section 4 - Contraception and STIs

Published online by Cambridge University Press:  24 November 2021

By
Johannes Bitzer
Edited by
Tahir Mahmood ,
Charles Savona-Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona-Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
Get access

Summary

Two basic groups of contraceptive methods can be distinguished: those based on hormones and those blocking the contact between spermatozoids and egg cells.

Combined hormonal contraceptives (CHC) contain synthetic oestrogen with a synthetic progestin that inhibits ovulation. Their use confers a small increase in the absolute risk of venous thromboembolism. CHC have, however, important additional benefits.

Progestins show no increased VTE risk. They can be used in different forms (oral pills, injections, IUDs, Implants). IUDs and implants are long-acting reversible contraceptives (LARCS)

The copper IUD is highly effective and available in different shapes, dosages of copper release, duration of actions, etc. Barrier methods and natural family planning methods are less effective than CHC and LARCs. Family planning professionals have to know the efficacy, health risks, side effects, additional benefits of each method as well as the medical eligibility criteria to help the individual woman to find the method that best suits her medical profile and her needs.

Keywords

combined hormonal contraceptionlong-acting reversible contraceptionvenous thromboembolismnatural family planning methodsminipill
Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Gynaecology
 , pp. 161 - 169
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Trussell, J. Contraceptive efficacy. In: Contraceptive Technology. New York: Ardent Media, 2011.Google Scholar
Faculty of Sexual & Reproductive Healthcare (FSRH). Combined hormonal contraception. 2012. Available at: www.fsrh.org/standards-and-guidance/documents/combined-hormonal-contraception.Google Scholar
World Health Organization. Family planning: a global handbook for providers. Available at: http://apps.who.int/iris/bitstream/10665/44028/1/9780978856373_eng.pdf.Google Scholar
European Medicines Agency. Combined hormonal contraceptives. Available at: www.ema.europa.eu/en/medicines/human/referrals/combined-hormonal-contraceptives.Google Scholar
Roach, RE, Helmerhorst, FM, Lijfering, WM, et al. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev 2015;8:CD011054.Google Scholar
Petitti, DB, Sidney, S, Quesenberry, CP Jr, Bernstein, A. Incidence of stroke and myocardial infarction in women of reproductive age. Stroke 1997;28:280–283.Google Scholar
Medicines and Healthcare products Regulatory Agency. Drug safety update: combined hormonal contraceptives and venous thromboembolism: review confirms risk is small. 2014.Google Scholar
Faculty of Sexual & Reproductive Healthcare (FSRH). Statement from the Clinical Effectiveness Unit: combined hormonal contraception and venous thromboembolism. 2016. Available at: www.fsrh.org/standards-and-guidance/documents/ceu-statement-combined-hormonal-contraception-and-venous.Google Scholar
Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Lancet 1996;347:1713–1727.Google Scholar
Marchbanks, PA, McDonald, JA, Wilson, HG, et al. Oral contraceptives and the risk of breast cancer. N Engl J Med 2002;346:2025–2032.Google Scholar
Folger, SG, Marchbanks, PA, McDonald, JA, et al. Risk of breast cancer associated with short-term use of oral contraceptives. Cancer Caus Contr 2007;18:189–198.Google Scholar
Moreno, V, Bosch, FX, Muñoz, N, et al. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet 2002;359:1085–1092.Google Scholar
Kuohung, W, Borgatta, L, Stubblefield, P. Low-dose oral contraceptives and bone mineral density: an evidence-based analysis. Contraception 2000;61:77–82.CrossRefGoogle ScholarPubMed
Lopez, LM, Grimes, DA, Schulz, KF, Curtis, KM, Chen, M. Steroidal contraceptives: effect on bone fractures in women. Cochrane Database Syst Rev 2014;6:CD006033.Google Scholar
Faculty of Sexual & Reproductive Healthcare (FSRH). Problematic bleeding with hormonal contraception. 2015. Available at: www.fsrh.org/standards-and-guidance/documents/ceuguidanceproblematicbleedinghormonalcontraception.Google Scholar
Schaffir, J, Worly, BL, Gur, TL. Combined hormonal contraception and its effects on mood: a critical review. Eur J Contracept Reprod Health Care 2016;21:347–355.CrossRefGoogle ScholarPubMed
Gallo, MF, Grimes, DA, Schulz, KF, Helmerhorst, FM. Combination contraceptives: effects on weight. Cochrane Database Syst Rev 2003;2:CD003987.Google Scholar
Jensen, J, Speroff, L. Health benefits of oral contraceptives. Obstet Gynecol Clinics 2000;27:705–721.Google Scholar
Cibula, D, Gompel, A, Mueck, AO, et al. Hormonal contraception and risk of cancer. Hum Reprod Update 2010;16:631–650.CrossRefGoogle ScholarPubMed
Hannaford, PC, Iversen, L, Macfarlane, TV, et al. Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners’ Oral Contraception Study. BMJ 2010;340:c927.Google Scholar
Farrow, A, Hull, MG, Northstone, K, et al. Prolonged use of oral contraception before a planned pregnancy is associated with a decreased risk of delayed conception. Hum Reprod 2002;17:2754–2761.CrossRefGoogle ScholarPubMed
Proctor, ML, Roberts, H, Farquhar, CM. Combined oral contraceptive pill (OCP) as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev 2001;(2):CD002120.Google Scholar
Iyer, V, Farquhar, C, Jepson, R. Oral contraceptive pills for heavy menstrual bleeding. Cochrane Database Syst Rev 2000;2:CD000154.Google Scholar
Goodman, NF, Cobin, RH, Futterweit, W, et al. American Association of Clinical endocrinologists, American College of Endocrinology and Androgen Excess and PCOS Society diseases state clinical review: guide to best practices in the evaluation and treatment of PCO syndrome – Part 1. Endocr Pract 2015;21:1291–1300.Google Scholar
Arowojolu, AO, Gallo, MF, Lopez, LM, Grimes, DA, Garner, SE. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev 2009;3:CD004425.Google Scholar
Moore, J, Kennedy, S, Prentice, A. Modern approach to combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev 2000;2:CD001019.Google Scholar
Pearlstein, TB, Bachmann, GA, Zacur, HA, Yonkers, KA. Treatment of premenstrual dysphoric disorder with a new drosperinone-containing oral contraceptive formulation. Contraception 2005;72:414–421.Google Scholar
FSRH Faculty of Sexual & Reproductive Healthcare (FSRH). UK medical eligibility criteria for contraceptive use (UKMEC). 2016. Available at: www.fsrh.org/standards-and-guidance/external/ukmec-2016-digital-version.Google Scholar
World Health Organization. Medical eligibility criteria (fifth edition). 2015. Available at: www.who.int/reproductivehealth/publications/family_planning/MEC-5/en.Google Scholar
Faculty of Sexual & Reproductive Healthcare (FSRH). Progestogen-only pills. 2015. Available at: www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-pop-mar-2015.Google Scholar
Samson, M, Porter, N, Orekoya, O, et al. Progestin and breast cancer risk: a systematic review. Breast Cancer Res Treat 2016;155:3–12.Google Scholar
Progestogen-only contraception and bone mineral density: a systematic review. Contraception 2006;73:470–487.Google Scholar
Faculty of Sexual & Reproductive Healthcare (FSRH). Progestogen-only injectable contraception. 2014. Available at: www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-injectables-dec–2014.Google Scholar
Tepper, NK, Whiteman, MK, Marchbanks, PA, et al. Progestin-only contraception and thromboembolism: a systematic review. Contraception 2016;94:678–700.Google Scholar
Vu, Q, Micks, E, McCoy, E, et al. Efficacy and safety of long-acting reversible contraception in women with cardiovascular conditions. Am J Cardiol 2016;117:302–304.Google Scholar
Kaunitz, AM, Arias, R, McClung, M. Bone density recovery after depot medroxyprogesterone acetate injectable contraception use. Contraception 2008;77:67–76.Google Scholar
Beatty, MN Blumenthal, PD. The levonorgestrel-releasing intrauterine system: safety, efficacy, and patient acceptability. Therapeut Clin Risk Manage 2009:5;561–574.Google Scholar
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 121: long-acting reversible contraception – implants and intrauterine devices. Obstet Gynecol 2011;118:184–196.Google Scholar
National Institute for Health and Care Excellence (NICE). Long-acting reversible contraception (update). 2014. Available at: www.nice.org.uk/guidance/cg30.Google Scholar
Backman, T, Rauramo, I, Jaakkola, K, et al. Use of the levonorgestrel-releasing intrauterine system and breast cancer. Obstet Gynecol 2005;106:813–811.Google Scholar
Dinger, J, Bardenheuer, K, Minh, TD. Levonorgestrel-releasing and copper intrauterine devices and the risk of breast cancer. Contraception 2011;83:211–217.Google Scholar
Soini, T, Hurskainen, R, Grenman, S, et al. Cancer risk in women using the levonorgestrel-releasing intrauterine system in Finland. Obstet Gynecol 2014;124:292–299.CrossRefGoogle ScholarPubMed
Soini, T, Hurskainen, R, Grenman, S, et al. Levonorgestrel-releasing intrauterine system and the risk of breast cancer: a nationwide cohort study. Acta Oncol 2016;55:188–192.Google Scholar
Mørch, L, Skovlund, C, Hannaford, P, et al. Contemporary contraception and the risk of breast cancer. N Engl J Med 2017;377:2228–2239.Google Scholar
Skovlund, CW, Mørch, LS, Kessing, LV, et al. Association of hormonal contraception with depression. JAMA Psychiatry 2016;73:1154–1162.Google Scholar
Bitzer, J, Rapkin, A, Soares, CN. Managing the risks of mood symptoms with LNG-IUS: a clinical perspective. Eur J Contracept Reprod Health Care 2018;23:321–325.Google Scholar
National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding. 2007. Available at: www.nice.org.uk/guidance/cg44/evidence/full-guideline–195071293.Google Scholar
Darney, P, Patel, A, Rosen, K, Shapiro, LS, Kaunitz, AM. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril 2009;91:1646–1653.CrossRefGoogle ScholarPubMed
Faculty of Sexual and Reproductive Healthcare Clinical Guidance. Intrauterine contraception. April 2015 (updated June 2015). Available at: www.fsrh.org/standards-and-guidance/documents/ceuguidanceintrauterinecontraception.Google Scholar
Ashley, SF, Gaudet, MM, La Veccia, C. Intrauterine devices and endometrial cancer risk: a pooled analysis of the Epidemiology of Endometrial Cancer Consortium. Int J Cancer 2015;136:E410–E422.Google Scholar
Faculty of Sexual & Reproductive Healthcare (FSRH). Barrier methods: contraception and STI prevention. 2012. Available at: www.fsrh.org/standards-and-guidance/documents/ceuguidancebarriermethodscontraceptionsdi.Google Scholar
Frank-Herrmann, P, Heil, J, Gnoth, C. et al. The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple’s sexual behaviour during the fertile time: a prospective longitudinal study. Hum Reprod 2007;22:1310–1319.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×