Download Applying CDCs Evidence Based Contraceptive

ApplyingCDCsEvidenceBasedContraceptiveMethods
Guideline
(InformationforCaseManagersonly)
Teenuselesseffectivemethodsandusethesemethodsinconsistently
ContraceptiveMethods:
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Pills55%
Condoms22%
DMPA10%
IUD4%
Other8%
Tier1:Mosteffectivelessthan1%pregnancy(LARC,Implant,
andIUDdevices)
Tier2:Injectable,Pills,Patch,Ring,Diaphragm
Tier3:Condoms,Withdrawn,Sponge,Spermicide18-28%
TeenscommonlyusedPillsandCondoms
Tier1Mosteffective99%
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LongActingReversibleContraception(LARC)onlybyhealthcareprovider
Levonorgestrel-ReleasingIntrauterineSystem
CopperIUD
Implant
Highlyrecommended(LARC)
o Forgettablecontraception
o NonDependentoncompliance
o LARCDeclaredANationalPriority
o Shouldbeconsideredfirstlinechoiceforallwoman
o Levenorgestrel:e.gMiernaeffectivefor5years
o Skylaeffectivefor3years
o S/EIrregularbleeding,Dysmenorrhea,MenstrualBloodLoss,Does
notprotectagainstSTIs
• CopperIUD:
o Approvedfor10years
o Effectiveforatleast10years
o S/EIrregularbleeding/heavybleeding,mosteffectiveemergency
contraception,doesnotprotectagainstSTIs
• Implant:
o Onlyoneavailableandeffectivefor3years
o S/EIrregularbleedinganddoesnotprotectagainstSTIs
Tier2:Mosteffectivelessthan6-12%pregnancy
Includes:Injectable,Pills,Patch,Ring
Itrequiresmoreeffortsbyuserandhashighertypicalfailurerates
Correctandconsistentuseofpillsandcondomsmaybedifficulttouse
Womenages18-24inlast3months45%missedmorethan1pill
Depo(DMPA):
o Oneinjectionevery3monthreliablecontraceptionfor3monthsand
effectsfor9months
o S/EirregularbleedingandAmenorrhea
o DoesnotprotectsagainstSTIs
o ContraceptivePills:
o combinepillcontainestrogenandprogestin
o Extendeduse
o S/EIrregularbleeding
o DoesnotprotectagainstSTIs
o ContraceptivePatch:
o Releaseestrogenandprogestin.OnepatchperweekthanIpatch
freeweek
o S/EIrregularBleeding
o DoesnotprotectagainstSTIs
o VaginalRing:
o Releaseestrogenandprogestin
o OneRing3weekthanoneweek
o S/EIrregularBleeding
o DoesnotprotectagainstSTIs
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Tier3:Needsmoreefforts12-28%pregnancy
o Includes:Condoms,Diaphragm,Fertilityawarenessbasedmethods,
Withdrawal(Highfailurerate),Spermicide
o MalecondomsreduceriskforSTIs,HIVwhenusedcorrectlyand
consistently
o QuickStart:
o Initiationofcontraceptiononanydayofcycle.
o Morereliableandfasterprotectionfromunplannedpregnancies.
o Advise7daysofbackuporabstinence.
o Noincreaseinunscheduledbleeding
o USFamilyPlanningGuidance:EvidenceBased
o BarrierstoLARCprovision
§ Patientpreference
§ Concernaboutsafetye.g.riskofPID
§ NottrainedinIUDinsertion
§ IUDsnotavailable
o TeenUseofLARC
o Barrierse.g.Cost,Knowledge,attitudeandneverheardIUD
LeastEffectiveEmergencyContraceptionifprimarymethodofbirthcontrolfails
o PlanB:swallowingthepillswithin3daysafterhavingunprotectedsex.
o Ella:Swallowthepillwithin5daysafterhavingunprotectedsex.
References
o TeenPregnancyPrevention:ApplicationofCDC’sEvidenceBased
contraceptionGuidance
o www.reproductiveaccess.org
o www.fda.gov/birthcontrol