Update on current contraceptive options: A case-based discussion of efficacy, eligibility, and use

Abstract

With high rates of unintended pregnancy in the United States, it is crucial for clinicians to be well-informed about the full spectrum of contraceptive options to improve reproductive autonomy. We review new contraceptive options including a nonhormonal intravaginal gel, hormonal contraceptives in the form of new pills, patches, and vaginal rings, and combined hormonal contraceptives that contain new estrogens as alternatives to ethinyl estradiol. We review updated prescribing methods for several established hormonal contraceptives such as depot medroxyprogesterone acetate, which is now available for subcutaneous self-injection. Additional choices of available contraceptive methods have important clinical implications that may remove unnecessary barriers to contraceptive use. KEY POINTSCertain long-acting reversible contraceptive methods can prevent pregnancy beyond the approved duration of use. However, this does not allow for extending the duration of use for lowest-dose progestin intrauterine devices.Intravaginal contraceptive gel offers a nonhormonal contraceptive alternative.Contraceptives with longer approved durations of use or that do not require frequent access to healthcare professionals can improve adherence and outcomes. ■ NONHORMONAL CONTRACEPTIVE INTRAVAGINAL GELA 47-year-old with latex allergy presents to the offi ce. She is interested in contraception, but does not want anything that contains hormones.

Exploring the latest developments in hormonal and nonhormonal contraceptive options

“…A missed dose of drospirenone 4 mg is one not taken 24 hours from the set Table 2. Newer products on market 2,5,6,13,14,17,18 administration time offering a wider window of administration compared to other progestin-only pills.…”

“…12 Produced by the fetal liver at 9 weeks' gestation, estetrol exhibits minimal impact on coagulation, liver function, triglycerides, and breast health. 13 Additional research may suggest its potential safety for individuals with relevant contraindications. At present, the listed contraindications on product labeling are the same as those for other combined oral contraceptives.…”

“…It works by preserving vaginal pH, which inhibits sperm motility while the gel acts as a barrier, preventing sperm from reaching the cervix. 13 Early FDA investigations revealed the product to exhibit 93% effectiveness under ideal conditions, while the AMPOWER phase 3 study demonstrated an 86.3% effectiveness rate with typical usage. 13 Because of this, it has been suggested that it could be a preferable contraceptive choice for individuals entering the late perimenopausal phase when the likelihood of pregnancy is diminished.…”

“…13 Early FDA investigations revealed the product to exhibit 93% effectiveness under ideal conditions, while the AMPOWER phase 3 study demonstrated an 86.3% effectiveness rate with typical usage. 13 Because of this, it has been suggested that it could be a preferable contraceptive choice for individuals entering the late perimenopausal phase when the likelihood of pregnancy is diminished. 12 It is an excellent choice for individuals who desire a nonhormonal method of birth control but have allergies that prevent them from using other types of barrier methods.…”

“…The utilization of intrauterine devices (IUDs) for contraception is steadily increasing among individuals across all reproductive age groups, now Table 3. Intrauterine devices 13,15…”