Barrier MOA Advantage Disadvantage Other notes

Spermicide Cell wall OTC, inexpensive, 28% failure,

Sponge with Mechanical OTC, absorbs excess ~Allergic rxns ~Educate on correct
spermicide (OTC) barrier to fluid, lower risk of ~failure 12-24% placement
sperm, UTI compared to ~vaginal infections ~can insert up to 24
inactivation of diaphram, ~hard to get hours before sex and
sperm correct placement leave up to 30hours after
~Not with past vaginal
infections of s. aureus
Condoms Mechanical Inexpensive, STD 18% failure rate ~No Vaseline
barrier, most protection, male -Allergic reaction ~Female condom is more
have spermicide plays role -Maintaining costly and less available
erection
-Interruption
foreplay
Diaphragm Mechanical Inexpensive ($250 12% failure rate ~Caution with s. aureus
barrier, for fit and $100 for ~Must leave in 6 hx
inactivation of device) hours after ~Not for abnormal pelvic
sperm No systemic side ~Add spermicide anatomy
effects with successive ~Do not use before 6
intercourse week post-partum
~Possible ~Check fit after
discomfort gaining/losing weight
Increased risk of
UTIs
Cervical Cap Mechanical Can be left for 48 17-23% failure ~Caution with s. aureus
barrier, hours rate hx or abn paps
inactivation of Less risk of UTI Less availability ~Do not use before 6-
sperm More sexual Harder to fit, can’t week post-partum
sensitivity fit all women Avoid in period
Fits on cervix better Leave in 6 hours
after sex
Non-Barrier
Methods
Periodic Avoid fertile ~No cost/SE’s 24% failure rate Motivated couple
Abstinence/ days (5 days ~For those who Difficulty id’ing
Fertility awareness before oppose BBT (basal body
ovulation and 3 contraception temp) patterns
days after) ~Encourages Irregular periods
communication in Keep extensive
couples records
Combination pills Suppression of ~Safe for most Failure 1-9% CI:
(mono/bi/triphasic ovulation, women - Thromboembolic
) change cervical ~reversible Cost $30/MO events
-estrogen and PG mucus and ~reduction of - Liver disease
endometrium endometrial/ovarian Have to take pill - Over 35/smoker
cancer daily - Obese, DM
**have most ~PMS relief, - Migraine w/ aura
benefits endometriosis, No STD protection - Estrogen
fibrocystic breast dependent
disease, functional Systemic effects, tumor
cysts, PCOS, acne physiologic - CAD/vascular
changes Ex: seasonale/seasonique
- Extended
regimen that
reduces to only 4
periods/yr
- Higher incidence
of breakthrough
bleeding
Progestin Only Pills Suppression of ~used in bfing moms 1-9% failure rate CI:
ovulation (not ~has no estrogen, no ~breakthrough - Undiagnosed
quite as much), suppression of bleeding common DUB
change cervical lactation ~fewer non- - Liver disease,
mucus and ~safer in smokers contraceptive current cancer
endometrium benefits
~continuous
taking
Contraceptive Suppression of ~no daily pill 1-9% failure rate
Patch ovulation, ~4th week is patch ~$35/Mo, no
change cervical free, changes weekly generic
(Estrogen and PG) mucus and for 3 weeks ~less effective if
endometrium ~same benefits as >198 lbs (based on
combo pill serum estrogen)
~adhesion
problems
~systemic SE’s,
higher risk of clots
Vaginal Ring (Nuva Suppression of No daily pill 1-9% failure
Ring) ovulation, Plastic (not latex) $35/Mo
change cervical Same benefits as ~Placement,
(Estrogen and PG) mucus and OCP expulsion issues
endometrium (need to replace
~Take ring out w/in 3 hours)
in 4th week ~systemic SE’s
~underlying
vaginal infections
IUD Inhibition of ~Low maintenance- <1% failure rate Be extra careful when
 ~mirena (5 yrs, sperm migration only check string ~expensive initially placing on soft uterus
PG) fertilization or placement ($600-900) (postpartum, lactating
~Skyla (5 yrs, PG) ovum transport ~longterm ~discomfort women)
~paragard (10 yrs, ~progesterone IUDs placing ~uterine sound can be
copper device) improve menstrual ~amenorrhea- used to determine depth
symptoms irregular bleeding prior to insertion
~initial heavier
more painful
periods
~expulsion (rare)
~risk of infection
~
Subdermal implant Changes in ~long term (3 years) <1% failure rate ~inserted while on period
(Progesterone)- cervical mucosa, ~reversible upon ~very expensive ~check for drug
nexplanon suppression of removal ($1696 + $464) interactions
ovulation ~no estrogen SE’s ~freq spotting, SE’s: irreg bleeding, WG,
~decreased flow and amenorrhea HA’s, abdominal pain,
anemia ~may be slightly acne, mood swings
~can use with visible under skin
lactating women
Depo-Provera Changes in -injections every 3 1-6% failure rate -should establish clinic
cervical mucus& months -cost: $225 +$75 protocols
endometrium, -no daily pill -risk of osteopenia
(progesterone suppression of -no estrogenic side (esp in 1st 2 yrs)-
injection) ovulation effects need calcium
-irregular bleeding
that can lead to
amenorrhea
-SE’s: HA, WG,
nausea, dizziness
-no STD protection
-***possible delay
to fertility
Emergency 1 or more of: -Option for up to 95% Put patient on
Contraception -inhibits rape/incest effective appropriate method to
(Post-Coital) ovulation -available w/o -same CI and SE as avoid future occurrences
-interfere with prescription oral (nausea, HA,
fertilization or irreg bleeding) Plan B-Levonorgestrel
tubal transport -cost $35-50 (better tolerated and
-altered more effective)
endometrial
receptivity to
implantation
-regression of
corpus luteum
Sterilization- Disruption of Most effective short < 1% failure rate Tubal sterilization using
Female Tubal tubal patency of abstinence -reversibility can micro-coils placed 99.8%
Ligation -compliance not an be very difficult effective after 4 years
issue -requires surgery
-complications:
- hemorrhage,
adhesions, bowel
damage, uterine
perforation,
infection
Sterilization-Male Disruption of Most effective short < 1% failure rate ***patient education is
Vasectomy Vas Deferens of abstinence -reversibility can utmost importance
-done in drs office, be very difficult
cost $1884 -complications:
hemorrhage,
hematoma,
infection