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CONTRACEPTION (Levonorgestrel IUD (52 mg, 20 mcg LNG/day. effective for 7…

- - - - IM injection, ovulation suppression, high dose. FSH not suppressed, LH surge blocked.
      - Failure rate: 3 pregnancies/100 women/year
      - Every 12 weeks and a grace period of two weeks
      - Effective, private, decreases risk of endometrial cancer, amenorrhea is common, slow return to fertility (can take up to a year), few contraindications
    - - Thickens cervical mucus, endometrial thinning, inhibits sperm
      - 3-7 years depending on device for length of use
      - Efficacy greater than 99%
      - Highly effective, improves heavy bleeding, dysmenorrhea, and endometriosis pain.
    - - Etonogestral, MoA suppresses ovulation via LH surge, thickening of cervical mucus, endometrial atrophy, low dose
      - Need to take a good medication history due to interaction effects
      - Failure rate: 0.05 pregnancies/100 women/year
      - Effect for at least 4 years but labeled for 3. Over triceps muscle in inner arm. Side effects include bleeding abnormalities.
    - - Failure rate: 9.6 pregnancies/100 women/year (slightly worse than combined pill)
      - Schedule is less forgiving
      - No withdrawal bleed, daily schedule, more unscheduled bleeding, avoids estrogen contraindications
  - - - Failure rate: 8 pregnancies/100 women/year
      - Ovulation inhibition, thickening of cervical mucus (which acts as a spermicide)
      - Side effects: unscheduled bleeding (more so in absence of estrogen), variable symptomatic side effects (nausea, headache, skin changes)
- - - - Failure rate: 27 pregnancies/100 women/year
    - - Failure rate: 29 pregnancies/100 women/year
      - Surfactant, destroys sperm cell membrane
      - Risk of disrupting vaginal epithelium. May increase STI transmission in high risk populations.
    - - Very specific criteria: exclusive breastfeeding, has not experience first postpartum menses, within six months of birth
      - Failure rate: 0.5-1.5 pregnancies/100 women/year
      - Suckling of neonate changes LH secretion
    - - Tubal sterilization
        
        2-3 incisions. Considered permanent.
        
        Tubal occlusion: clip, ring, cautery. Salpingectomy (tubal excision) decreased risk of ovarian cancer.
      - Vasectomy
        
        Small opening is made in skin of scrotal sac to deliver vas deferens
        
        Ligate, cauterize, or clip
        
        No scalpel or sutures required
        
        Failure rate: 0.15 pregnancies/100 women/year
        
        Sperm within the vas can survive for 2-3 months. Wait this time or 20-25 ejaculates (whichever is longer). Considered permanent, although reversal can be achieved in 40-75% of cases.
    - - Primarily functions as a spermicide due to foreign body reaction of uterus
      - Releases copper ions and salts: 380 mm2 of copper surface area
        
        Inflammatory response: endometrial production of cytotoxins
        
        Alterations in cervical mucus and endometrial secretions
        
        Biochemical and morphologic impact on endometrium
      - Very few sperm if any reach the ovum in the fallopian tube
      - Failure rate: 0.5 pregnancies/100 women/year
      - Risk of expulsion, perforation, malposition, infection (all very low). Contraindicated with purulent cervicitis.
  - - - Polyurethane - can be used with latex allergy
      - More expensive than male condom
      - Protects against STIs
      - Failure rate: 21 pregnancies/100 women/year
    - - Failure rate: 18 pregnancies/100 women/year
      - No prescription
      - Cheap
      - Can be used with other methods
      - Protects against STIs