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Feature Article

An updated guide to contraception. Part 1: Short-acting methods

Kathleen McNamee, Caroline Harvey, Mary Stewart, Deborah Bateson
OPEN ACCESS

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© RICCARDO PICCININI/SHUTTERSTOCK MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY
© RICCARDO PICCININI/SHUTTERSTOCK MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY

Abstract

This first article in an updated three-part series on contraception provides a practical guide to the short-acting methods – combined hormonal contraceptives (combined oral contraceptives and the vaginal ring) and the progestogen-only pill. Subsequent articles will provide updates on othe contraceptive methods.

Key Points

  • Combined hormonal contraceptives (CHCs), which contain an oestrogen and a progestogen, are available as combined oral contraceptives (COCs) and the vaginal ring.
  • The advantages of CHCs include beneficial effects on acne, a decrease in menstrual pain and bleeding and the ability to manipulate menstrual cycles.
  • CHC use is associated with some serious risks, but the absolute risk is low for most women of reproductive age.
  • No increased risk of venous thromboembolism or arterial vascular disease has been associated with use of the progestogen-only pill (POP), although evidence is limited.
  • The option of using long-acting reversible contraceptives (intrauterine devices and subdermal implants), which require minimal ongoing user actions, should be discussed with women renewing CHC and POP prescriptions.

Contraception allows women, and couples, to determine if and when to have children. This updated series of three articles provides the latest evidence-based information on the different methods of contraception available in Australia. In this article, the short-acting methods – combined hormonal contraceptives (CHCs), which are available as combined oral contraceptives (COCs) and the vaginal ring, and progestogen-only pills (POPs) – are covered. The second article will discuss long-acting reversible contraceptives (the subdermal implant, intrauterine methods and the depot medroxyprogesterone acetate injection), and the last article will cover emergency contraception and barrier, permanent and fertility awareness methods. 

Most contraceptive methods are dependent on women rather than men taking the active role. With few male contraceptive methods available, further research and advocacy are required in this area. Although gendered language has been used throughout this series of articles, clinicians also need to be aware that transgender men may be at risk of unintended pregnancy.

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Choosing a contraceptive method

The role of the clinician is to ensure that patients are aware of all suitable methods of contraception to allow well-informed choices. Women presenting for a repeat COC prescription may be unaware of other options available to them. There are many useful resources, including fact sheets from family planning organisation websites, to help inform women of their options. 

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Contraceptive choice is determined by many factors, including cost, access, the presence of medical conditions, concurrent medications, relationship status and personal preferences and beliefs. Taking a thorough medical and social history is essential, with key points highlighted in Box 1

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The UK Medical Eligibility Criteria (MEC) system supports the safe provision of contraception and is a useful framework within which to consider contraindications to contraceptive pills and the vaginal ring (Table 1).1 Conditions affecting eligibility for the use of each method are classified in one of four categories. A MEC 1 condition is one for which no restrictions exist, whereas a MEC 4 condition represents an absolute contraindication. 

Pages

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© RICCARDO PICCININI/SHUTTERSTOCK MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY
© RICCARDO PICCININI/SHUTTERSTOCK MODELS USED FOR ILLUSTRATIVE PURPOSES ONLY
Dr McNamee is Medical Director of Family Planning Victoria; and Adjunct Senior Lecturer in the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Vic. Dr Harvey is a Sexual and Reproductive Health GP at the Institute for Urban Indigenous Health, Brisbane, Qld. Dr Stewart is a sexual health and sexual assault doctor at Royal North Shore Hospital, Sydney. Associate Professor Bateson is Medical Director of Family Planning NSW; and Clinical AssociateProfessor intheDisciplineofObstetrics, Gynaecology and Neonatology at The University of Sydney, Sydney, NSW.