Contraception for women: an evidence based overview

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b2895 (Published 7 August 2009)
Cite this as: BMJ 2009;339:b2895

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  1. Jean-Jacques Amy, editor in chief1,
  2. Vrijesh Tripathi, lecturer2
  1. 1European Journal of Contraception and Reproductive Health Care, Opalfeneweg 3, B-1740 Ternat, Belgium
  2. 2Faculty of Science and Agriculture, University of West Indies, St Augustine, Trinidad and Tobago, West Indies
  1. Correspondence to: J-J Amy, Florencestraat, 62, B-1050 Brussels, Belgium jeanjacques.amy{at}skynet.be

    Summary points

    • Combined oestrogen and progestogen contraceptives inhibit ovulation. Their biological effects and safety profiles are similar regardless of route of administration

    • Progestogen-only methods act by various mechanisms and can be used by women in whom oestrogens are contraindicated

    • Copper bearing intrauterine devices combine the highest efficacy with the lowest cost. The levonorgestrel releasing intrauterine system reduces menstrual blood loss

    • When used correctly, the lactational amenorrhoea method prevents conception in more than 98% of women during the first six months after childbirth

    • Levonorgestrel-only emergency contraceptive pills and copper bearing intrauterine devices are valuable methods of emergency contraception

    • Emergency contraceptive pills prevent pregnancy; they should be taken as soon as possible, and not later than 72 hours after unprotected intercourse

    Contraception allows parents to choose the number and spacing of children. Each year, family planning programmes prevent an estimated 187 million unintended pregnancies, including 60 million unplanned births and 105 million abortions, and avert an estimated 2.7 million infant deaths and 215 000 pregnancy related deaths.1

    The prevalence of contraceptive use differs across the world owing to differences in desired number of children, awareness, funding, and service delivery, with an overall prevalence of use worldwide of 63%. Female sterilisation and intrauterine devices account for nearly 40% in less developed regions, and pills, intrauterine devices, and condoms for the same proportion in more developed regions.2 This article reviews evidence based information on contraceptive methods currently available for women.

    Sources and selection criteria

    We prepared this review by searching Cochrane reviews, PubMed, and our personal archives of references.

    The family planning consultation

    Counselling

    Counselling is thought to enable clients to make contraceptive choices that best fit their values and needs; it should lead to greater satisfaction and more correct and longer use of contraception, particularly when partners are involved. However, a Cochrane review of randomised controlled trials that acknowledged heterogeneity between studies found …

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