11 - Contraception and fertility

Summary

Case: S.J. is a 42-year-old woman who has recently remarried four years after her divorce. She used condoms as a teenager, oral contraception in her twenties and mid thirties, and abstinence over the past four years. She is unsure whether she wants to restart hormonal contraception. In her latest job, she works at night, this makes it hard to remember regular contraception. She is menstruating regularly and so assumes she is still fertile; she does not want to become pregnant.

Introduction

The need for reliable, safe, and reversible contraception has become more evident, and the duration of their use has increased as many women opt to delay childbearing into the late third and fourth decades. Though the decision to delay childbearing results in greater satisfaction, reproductive health discussions must now include a frank and evidence-based presentation of the potential health risks, complications, and decreased fertility rates associated with delayed childbearing and advanced maternal age.

Contraception

Contraceptive methods can be classified into types – physical barriers and hormonal methods – or as folk methods, traditional methods, and contemporary methods (Table 11.1).

Individual decisions regarding contraceptive methods vary widely among women. Factors that may influence decision-making include age, attitudes and beliefs regarding family planning, and concerns over the use of exogenous hormones, most notably regarding cancer and thromboembolic disease. Failure rates vary by the method (Table 11.2).

Barrier devices

Tubal ligation

Since the advent of tubal sterilization in 1823, many techniques have been described.