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Contraception Selection, Effectiveness, and Adverse Effects: A Review
Stephanie Teal1, Alison Edelman2
1Department of OB/GYN, University Hospitals Medical Center and Case Western Reserve University, Cleveland, Ohio.
JAMA
|December 28, 2021
Summary
Choosing the right birth control involves balancing effectiveness and risks. Long-acting reversible contraceptives offer the highest effectiveness, while oral contraceptive pills remain popular but carry higher risks.
Area of Science:
- Reproductive Health
- Contraception
- Women's Health
Background:
- Approximately 87% of US women use contraception during their lifetime.
- Oral contraceptive pills are the most common reversible method (21.9% of users).
- Long-acting reversible contraceptives (LARCs) usage increased from 6% (2008) to 17.8% (2016).
Purpose of the Study:
- To review contraceptive methods, their effectiveness, risks, and benefits.
- To highlight the importance of patient-centered contraceptive selection.
Main Methods:
- Review of contraceptive effectiveness based on drug/device efficacy, fecundability, coital frequency, adherence, and continuation.
- Comparison of pregnancy rates and risks associated with different contraceptive categories.
- Analysis of non-contraceptive benefits and risks of hormonal contraceptives.
Main Results:
- Oral contraceptive pills have a 4%-7% annual pregnancy rate.
- LARCs (intrauterine devices, subdermal implants) have <1% annual failure rates.
- Estrogen-containing methods increase venous thrombosis risk; progestin-only and nonhormonal methods have lower risks.
Conclusions:
- LARCs offer the highest contraceptive effectiveness.
- Oral contraceptive pills are widely used but less effective and carry higher risks than LARCs.
- Optimal contraceptive choice requires shared decision-making between patient and clinician, considering individual values and preferences.
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