Evidence-Based Contraception: Common Questions and Answers.

Area of Science:

• Reproductive Health
• Contraception
• Primary Care Medicine

Background:

• Primary care clinicians play a vital role in preventing unintended pregnancies.
• Recent advancements in contraceptive methods offer improved efficacy and extended use options.
• Patient-centered care, considering medical comorbidities and individual circumstances, is crucial for effective contraception counseling.

Purpose of the Study:

• To review recent evidence on various contraceptive methods.
• To highlight the most effective options for emergency contraception.
• To discuss extended use recommendations and specific patient populations.

Main Methods:

• Review of current scientific literature and clinical guidelines on contraception.
• Analysis of effectiveness, side effects, and contraindications for different contraceptive methods.
• Consideration of patient-specific factors, including medical history, body mass index, and gender identity.

Main Results:

• Copper intrauterine devices and levonorgestrel-releasing intrauterine systems are highly effective for emergency contraception and long-term use.
• Ulipristal is the most effective oral emergency contraceptive, while oral levonorgestrel is less effective, especially in patients with higher BMI or after 72 hours.
• Combined oral contraceptives should be avoided in patients with migraine with aura due to increased stroke risk.

Conclusions:

• Primary care settings are ideal for discussing and implementing effective contraception strategies.
• Shared decision-making is essential for selecting appropriate long-acting reversible contraceptives (LARCs) and managing extended use.
• A full range of contraceptive options, including those suitable for transgender and gender-diverse patients, should be offered.