Contraception in Medically Complex Adolescents and Young Adults

Figures & data

Table 1 Contraceptive Failure Rates

Contraception Method	Recommended Frequency of Use	Perfect Use	Typical Use
Barrier methods	At every sexual encounter
Male condom		2%	13%
Female condom		5%	21%
Spermicide		16%	21%
Vaginal contraceptive gel		7%	14%
Combined hormonal and progestin only oral contraception	Every day at the same time	0.3%	7%
Transdermal contraceptive patch	Weekly	0.3%	7%
Vaginal ring	Monthly	0.3%	7%
Injectable depot medroxyprogesteroneacetate	Every 13–15 weeks	0.2%	4%
Subdermal implant	Up to 4 years	0.1%	0.1%
Levonorgesetrel-containing intrauterine device	3–8 years	0.1–0.3%	0.1–0.4%
Copper intrauterine device	10–12 years	0.6%	0.8%

Notes: Data from: https://www.guttmacher.org/fact-sheet/contraceptive-effectiveness-united-states; https://hcp-phexxi.com/efficacy_and_safety. Typical Use: Inconsistent or incorrect usage. Perfect use: Use method as prescribed and correctly.

Box 1 Contraindications to Use of Estrogen Containing Contraception

Severe hypertension (systolic ≥140 mmHg or diastolic ≥90 mmHg* or systolic ≥160 mmHg or diastolic ≥100 mmHg**) or vascular disease

Complicated valvular disease (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis)

Migraine headaches with aura

Specific Liver Diseases (cirrhosis, hepatocellular adenoma or malignant hepatoma)

Women aged ≥35 years who smoke ≥15 cigarettes per day

Venous thromboembolism History of thromboembolism not receiving anticoagulation History an acute embolic event

Breast cancer

Complicated solid organ transplant

Diabetic nephropathy/retinopathy/neuropathy

Notes: Data from Curtis KM, Tepper NK, Jatlaoui TC, et al. US Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep 2016; 65:1. Medical eligibility criteria for contraceptive use. Fifth Edition. World Health Organization. 2015 www.apps.who.int/iris/bitstream/handle/10665/181468/9789241549158_eng.pdf;jsessionid=0F5BCF5FB640060B05CD47F1AF197A2E?sequence=1. *per Centers for Disease Control and Prevention recommendations. **Per World Health Organization recommendations.

Table 2 Emergency Contraception

Method	Dose	Efficacy Window
Oral ulipristal acetate	30 mg	Within 120 hours
Oral levonorgestrel (LNG)	1.5 mg	Within 72 hours
Combined oral estrogen and LNG contraceptive pills	100 mcg of ethinyl estradiol and 0.5 mg of LNG*	Within 120 hours
LNG intrauterine device**	52 mg	Within 120 hours
Copper intrauterine device	380 mm^2	Within 120 hours***

Notes: *Repeat dosing in 12 hours is required. **While there is evidence to show LNG IUD an effective form of EC, this method is not universally recognized as EC and not included in WHO guidelines*** can be inserted beyond 5 days after condom less intercourse if not >5 days after ovulation.