Contraception Options and Guidelines

Types of Contraception

1) Combined Oral Contraceptive Pill (COCP)
. Safe for women under 20 years old.
. Contraindicated in breastfeeding for the first 6 months postpartum.
. Contraindicated in smokers, those with a history of thromboembolism, obesity, migraines with aura, and controlled hypertension.

2) Progesterone-Only Pill (POP)
. Suitable for young women and breastfeeding mothers.
. Oral administration.

3) Intrauterine System (IUS)
Mirena® (Levonorgestrel)
. Not recommended for women under 20 years old.
. Can cause initial bleeding and spotting.
. Most users become amenorrheic after one year.
. Used for long-term contraception.

4) Progesterone-Only Injections
Depo-Provera (Medroxyprogesterone acetate)
. Administered every 3 months.
. Not recommended for women under 20 due to osteoporosis risk.
. Suitable for women with sickle cell disease or menorrhagia.
. Can cause initial bleeding and spotting.

5) Progesterone-Only Implants
Nexplanon® (Etonogestrel implant)
. Safe for women under 20.
. Long-term contraception method.

6) Emergency Contraception
Levon Elle Pill
. Effective within 72 hours (3 days) of unprotected sex.
Copper IUD or Ella One Pill
. Effective within 120 hours (5 days) of unprotected sex.

7) Barrier Methods
Condoms
. Reduce the risk of HPV infections and cervical cancer.

Which contraceptive method is suitable?

Depo-Provera and IUS Users
. If initial bleeding becomes problematic:
. COCP for 3 months.
. Mefenamic acid or Tranexamic acid for 5 days.

Postpartum Contraception
. No contraception required for the first 21 days.
. Breastfeeding women: COCP after 6 months.
. Non-breastfeeding women: COCP after 6 weeks.

Special Considerations
Learning Difficulties
. Avoid pills (COCP, POP) as patients may forget to take them.
Fibroids
. If not distorting the uterine cavity: IUS (Mirena) is preferred.
. If distorting the cavity: implants (e.g., Nexplanon).

Emergency Contraception
Levon Elle Pill
. Use within 72 hours (3 days) of unprotected sex.
Copper IUD or Ella One Pill
. Use within 120 hours (5 days) of unprotected sex.

Contraindications for COCP
. Smoking
. History of thromboembolism
. Obesity (BMI > 30 kg/m²)
. Postpartum (breastfeeding: contraindicated for 6 months; non-breastfeeding: contraindicated for 6 weeks)
. Migraine with aura
. Hypertension (even if well-controlled)