Women's Health & Prenatal

Long-acting reversible contraceptives — the levonorgestrel and copper IUDs and the etonogestrel subdermal implant. They are >99% effective because they are independent of user adherence.

Tier 1 (<1/100/yr): IUDs, implant, sterilization. Tier 2 (6-9/100/yr): pills, patch, ring, DMPA. Tier 3 (>9/100/yr): condoms, diaphragm, withdrawal, fertility awareness.

The CDC US Medical Eligibility Criteria rate methods by condition: Category 1 = no restriction, 2 = advantages usually outweigh risks, 3 = risks usually outweigh advantages (generally avoid), 4 = unacceptable health risk (do not use).

Estrogen is contraindicated (MEC 3/4) with: smoker age >35 (>=15 cigarettes/day), migraine with aura at any age, history of VTE/known thrombophilia, current breast cancer, uncontrolled hypertension, <21 days postpartum, and active liver disease.

Estrogen further raises the already-elevated ischemic stroke risk in women with migraine with aura. Progestin-only methods (POP, implant, DMPA, LNG-IUD) are acceptable alternatives.