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The overall failure rate for the contraceptive patch has been reported to be only 0.88 pregnancies per 100 women-years, with a method failure rate of 0.7 pregnancies per 100 women-years. However, this form of contraception may be less effective in women weighing more than 90 kg (198 lb).19In a study20 comparing the contraceptive patch and OCPs, spotting occurred at a higher rate in the first two months of patch use. However, spotting rates for the two contraceptive methods were similar in subsequent cycles. A key finding in this study was that compliance was significantly greater with patch use than with OCP use. Although adverse Tiffany Bangles rates were similar with both contraceptive methods, application site reactions were unique to the patch, and breast discomfort was more common in the first two months of patch use. Finally, the study showed that patch adhesion appears to be reliable, with only 2.8 percent of the patches partially detaching and 1.8 percent completely detaching.

The FDA recently approved the use of an intrauterine system (Mirena) that releases 20 mcg of levonorgestrel per day and provides effective contraception for at least five years (Figure 2). This intrauterine system has been shown to be as effective as copper-containing intrauterine devices (IUDs).21 [SOR A, systematic review of randomized controlled trials (RCTs)] Pregnancy rates are comparable with those occurring with surgical sterilization.22

Although copper-containing IUDs can increase bleeding and dysmenorrhea, the levonorgestrel system actually Tiffany Cuff Links these symptoms.21 The typical bleeding profile with the new intrauterine system is irregular bleeding or spotting for the first six months of use, followed by very light menses, with 20 percent of women having amenorrhea at one year of use. The amenorrhea results from the local action of levonorgestrel, which creates an atrophie endometrium. Because estradiol levels are maintained, osteopenia is not associated with this contraceptive method.Only minimal side effects have been found with the Tiffany Bracelets system.23 As with copper-containing IUDs, there is a risk of expulsion and ectopic pregnancy. Side effects unique to the levonorgestrel system have been related to the hormonal component and include a slight increase in the rates of headaches and acne.21

Recent data indicate that copper-containing IUDs are associated with lower rates of pelvic inflammatory disease (PID) and infertility than was previously thought.24,25 Evidence suggests that the risk of PID is even lower with the levonorgestrel system.23 [Strength of recommendation: A,RCT]The new intrauterine system and the standard copper-containing IUD are inserted using different devices. Hence, attention to technique is important. The levonorgestrel system costs significantly more than the standard IUD. Note that the copper-containing IUD has been shown to be the most cost-effective method of birth control at two years.2

A brief overview of current contraceptive options is provided in Table 2.8,11,26,27 When counseling a patient about contraceptive methods, the family physician should be aware that the only effective contraceptive for any patient is the one that the patient is willing to use Tiffany Earrings and correctly. Ultimately, the patient is the one who must decide on the method of contraception; this decision often will be based on the patient's personal beliefs, preferences, and specific needs at the time. If needs change, a patient may want to switch to a different method of contraception. The physician's role is to educate the patient about the advantages and disadvantages of each contraceptive method that is medically appropriate for that patient and then allow the patient to choose the Tiffany Key Rings desirable method.

Many patients who use contraception have medical conditions; therefore, it is important to discuss the safety of various contraceptive methods, because some are contraindicated in certain circumstances. The World Health Organization27 has established medical eligibility criteria for contraceptive use. If a patient's first choice for contraception is contraindicated, the physician should help the patient select an appropriate alternative.



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