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Contraception Selection, Effectiveness, and Adverse EffectsA Review

Educational Objective
To understand the benefits and risks of contraceptive methods.
1 Credit CME
Abstract

Importance  Many women spend a substantial proportion of their lives preventing or planning for pregnancy, and approximately 87% of US women use contraception during their lifetime.

Observations  Contraceptive effectiveness is determined by a combination of drug or device efficacy, individual fecundability, coital frequency, and user adherence and continuation. In the US, oral contraceptive pills are the most commonly used reversible method of contraception and comprise 21.9% of all contraception in current use. Pregnancy rates of women using oral contraceptives are 4% to 7% per year. Use of long-acting methods, such as intrauterine devices and subdermal implants, has increased substantially, from 6% of all contraceptive users in 2008 to 17.8% in 2016; these methods have failure rates of less than 1% per year. Estrogen-containing methods, such as combined oral contraceptive pills, increase the risk of venous thrombosis from 2 to 10 venous thrombotic events per 10 000 women-years to 7 to 10 venous thrombotic events per 10 000 women-years, whereas progestin-only and nonhormonal methods, such as implants and condoms, are associated with rare serious risks. Hormonal contraceptives can improve medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder. Optimal contraceptive selection requires patient and clinician discussion of the patient’s tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences.

Conclusions and Relevance  Oral contraceptive pills are the most commonly used reversible contraceptives, intrauterine devices and subdermal implants have the highest effectiveness, and progestin-only and nonhormonal methods have the lowest risks. Optimal contraceptive selection incorporates patient values and preferences.

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Article Information

Corresponding Author: Stephanie Teal, MD, MPH, Department of OB/GYN, University Hospitals Medical Center and Case Western Reserve University, 11100 Euclid Ave, MAC-5304 Cleveland, OH 44106 (Stephanie.Teal@uhhospitals.org).

Accepted for Publication: November 10, 2021.

Author Contributions: Drs Teal and Edelman had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Both authors.

Critical revision of the manuscript for important intellectual content: Edelman.

Administrative, technical, or material support: Both authors.

Supervision: Both authors.

Conflict of Interest Disclosures: Dr Teal reported receiving grants from Merck & Co, Bayer Healthcare, Sebela, and Medicines360, and personal fees from Merck & Co and Bayer Healthcare outside the submitted work. Dr Edelman reported receiving grants from Merck, research funds from HRA Pharma, and royalties from UpToDate outside the submitted work.

References
1.
Daniels  K , Mosher  WD .  Contraceptive methods women have ever used: United States, 1982-2010.   Natl Health Stat Report. 2013;(62):1-15.PubMedGoogle Scholar
2.
Kavanaugh  ML , Pliskin  E .  Use of contraception among reproductive-aged women in the United States, 2014 and 2016.   F S Rep. 2020;1(2):83-93. doi:10.1016/j.xfre.2020.06.006 PubMedGoogle Scholar
3.
Centers for Disease Control and Prevention. National Ambulatory Medical Care survey: 2016 national summary tables. Accessed November 2, 2020. https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2016_namcs_web_tables.pdf
4.
National Center for Health Statistics, Centers for Disease Control and Prevention. Key statistics from the National Survey of Family Growth—S listing. Accessed September 17, 2021. https://www.cdc.gov/nchs/nsfg/key_statistics/s.htm
5.
Geist  C , Aiken  AR , Sanders  JN ,  et al.  Beyond intent: exploring the association of contraceptive choice with questions about Pregnancy Attitudes, Timing and How important is pregnancy prevention (PATH) questions.   Contraception. 2019;99(1):22-26. doi:10.1016/j.contraception.2018.08.014 PubMedGoogle ScholarCrossref
6.
Bellanca  HK , Hunter  MS .  One Key Question: preventive reproductive health is part of high quality primary care.   Contraception. 2013;88(1):3-6. doi:10.1016/j.contraception.2013.05.003 PubMedGoogle ScholarCrossref
7.
Endrikat  J , Gerlinger  C , Richard  S , Rosenbaum  P , Düsterberg  B .  Ovulation inhibition doses of progestins: a systematic review of the available literature and of marketed preparations worldwide.   Contraception. 2011;84(6):549-557. doi:10.1016/j.contraception.2011.04.009 PubMedGoogle ScholarCrossref
8.
Dericks-Tan  JS , Koch  P , Taubert  HD .  Synthesis and release of gonadotropins: effect of an oral contraceptive.   Obstet Gynecol. 1983;62(6):687-690.PubMedGoogle Scholar
9.
Critchley  HO , Wang  H , Jones  RL ,  et al.  Morphological and functional features of endometrial decidualization following long-term intrauterine levonorgestrel delivery.   Hum Reprod. 1998;13(5):1218-1224. doi:10.1093/humrep/13.5.1218 PubMedGoogle ScholarCrossref
10.
Mahmood  T , Saridogan  E , Smutna  S , Habib  AM , Djahanbakhch  O .  The effect of ovarian steroids on epithelial ciliary beat frequency in the human fallopian tube.   Hum Reprod. 1998;13(11):2991-2994. doi:10.1093/humrep/13.11.2991 PubMedGoogle ScholarCrossref
11.
Kesserü  E , Camacho-Ortega  P , Laudahn  G , Schopflin  G .  In vitro action of progestogens on sperm migration in human cervical mucus.   Fertil Steril. 1975;26(1):57-61.PubMedGoogle ScholarCrossref
12.
Sundaram  A , Vaughan  B , Kost  K ,  et al.  Contraceptive failure in the United States: estimates from the 2006-2010 National Survey of Family Growth.   Perspect Sex Reprod Health. 2017;49(1):7-16. doi:10.1363/psrh.12017 PubMedGoogle ScholarCrossref
13.
Winner  B , Peipert  JF , Zhao  Q ,  et al.  Effectiveness of long-acting reversible contraception.   N Engl J Med. 2012;366(21):1998-2007. doi:10.1056/NEJMoa1110855 PubMedGoogle ScholarCrossref
14.
Duijkers  IJM , Heger-Mahn  D , Drouin  D , Colli  E , Skouby  S .  Maintenance of ovulation inhibition with a new progestogen-only pill containing drospirenone after scheduled 24-h delays in pill intake.   Contraception. 2016;93(4):303-309. doi:10.1016/j.contraception.2015.12.007 PubMedGoogle ScholarCrossref
15.
Grimes  DA , Lopez  LM , O’Brien  PA , Raymond  EG .  Progestin-only pills for contraception.   Cochrane Database Syst Rev. 2013;(11):CD007541. doi:10.1002/14651858.CD007541.pub3PubMedGoogle Scholar
16.
Hubacher  D , Lopez  L , Steiner  MJ , Dorflinger  L .  Menstrual pattern changes from levonorgestrel subdermal implants and DMPA: systematic review and evidence-based comparisons.   Contraception. 2009;80(2):113-118. doi:10.1016/j.contraception.2009.02.008 PubMedGoogle ScholarCrossref
17.
Gardner  JM , Mishell  DR  Jr .  Analysis of bleeding patterns and resumption of fertility following discontinuation of a long acting injectable contraceptive.   Fertil Steril. 1970;21(4):286-291. doi:10.1016/S0015-0282(16)37443-X PubMedGoogle ScholarCrossref
18.
Contraceptive Technology. Table 26-1: percentage of women experiencing an unintended pregnancy during the first year of typical use and the first year of perfect use of contraception and the percentage continuing use at the end of the first year: United States. 2018. Accessed November 2, 2020. http://www.contraceptivetechnology.org/wp-content/uploads/2013/09/Contraceptive-Failure-Rates.pdf
19.
Schreiber  CA , Teal  SB , Blumenthal  PD , Keder  LM , Olariu  AI , Creinin  MD .  Bleeding patterns for the Liletta levonorgestrel 52 mg intrauterine system.   Eur J Contracept Reprod Health Care. 2018;23(2):116-120. doi:10.1080/13625187.2018.1449825PubMedGoogle ScholarCrossref
20.
Ali  M , Akin  A , Bahamondes  L ,  et al; WHO Study Group on Subdermal Contraceptive Implants for Women.  Extended use up to 5 years of the etonogestrel-releasing subdermal contraceptive implant: comparison to levonorgestrel-releasing subdermal implant.   Hum Reprod. 2016;31(11):2491-2498. doi:10.1093/humrep/dew222 PubMedGoogle ScholarCrossref
21.
Mansour  D , Korver  T , Marintcheva-Petrova  M , Fraser  IS .  The effects of Implanon on menstrual bleeding patterns.   Eur J Contracept Reprod Health Care. 2008;13(suppl 1):13-28. doi:10.1080/13625180801959931 PubMedGoogle ScholarCrossref
22.
Belsey  EM .  Vaginal bleeding patterns among women using one natural and eight hormonal methods of contraception.   Contraception. 1988;38(2):181-206. doi:10.1016/0010-7824(88)90038-8 PubMedGoogle ScholarCrossref
23.
Vessey  MP , Doll  R .  Investigation of relation between use of oral contraceptives and thromboembolic disease.   Br Med J. 1968;2(5599):199-205. doi:10.1136/bmj.2.5599.199 PubMedGoogle ScholarCrossref
24.
Heinemann  LAJ , Dinger  JC .  Range of published estimates of venous thromboembolism incidence in young women.   Contraception. 2007;75(5):328-336. doi:10.1016/j.contraception.2006.12.018 PubMedGoogle ScholarCrossref
25.
Petitti  DB , Sidney  S , Bernstein  A , Wolf  S , Quesenberry  C , Ziel  HK .  Stroke in users of low-dose oral contraceptives.   N Engl J Med. 1996;335(1):8-15. doi:10.1056/NEJM199607043350102PubMedGoogle ScholarCrossref
26.
ESHRE Capri Workshop Group.  Venous thromboembolism in women: a specific reproductive health risk.   Hum Reprod Update. 2013;19(5):471-482. doi:10.1093/humupd/dmt028 PubMedGoogle ScholarCrossref
27.
Dinger  JC , Heinemann  LAJ , Kühl-Habich  D .  The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance Study on oral contraceptives based on 142,475 women-years of observation.   Contraception. 2007;75(5):344-354. doi:10.1016/j.contraception.2006.12.019 PubMedGoogle ScholarCrossref
28.
Dinger  JC , Bardenheuer  K , Assmann  A .  International Active Surveillance Study of Women Taking Oral Contraceptives (INAS-OC Study).   BMC Med Res Methodol. 2009;9:77. doi:10.1186/1471-2288-9-77 PubMedGoogle ScholarCrossref
29.
Jackson  E , Curtis  KM , Gaffield  ME .  Risk of venous thromboembolism during the postpartum period: a systematic review.   Obstet Gynecol. 2011;117(3):691-703. doi:10.1097/AOG.0b013e31820ce2db PubMedGoogle ScholarCrossref
30.
Tepper  NK , Whiteman  MK , Marchbanks  PA , James  AH , Curtis  KM .  Progestin-only contraception and thromboembolism: a systematic review.   Contraception. 2016;94(6):678-700. doi:10.1016/j.contraception.2016.04.014 PubMedGoogle ScholarCrossref
31.
Mantha  S , Karp  R , Raghavan  V , Terrin  N , Bauer  KA , Zwicker  JI .  Assessing the risk of venous thromboembolic events in women taking progestin-only contraception: a meta-analysis.   BMJ. 2012;345:e4944. doi:10.1136/bmj.e4944 PubMedGoogle Scholar
32.
Centers for Disease Control and Prevention. United States Medical Eligibility Criteria for Contraceptive Use, 2016 (US MEC). Accessed October 29, 2020. https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/summary.html
33.
Grimes  DA , Gallo  MF , Grigorieva  V , Nanda  K , Schulz  KF .  Fertility awareness-based methods for contraception: systematic review of randomized controlled trials.   Contraception. 2005;72(2):85-90. doi:10.1016/j.contraception.2005.03.010 PubMedGoogle ScholarCrossref
34.
Trussell  J , Grummer-Strawn  L .  Further analysis of contraceptive failure of the ovulation method.   Am J Obstet Gynecol. 1991;165(6, pt 2):2054-2059. doi:10.1016/S0002-9378(11)90581-X PubMedGoogle ScholarCrossref
35.
Ortiz  ME , Croxatto  HB .  Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action.   Contraception. 2007;75(6)(suppl):S16-S30. doi:10.1016/j.contraception.2007.01.020 PubMedGoogle ScholarCrossref
36.
Sivin  I , el Mahgoub  S , McCarthy  T ,  et al.  Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380Ag intrauterine devices: a five-year randomized study.   Contraception. 1990;42(4):361-378. doi:10.1016/0010-7824(90)90046-X PubMedGoogle ScholarCrossref
37.
Hubacher  D , Lara-Ricalde  R , Taylor  DJ , Guerra-Infante  F , Guzmán-Rodríguez  R .  Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women.   N Engl J Med. 2001;345(8):561-567. doi:10.1056/NEJMoa010438 PubMedGoogle ScholarCrossref
38.
Grentzer  JM , Peipert  JF , Zhao  Q , McNicholas  C , Secura  GM , Madden  T .  Risk-based screening for Chlamydia trachomatis and Neisseria gonorrhoeae prior to intrauterine device insertion.   Contraception. 2015;92(4):313-318. doi:10.1016/j.contraception.2015.06.012 PubMedGoogle ScholarCrossref
39.
Sufrin  CB , Postlethwaite  D , Armstrong  MA , Merchant  M , Wendt  JM , Steinauer  JE .  Neisseria gonorrhea and Chlamydia trachomatis screening at intrauterine device insertion and pelvic inflammatory disease.   Obstet Gynecol. 2012;120(6):1314-1321. doi:10.1097/AOG.0b013e318273364c PubMedGoogle ScholarCrossref
40.
Turok  DK , Eisenberg  DL , Teal  SB , Keder  LM , Creinin  MD .  A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement.   Am J Obstet Gynecol. 2016;215(5):599.e1-599.e6. doi:10.1016/j.ajog.2016.05.017 PubMedGoogle ScholarCrossref
41.
Mohllajee  AP , Curtis  KM , Peterson  HB .  Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? a systematic review.   Contraception. 2006;73(2):145-153. doi:10.1016/j.contraception.2005.08.007 PubMedGoogle ScholarCrossref
42.
Centers for Disease Control and Prevention. US Selected Practice Recommendations for Contraceptive Use (US SPR). Accessed October 29, 2020. https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/summary.html
43.
Turok  DK , Gero  A , Simmons  RG ,  et al.  Levonorgestrel vs copper intrauterine devices for emergency contraception.   N Engl J Med. 2021;384(4):335-344. doi:10.1056/NEJMoa2022141 PubMedGoogle ScholarCrossref
44.
Turok  DK , Sanders  JN , Thompson  IS , Royer  PA , Eggebroten  J , Gawron  LM .  Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study.   Contraception. 2016;93(6):526-532. doi:10.1016/j.contraception.2016.01.009 PubMedGoogle ScholarCrossref
45.
von Hertzen  H , Piaggio  G , Ding  J ,  et al; WHO Research Group on Post-ovulatory Methods of Fertility Regulation.  Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial.   Lancet. 2002;360(9348):1803-1810. doi:10.1016/S0140-6736(02)11767-3 PubMedGoogle ScholarCrossref
46.
Glasier  AF , Cameron  ST , Fine  PM ,  et al.  Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis.   Lancet. 2010;375(9714):555-562. doi:10.1016/S0140-6736(10)60101-8 PubMedGoogle ScholarCrossref
47.
Brache  V , Cochon  L , Deniaud  M , Croxatto  HB .  Ulipristal acetate prevents ovulation more effectively than levonorgestrel: analysis of pooled data from three randomized trials of emergency contraception regimens.   Contraception. 2013;88(5):611-618. doi:10.1016/j.contraception.2013.05.010 PubMedGoogle ScholarCrossref
48.
Polis  CB , Schaffer  K , Blanchard  K , Glasier  A , Harper  CC , Grimes  DA .  Advance provision of emergency contraception for pregnancy prevention (full review).   Cochrane Database Syst Rev. 2007;(2):CD005497. doi:10.1002/14651858.CD005497.pub2PubMedGoogle Scholar
49.
Glasier  A , Cameron  ST , Blithe  D ,  et al.  Can we identify women at risk of pregnancy despite using emergency contraception? data from randomized trials of ulipristal acetate and levonorgestrel.   Obstet Gynecol Surv. 2013;68(3):208–210. doi:10.1097/OGX.0b013e318285bc06Google ScholarCrossref
50.
Raymond  EG , Halpern  V , Lopez  LM .  Pericoital oral contraception with levonorgestrel: a systematic review.   Obstet Gynecol. 2011;117(3):673-681. doi:10.1097/AOG.0b013e318209dc25 PubMedGoogle ScholarCrossref
51.
Stanczyk  FZ .  All progestins are not created equal.   Steroids. 2003;68(10-13):879-890. doi:10.1016/j.steroids.2003.08.003 PubMedGoogle ScholarCrossref
52.
Tsuchiya  Y , Nakajima  M , Yokoi  T .  Cytochrome P450-mediated metabolism of estrogens and its regulation in human.   Cancer Lett. 2005;227(2):115-124. doi:10.1016/j.canlet.2004.10.007 PubMedGoogle ScholarCrossref
53.
Food and Drug Administration. Clinical drug interaction studies: Cytochrome P450 enzyme- and transporter-mediated drug interactions guidance for industry. Published January 2020. Accessed June 29, 2021. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/clinical-drug-interaction-studies-cytochrome-p450-enzyme-and-transporter-mediated-drug-interactions
54.
Nanda  K , Stuart  GS , Robinson  J , Gray  AL , Tepper  NK , Gaffield  ME .  Drug interactions between hormonal contraceptives and antiretrovirals.   AIDS. 2017;31(7):917-952. doi:10.1097/QAD.0000000000001392 PubMedGoogle ScholarCrossref
55.
Gaffield  ME , Culwell  KR , Lee  CR .  The use of hormonal contraception among women taking anticonvulsant therapy.   Contraception. 2011;83(1):16-29. doi:10.1016/j.contraception.2010.06.013 PubMedGoogle ScholarCrossref
56.
Simmons  KB , Haddad  LB , Nanda  K , Curtis  KM .  Drug interactions between non-rifamycin antibiotics and hormonal contraception: a systematic review.   Am J Obstet Gynecol. 2018;218(1):88-97.e14. doi:10.1016/j.ajog.2017.07.003 PubMedGoogle ScholarCrossref
57.
Simmons  KB , Haddad  LB , Nanda  K , Curtis  KM .  Drug interactions between rifamycin antibiotics and hormonal contraception: a systematic review.   BJOG. 2018;125(7):804-811. doi:10.1111/1471-0528.15027 PubMedGoogle ScholarCrossref
58.
Christensen  J , Petrenaite  V , Atterman  J ,  et al.  Oral contraceptives induce lamotrigine metabolism: evidence from a double-blind, placebo-controlled trial.   Epilepsia. 2007;48(3):484-489. doi:10.1111/j.1528-1167.2007.00997.x PubMedGoogle ScholarCrossref
59.
Westhoff  C , Britton  JA , Gammon  MD , Wright  T , Kelsey  JL .  Oral contraceptive and benign ovarian tumors.   Am J Epidemiol. 2000;152(3):242-246. doi:10.1093/aje/152.3.242 PubMedGoogle ScholarCrossref
60.
Vessey  M , Metcalfe  A , Wells  C , McPherson  K , Westhoff  C , Yeates  D .  Ovarian neoplasms, functional ovarian cysts, and oral contraceptives.   Br Med J (Clin Res Ed). 1987;294(6586):1518-1520. doi:10.1136/bmj.294.6586.1518 PubMedGoogle ScholarCrossref
61.
Edelman  A , Micks  E , Gallo  MF , Jensen  JT , Grimes  DA .  Continuous or extended cycle vs cyclic use of combined hormonal contraceptives for contraception.   Cochrane Database Syst Rev. 2014;(7):CD004695. doi:10.1002/14651858.CD004695.pub3 PubMedGoogle Scholar
62.
Arowojolu  AO , Gallo  MF , Lopez  LM , Grimes  DA , Garner  SE .  Combined oral contraceptive pills for treatment of acne.   Cochrane Database Syst Rev. 2012;(6):CD004425. doi:10.1002/14651858.CD004425.pub5PubMedGoogle Scholar
63.
van Zuuren  EJ , Fedorowicz  Z .  Interventions for hirsutism excluding laser and photoepilation therapy alone: abridged Cochrane systematic review including GRADE assessments.   Br J Dermatol. 2016;175(1):45-61. doi:10.1111/bjd.14486 PubMedGoogle ScholarCrossref
64.
Hurskainen  R , Teperi  J , Aalto  A-M ,  et al.  Levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of essential menorrhagia: predictors of outcome.   Acta Obstet Gynecol Scand. 2004;83(4):401-403. doi:10.1111/j.0001-6349.2004.00440.x PubMedGoogle ScholarCrossref
65.
Istre  O , Trolle  B .  Treatment of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection.   Fertil Steril. 2001;76(2):304-309. doi:10.1016/S0015-0282(01)01909-4 PubMedGoogle ScholarCrossref
66.
Wong  CL , Farquhar  C , Roberts  H , Proctor  M .  Oral contraceptive pill for primary dysmenorrhoea.   Cochrane Database Syst Rev. Published July 8, 2009. doi:10.1002/14651858.CD002120.pub2Google Scholar
67.
Lowe  RF , Prata  N .  Hemoglobin and serum ferritin levels in women using copper-releasing or levonorgestrel-releasing intrauterine devices: a systematic review.   Contraception. 2013;87(4):486-496. doi:10.1016/j.contraception.2012.09.025 PubMedGoogle ScholarCrossref
68.
Lethaby  A , Wise  MR , Weterings  MA , Bofill Rodriguez  M , Brown  J .  Combined hormonal contraceptives for heavy menstrual bleeding.   Cochrane Database Syst Rev. 2019;2:CD000154. doi:10.1002/14651858.CD000154.pub3PubMedGoogle Scholar
69.
Reid  PC , Virtanen-Kari  S .  Randomised comparative trial of the levonorgestrel intrauterine system and mefenamic acid for the treatment of idiopathic menorrhagia: a multiple analysis using total menstrual fluid loss, menstrual blood loss and pictorial blood loss assessment charts.   BJOG. 2005;112(8):1121-1125. doi:10.1111/j.1471-0528.2005.00642.x PubMedGoogle ScholarCrossref
70.
Matteson  KA , Rahn  DD , Wheeler  TL  II ,  et al; Society of Gynecologic Surgeons Systematic Review Group.  Nonsurgical management of heavy menstrual bleeding: a systematic review.   Obstet Gynecol. 2013;121(3):632-643. doi:10.1097/AOG.0b013e3182839e0e PubMedGoogle ScholarCrossref
71.
Soysal  S , Soysal  ME .  The efficacy of levonorgestrel-releasing intrauterine device in selected cases of myoma-related menorrhagia: a prospective controlled trial.   Gynecol Obstet Invest. 2005;59(1):29-35. doi:10.1159/000080932 PubMedGoogle ScholarCrossref
72.
Suhonen  S , Haukkamaa  M , Jakobsson  T , Rauramo  I .  Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: a comparative study.   Contraception. 2004;69(5):407-412. doi:10.1016/j.contraception.2003.11.008 PubMedGoogle ScholarCrossref
73.
Abou-Setta  AM , Houston  B , Al-Inany  HG , Farquhar  C .  Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery.   Cochrane Database Syst Rev. 2013;(1):CD005072. doi:10.1002/14651858.CD005072.pub3 PubMedGoogle Scholar
74.
Fedele  L , Bianchi  S , Raffaelli  R , Portuese  A , Dorta  M .  Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device.   Fertil Steril. 1997;68(3):426-429. doi:10.1016/S0015-0282(97)00245-8 PubMedGoogle ScholarCrossref
75.
Toivonen  J , Luukkainen  T , Allonen  H .  Protective effect of intrauterine release of levonorgestrel on pelvic infection: three years’ comparative experience of levonorgestrel- and copper-releasing intrauterine devices.   Obstet Gynecol. 1991;77(2):261-264. doi:10.1097/00006250-199102000-00019 PubMedGoogle ScholarCrossref
76.
Stanback  J , Nakintu  N , Qureshi  Z , Nasution  M .  Does assessment of signs and symptoms add to the predictive value of an algorithm to rule out pregnancy?   J Fam Plann Reprod Health Care. 2006;32(1):27-29. doi:10.1783/147118906775275370 PubMedGoogle ScholarCrossref
77.
Stanback  J , Nanda  K , Ramirez  Y , Rountree  W , Cameron  SB .  Validation of a job aid to rule out pregnancy among family planning clients in Nicaragua.   Rev Panam Salud Publica. 2008;23(2):116-118. doi:10.1590/S1020-49892008000200007 PubMedGoogle ScholarCrossref
78.
Stanback  J , Qureshi  Z , Sekadde-Kigondu  C , Gonzalez  B , Nutley  T .  Checklist for ruling out pregnancy among family-planning clients in primary care.   Lancet. 1999;354(9178):566. doi:10.1016/S0140-6736(99)01578-0 PubMedGoogle ScholarCrossref
79.
Wilcox  AJ , Baird  DD , Dunson  D , McChesney  R , Weinberg  CR .  Natural limits of pregnancy testing in relation to the expected menstrual period.   JAMA. 2001;286(14):1759-1761. doi:10.1001/jama.286.14.1759 PubMedGoogle ScholarCrossref
80.
Steier  JA , Bergsjø  P , Myking  OL .  Human chorionic gonadotropin in maternal plasma after induced abortion, spontaneous abortion, and removed ectopic pregnancy.   Obstet Gynecol. 1984;64(3):391-394.PubMedGoogle Scholar
81.
Barnhart  K , Sammel  MD , Chung  K , Zhou  L , Hummel  AC , Guo  W .  Decline of serum human chorionic gonadotropin and spontaneous complete abortion: defining the normal curve.   Obstet Gynecol. 2004;104(5, pt 1):975-981. doi:10.1097/01.AOG.0000142712.80407.fd PubMedGoogle ScholarCrossref
82.
Westhoff  C , Kerns  J , Morroni  C , Cushman  LF , Tiezzi  L , Murphy  PA .  Quick Start: novel oral contraceptive initiation method.   Contraception. 2002;66(3):141-145. doi:10.1016/S0010-7824(02)00351-7 PubMedGoogle ScholarCrossref
83.
Westhoff  C , Heartwell  S , Edwards  S ,  et al.  Initiation of oral contraceptives using a quick start compared with a conventional start: a randomized controlled trial.   Obstet Gynecol. 2007;109(6):1270-1276. doi:10.1097/01.AOG.0000264550.41242.f2 PubMedGoogle ScholarCrossref
84.
Schafer  JE , Osborne  LM , Davis  AR , Westhoff  C .  Acceptability and satisfaction using Quick Start with the contraceptive vaginal ring versus an oral contraceptive.   Contraception. 2006;73(5):488-492. doi:10.1016/j.contraception.2005.11.003 PubMedGoogle ScholarCrossref
85.
Richards  M , Teal  SB , Sheeder  J .  Risk of luteal phase pregnancy with any-cycle-day initiation of subdermal contraceptive implants.   Contraception. 2017;95(4):364-370. doi:10.1016/j.contraception.2017.01.010 PubMedGoogle ScholarCrossref
86.
Bracken  MB , Holford  TR , White  C , Kelsey  JL .  Role of oral contraception in congenital malformations of offspring.   Int J Epidemiol. 1978;7(4):309-317. doi:10.1093/ije/7.4.309 PubMedGoogle ScholarCrossref
87.
Edelman  AB , Koontz  SL , Nichols  MD , Jensen  JT .  Continuous oral contraceptives: are bleeding patterns dependent on the hormones given?   Obstet Gynecol. 2006;107(3):657-665. doi:10.1097/01.AOG.0000199950.64545.16 PubMedGoogle ScholarCrossref
88.
Gallo  MF , Nanda  K , Grimes  DA , Lopez  LM , Schulz  KF .  20 µg versus >20 µg estrogen combined oral contraceptives for contraception.   Cochrane Database Syst Rev. 2011;(1):CD003989. doi:10.1002/14651858.CD003989.pub4 PubMedGoogle Scholar
89.
Schindler  AE , Campagnoli  C , Druckmann  R ,  et al.  Classification and pharmacology of progestins.   Maturitas. 2003;46(suppl 1):S7-S16. doi:10.1016/j.maturitas.2003.09.014 PubMedGoogle ScholarCrossref
90.
Creinin  MD , Jensen  JT .  Oral contraceptive generations: time to stop using a marketing myth to define nomenclature.   Contraception. 2020;102(3):143-144. doi:10.1016/j.contraception.2020.05.017 PubMedGoogle ScholarCrossref
91.
Edelman  A , Lew  R , Cwiak  C , Nichols  M , Jensen  J .  Acceptability of contraceptive-induced amenorrhea in a racially diverse group of US women.   Contraception. 2007;75(6):450-453. doi:10.1016/j.contraception.2007.02.005 PubMedGoogle ScholarCrossref
92.
Sulak  PJ , Scow  RD , Preece  C , Riggs  MW , Kuehl  TJ .  Hormone withdrawal symptoms in oral contraceptive users.   Obstet Gynecol. 2000;95(2):261-266.PubMedGoogle Scholar
93.
Ruchhoft  EA , Elkind-Hirsch  KE , Malinak  R .  Pituitary function is altered during the same cycle in women with polycystic ovary syndrome treated with continuous or cyclic oral contraceptives or a gonadotropin-releasing hormone agonist.   Fertil Steril. 1996;66(1):54-60. doi:10.1016/S0015-0282(16)58387-3 PubMedGoogle ScholarCrossref
94.
Birtch  RL , Olatunbosun  OA , Pierson  RA .  Ovarian follicular dynamics during conventional vs continuous oral contraceptive use.   Contraception. 2006;73(3):235-243. doi:10.1016/j.contraception.2005.09.009 PubMedGoogle ScholarCrossref
95.
Edelman  AB , Cherala  G , Munar  MY , McInnis  M , Stanczyk  FZ , Jensen  JT .  Correcting oral contraceptive pharmacokinetic alterations due to obesity: a randomized controlled trial.   Contraception. 2014;90(5):550-556. doi:10.1016/j.contraception.2014.06.033 PubMedGoogle ScholarCrossref
96.
Dinger  J , Do Minh  T , Buttmann  N , Bardenheuer  K .  Effectiveness of oral contraceptive pills in a large US cohort comparing progestogen and regimen.   Obstet Gynecol. 2011;117(1):33-40. doi:10.1097/AOG.0b013e31820095a2 PubMedGoogle ScholarCrossref
97.
Nelson  AL .  Comprehensive overview of the recently FDA-approved contraceptive vaginal ring releasing segesterone acetate and ethinylestradiol: a new year-long, patient controlled, reversible birth control method.   Expert Rev Clin Pharmacol. 2019;12(10):953-963. doi:10.1080/17512433.2019.1669448 PubMedGoogle ScholarCrossref
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