Methods currently available include hormonal methods such as oral contraceptive pills, contraceptive patch, vaginal contraceptive ring, and injectable hormonal contraception. There are also barrier methods such as diaphragm and condoms. The intrauterine device or sterilization can also be considered for the appropriate patient.

Oral contraceptives should be initiated on either the first day of menses or the first Sunday after menses begins.

If miss one tablet, take two tablets the next day and continue the pack as indicated. If miss two or more tablets, take one tablet as soon as possible and then continue to take one tablet twice daily until each of the missed tablets has been taken. Women who have missed more than two consecutive tablets should be advised to use an additional form of contraception (eg, condoms) while they complete taking the current pack of pills. Be aware that irregular usage may cause breakthrough bleeding. Women who persistently miss tablets each cycle should consider other contraceptive choices that do not require daily compliance.

Nausea and breast tenderness commonly occur in oral contraceptive users. Fortunately, the frequency and severity of these symptoms usually decline over the first several months of use. The pill should not cause weight gain. Studies demonstrate no more than a two pound gain or loss over a year. Headaches are occasionally reported by women using oral contraception and require appropriate evaluation. Intermenstrual spotting or bleeding occur in approximately one quarter of women during the first three months of use but become much less common with ongoing use. If intermenstrual bleeding occurs after three months of use, the patient should be evaluated for possible causes and consider change in the contraceptive pill. Occasionally, patients might experience amenorrhea (cessation of menses) on the pill. Although not medically harmful, an alternate oral contraceptive pill might be prescribed in order to restore cyclic bleeding and relieve patient anxiety.

Spotting or intermenstrual bleeding during the first three packs after initiation of oral contraception is common and does not need immediate evaluation. Intermentrual bleeding will most likely resolve with continued use of the pill as directed. As long as there are no missed pills, it is just as effective for contraception. If bleeding continues after the third pack of pills, contact your physician for possible evaluation and consider change in the contraceptive pill. If there are missed pills, evaluate for possible pregnancy with a urine pregnancy test.

Also called “morning after pill” or “post-coital contraception”, it is high doses of hormones that need to be taken within 72 hours of unprotected sexual intercourse. Treatment consists of two doses taken 12 hours apart. Nausea and vomiting occurs in 30-60% of patients and lasts up to two days. Patients should seek medical attention if menses has not begun within 21 days after the treatment.