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Oral contraceptive (OC) regimens that manipulate the hormone-free interval are getting more popular now that there are several products specifically approved by the FDA for this indication. Of course, cyclic or monthly withdrawal bleeding when using hormonal contraception is not physiologically necessary. The traditional OC cyclic dosing (21 days of active hormone, 7-day hormone-free interval) was chosen instead for its ability to mimic the natural menstrual cycle and to conform to 1950s' societal pressures--not for its biological superiority. [ABSTRACT FROM AUTHOR]

Reviewing the latest pros, cons, and contraindications will enable you to better educate patients weighing this option. Newer regimens have higher success rates, fewer side effects, differing dosages and routes--and can be used as late as 63 days' gestation, according to these experts. [ABSTRACT FROM AUTHOR]

Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest.

Learning how to best meet a patient's contraceptive needs improves her chances of using her birth control consistently and is crucial to providing patient-centered care. The best contraceptive method for an individual patient is the one that is safe and that she is most comfortable using. Women's health care providers must be equipped to talk to each patient about her needs and options. The shared decision-making model in contraceptive counseling allows the patient and provider to work together in order to meet a patient's needs while remaining medically safe.

Sterilization is a frequently used method of contraception. Female sterilization is performed 3 times more frequently than male sterilization, and it can be performed immediately postpartum or as an interval procedure. Methods include mechanical occlusion, coagulation, or tubal excision. Female sterilization can be performed using an abdominal approach, or via laparoscopy or hysteroscopy. When an abdominal approach or laparoscopy is used, sterilization occurs immediately. When hysteroscopy is used, tubal occlusion occurs over time, and additional testing is needed to confirm tubal occlusion. Comprehensive counseling about sterilization should include discussion about male sterilization (vasectomy) and long-acting reversible contraceptive methods., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Combination hormonal contraception and progestin-only contraception (including depot medroxyprogesterone acetate [DMPA]) are effective and convenient forms of reversible contraception that millions of women use worldwide. In recent years, observations of reduced bone mineral density in current users of these methods have led to concerns that this hormone-induced bone loss might translate into long-term increased fracture risk. Special focus has been placed on adolescent users who have not yet attained their peak bone mass as well as perimenopausal users. In 2004, the FDA added a black box warning to DMPA package labeling warning of the risk of significant bone loss and cautioning against long-term use (> 2 years). This article reviews evidence on the use of hormonal contraception and its effect on bone density in adolescent, premenopausal, and perimenopausal populations. Recommendations from reproductive healthcare organizations are reviewed and clinical recommendations are provided.

Objective: We sought to compare sexual function and hormone concentrations in combined oral contraceptive (COC) and injectable progestin users., Study Design: Sexually active COC and depot medroxyprogesterone acetate (DMPA) users completed the Female Sexual Function Index (FSFI) questionnaire, a demographic data form, and had serum testosterone and estradiol levels measured. Multiple linear regression was used to measure associations of interest., Results: Among 50 subjects enrolled, COC users had lower levels of free testosterone compared to DMPA users (0.2 vs 0.6 pg/mL; P < .0001) and higher levels of estradiol (75.8 vs 62.8 pg/mL; P = .0057), but scores of desire (4.2 vs 3.8; P = .27), scores of arousal (5.0 vs 4.8; P = .46), or total scores (30.1 vs 28.8; P = .28) were no different. Demographic characteristics were similar except for ethnicity, level of education, gravidity, parity, and frequency of intercourse. In multivariate analysis, birth control type was not significantly associated with desire score or total FSFI score., Conclusion: While users of COC and DMPA have significantly different sex hormone levels, they are not different in sexual function as measured by the FSFI., (Copyright © 2010 Mosby, Inc. All rights reserved.)

Background: The study was conducted to characterize the relationship between formal sex education and the use and type of contraceptive method used at coital debut among female adolescents., Methods: This study employed a cross-sectional, nationally representative database (2002 National Survey of Family Growth). Contraceptive use and type used were compared among sex education groups [abstinence only (AO), birth control methods only (MO) and comprehensive (AM)]. Analyses also evaluated the association between demographic, socioeconomic, behavioral variables and sex education. Multiple logistic regression with adjustment for sampling design was used to measure associations of interest., Results: Of 1150 adolescent females aged 15-19 years, 91% reported formal sex education (AO 20.4%, MO 4.9%, AM 65.1%). The overall use of contraception at coitarche did not differ between groups. Compared to the AO and AM groups, the proportion who used a reliable method in the MO group (37%) was significantly higher (p=.03) (vs. 15.8% and 14.8%, respectively)., Conclusions: Data from the 2002 NSFG do not support an association between type of formal sex education and contraceptive use at coitarche but do support an association between abstinence-only messaging and decreased reliable contraceptive method use at coitarche., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objective: This study was conducted to assess prevalence and correlates of prior contraceptive use among hospitalized obstetric patients in Kabul, Afghanistan., Study Design: Medically eligible (e.g., conditions not requiring urgent medical attention, such as eclampsia, or not imminently delivering [dilation > or =8 cm]) obstetric patients admitted to three Kabul public hospitals were consecutively enrolled in this cross-sectional study. An interviewer-administered questionnaire assessed demographic information, health utilization history, including prior contraceptive use, and intent to use contraception. Correlates of prior contraceptive use were determined with logistic regression., Results: Of 4452 participants, the mean age was 25.7 years (SD, +/-5.7 years), 66.4% reported pregnancy before the presenting gestation, 88.4% had > or =1 prenatal care visit and 82.4% reported the current pregnancy was desired. Most (67.4%) had no formal education. One fifth (22.8%) reported using contraception before this pregnancy. Among women with any pregnancy before the current gestation (98.6% of prior users), prior contraceptive use was independently associated with having lived outside Afghanistan in the last 5 years (adjusted odds ratio [AOR], 1.35; 95% confidence interval [CI], 1.12-1.63), having a skilled attendant at the last birth (AOR, 1.35; 95% CI, 1.07-1.71), having a greater number of living children (AOR, 1.30; 95% CI, 1.20-1.41), longer mean birth interval (years) (AOR, 1.21; 95% CI, 1.11-1.38) and higher educational level (AOR, 1.16; 95% CI, 1.09-1.22). Immediate desire for another pregnancy and spousal disapproval were the most common reasons for not utilizing contraception., Conclusion: Prior contraceptive use is low among the women in Kabul, Afghanistan, particularly for younger less educated women. Programming in Kabul to strengthen postpartum contraceptive counseling should address barriers to contraceptive use, including immediate desire for pregnancy and spousal attitudes.

Contraceptive implants are safe, highly effective, and long-term methods of contraception that are widely applicable to any reproductive-aged woman. Implants require minimal user compliance and are cost-effective. The new single-rod system simplifies insertion and removal, making implants more accessible for both providers and patients. Specifically, progestin-only implants are safe options for various women including adolescents, postpartum, breast-feeding, those who are medically complicated, or those who have contraindications to or intolerance of estrogen-containing contraceptives.