Considerations for the use of progestin-only contraceptives.
OBJECTIVE
To highlight the characteristics of progestin-only contraceptives (POCs) currently available in the United States, and to explore the potential of these agents as first-line contraceptive options for women seeking health promotion by prevention of an unwanted pregnancy. The progestin-only pills (Micronor and Ovrette), depot medroxyprogesterone acetate (DMPA) injections (Depo-Provera and depo-subQ provera 104), levonorgestrel intrauterine system (IUS) (Mirena), and etonogestrel implant (Implanon) will be reviewed. The use of levonorgestrel (Plan B) as an emergency contraceptive will also be considered briefly.


METHODS
Worldwide medical literature and the prescribing information for the specified products.


CONCLUSIONS
A number of POCs are currently available for routine birth control in the United States, ranging from the daily progestin-only pill to nondaily contraceptive options such as injectable DMPA, the levonorgestrel-releasing IUS, and the etonogestrel-releasing contraceptive implant. Each of these methods has specific advantages, but also specific drawbacks that can result in discontinuation of treatment if users are not given adequate information about what to expect in terms of side effects. It is critical that clinicians provide adequate and accurate information along with detailed counseling to women who are considering using POCs, as well as providing periodic reinforcement of the information at regular clinic visits for those already using POCs.


CONCLUSIONS
Given that a large number of pregnancies are unplanned and create a significant impact on social, economic, and health outcomes, it is important for the clinician to have a vast knowledge of contraceptive options. POCs offer significant choices in contraception. By proactively addressing common concerns (such as potential effects on weight, mood, menstrual bleeding patterns, and bone mineral density), clinicians may improve the likelihood of adherence and continuation with POCs for routine birth control.
Nell Hodgson Woodruff School of Nursing at Emory University, Atlanta, Georgia 30322, USA. Sfree01@emory.edu
Sarah
S
Freeman
Lee P
LP
Shulman
D003271:Contraceptive Agents, Female / Q000009:adverse effects / Q000600:supply & distribution; D003280:Contraceptives, Oral, Synthetic; D003281:Contraceptives, Postcoital; D003376:Counseling; D017135:Desogestrel; D011307:Drug Prescriptions / Q000451:nursing / Q000706:statistics & numerical data; D005193:Family Planning Services / Q000193:education / Q000379:methods* / Q000600:supply & distribution; D005260:Female; D006293:Health Promotion; D006801:Humans; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate; D009369:Neoplasms / Q000139:chemically induced / Q000453:epidemiology; D009640:Norethindrone; D009644:Norgestrel; D010353:Patient Education as Topic; D018579:Patient Selection; D049168:Pregnancy, Unplanned; D045167:Progesterone Congeners / Q000009:adverse effects / Q000600:supply & distribution; D012307:Risk Factors; D014481:United States
D003271:Contraceptive Agents, Female; D003280:Contraceptives, Oral, Synthetic; D003281:Contraceptives, Postcoital; D045167:Progesterone Congeners; C044815:etonogestrel; D009644:Norgestrel; D016912:Levonorgestrel; D017135:Desogestrel; D017258:Medroxyprogesterone Acetate; D009640:Norethindrone