title: Ten Challenges in Contraception.
abstract: Despite the introduction of promising products into the contraceptive market, the rate of unintended pregnancies remains high. Women with underlying medical conditions should have access to safe and effective contraceptive methods for various reasons, including the potential deleterious effect of the disease on the pregnancy or the effect of the pregnancy on the disease process. Healthcare providers are often confronted with cases in which contraception counseling is problematic due to controversial evidence and persistent myths. This review will examine a number of medical conditions that often create contraception counseling challenges. It should in no way be considered as an extensive review of all contraceptive options for a given medical condition. The following topics will be explored: depression, immunosuppression, inflammatory bowel diseases, past bariatric surgery, liver diseases, family history of breast cancer, migraines, polycystic ovarian syndrome, perimenopausal state, and sickle cell disease. We advocate for improved information and accessibility to contraception as a means of decreasing the rate of unintended pregnancies.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Queen's University , Kingston, Ontario, Canada .
authors.forename: Audrey
authors.initials: A
authors.lastname: Binette
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Queen's University , Kingston, Ontario, Canada .
authors.forename: Kerry
authors.initials: K
authors.lastname: Howatt
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Queen's University , Kingston, Ontario, Canada .
authors.forename: Ashley
authors.initials: A
authors.lastname: Waddington
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Queen's University , Kingston, Ontario, Canada .
authors.forename: Robert L
authors.initials: RL
authors.lastname: Reid
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D000066491:Clinical Decision-Making; D003267:Contraception / Q000379:methods*; D000075202:Contraindications; D005193:Family Planning Services; D005260:Female; D006176:Gynecology; D006297:Health Services Accessibility; D006801:Humans; D017410:Practice Guidelines as Topic; D014481:United States
keywords: abortion; academic medicine; adolescent health; contraception; gynecology