Long-acting contraception considered safe, highly effective for prevention of unplanned pregnancies

Herbert Peterson

CHAPEL HILL – Women in the United States have several choices of highly effective and safe long-acting methods to prevent becoming pregnant, according to an article in the Nov. 17 issue of the New England Journal of Medicine.

“Modern contraceptives have made it possible for countless women and couples to plan their pregnancies,” said lead author Dr. Herbert B. Peterson, chairman of the University of North Carolina at Chapel Hill School of Public Health’s maternal and child health department. “Still, there are about 80 million unintended pregnancies each year worldwide. “Here in the U.S., we estimate that about half of women ages 15 to 44 have at least one unplanned pregnancy, and at least half of those women were using some kind of contraceptives.”

Peterson also is professor of obstetrics and gynecology at UNC’s School of Medicine. He and Dr. Kathryn M. Curtis, an epidemiologist with the Division of Reproductive Health at the U.S. Centers for Disease Control and Prevention, wrote “Long-Acting Methods of Contraception” for the journal’s “Clinical Practice” section.

This journal feature begins with a case vignette highlighting a common clinical problem. Authors then present evidence supporting various strategies, offer a review of any formal guidelines and conclude with their clinical recommendations.

Pregnant woman

The case vignette Peterson and Curtis focus on is a healthy 23-year-old woman who wants no more children and wants to determine the most appropriate contraceptive method for her. The researchers discuss the advantages and disadvantages of intrauterine devices (IUDs) and progestin implants, as well as tubal sterilization for women and vasectomy for men.

IUDs and progestin implants are appropriate for women who are either spacing their pregnancies or have completed childbearing, they wrote. By contrast, tubal sterilization and vasectomy are intended only for those who are certain they want to prevent pregnancy permanently.

IUDs are the most popular nonpermanent method of contraception worldwide, they wrote, but in 2002, only 2 percent of women nationwide used the devices. The available IUDs are considered the most cost-effective, non-permanent contraceptive methods by third-party payors, the authors said. They also are considered safe for women at low risk for sexually transmitted infections, although there are rare risks of ectopic gestation (pregnancy somewhere other than in the cavity of the uterus), spontaneous abortion and pre-term delivery. The authors said, however, that the absolute risk of ectopic pregnancy is less than half the risk for women using no contraception. The main side effects of IUDs are menstrual abnormalities. The next category was progestin implants, which provide highly effective, long-acting contraception, the authors wrote, but are not currently marketed nationwide, even though two have been approved by the U.S. Food and Drug Administration, and a third implant is currently under review. As with IUDs, the main side effects of progestin implants are menstrual abnormalities.

Worldwide, approximately 180 million women have undergone tubal sterilization. In 2002, 28 percent of U.S. women between the ages of 30 and 34 who used contraception had undergone the procedure. Although sterilization is highly effective, the authors said women should be certain they do not ever want to become pregnant again.

“Although most people remain satisfied with their decision to undergo sterilization, feelings of regret after the procedure are not rare,” they said.

Vasectomy is also an option for men and couples who want to prevent pregnancy permanently. Worldwide, the authors reported, almost 43 million men have had the procedure. In 2002, 9 percent of U.S. women who were using contraception relied on their partner’s vasectomy.

Vasectomy is usually performed on an outpatient basis under local anesthesia and is highly effective. Surgical complications from vasectomy are infrequent and usually minor.

The authors concluded that the woman in the vignette they chose was a good candidate for long-term contraception, including sterilization if she chooses this option after careful counseling. As the authors said, women should not be denied tubal sterilization because of young age alone, but many such women are well served by using a non-permanent, long-acting method at least for several years.

“It’s important that women know about the advantages and disadvantages of long-acting contraceptives as they choose how to control when and whether they become pregnant,” Peterson said. # # #

For further information please contact Ramona DuBose either by phone at 919-966-7467 or by e-mail at ramona_dubose@unc.edu.