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11 - Contraception and fertility

from Part II - Hormonal changes

Published online by Cambridge University Press:  21 August 2009

Tracey D. Conti
Affiliation:
University of Pittsburgh, Pittsburgh, PA, USA
Jo Ann Rosenfeld
Affiliation:
The Johns Hopkins University
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Summary

Case: S.J. is a 42-year-old woman who has recently remarried four years after her divorce. She used condoms as a teenager, oral contraception in her twenties and mid thirties, and abstinence over the past four years. She is unsure whether she wants to restart hormonal contraception. In her latest job, she works at night, this makes it hard to remember regular contraception. She is menstruating regularly and so assumes she is still fertile; she does not want to become pregnant.

Introduction

The need for reliable, safe, and reversible contraception has become more evident, and the duration of their use has increased as many women opt to delay childbearing into the late third and fourth decades. Though the decision to delay childbearing results in greater satisfaction, reproductive health discussions must now include a frank and evidence-based presentation of the potential health risks, complications, and decreased fertility rates associated with delayed childbearing and advanced maternal age.

Contraception

Contraceptive methods can be classified into types – physical barriers and hormonal methods – or as folk methods, traditional methods, and contemporary methods (Table 11.1).

Individual decisions regarding contraceptive methods vary widely among women. Factors that may influence decision-making include age, attitudes and beliefs regarding family planning, and concerns over the use of exogenous hormones, most notably regarding cancer and thromboembolic disease. Failure rates vary by the method (Table 11.2).

Barrier devices

Tubal ligation

Since the advent of tubal sterilization in 1823, many techniques have been described.

Type
Chapter
Information
Women's Health in Mid-Life
A Primary Care Guide
, pp. 191 - 206
Publisher: Cambridge University Press
Print publication year: 2004

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References

National Library of Medicine – birth control/contraception: www.nlm.nih.gov/medlineplus/birthcontrolcontraception.html
Food and Drug Administration birth control guide: www.fda.gov/fdac/features/1997/babytabl.html
Contraception Online: www.contraceptiononline.org/
Alan Guttmacher Institute. www.agi-usa.org
www.ivf/infertility.co.uk. Designed by infertility specialists primarily for couples who are experiencing difficulty in having a child and who think that they might need medical help
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The Alan Guttmacher Institute. Facts in brief: contraceptive use. www.agi-usa.org/pubs/fb_contr_use.html. Accessed March 17, 2003
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