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1. Prophylaxis
i. Oral contraception combination (estrogen and progestin). See chart in Contraception, oral - combination therapy.

OR

ii. Levonorgestrel implant 6 x 36 mg capsules; replace every 5 years $450.00/kit

OR

iii. Intramuscular progesterone

medroxyprogesterone 150 mg IM, every 3 months $13.96/3 months

OR

iv. Intrauterine devices (IUDs)

progesterone device replace annually $25-50 (approx.)

or copper device replace every 2 years $25-50 (approx.)

OR

2. Barrier contraception

Six methods of contraception used only during coitus: spermicide, male condoms, female condoms, sponges, diaphragms and cervical caps. The last two methods require an office visit for fitting.

i. Post-coital

norgestrel/ethinyl estradiol 1.0 mg/100 µg (2 tablets) as soon as possible after intercourse and 2 tablets 12 h later $11.55/pkg

Second-line therapies:

Prophylaxis

Oral contraception, progestin

norethindrone 0.35 mg $12.21/month

Additional instructions and notes

-Approximate failure rates for the various methods in actual use are: levonorgestrel implant 0.09%; intramuscular progesterone 0.3%; copper IUD 0.8%; progesterone IUD 2%; oral contraceptives (all types) 3%; condom 12%; diaphragm 18%; cervical cap 18%; spermicides 21%; female condom 21%; sponge 24%.

-Oral contraceptives containing only progestin have a higher failure rate.

-Candidates for progestin-only contraceptives are women who have hypertension, migraine headaches or cardiovascular risk factors that are relative contraindications to the use of combined oral contraceptives.

-To minimize the risk of adverse cardiovascular effects, prescribe oral contraceptives containing 35 µg of estrogen or less and a low dose of a progestin.

-Patients considered for IUDs should be parous, monogamous women, who are not at increased risk for pelvic inflammatory disease.

-Natural family planning has a high failure rate, is time consuming and offers no protection against sexually transmitted diseases.

-Begin postcoital therapy within 72 h of intercourse after establishing the absence of pre-existing pregnancy.

-Anti-emetics should be used in conjunction with postcoital therapy.

-Patients should have a pregnancy test 1 week after postcoital therapy.

-The failure rate for postcoital therapy is about 25%.

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