The most widely used methods for fertility control include (1) barrier methods, (2) oral contraceptives, (3) intrauterine devices, (4) long-acting progestins, (5) sterilization, and (6) abortion.

Oral contraceptive agents are widely used for both prevention of pregnancy and control of dysmenorrhea and anovulatory bleeding. Combination oral contraceptive agents contain synthetic estrogen (ethinyl estradiol or mestranol) and synthetic progestins. Some progestins possess an inherent androgenic action. Low-dose norgestimate and third-generation progestins (desogestrel, gestodene, drospirenone) have a less androgenic profile; levonorgestrel appears to be the most androgenic of the progestins and should be avoided in pts with hyperandrogenic symptoms. The three major formulation types include fixed-dose estrogen-progestin, phasic estrogen-progestin, and progestin only.

Despite overall safety, oral contraceptive users are at risk for venous thromboembolism, hypertension, and cholelithiasis. Risks for myocardial infarction and stroke are increased with smoking and aging. Side effects, including breakthrough bleeding, amenorrhea, breast tenderness, and weight gain, are often responsive to a change in formulation.

Absolute contraindications to the use of oral contraceptives include previous thromboembolic disorders, cerebrovascular or coronary artery disease, carcinoma of the breasts or other estrogen-dependent neoplasia, liver disease, hypertriglyceridemia, heavy smoking with age >35, undiagnosed uterine bleeding, or known or suspected pregnancy. Relative contraindications include hypertension and anticonvulsant drug therapy.

New methods include a weekly contraceptive patch, a monthly contraceptive injection, and a monthly vaginal ring. Long-term progestins may be administered in the form of Depo-Provera or a subdermal progestin implant.

Emergency contraceptive pills, containing progestin only, can be used within 72 h of unprotected intercourse for prevention of pregnancy. Mifepristone (RU486) also may be used but is not available in most countries.

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