TIER 1

TIER 1 MECHANISM ADVERSE EFFECTS TIMING OTHER NOTES

1. IUD  (+) Local inflammatory response   Ectopic  Interval IUD – Near the end of CONTRAINDICATIONS:
a.) Cu-IUD Decreased sperm & egg viability  Lost device (Esp. w/in 1 month) so normal menses  Pregnancy
 (+) Inflammation against blastocyst follow up after 4-6 weeks is  Immediate IUD – 1st 10 minutes  Acute PID
b.) LNG-IUS (w/ progestin)  Atrophy of endometrium  needed post IUD insertion after placental delivery (Note:  Distorted uterine cavity
Hindered implantation  Perforation (Mostly fundus) Higher expulsion rate)  AUB of unknown etiology
 (+) Scant viscous cervical mucus to  Menstrual change, dysmenorrhea  Recent endometritis (3 months)
obstruct sperm motility (Cu-IUD: Heavy bleeding; LNG-IUS:  Allergy
irregular spotting up to 6 months)  Untreated acute lower genital
 Infection (esp. during 1st 3 weeks) tract infection
– N. gonorrhea, C. trachomatis,  Uterine/cervical CA
vaginal flora; Actinomyces israeli  Liver diseases, Breast diseases
(Tx: broad-spectrum antibiotics. (For LNG-IUS)
Remove IUD if no improvement
w/in 24-72 hours)
 Pregnancy
2. IMPLANT  Decrease in LH  Blocks ovulation  Irregular bleeding (Remedy: Add  Subdermally, 8 cm from the
a.) Etonorgestrel  Atrophy of endometrium  2-week course estrogen or short- medial condyle/elbow
(Nexplanon) – 30 mcg unfavorable endometrium course NSAID)  Within 5 days of menses
 Sustained amenorrhea (For  If inserted at other times, add
prolonged use) “Back-up Method”
 Nerve injury (Medial antebrachial  Transitioning method:
cutaneous and median nerves) - On the day of 1st placebo
COC pill
- On the day of when the next
DMPA is due
- Within 24 hours from last POP
TIER 2
TIER 2 MECHANISM ADVERSE EFFECTS TIMING OTHER NOTES
1. PILLS  Endometrial atrophy  Drospirenone: (+) Antiandrogenic, MISSED PILL WINDOW
a.) Progestin – only (POP)  Thickening of cervical mucus antimineralocorticoid Norethindrone: Taken daily  Norethindrone: 3 hours
Norethindrone 0.35 mg [Note: monitor serum K levels] and continuously
Drospirenone 4 mg  Drospirenone: Taken 24 days  Drospirenone: 24 hours
Desogestrel 0.075 mg then 4 days withdrawal
 Desogestrel: Taken daily and  Desogestrel: 12 hours
continuously

b.) Combined (COC)  Suppression of hypothalamic  Breast tenderness  Taken 21 to 81 days then CONTRAINDICATIONS:
“Cycle-control” gonadotropic-releasing factors   Weight gain placebo for 4 to 7 days  Pregnancy
Inhibition of ovulation  Nausea  Ideally on day 1 of menses (If  Uncontrolled hypertension
Monophasic – Constant  Estrogen: Stabilizes endometrium  Headache started on any day, add back  Smokers > 35 y/o
dose of progetin  Progesterone: Thickens the  Increased TAG and HDL up method)  DM with vascular problems
cervical mucus  Protective against endometrial  CVD/CAD, DVT.
(*Other phasic pills – to and ovarian CA  “Extended cycle” (13 weeks) – Thrombophlebitis
progestin content and  Risk for cervical CA 12 weeks of hormones then 1  Undiagnosed abnormal genital
associated side effect week withdrawal (indicated for bleeding
per cycle) those with serous menstrual  Jaundice, liver diseases
symptoms)  Estrogen-dependent neoplasia

MISSED PILLS
 1-2 Missed pills: Take 1 recent
missed pill ASAP, without back
up method
 3 Missed pills during 1st/2nd
week: Take 1 recent missed pill
ASAP, WITH back up method
for 7 days (Add emergency
contraception if with
intercourse in the past 5 days)
 3 Missed pills during 3rd week:
Discard then start a new pack
2. DMPA (Depo-Provera)  Same with progestins  Prolonged anovulation  Within 1st 5 of menses (Avoid
150 mg every 3 months  Delayed fertility resumption massage to allow slow release)
 Regular menses could resume up
to 1 year
 Weight gain
 Bone density loss (Reversible)
 Decreased HDL
3. RINGS  Inserted within 5 days of  Maybe removed for intercourse
Nuva Ring: Ethinyl estradiol + Etonorgesrel menses but must be replaced
Annovera: Ethinyl estradiol + Segesterone acetate  Good for 3 weeks then - w/in 3 hours for Nuva ring
removed for 1 week - w/in 2 hours for annovera
(Withdrawal)
4. PATCHES  Obese ( > 90 kg)  Risk for failure  Every 3 weeks with 1 week  Applied on buttocks, upper outer
Xylane: Ethinyl estradiol + Norelgestromin patch free arm, lower abdomen, or upper
Twirla: Ethinyl estradiol + Levonorgestrel torso

TIER 3 NOTES
1. CONDOM  With adjunct water-based lubricant (NOTE: Do not use nonoxynol spermicidal lubricants together with condoms)
 Protective against STD including HIV
 Stored in a cool, dry place between 0 to 37.7 C
2. DIAPHRAGM  Spermicide is added into the dome cup and along the rim
 Inserted hours before intercourse
 Removed after 6 hours (If already > 6 hours, add spermicide)
3. CERVICAL CAP  In place for 6 hours after coitus, can be up to 48 hours

TIER 4 NOTES
1. FETILITY AWARENESS METHOD
a.) Standard Days  Avoid intercourse on days 8 to 19
 There should be regular monthly menstrual cycles every 26 to 32 days
b.) Two-Day Method  Based on vaginal wetness – Do not have intercourse on the day and day after once there would be any secretions regardless of type, color, and
consistency. Can have intercourse if no mucus noted
c.) Symptothermal  BBT + Billings/Cervical mucus method
 Do not have intercourse on Day 1 to 3 of menses after there is an increase in temp of 0.4 F from BBT and until 4th day when there is “wetness”
d.) Basal Body Temp (BBT)  Refrain from intercourse from day 1 to 3 after a temp rise of 0.2 – 0.5 C from 1 – 2 days before LH surge
e.) Calendar Rhythm  Refrain from intercourse during fertile period
 Shortest cycle – 18 = Start of fertile period
 Longest cycle – 11 = End of fertile period
 The 6 previous cycles must be recorded to be satisfactory
f.) Cervical mucus method /  Refrain from intercourse when there is clear, wet, and slippery mucus secretion up to the 4th day of peak “wetness”
Billings Ovulation method  Recommended for any reproductive age women without infection or abnormal discharge
g.) Lactation Amenorrhea  Monthly cycle has not returned yet
Method (LAM)  Fully breastfeeding (at least 10-12x/day with daytime feeding < 4 hours apart and nighttime feeding < 6 hours apart
 Baby is < 6 months
(Note: Avoid breastfeeding if with HIV, HSV, active/untreated TB)
h.) Saliva Ovulation Monitor  Started at the end of menses. Avoid intercourse when a ferning pattern is observed
  No fluid/food intake for at least 1 hour. Rinse the mouth with small amount of water for 5 min.
 Collection is done under the tongue, dried for 30 min, then looked under a microscope.  (+) Ferning = Fertile

2. SPONGE  Nonxynol – 9 = Chemic + Physical barrier, effective up to 1 hour

 Lactic acid, citric acid, potassium bitartrate

3. CERVICAL CAP  Up to 24 hours prior to intercourse then can remain in place for 6 hours post intercourse