This handout is for contraception management (us-mec / us-spr — method selection & comorbidity). Your care team identified this based on: request to start/switch contraception (us-mec 2024 nguyen).
Other reasons your team may use this plan: established method review / annual visit / tolerability (us-spr 2024 curtis); unprotected/under-protected intercourse — emergency contraception (us-spr 2024 curtis); postpartum / post-abortion contraception planning incl. immediate larc (us-mec 2024 nguyen).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| etonogestrel subdermal implant | — | subdermal | in situ up to 3 yr (evidence supports up to 5 yr) | Typical-use failure ~0.1%/yr — top-tier; US-MEC cat 1 for the great majority incl. migraine-with-aura, VTE history, breastfeeding, age ≥35 smoker (progestin-only). Adherence-independent: CHOICE adjusted HR for unintended pregnancy with pill/patch/ring vs LARC = 21.8 (95% CI 13.7–34.9), undiminished in adolescents. Immediate postpartum insertion improves initiation vs delayed (RR 1.48, 95% CI 1.11–1.98) with little/no impact on breastfeeding at 6 mo (RR 0.97, 95% CI 0.92–1.01); progestin-only implant US-MEC cat 1 from immediately postpartum incl. breastfeeding. Enzyme-inducer-independent efficacy (non-oral) (Trussell 2011; Winner 2012 NEJM; Sothornwit 2022 Cochrane; US-MEC 2024 Nguyen) |
| levonorgestrel intrauterine system (LNG-IUS 52 mg / 19.5 mg / 13.5 mg) | — | intrauterine | in situ 3–8 yr by formulation | Typical-use failure ~0.1–0.4%/yr; also therapeutic for heavy menstrual bleeding (AUB overlap) and primary dysmenorrhea. US-MEC cat 1–2 across most comorbidities; valid for EC (Turok 2021 NEJM). Immediate postpartum insertion improves initiation (RR 1.27, 95% CI 1.07–1.51) but conditional expulsion penalty RR 4.55 (95% CI 2.52–8.19) vs delayed — counsel + string check, net benefit retained (Sothornwit 2022 Cochrane). Non-contraceptive benefit routes to gyn.abnormal-uterine-bleeding.core.v1 / gyn.dysmenorrhea.core.v1 |
| copper T380A intrauterine device | — | intrauterine | in situ up to 10–12 yr | Typical-use failure ~0.8%/yr; fully non-hormonal — US-MEC cat 1 even when all hormones are cat 3/4 (e.g. current breast cancer) and unaffected by enzyme inducers; the single most effective EC up to 120 h. Immediate-IUD 12-mo unintended pregnancy RR 0.26 (95% CI 0.17–0.41) vs delayed insertion (Trussell 2011; Turok 2021 NEJM; Sothornwit 2022 Cochrane; US-MEC 2024 Nguyen) |
Plan: Contraceptive method selection — efficacy tier × US-MEC comorbidity gating (US-MEC 2024 Nguyen; US-SPR 2024 Curtis)
Use these zones to know what to do based on how you feel.
Call 911 or go to the nearest emergency room right away if you have:
Continuation support (LARC continuation is the dominant effectiveness driver — Winner 2012 CHOICE); timely removal/replacement at duration; perimenopausal transition planning (when to stop CHC, switch to non-estrogen or to menopause engine); return-to-fertility counselling (immediate for LARC/CHC; median ~10 mo delay after last DMPA); advance EC supply; re-assess goals (US-MEC 2024 Nguyen; US-SPR 2024 Curtis)
Guideline: CDC U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 (Nguyen AT et al, MMWR Recomm Rep 2024;73[RR-4]:1-126) + CDC U.S. Selected Practice Recommendations for Contraceptive Use, 2024 (Curtis KM et al, MMWR Recomm Rep 2024;73[RR-3]:1-77); ACOG LARC/contraception; WHO MEC (aligned)