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Hormonal contraception 

Hormonal contraception
Chapter:
Hormonal contraception
Author(s):

Bliss Kaneshiro

and Alison Edelman

DOI:
10.1093/med/9780199235292.003.0817
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date: 11 December 2019

The first widely available hormonal contraceptive method, the birth control pill, was first introduced in the 1960s. It was both a response to, and a reflection of, the societal and philosophical currents of the time. The idea that fertility could be controlled, pregnancy planned, and population stabilized to decrease poverty, manifested reason and rationalism, as well as the concept that science could be used to improve life. Indeed, the increased utilization of various hormonal contraceptive methods over the last four decades is now regarded as one of the most successful public health ventures of our time. Money spent on family planning services has been estimated to result in more than triple the savings in prenatal and neonatal costs (1).

Although it is now viewed as one of the great inventions of the 20th century, hormonal contraception has also been controversial. It allowed for the separation of sex from pregnancy and reproduction, and is cited by many as a catalyst to the sexual revolution. Consequently, hormonal contraceptives have been some of the best studied and closely scrutinized medications in history.

Hormonal contraceptives can be divided into two major categories, the progestin-only methods and combined hormonal contraception, which contains an oestrogen and progestin component. With all hormonal contraceptives, the progestin component has the dominant hormonal effect. The progestin component is also responsible for the mechanism of contraceptive action with the oestrogen component of the combined methods serving mainly to regulate bleeding (2). The combined hormonal methods have been constituted in the form of a pill, injection, transdermal patch, and ring. Progestin-only methods have been formulated to be delivered in the form of a pill, injection, subdermal implant, and intrauterine device (IUD).

Overall, hormonal contraception has been shown to be remarkably safe, especially when compared with pregnancy, which is one of the most medically-threatening times in a woman’s life. The World Health Organization (WHO) has published evidence-based guidelines to help assist in contraceptive decision-making. The WHO Medical Eligibility Criteria utilizes a grading system to provide information about the safety of a particular method in women with medical conditions (1 = no restrictions for use; 2 = the advantages generally outweigh the risks; 3 = the risks outweigh the benefits; 4 = the risk is unacceptable). This grading system is based on an extensive review of the literature, as well as expert consensus statements (3).

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