Progestin-only contraception

Abstract

There are three main progestin-only contraceptives (POCs) available in the United States: progestin-only pills (containing norethindrone acetate), injectable depot medroxy progesterone acetate (DMPA or Depo-Provera ® IM and SC forms) and the etonogestrel implant (Implanon ® NEXPLANON ®). POCs have advantages over combination methods for female adolescents with contraindications to estrogens because POCs carry very few cardiovascular risks and do not increase risk for thromboembolism. DMPA is particularly beneficial for female adolescents with sickle cell disease, seizure disorder, and for those taking anticonvulsants and other cytochrome p450 inducing medications. POCs also avoid adverse effects attributed to estrogens such as nausea, headache, edema and breast tenderness that often lead to poor adherence. Both DMPA and the etonogestrel implants are long-acting, convenient, discreet, and cost-effective methods that are highly desirable by female adolescents who may have difficulties adhering to coital, daily, weekly, or monthly, more user-dependent methods. POCs offer a safe, reversible, and effective alternative to combination contraceptive methods, with particular benefits and without the adverse effects or health risks associated with exogenous estrogens.