Contraception
Prevention of unintended pregnancy via hormonal, barrier, intrauterine, or natural methods. Per WHO MEC 5th edition 2015 and Spanish SEGO/SEC 2023, choice depends on age, reproductive plans, lactation status, comorbidities, and preference. Efficacy measured by Pearl Index (pregnancies per 100 women-years): perfect-use COCs 0.3, typical-use 7–9; LNG-IUS 0.2; implant 0.05; barrier methods 12–18; fertility awareness 24.
ICD-10 Z30.015 drugs
Also known as: Birth control, Family planning
Drugs used for this condition
- ACopper intrauterine deviceFirst line · Non-hormonal intrauterine contraceptive deviceLong-acting non-hormonal contraception for 5–10 years. Per SEGO 2023, first-line for women with hormonal contraindications, breastfeeding, or hormone intolerance. Also available as emergency contraception within 120 h post-coitus (>99% efficacy).
- ADesogestrelFirst line · Progestogen-only pill (POP)Regular contraception in women with estrogen contraindications (smoking after 35, migraine with aura, thrombophilia, prior VTE, breastfeeding). Per SEGO 2023 and FSRH 2017, the preferred mini-pill. Pearl Index 0.4 perfect-use, 9 typical-use. Taken continuously (no breaks or placebo) at the same time with a 12-hour missed-dose window.
- AEstradiol + Nomegestrol acetateFirst line · Monophasic COC with natural estrogenRegular contraception for reproductive-age women. Per SEGO 2023, preferred to minimize hemostatic and lipid effects. Dose 1.5 mg estradiol + 2.5 mg nomegestrol, 24 active + 4 placebo tablets. Amenorrhea in 20–30% is expected, not pathological.
- AEstradiol valerate + DienogestFirst line · COC with natural estrogen (quadriphasic)Regular contraception, especially in women >35 and with sensitivity to ethinylestradiol. Per SEGO 2023, Qlaira is recommended for heavy and prolonged menstrual bleeding – EMA-approved for this (PRO-MENS RCT 2014). 26 active + 2 placebo tablets.
- AEthinylestradiol + DesogestrelFirst line · Combined oral contraceptives (COC), third generationRegular contraception for reproductive-age women. Per SEGO 2023, preferred for moderate acne, painful menses, or intolerance to second-generation COCs. Due to higher VTE risk, NICE 2019 and MHRA recommend trying levonorgestrel COCs first. Dose 20–30 µg ethinylestradiol + 150 µg desogestrel. 21 days on, 7 days off.
- AEthinylestradiol + GestodeneFirst line · COC third generation with gestodeneRegular contraception. Per SEGO 2023, preferred in patients prone to edema and weight gain on 2nd-gen COCs (gestodene's antimineralocorticoid activity reduces fluid retention). NICE 2019 and MHRA still recommend levonorgestrel first-line due to lower VTE risk. Dose 20–30 µg ethinylestradiol + 75 µg gestodene.
- AEthinylestradiol + LevonorgestrelFirst line · Combined oral contraceptives (COC), second generationRegular contraception for women of reproductive age. Per WHO MEC 2015 and SEGO 2023, the preferred COC without VTE risk factors (smoking after 35, migraine with aura, thrombophilia, BMI ≥35, uncontrolled hypertension). One tablet at the same time daily for 21 days, then 7-day break with withdrawal bleed. Efficacy – Pearl Index 0.3 perfect-use. A missed dose >24 h reduces protection – use backup barrier for 7 days.
- AEthinylestradiol + NorgestimateFirst line · COC with norgestimateRegular contraception. Per SEGO 2023, norgestimate COCs are useful in moderate acne without severe hirsutism. Dose 35 µg ethinylestradiol + 250 µg norgestimate. 21 + 7 days. VTE risk intermediate between 2nd and 3rd-generation COCs.
- AEtonogestrel (implant)First line · Subcutaneous long-acting hormonal implant (LARC)Long-acting reversible contraception (LARC) for 3 years. Per SEGO 2023 and FSRH 2017, first-line for women of any age, including teens. Suitable with estrogen contraindications, breastfeeding, or forgetfulness. Insertion takes 1–3 minutes in office under local anesthesia.
- AEtonogestrel + Ethinylestradiol (vaginal ring)First line · Combined hormonal contraceptive, vaginal routeRegular contraception for reproductive-age women. Per SEGO 2023, a convenient alternative to COCs when daily pill-taking is difficult. Inserted for 21 days, then 7-day ring-free interval with withdrawal bleed. No daily memory required – one action per month.
- ALevonorgestrel (intrauterine system)First line · Long-acting intrauterine hormonal system (LARC)Long-acting reversible contraception for 3–5 years. Per SEGO 2023, FSRH 2017, NICE NG88 2018, first-line, including nulliparous women. Mirena is also approved for heavy menstrual bleeding (90% reduction by month 6). Office insertion, 5–10 minutes with mild discomfort.
- AMedroxyprogesterone acetate depotSecond line · Progestogen-only long-acting injectable contraceptiveContraception for women who find daily pills inconvenient and dislike implants or IUDs. Per SEGO 2023, second-line due to BMD reduction and delayed fertility return. Pearl Index 0.2 perfect-use. Especially valuable in endometriosis and sickle cell disease (reduces crises).
- ANorelgestromin + Ethinylestradiol (transdermal patch)Second line · Combined hormonal contraceptive, transdermal routeRegular contraception in women with daily-pill difficulties seeking a simpler regimen. Per SEGO 2023, second-line after 2nd-gen COCs (levonorgestrel) due to higher VTE risk. One patch weekly for 3 weeks, then 1 patch-free week with withdrawal bleed.
- BNorethisteroneSecond line · Older-generation progestogen-only pillContraception when estrogen is contraindicated and desogestrel is unavailable. Per SEGO 2023, inferior to desogestrel due to a strict 3-hour missed-dose window – higher unintended-pregnancy risk with typical use. Taken continuously at the same time.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit