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Contraception
Choosing contraception balances effectiveness, contraindications and the woman's wishes: implants and intrauterine devices (LARC) are the most effective, and oestrogen is the component behind most contraindications, above all the risk of thrombosis.
Why it matters in the exam
Exam questions present a woman with a medical condition — migraine with aura, smoking after age 35, hypertension, previous thrombosis, epilepsy, breastfeeding — and ask which method is suitable or forbidden. The answer rests on the medical eligibility categories (MEC), where category 4 means an unacceptable risk. Most contraindications concern the combined pill, so in many questions the answer is an intrauterine device, an implant or a progestin-only method.
Further topics that are asked: emergency contraception (the copper device is the most effective, ulipristal up to 5 days, levonorgestrel up to 72 hours and less effective at higher body weight), what to do after missed pills, interactions with liver-enzyme-inducing drugs (rifampin, carbamazepine, phenytoin), and the non-contraceptive benefits — the combined pill lowers ovarian and endometrial cancer, and the hormonal device treats heavy menstrual bleeding. The DMPA injection causes loss of bone density and a slow return of fertility.
Key points
- LARC (implant and IUDs) is the most effective.
- Oestrogen is forbidden with migraine with aura, thrombosis, smoking from age 35 and severe hypertension.
- Emergency contraception: copper IUD up to 5 days, ulipristal up to 120 hours, levonorgestrel up to 72 hours.
- Enzyme inducers lower the effectiveness of the pill.
- The combined pill lowers ovarian and endometrial cancer.
Summary table
| Method | Typical-use failure per year | Advantages | Contraindications and traps |
|---|---|---|---|
| Implant (etonogestrel) | Less than 1% | The most effective; up to 3 years | Irregular bleeding |
| Hormonal IUD (LNG-IUD) | Less than 1% | Reduces menstrual bleeding; treats menorrhagia | Active pelvic infection, distorted uterine cavity |
| Copper IUD | Less than 1% | Hormone-free; emergency contraception up to 5 days | Heavier, more painful periods; Wilson disease |
| Combined pill | About 7% | Lowers ovarian and endometrial cancer, acne and dysmenorrhoea | Category 4: migraine with aura, smoking 15 or more cigarettes a day from age 35, BP 160/100 or more, thrombosis, less than 21 days postpartum |
| DMPA (injection) | About 4% | Every 3 months; suits epilepsy and sickle cell disease | Loss of bone density, weight gain, slow return of fertility |
| Condom | About 13% | Protects against sexually transmitted infections | Depends on correct use at every act |
Free exam questions
שאלה: איזה מהמצבים הבאים מהווה התוו י( ית נגד יחסית Relative contraindication ) לשימוש בגלולה משולבת? (the question as examined, in Hebrew)
- א. Pituitary microadenoma
- ב. Multiple sclerosis
- ג. Mitral valve prolapse
- ד. Peripartum cardiomyopathy .בעבר
מה מהבאים מהווה התוויית נגד מוחלטת לשימוש באמצעי מניעה מסוג implant? (the question as examined, in Hebrew)
- א. מחלת כבד
- ב. עישון סגריות
- ג. מסתם תותב
- ד. מחלות קרדיווסקולריות
מטופלת בת 38 סובלת מכאב אגני חמור על רקע אנדומטריוזיס. אינה מעוניינת בניתוח. באולטרהסאונד נצפה רחם רגיל בכפיפה אחורית, שחלה ימין עם אנדומטריומה בקוטר 3 ס"מ. הוחלט לטפל ב- GnRH agonist. בהנחה שהטיפול יהיה ממושך, איזה מהטיפולים הבאים יש להוסיף? (the question as examined, in Hebrew)
- א. אסטרדיול
- ב. נורטינדרון אצטט
- ג. אנסטרזול
- ד. התקן מירנה
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Sources
- CDC U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 — Combined hormonal contraceptives; intrauterine devices; emergency contraception
- WHO Medical eligibility criteria for contraceptive use, 5th edition (2015) — Classification tables
- ACOG Practice Bulletin No. 186, 2017 — Long-Acting Reversible Contraception: Implants and Intrauterine Devices
- Speroff's Clinical Gynecologic Endocrinology and Infertility, 9th edition (2019) — Oral Contraception
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.