In adolescents, depot medroxyprogesterone may be an ideal option, but its use is associated with poor continuation rates. Although the major problem is menstrual irregularity; the time, expense and inconvenience of a gynaecological visit also pose a barrier to use. Self-administration might make visit unnecessary. Adequate training and counselling regarding bleeding patterns may maximize success rates with self-administration (15).
Currently, the need for contraception in a period of life characterized by irregular menstrual cycles as the perimenopause, represents a social event.
The introduction of new lower-dose contraceptives and progestin-only formulations as implants and IUD-releasing progestin has deeply changed the indications for hormonal contraception, allowing its use in women in whom it was previously contraindicated (16.17,18,19,20).
Adverse Effects of Hormonal contraception
- Moderate adverse effects
- Cardiovascular Effects
- Other Effects
- Cancer Risks
- Contraception in women HIV infected
- Mild Adverse effects
- - Irregular Bleeding Pattern
- - Ovarian cysts
- - Depression
- - Low Libido
- - Vaginal Infections
- New Perspectives immunocontraception
- - PMRS and PAS
- Contraceptive counseling
Although, gynecologist’s personal opinions and poor knowledges about this field, often lead to refuse contraception in older women. Other important problems regard the contraceptive counselling post-abortion, post-partum and the contraceptive guidance for women at risk of sexually transmitted diseases or affected by HPV, and/or HIV infections (21,22,23,24,25,26,27,28,29,30,31).
Although many studies have shown a disappointing periabortion contraceptive uptake; it was found that contraceptive counseling by a dedicate team, during pre-abortion visit, can dramatically improve post-abortion contraception uptake. In addition, according to the woman’s preference it is possible to provide immediate post-abortal IUD-insertion (32,33).
Preconception counselling is very important in adolescent sexually active with type 1-diabetes. In fact,early and unsafe sexual practices may increase their risk for unplanned pregnancy that could result in pregnancy-related complications.
Enhancing knowledge and attitude towards preconception counselling and reproductive health education may reduce these risks and may permit a future, healthy reproductive life (34,35,36).
Expert counselling is necessary to plan birth control strategy in women affected by chronic serious diseases or transplant-recipients. In these women, sometimes there is difficulty to select a hormonal contraceptive risk-free, but pregnancy may be even riskier (37,38,39,40,41,42).