Hormonal Contraception

Definition

Hormonal contraception refers to methods of birth control that utilize synthetic hormones (estrogen, progestin, or both) to prevent pregnancy by suppressing ovulation, altering cervical mucus, and modifying the endometrium.

Epidemiology

• Widely used globally among women of reproductive age.
• Usage varies by region, socioeconomic status, and education level.
• Combined oral contraceptives are the most commonly used hormonal method.
• Long-acting reversible contraceptives (LARCs) such as implants and intrauterine devices are increasingly preferred due to high efficacy.
• Hormonal contraception also used for non-contraceptive benefits, including regulation of menstrual cycles and management of dysmenorrhea.

Etiology

• Not a disease but a medical intervention.
• Methods include combined estrogen-progestin contraception, progestin-only methods, and emergency contraception.
• Hormonal formulations vary in dosage, route (oral, injectable, implant, patch, vaginal ring), and duration of action.
• Patient factors: age, comorbidities, risk factors for thrombosis, and lifestyle affect choice.

Pathophysiology

• Estrogen and/or progestin suppress hypothalamic-pituitary-ovarian axis, inhibiting ovulation.
• Progestin thickens cervical mucus, reducing sperm penetration.
• Endometrial changes reduce likelihood of implantation.
• Altered tubal motility may also contribute to contraceptive effect.
• Continuous or extended use can modify menstrual bleeding patterns.