Spermicides. 70% effective vs pregnancy. No protection vs STDs*. Allergies may occur. May increase risk of HIV infection24. Female condom. 80% effective vs ...
Contraceptives
Table 1. Advantages and disadvantages of available contraceptive methods for women with schizophrenia Method Advantages Disadvantages Comments/cautions Abstinence Effective vs pregnancy and STDs No protection vs unexpected Women with schizophrenia at risk contingencies. for sexual assault17 Natural family planning Rhythm Withdrawal Female barrier methods
80% effective vs pregnancy
80% effective vs pregnancy
Sponges
No prescription or fitting needed
Spermicides
70% effective vs pregnancy
Female condom
80% effective vs pregnancy Also prevents STDs No prescription or fitting needed Not effective vs pregnancy or STDs
Male barrier methods Male condom
APs cause irregular periods No protection vs STDs* Depends on male partner. No protection vs STDs*
Use does not rely on male partner
Cervical caps and diaphragm
Douching
90% effective vs pregnancy
97% effective vs pregnancy and STDs26
Calculations may be difficult for women with cognitive impairment Require advance planning and some skill to insert properly
Require fitting and maintenance No protection vs STDs* ??Effectiveness No protection vs STDs* No protection vs STDs* Allergies may occur May increase risk of HIV infection24 Awkward, expensive Allergy to latex prohibits use. May contribute to pelvic disease or ectopic pregnancy23 Depends on male partner Uncomfortable for male. Allergy to latex prohibits use.
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Contraceptives
Vasectomy by partner Oral contraceptive (combined hormones)
Effective vs pregnancy 97-99% effective vs pregnancy Potential for improvement of schizophrenia symptoms34-36
Requires committed partner Hard to remember Potential for drug interactions Hormonal SEs Risk of vascular thrombosis No protection vs STDs*
Assess women 35 yrs and older for CVD risk factors (hypertension, smoking, diabetes, nephropathy, other vascular diseases, migraines) prior to use32 APs also increase risk of vascular thrombosis Potential for interactions with some AEs and APs
Breakthrough bleeding and other hormonal SEs No protection vs STDs*
99% effective vs pregnancy
Requires injection every 12 weeks. Breakthrough bleeding and other hormonal SEs Temporarily irreversible if SEs develop No protection vs STDs*
Other hormonal formulations Patch
97-99% effective vs pregnancy
Skin irritation Must remember to change
Must be taken in the same 3 hr period every day, which may be difficult for women with schizophrenia May cause weight gain Decreases bone mineral density-increased calcium intake needed45,46 May lower glucose tolerance in diabetes44 May be good option for women with schizophrenia who have trouble with advance planning and remembering to take daily pills Not subject to drug interactions since not metabolized via liver Cost can be an issue
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Contraceptives
Subdermal implant
97-99% effective vs pregnancy
Estrogen skin gel Ring
Hormonal SEs No protection vs STDs* Inserted and removed by MD Hormonal SEs No protection vs STDs* ? Effectiveness Skin irritation Hormonal SEs.
Over 95 % effective vs pregnancy
No protection vs STDs
Over 95% effective vs pregnancy.
Inserted and removed by MD No protection vs. STDs* May be expelled.
Over 95% effective vs pregnancy 75%--89% effective vs pregnancy. No prescription required Effective vs pregnancy
Inserted and removed by MD. No protection vs STDs* May be expelled Hormonal SEs. Must be taken within 120 hrs No protection vs STDs Irreversible
Cost can be an issue Cost can be an issue Can be used cyclically or continuously May be good option for women with schizophrenia who have trouble with advance planning and remembering to take daily pills First-line contraceptive method for women with a history of deep venous thrombosis, pulmonary embolism, or heart disease Not subject to drug interactions since not metabolized via liver Does not induce abortion
AEs = anti-epileptic agents APs = antipsychotic medications, SEs = side effects, STDs = sexually transmitted diseases; vs = against, *Women with multiple partners also need to use barrier method (e.g., condoms) to prevent STDs