Therapeutic options
| Pros | Cons | |
|---|---|---|
| BMD, bone mineral density; DMPA, depot medroxyprogesterone acetate injections; GnRH, gonadotrophin-releasing hormone; LNG-IUS, levonorgestrel intrauterine system. | ||
| DMPA injections | Simple, effective | Injection |
| Contraceptive effect | BMD concerns | |
| Weight gain | ||
| Breakthrough bleeding | ||
| possible | ||
| Oral | Oral route | BMD concerns |
| progestogens | Contraceptive effect | Weight gain |
| Breakthrough bleeding | ||
| possible | ||
| Continuous use | Oral route | Periods reduced, not |
| of COC | Contraceptive effect | eliminated |
| pills | Thromboembolism | |
| Concerns about increased | ||
| breast and cervical cancer | ||
| risk | ||
| GnRH | Highly effective | Injection |
| analogues | Contraceptive effect | BMD concerns |
| Option of add-back | Expensive | |
| oestrogen or tibolone | Menopausal symptoms | |
| therapy | Sterile abscesses | |
| Polycystic ovary concerns | ||
| LNG-IUS | No systemic drugs | Invasive |
| Contraceptive effect | Periods reduced, often not | |
| eliminated | ||
| Device expulsion, infection | ||
| Endometrial | Less invasive than | Invasive |
| ablation | hysterectomy | Ethical and legal concerns |
| Poor efficacy, may need | ||
| repeat procedures | ||
| No contraceptive effect | ||
| Potential for permanent | ||
| sterility | ||
| Hysterectomy | Highly effective | Major surgery |
| Permanent sterility | ||
| Ethical and legal concerns | ||