Prescribing contraceptives for women with schizophrenia.

Although women with serious mental illness have high rates of lifetime sexual partners they infrequently use contraception. Consequently the prevalence of sexually transmitted infections is high in this population. In addition while the overall rate of pregnancy in women with schizophrenia of child-bearing age is lower than in the general population the percentage of pregnancies that are unwanted is higher than that in the general population. The objective of this paper is to help clinicians explore knowledge of appropriate methods of contraception for women who suffer from schizophrenia. The authors reviewed recent literature on the use of contraceptive methods by women with schizophrenia treated with antipsychotic and adjunctive medications. Contraceptive counseling to women and their partners is an important part of comprehensive care for women with serious and persistent mental illness. Women with schizophrenia who smoke are overweight or have diabetes migraine cardiovascular disease or a family history of breast cancer should be offered non-hormonal contraception. Women with more than one sexual partner should be advised on barrier methods in addition to any other contraceptive measures they are using. Clinicians should be alert for potential interactions among oral hormonal contraceptives smoking and therapeutic drugs. Long-lasting contraceptive methods such as intrauterine devices progesterone depot injections or tubal ligation are reasonable options for women having no wish to further expand their families. (Journal of Psychiatric Practice 2011;17:258-269).