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The introduction of the first hormonal contraceptive was one of the most important events of the twentieth century for women. The availability of oral contraceptives (OCs) provided women with greater control over their reproductive lives. As OC usage steadily increased, so did concern over health risks associated with their use. Concluding that adverse events were dose-related, scientists sought to develop lower-dose formulations. In the four decades since the first OC, women seeking contraception have benefited from the development of non-oral hormonal delivery systems, including injectables, intrauterine devices, implants, a vaginal ring, and a contraceptive patch. It is hoped that this expanding menu of choices affords women opportunities to find methods better suited to their individual needs. Clinicians should continually evaluate their patients' hormonal contraceptive needs, and provide adequate counseling so that every woman is afforded the opportunity to achieve contraceptive success.

Unintended pregnancy continues to be a major public health issue in this country. Approximately 50% of pregnancies in the United States are unintended, and, of these, half end in abortion. Although tubal sterilization is highly effective, many women subsequently express regret and remorse. Oral contraceptives represent an effective, reversible method. However, many women have difficulty using them consistently and correctly. Recently, four new delivery systems for hormonal contraception have become available in the United States: the monthly injection, the levonorgestrel intrauterine system, the combination hormonal contraceptive vaginal ring, and the transdermal contraceptive patch. All four new methods are effective, readily reversible, generally discreet, and reduce daily compliance challenges. The monthly injection, vaginal ring, and transdermal patch can be discontinued without the need for an office visit. This expanded menu of effective contraceptive options should help women find a method that suits their particular life style.