Contraceptive	Advantages	Disadvantages
Combined oral contraceptives	Widely available and affordable	Failure rate for typical use is 8%; estrogen-containing contraceptives may increase blood levels of corticosteroids, cyclosporine (Sandimmune), tacrolimus (Prograf), and sirolimus
Intrauterine devices	No increased risk of infection; no change in effectiveness for immunosuppressed patients; no drug interactions; does not contain estrogen	—
Intravaginal ring and combined hormonal contraceptive patch	Avoids first-pass effect; may decrease risk of drug interactions with estrogen; intravaginal ring has lower total daily dose of estrogen	Complications related to estrogen-containing contraceptives; increased circulating levels of estrogen with patch
Medroxyprogesterone (Provera)	Avoids first-pass effect; does not contain estrogen	U.S. Food and Drug Administration boxed warning for bone health combined with propensity for decreased bone mineral density
Subdermal implants	Fewer bone density effects compared with medroxyprogesterone; does not contain estrogen	—