Contraceptive Options

• The birth control pill is taken daily and can make periods more regular and lighter. It also has a protective effect against ovarian and endometrial cancers.
• The decision about whether to take an oral contraceptive should be made only after consultation with a health professional.

Smokers and women with certain medical conditions should not take the combination pill. These conditions include:

1) Pregnancy or breast-feeding.
2) A history of blood clots, heart attacks, strokes, or angina.
3) Cancer of the breast, vagina, cervix, or uterus.
4) Any undiagnosed, abnormal vaginal bleeding.
5) Liver tumors.
6) Jaundice due to pregnancy or use of birth control pills.

Women with the following conditions should discuss with the doctor whether the benefits of the pill outweigh its risks for them:

1) High blood pressure; heart, kidney or gallbladder disease
2) A family history of heart attack or stroke
3) Severe headaches or depression
4) Elevated cholesterol or triglycerides
5) Epilepsy
6) Diabetes

Minor side effects, which usually subside after a few months’ use, include: nausea, headaches, breast swelling, fluid retention, weight gain, irregular bleeding, and depression. Sometimes taking a pill with a lower dose of hormones can reduce these effects.

Serious side effects of the pill include blood clots that can lead to stroke, heart attack, pulmonary embolism, or death. The pills may also cause high blood pressure that returns to normal after oral contraceptives are stopped.

Although taken daily like combined oral contraceptives, minipills contain only the hormone progestin and no estrogen. They work by reducing and thickening cervical mucus to prevent sperm from reaching the egg. They also keep the uterine lining from thickening, which prevents pregnancy. These pills are slightly less effective than combined oral contraceptives.

   
Norplant was the first contraceptive implant, but is no longer available.

Implanon is a new implantable contraceptive option which is progesertone containing only.  It is a non-biodegradable flexible rod containing 68 mg of etonogestrel.   It is placed subdermally (below the skin surface) by a trained physician  and can be removed at any time, but should not be left in place for longer than 3 years.  Please visit www.implanon.com for more information.

NuvaRing is a plastic ring inserted into the vagina that contains 2 types of hormones (estrogen and progestin), which work together to prevent your ovaries from producing mature eggs.  A new ring is used each month.  With, Nuvaring the hormones are absorbed and distributed into your bloodstream through the vagina. When used correctly, Nuvaring is 99% effective in preventing pregnancy.

The ring should be removed 3 weeks after insertion, on the same day of the week it was inserted.  Your menstrual period will usually start 2 to 3 days after you remove NuvaRing.  After a 1 week break, you insert a new ring.  Please visit www.nuvaring.com for more information.

Ortho Evra or the Patch is a thin, beige, plastic patch that sticks to the skin.  The sticky part of the patch contains progestin and estrogen which are the same 2 hormones found in the birth control pill.  These hormones are continuously absorbed through the skin and into the bloodstream.  Because the hormones are absorbed through the skin the estrogen exposure is higher than taking a birth control pill and may therefore pose a higher risk of side effects or complications.

Apply the patch on the same day each week for 3 weeks in a row.  Make sure you remove the old patch before applying the new patch.  During week 4 , DO NOT wear a patch and your period should begin during this week.  Following week 4, repeat the same steps.   The patch should NEVER be applied directly to your breasts.

Please see www.orthoevra.com for more information.

The  birth control shot is an injection of a hormone known as Depo-Provera.  It prevents pregnancy for 3 months at a time.

The birth control shot releases a hormone called Progestin into the body, which works by keeping eggs from leaving the ovaries(prevents ovulation).   Pregnancy cannot occur if there is no egg to join a sperm.

The birth control shot is one of the most effective methods of birth control available.  It works best when you get the shot regularly every 12 weeks.  Less than 1 out of 100 women will get pregnant each year if the shot is used as directed. If you get the shot within the first 7 days of your cycle, you are protected from pregnancy immediately. If you get the shot within 5 days after miscarriage or an abortion, or within 3 weeks after giving birth, you are protected from pregnancy immediately.  Otherwise you will need to use a backup method. Depo-Provera does not protect against STDs.

The IUD is a small, plastic device that is inserted and left inside the uterus to prevent pregnancy.

There are currently two types of IUD’s.
•    the hormonal IUD (www.mirena.com)
•    the copper IUD (www.paragard.com)

IUDs are among the most effective forms of birth control and unlike sterilization are reversible.  If you want to get pregnant the IUD can be removed.

Sterilization is a permanent method of birth control.

Sterilization procedures for women are called tubal sterilizations and involves closing the fallopian tubes to prevent the egg from moving down the fallopian tube and prevents the sperm from moving through the fallopian tubes to meet the egg.  It is a surgical procedure in which the tubes are closed off by being cut, tied, banded, clipped, or sealed with electric current. Tubal ligation is highly effective with less than 1 woman out of 100 who have the procedure will become pregnant in the first year.

Spermicides come in many forms—foams, jellies, gels, and Suppositories.  They work by forming a physical and chemical barrier to sperm. They are available without a prescription and are inserted into the vagina within an hour before intercourse. If intercourse is repeated, you will need to insert more spermicide. The active ingredient in most spermicides is the chemical nonoxynol 9. The failure rate for spermicides in preventing pregnancy when used alone varies from 20-30 percent. People who experience burning or irritation with these products should not use them. After intercourse, the spermicide has to remain in place for at least 6-8 hours to ensure that all sperm are killed. Don’t douche during this time.

The male condom prevents pregnancy by blocking the passage of sperm. A condom can be used only once. Some have a chemical added to kill sperm, usually nonoxynol-9. A condom prevents direct contact with semen, infectious genital secretions, and genital lesions and discharges. Most condoms are made from latex rubber, or a type of plastic called polyurethane, while a small percentage are made from lamb intestines (sometimes called “lambskin” condoms).

Except for abstinence, latex condoms are the MOST EFFECTIVE METHOD for reducing the risk of infection from the viruses that cause AIDS, other HIV-related illnesses, and other STDs. For people who are sensitive to latex, polyurethane condoms are a good alternative. Some condoms are pre-lubricated. These lubricants do not increase birth control or STD protection. Non-oil-based lubricants, such as water or K-Y jelly, can be used with latex or lambskin condoms, but oil-based lubricants, such as petroleum jelly (Vaseline), lotions, or massage or baby oil, should NOT be used because they can weaken the condom and cause it to break.

The female condom consists of a lubricated polyurethane sheath shaped similarly to the male condom. The closed end, which has a flexible ring, is inserted into the vagina, while the open end remains outside, partially covering the labia. The female condom, like the male condom, is available without a prescription and is intended for one-time use. It should not be used with a male condom because they both may slip out of place.

The sponge is a disk-shaped polyurethane device containing a spermicide (nonoxynol-9) or other agent. Inserted into the vagina to cover the cervix, the sponge is attached to a woven polyester loop for easier removal. It may be available again in the U.S. soon. The sponge protects for up to 24 hours and for multiple acts of intercourse within this time. It should be left in place for at least six hours after intercourse but should be removed no more than 30 hours after insertion because of the risk, though low, of toxic shock syndrome. This is a potentially fatal infection caused by a strain of the bacterium Staphylococcus aureus and in the past, more commonly associated with tampon use.

The diaphragm is a flexible rubber disk with a rigid rim.

Diaphragms range in size from 2 to 4 inches in diameter and are designed to cover the cervix during and after intercourse so that sperm cannot reach the uterus. Spermicidal jelly or cream must be placed inside the diaphragm for it to be effective. The diaphragm must be fitted by a health professional and the correct size prescribed to ensure a snug seal with the vaginal wall. If intercourse is repeated, additional spermicide should be added with the diaphragm still in place. The diaphragm should be left in place for at least six hours after intercourse. The diaphragm used with spermicide has a failure rate of 6 to 18 percent.

In addition to the possible allergic reactions or irritation common to all barrier methods, there have been some reports of bladder infections with this method. Toxic shock syndrome (TSS) is an extremely rare side effect.

The cervical cap is a dome-shaped rubber cap in various sizes that fits snugly over the cervix. It is used with a spermicide and must be fitted by a health professional. It is more difficult to insert than the diaphragm, but may be left in place for up to 48 hours. In addition to the allergic reactions that can occur with any barrier method, 5.2-27 percent of users in various studies have reported an unpleasant odor and/or discharge. There also appears to be an increase of irregular Pap tests in the first six months of use, and toxic shock syndrome (TSS) is an extremely rare side effect. The cap has a failure rate of about 6-18 percent.