Birth Control Methods/Forms

1. Birth Control Methods/Forms Mrs. Farver Health

2. Key Turning Points in History • 1937: America Medical Association ends the 25 year opposition to contraception; recognized that birth control needs to be taught in medical school. • 1960: BIRTH CONTROL PILL becomes available in the in the U.S. • 1966: Griswold Decision: Supreme Court declares laws prohibiting sale and use of contraceptive are unconstitutional.

3. Hormonal Birth Control • Requires a Prescription from a Doctor • Exception is morning after pill if you are 18 or older • Suppresses ovulation • Uses doses of estrogen and progestin to regulate cycle an assure no release of the egg from the ovary • Thickens cervical mucus • Thins endometrium • Slows tubal motility

4. Hormonal – The Pill (oral contraception) • 21 day, 28 day, or seasonal packs • 1 pill is taken daily • Time sensitive, the pill is to be taken at the same time every day Effectiveness: • Perfect Use Failure Rate in First Year: 0.1% (of every 1,000 women who take pills for one year 1 will become pregnant in the first year) • Typical Use Failure Rate in First Year: 5 % (of every 1,000 women who take pills for one year 5 will become pregnant in the first year)

5. The Pill (cont.) ADVANTAGES • Regulates menses • Decreases blood loss/ menstrual cramps • No disruption at time of intercourse • Decrease risk of ovarian/endometrial cancer • Treatment for acne DISADVANTAGES • Mood Changes, depression, anxiety • Daily pill taking may be stressful • No Protection against STI (Sexually Transmitted Infections), including HIV • Nausea, breast tenderness, especially in the first few cycles • Weight gain

6. Hormonal – Ortho Evra (The Patch) • 1 Patch a week, for 3 weeks • 4th week patch free, Menstruation • Usually worn lower abdomen or buttocks Effectiveness: • Perfect Use Failure Rate in First Year: 1 women of every 1,000 women will become pregnant in the first year • Overall Failure Rate: ?

7. Ortho Evra Cont. Advantages: • Menstrual (Similar to the Pills) • Nothing to do on a daily basis • No disruption at time of intercourse Disadvantages: • Mood Changes, depression, anxiety • No Protection against STI (Sexually Transmitted Infections), including HIV • Nausea, breast tenderness, especially in the first few cycles • Weight gain • Cannot use if breastfeeding

8. Ortho Evra – The Patch Special Considerations: • Avoid placing the patch on exactly the same site two consecutive weeks • NEVER PLACE PATCH ON THE BREAST!!! • Location of patch should not be altered mid-week • No band aide, tattoos or decals on top of patch as it may alter absorption of hormones • It is unknown if tanning beds interfere with efficacy • Avoid placing lotion/creams/powderson site

9. Hormonal – Nuva Ring • Thin flexible transparent ring • Left in place in the vagina for three weeks and removed for a week to allow a menstrual period the fourth week. • Maintains a steady low release rate while in place. Effectiveness: • Overall pregnancy rate:1.2 per 100 women

10. Nuva Ring Advantages: • Only TWO TASKS: Insertion/Removal 1x month • Steady even hormonal levels in blood are achieved • Privacy/No visible patch or pill packages • 95% of women say they cannot feel device Disadvantages: • Some women dislike placing/removing objects into/out of their vagina • Adverse side effects similar to the pill • Could Fall Out

11. Hormonal - DepoProvera “The Shot” • Injected intra-muscularly into the deltoid or gluteus-maximums every 11 to 13 weeks. • Progestin only • Four times a year Effectiveness: • Perfect use failure rate in first year: 0.3% • Typical use failure rate in first year: 3%

12. DEPO Continued Advantages: • Less menstrual blood loss and anemia • After one year 50% of users will develop amenorrhea • 80% will develop amenorrhea in 5 years • Only need to remember 1x every three months Disadvantages: • Irregular menses during first several months • Unpredictable spotting and bleeding • Possible weight gain: Progressive-Significant (5.4 1st year, after 5 years 16.5) • Patient fear of pregnancy or build up of menses in uterus if not explained well • Decreased libido • Fear of needles • Return to fertility is long average 10 months from last injection

13. Hormonal and Non-Hormonal – Intrauterine Device (IUD)Paraguard or Mirena • T-shaped device with two flexible arms that bend down for insertion but open into the uterus. • Two straw-colored strings protrude through the cervix into the vaginal canal

14. IUD – Mirena (Hormonal) Mechanism: Mirena • Progestin Only • Causes cervical mucus to become thicker then by preventing sperm from moving up the reproductive track • Prevents implantation • Cumulative 5 year failure rate: .7%

15. IUD - Mirena Advantages: • After 3-4 months it decreases menstrual blood loss more than 70% • Amenorrhea: 20% by 1 year, 60% by 5 years • Reduced risk PID, ectopic pregnancy by 60% • As effective, or more effective than female sterilization • Long lasting method, up to 5 years • Immediate return to fertility Disadvantages: • Possible expulsion • Acne, Headaches, discomfort after insertion or removal • Risk of PID increased • Ovarian cysts, most regress spontaneously

16. IUD – Paraguard (Non-Hormonal) Mechanism: Paragard • Works by preventing fertilization • Works primarily as a spermicide,Copper ions inhibit sperm motility so they rarely reach the tube • Cumulative 10 year failure rate:2.1-2.8%

17. IUD - Paraguard Advantages: • Effective long term (10 years) contraception from a single decision. • Requires no action at time of intercourse • Cost effective • Rapid return to fertility • Good option for women who cannot use hormones • 95% user satisfaction, the highest of any other contraceptive currently begin used by women. Disadvantages: • Blood loss during menstruation increased by 35% and increase cramping • Must check strings monthly after menstruation • Requires office procedure for insertion and removal, can be uncomfortable • Increase risk of infection PID • Uterine perforation • May be expelled

18. Hormonal - Implanon • Progestin only • Thin, flexible, plastic implant about the size of a matchstick. • Inserted under the skin by the bicep muscle. • Implanted in the arm for3 years. • Constantly releases progestin into the bloodstream • Suppresses ovulation

19. Implanon Advantages: • Insertion only takes a few minutes • Protection against pregnancy is immediate if you get the implant during the 1st five days of your period • Ability to get pregnant is immediate after removal • Gives continuous long-lasting birth control without sterilization • No medicine to take every day Disadvantages: • Irregular bleeding is the most common side effect • Periods become lighter and may stop altogether or periods may become heavier and last longer • Some women will have longer heavier periods • Acne, change in appetite, or sex drive • Pain at the site of insertion

20. Emergency Hormonal Contraception – Plan B (Morning After Pill) Description: • Progestin Only (More effective less side effects than combine EC) • ASAP, but can be used up to 120 hours, sooner is better • Pills must be taken 12 hours apart • Over-the-counter for women ages 18 and over • FDA recently passed a ruling allowing EC to be OTC for women beginning at 17 yearsof age, but it has not gone effect as of yet • There is no limit to the number times in a year a woman can use EC, but it is not to be used in place of birth control (it is also expensive).

21. Plan B – Morning After Pill Advantages • Opportunity to prevent pregnancy after, rape, mistake or method failure • Reduces anxiety • Process attaining EC may initiate women to use ongoing Disadvantages • Time limitation • Next menses may be early • Notable changes in flow for next menses • Not as effective as other forms of birth control • Can be more expensive • 23% experience nausea few experience vomiting

22. Non-Hormonal Birth Control • Cervical Cap/Diaphragm – Need a doctor to size for you • Male Condom • Female Condom • Spermicide • Withdrawal Method • Natural Family Planning • Abstinence – the only 100% effective birth control