On-Line Contraceptive Class

1. On-Line Contraceptive Class Eastern Illinois University Health Service

2. Objectives • Upon completion the student will… • Be knowledgeable of the annual gynecological exam process • Understand the necessity of annual gynecological exam • Learn about current contraceptive options • Be aware of common benefits and possible adverse reactions of contraceptive use

3. The Gynecological Appointment • During the gynecological appointment you may receive the following… • Pap Smear • Pelvic Exam • Chlamydia testing • Breast Exam • Thyroid assessment • Heart and lung assessment with a stethoscope • Abdominal exam • Sexually Transmitted Infection Screening

4. Pap Smear ScreeningDefined • The pap smear is a screening test on cells from the uterine cervix (mouth of the uterus). • Many types of cells can be identified and examined for abnormalities. • Over a long period of time, a small percentage of untreated abnormal cells may result in progressively severe changes or even cancer of the cervix. • Regular pap smears may lead to earlier detection and treatment of abnormal cervical cells.

5. Pap Smear Recommendations • It is currently recommended that young women age 21 and older receive a pap smear even if they are not sexually active. • Women not age 21 who are sexually active should have an initial pap smear screening within 2-3 years of first intercourse. • At EIU health service most women requesting hormonal contraceptives who are sexually active, will be required to have a pap smear and chlamydia testing.

6. The Pap Smear • During the pap smear your health care provider will place a small instrument called a speculum into the vagina. The speculum will allow the provider to visualize your cervix. • A small soft cervix brush is used to remove loose microscopic cells from the outer surface and inner transformation zone of the cervix.

7. The Pap Smear • The cells are then placed into a preservative solution and sent to a pathologist for evaluation. • At EIU we use the SurePath pap test. • At EIU the wait for pap smear reports is approximately 2-3 weeks.

8. The Pelvic Exam • This is an examination of the uterus, fallopian tubes and ovaries. Each of these will be examined for size, position, tenderness, and abnormal growths. • During the pelvic exam the provider will place two fingers into the vagina to move the organs to be examined while pressing down with the other hand over your abdomen. • This will be done with all Pap Smears and STI exams.

9. The Breast Exam • This exam should be done annually by your health care provider. • You will be instructed on how to do a self breast exam. • The best time to do a breast exam is just after your menstrual period. • Any changes in breast tissue should be evaluated by your health care provider.

10. Monthly Self Breast Exam • Breast self-exam is the best way to detect abnormal lumps or changes in the breast. • Your ability to detect changes will improve with practice so be sure to examine your breasts every month.

11. Sexually Transmitted Infections (STI) • These infections are spread through sexual contact with infected persons. • There are several types of STIs. • If a treatment is available, the type or method will depend upon the particular infection. • Many STIs can be spread even when a condom is utilized. • Abstinence is the best way to ensure safety from sexually transmitted infections. • Many people with STIs are asymptomatic and therefore are not aware of the infection and can spread the infection to a partner.

12. Screening For STIs • Current CDC recommendations advise annual chlamydia testing for all sexually active females age 17-25. • A laboratory test for chlamydia is obtained during all pap smear appointments at EIU health service. A female student may choose to add additional STI screenings to her pap smear appointment for a small fee. • STI screening without a pap smear is available to male and female students for a fee.

13. Screenings Available at EIU • Standard STI/Vaginal infection exam • Chlamydia • Gonorrhea • Trichamoniasis • Syphilis (blood test) • Yeast and Bacterial Vaginosis (These are not STIs)

14. Bacterial STI’s Chlamydia- Don’t let yourself become a number • According to the U.S. Centers for Disease Control and Prevention, 40 percent of Chlamydia cases are reported among young people 15 to 19 years old. • Research has shown that women infected with Chlamydia are three to five times more at risk of acquiring HIV if exposed to the virus than women not infected.

15. Bacterial STI’s Gonorrhea- When the numbers get personal • Gonorrhea is a curable sexually transmitted disease (STD), second only to Chlamydia as the most frequently reported STD in the U.S. • Women ages 15 to 19 are at greatest risk for gonorrhea. In the U.S., approximately 7.5 percent of all reported gonorrhea is found in younger persons aged 15 to 19 years of age. The highest rates of infection are usually found in 15 to 19-year-old women and 20 to 24-year-old men. • Approximately 50 percent of women infected with gonorrhea have no symptoms. Diagnosis most often results from partner notification as a result of infection in men, which usually produces symptoms. • Up to 40 percent of women with gonorrhea who are not treated will develop pelvic inflammatory disease (PID). About 20 percent of women with PID become infertile and 18 percent experience chronic pelvic pain.

16. Additional STI Concerns Viruses: • Herpes Simplex Virus– can be identified by visual inspection when symptoms are present. Testing is available to aid in diagnosis and typing of the virus. • Genital Warts (HPV) – can be identified by visual inspection and treated when they are present. • Cervical HPV – the pap smear is the best detection for this infection.

17. Gardasil • Gardasil is a vaccine indicated in girls and women 9-26 years of age for the prevention of certain diseases caused by HPV (Human Papilloma Virus) types 6, 11, 16 and 18. • These diseases include cervical cancer, genital warts and precancerous cervical lesions.

18. Gardasil Continued • Gardasil vaccine is a series of 3 injections given over a 6 month period • Gardasil is available at Health Service • Currently only women can receive this vaccine • Please call or come to Health Service for more information regarding this vaccine.

19. HIV Testing • HIV testing is available at the Coles County Health Department. • At the Coles County Health Department, the HIV sample is obtained with a soft mouth swab. • The testing is free and anonymous. • Business cards for this service are available at health service. • Information is also available through the tele-nurse (581-2727).

20. Viral STI’s Genital Herpes- When the numbers get personal • An estimated two out of every three persons infected with genital herpes don’t know they are infected because they have no visible or no recognized symptoms. • Up to 30 percent of genital herpes infections are caused by HSV-1 (oral herpes), primarily resulting from oral-genital sex. • Although herpes vaccine research is being conducted, no vaccine is currently available.

21. Contraceptive Choices • Abstinence is the only method of contraception that is 100% effective • With the continual rise in sexually transmitted infections and the risk of unplanned pregnancy, abstinence is a valuable option.

22. Barrier Contraception • Male Condom • 97% effective when used correctly • Available at EIU pharmacy • 6 condoms/$1.00 • Female Condom • 95% effective when used correctly • Available at local pharmacies • Diaphragm • 94% effective when fitted and used correctly • Fitting available at EIU health service

23. Effectiveness of Condom Use • Of 100 women whose partners use condoms, about 14 will become pregnant during the first year of typical use. (“Typical use” refers to failure rates for women and men whose condom use is not consistent or always correct.) Only two will become pregnant with perfect use. (“Perfect use” refers to failure rates for women and men whose condom use is consistent and always correct.) • Perfect use is the KEY WORD and is something many people fail to do correctly EACH TIME. • The latex condom offers better protection against STI’s than any other birth control method. It inhibits exchange of body fluids that may be infected.

24. Barrier Methods Male Condom 97% effective – perfect use 85% effective – typical use Diaphragm 94% effective – perfect use 84% effective – typical use Female Condom 95% effective – perfect use 79% effective – typical use Withdrawal 96% effective – perfect use 73% effective – typical use Hormonal Methods Depo-Provera 99.7% effective – perfect use 97% effective – typical use The Pill 99.7% effective – perfect use 92% effective – typical use Nuva Ring 99.7% effective – perfect use Unknown – new product Comparing Birth Control Methods

25. Safe with All Condoms: Aloe-9® Aqua Lube ® AstroGlide ® deLube ® ForPlay ® Glycerin Gynol II ® H-R lubricating jelly K-Y ® Jelly PrePair ® Ramses ® Personal Spermicide Silicone lubricant Spermicides Touch ® Personal Lubricant Water and saliva Wet ® Egg whites Unsafe with Latex Condoms: Baby oil Cold creams Cornhuskers ® lubricant Edible oils (olive, peanut, corn, sunflower) Hand and body lotions Massage oils Mineral oil Petroleum jelly Shortening Suntan oil and lotions Bag Balm ® Whipped cream Certain vaginal yeast infection medications A Guide to Condom Lubrications

26. Hormonal Contraceptives at EIU Health Service • Combination • Oral – Birth Control Pills, both monthly cycle and extended cycle types • Vaginal Ring – Nuva-Ring • Progesterone only • Injectable – Depo-Provera • Oral - Errin (Generic Mircronor)

27. Combination Hormonal Contraceptives • These contraceptives contain various amounts of estrogen and progesterone. • These hormones are normally present in females and work to regulate the female reproductive cycle. • In hormonal contraceptives, estrogen and progesterone are used to suppress egg (follicle) production and fertilization. They also work by thickening cervical mucus thus blocking sperm from reaching an egg.

28. Benefits for combination hormonal contraception • Many known benefits exist. Some include… • Regulation of menses • Reduction of menstrual cramps • Prevention of pregnancy • Reduction of ovarian cysts • May improve bone density • Reduced occurrence of iron deficiency anemia • Prevention of non-cancerous breast diseases • May play a role in the prevention of rheumatoid arthritis

29. Risks/Side Effectsfor combination hormonal contraception • Side effects may include nausea, breast tenderness, weight changes, mild spotting, changes in libido, and changes in mood. • These symptoms are generally mild and should subside within 2-3 cycles. • If they do not subside by the end of the third cycle make an appointment to discuss this with your healthcare provider.

30. Adverse Eventsfor combination hormonal contraception • Certain physical or mental changes warrant alerting your healthcare provider. • These include (ACHES): • A stands for abdominal pain • C stands for chest pain, cough, or shortness of breath • H stands for headache, dizziness, or weakness • E stands for eye problems, vision loss or blurring • S stands for severe leg pain in calf or thigh (due to potential blood clot)

31. Potential Medication Interactionsfor combination hormonal contraception • Antibiotics • Some interfere with the combined hormonal contraception. Always ask the pharmacist. • Antacids – Tums, Rolaids, Maalox, etc • Avoid use within two hours of taking oral contraceptives. • Anticonvulsants – controls seizure and epilepsy • May reduce the effectiveness. Talk to the prescribing doctor prior to initiating any hormonal contraception.

32. Smoking • When taking any of the combination hormonal contraceptives, smoking is not advised. • Smoking significantly increases the likelihood that an adverse event, such as a blood clot, can occur. • Smokers over the age of 35 have an even higher risk of experiencing an adverse event.

33. Oral Contraceptives • When taken correctly oral contraceptives are 99% effective in prevention of pregnancy. • Oral contraceptives do not prevent the transmission of STIs.

34. Oral Contraceptives • At EIU pharmacy most oral contraceptives contain both estrogen and progesterone. • Errin (generic Micronor) is a progesterone only oral contraceptive pill available at EIU pharmacy. It may inhibit ovulation but mainly works to thicken cervical mucus. • Progesterone only pills may not be as effective as estrogen and progesterone combination pills.

35. Oral Contraceptives When to start? • Day 1 start – You may start the first pill on the 1st day of your menstrual cycle. You will not need additional contraception for this method. • Sunday Start – You may start the pill on the Sunday after your period starts. If you use this method, you will need to use another form of contraception for first 7 days (ie. condom).

36. Oral ContraceptivesWhen to start? • Anyday start – In many instances you may be able to start your first pill any day of the month. Please discuss this option with your women’s health provider.

37. Considerations When Taking the Pill • Schedule the pill –take the pill at the same time everyday. • Take the pill after a meal – this will minimize nausea and vomiting. • If you are consistently nauseated – take the pill in the evening at bedtime.

38. What If I Forget to take the pill?(first of two pages) • 1 missed pill – take it as soon as you remember. Take the next pill at the regular time. You do not need to use back-up contraception. • When more than one pill is forgotten, use additional contraception for 7 full days. • 2 missed pills - during week 1 or 2, take two pills on the day you remember and two pills the next day. Then take one pill daily. • 2 missed pills – week 3, for Sunday starters take one pill daily through Sunday. Begin new pill pack on Sunday. For day one starters, discard remaining pills and start new pack.

39. Missed PillsContinued • 3 or more missed pills – Sunday starters take one pill per day until Sunday and start a new pack on Sunday. For day one starters, throw away remaining pills and start a new pack. • For most oral contraceptive packs the pills in week 4 are reminders. They do not contain any contraceptive medication. Throw away any forgotten pills from week 4. • If you are confused, always use back up contraception until you speak with a nurse or provider at health services.

40. Aviane (generic Alesse) Cryselle (generic Lo/Ovral) Cyclessa Desogen Errin (generic Mircronor) Jolessa (generic Seasonale 91 day pack) Junel FE 1/20 and 1.5/30 (generic Loestrin) Kariva (generic Mircette) Nortrel 7-7-7 (generic Ortho Novum 7-7-7) Nortrel .5/35 (generic Modicon)) Nortrel 1/35 (generic Ortho Novum 1/35) Ortho-Tri-Cyclen Lo Portia (generic Nordette) Previfem (generic Ortho-Cyclen) Tri-Levlen (generic Triphasil) Tri-Previfem (generic Ortho Tri-Cyclen) Oral Contraceptives available at EIU pharmacy

41. NuvaRing – “The Ring” • Is a small (about 2” diameter), soft ring that is inserted into the vagina • Works similarly to combination oral contraceptives • Like birth control pills, the Nuva-Ring is highly effective in preventing pregnancy when used correctly. • While the ring is worn, it continuously delivers hormones to the vaginal wall and into the bloodstream

42. NuvaRing Unique Benefits/Side Effects • Benefits • Once per cycle dosing • Discreet • Side Effects • Increased vaginal discharge

43. NuvaRing What To Do • Ring is inserted and left in place for 21 days • After 21 days, ring is removed and period occurs • New ring is inserted after 7 days without one • Ring conforms to the body; very few women have the ring fall out • Most women (and their partners) cannot feel the ring • Check with health care provider about when to insert

44. NuvaRing When to start? • If you are currently on the pill/patch start when you would normally begin a new pack at the end of your cycle. • If you are not currently using hormonal contraception… • Counting the first day of your menstrual period as “Day 1” insert your first Nuva-Ring between day 1 and day 5 of your menstrual period. • Insert the ring by no later than day 5 even if you are still bleeding.

45. NuvaRing How to insert? • You just squeeze the nuvaring between your fingers and insert it into the vagina. • It does not need to be in any special location to be effective. • Can be placed inside tampon applicator to insert. • To remove, just insert your finger and take it out.

46. NuvaRing What if it falls out? • Less than 2.2% of users have reported problems with the ring falling out. • If the ring falls out or gets pulled out just rinse with warm water and re-insert.

47. Review of Combined Hormonal Contraception Available at EIU • Oral contraceptives and NuvaRing (vaginal ring) are available at EIU pharmacy. • All of these methods are highly effective in preventing pregnancy when they are used correctly. • Hormonal contraception does not protect against HIV infection and other sexually transmitted infections.

48. Common Question • How long can I continue to take the pill? It is not necessary to “take a break” from the pill or ring. Some experts believe that the risks identified with these types of contraception start to rise after age 30, especially if you smoke.

49. Common Question • Will the use of hormonal contraception affect my future fertility? Approximately 80% of women regain normal fertility within three months after discontinuing the pill, 95% within one year. Use of oral contraception may increase fertility by decreasing the incidence of ovarian cysts and pelvic inflammatory disease.

50. Depo-Provera “The Shot” • Depo-Provera, “the shot” is a progesterone only injection widely utilized for contraception. • When used correctly, it is one of the most effective methods for preventing pregnancy. • The injection is effective for at least 12 weeks.