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1. Choosing a contraception that’s right for u w w w . s e x u a l i t y a n d u . c a

2. s e x u a l i t y a n d u . c a Unintended Pregnancies Unintended pregnancies with various contraceptive methods Numbers given are pregnancies for every 1000 women during first year of use Adapted from Trussell et al, 2004.

3. Oral contraceptives s e x u a l i t y a n d u . c a What are they? • Prescription tablets taken once a day • There are two main types: 1. Combination pill which contains two female hormones similar tothe body’s own estrogen and progesterone 2. Progestin-only pill (or mini-pill) which does not contain estrogen • Available under a variety of brand names with various strengths and formulations How do they work? • Stop the release of a mature egg • Thicken the cervical mucus making it difficult for sperm to get to the egg • Change the lining of the uterus making implantation difficult Failure rate: 80 per 1000 women per year

4. Oral contraceptives s e x u a l i t y a n d u . c a What are the advantages? 1. One of the most effective reversible birth control methods when taken consistently and reliably 2. Simple and easy to use 3. Regulates menstrual cycle and reduces cramps 4. Does not interfere with intercourse 5. Decreases acne 6. Reduces the risks of endometrial and ovarian cancer 7. May reduce perimenopausal symptoms

5. Oral contraceptives s e x u a l i t y a n d u . c a What are the disadvantages? 1. Must be taken every day. The progestin-only pill must be taken at the same time every day 2. May cause irregular bleeding or spotting 3. Effectiveness may be reduced by other medications 4. Should not be used by women over the age of 35 who smoke 5. May increase the risk of blood clots, particularly in women who have certain blood disorders or a family history of blood clots 6. Does not protect against STIs 7. May increase the number of headaches 8. May not be suitable for breastfeeding women

6. Transdermalpatch s e x u a l i t y a n d u . c a What is it? • A patch that releases hormones through the skin • Can be placed on the buttocks, upper outer arms, lower abdomen, or upper torso excluding the breast • A new patch is applied once a week for three weeks followed by one week without a patch How does it work? • Prevents the ovary from releasing an egg • Thickens the cervical mucus making it difficult for sperm to get to the egg • Changes the lining of the uterus making implantation difficult Failure rate: 80 per 1000 women per year

7. Transdermalpatch s e x u a l i t y a n d u . c a What are the advantages? 1. A reversible and highly effective birth control method 2. Once-a-week regimen; no daily contraceptive routine required 3. Simple and easy to use 4. Regulates menstrual cycle and reduces cramps 5. Does not interfere with intercourse 6. Expected to provide other benefits similar to oral contraceptives; research is needed

8. Transdermalpatch s e x u a l i t y a n d u . c a What are the disadvantages? 1. May cause irregular bleeding or spotting 2. May cause breast sensitivity or headache 3. Does not protect against STIs 4. Patch may detach from skin (less than 2%) 5. Possible skin irritation at the application site

9. Vaginal ring s e x u a l i t y a n d u . c a What is it? • A flexible, nearly transparent ring that measures 54 mm (about 2 inches) across • The ring releases a continuous dose of hormones for three weeks while it is in the vagina How does it work? • Prevents the ovary from releasing an egg • Thickens the cervical mucus making it difficult for sperm to reach the egg • Changes the lining of the uterus making implantation difficult Failure rate: 80 per 1000 women per year

10. Vaginal ring s e x u a l i t y a n d u . c a What are the advantages? 1. A reversible and highly effective birth control method 2. Once-a-month regimen; no daily contraceptive routine required 3. Regulates menstrual cycles 4. Does not interfere with intercourse 5. Does not require daily attention 6. Expected to provide other benefits similar to oral contraceptives; research is needed

11. Vaginal ring s e x u a l i t y a n d u . c a What are the disadvantages? 1. Does not protect against STIs 2. May cause irregular bleeding or spotting 3. May cause side effects such as headache, nausea, or breast tenderness 4. May cause vaginal discomfort 5. The ring may be expelled from the vagina but this is uncommon

12. Injectable contraceptives s e x u a l i t y a n d u . c a What is it? • It contains a hormone called progesterone; it does not contain estrogen • The injection is given in the upper arm or buttocks every 12 to 13 weeks (four times a year) How does it work? • Prevents the ovary from releasing an egg • Thickens the cervical mucus making it difficult for sperm to get to the egg • Changes the lining of the uterus making implantation difficult Failure rate: 30 per 1000 women per year

13. Injectable contraceptives s e x u a l i t y a n d u . c a What are the advantages? 1. One of the most effective reversible birth control methods available 2. Does not contain estrogen 3. No daily contraceptive routine required; 1 injection lasts for 3 months 4. Effectiveness is not reduced by other common medications 5. May be suitable for breastfeeding women or women who smoke 6. With continued use, menstrual cycles cease in over half of users after the first year, and two-thirds of users after two years of use 7. Improves symptoms of endometriosis 8. Reduces the risk of endometrial cancer 9. Effective immediately when given during the first 5 days of a normal menstrual period

14. Injectable contraceptives s e x u a l i t y a n d u . c a What are the disadvantages? 1. Initially, irregular bleeding is the most common side effect 2. Decrease in bone mineral density which may be reversible when a woman stops taking the injection. Calcium supplementation is advised. 3. May be associated with weight gain in some women 4. Takes an average of nine months after the last injection for the ovaries to start releasing eggs again 5. Does not protect against STIs 6. The lack of a monthly period may be bothersome for some women

15. Intrauterine system (IUS) s e x u a l i t y a n d u . c a What is it? • A T-shaped device that contains a hormone called levonorgestrel • The hormone is released slowly over time and acts on the lining of the uterus • It is inserted into the uterus by your physician in the doctor’s office • Two threads may be felt in the vagina, so a woman can check for herself to ensure that the IUS is still in place How does it work? • Thickens the cervical mucus making it difficult for sperm to reach the egg • Causes changes in the lining of the uterus that helps to prevent implantation • In some women, it may prevent the ovary from releasing an egg Failure rate: 1 per 1000 women per year

16. Intrauterine system (IUS) s e x u a l i t y a n d u . c a What are the advantages? 1. Long-acting contraceptive; can be left in place for up to five years 2. No daily contraceptive routine required; device provides five years of contraception 3. Does not contain estrogen 4. Does not interfere with intercourse 5. Regulates menstrual cycle and reduces cramps 6. May be suitable for women who are breastfeeding 7. May reduce pain due to endometriosis 8. May lower the risk of precancerous cells developing in the lining of the uterus 9. Some users will stop having menstrual cycles during insertion period

17. Intrauterine system (IUS) s e x u a l i t y a n d u . c a What are the disadvantages? 1. Possible side effects include irregular bleeding or spotting in the first months after insertion 2. Perforation of the uterus may occur at the time of insertion, but this is rare 3. May be expelled from the uterus, which happens with 6% of IUS users 4. Does not protect against STIs 5. Requires a physician for insertion and removal

18. s e x u a l i t y a n d u . c a Side-Effects of Hormonal Contraception Sideeffects that may occur during the first few months on hormonal contraception include : irregular bleeding, spotting nausea mood swings bloating breast tenderness headaches

19. s e x u a l i t y a n d u . c a Side-Effects of Hormonal Contraception Reason: Your body is getting used to birth control Fluctuating hormone levels when you start When will it stop? Most symptoms are normal and will decrease or stop in the first 2-3 months. If they bother you or don’t get better: Talk to your healthcare provider There might be a method that’s better suited for you.

20. s e x u a l i t y a n d u . c a Myths and Misconceptions about Hormonal Contraception Common myths and misconceptions Causes weight gain Causes acne Causes infertility Causes birth defects Should take a break from time to time Smokers should not be taking it Women over age 35 should not take the Pill No need for condoms if you’re on the Pill

21. s e x u a l i t y a n d u . c a What To Ask Your Healthcare Provider • Following are some questions you might want to ask regarding your sexual health. A good idea is to make a list before you visit. • Birth control related: • How do I know what birth control method is best for me? • How to take your method • How to deal with missed pills, patches, rings, or injections • What are the side-effects? Which are normal and how can I cope with them. • General women’s health • Should I get a mammogram? How do I know if I'm doing my breast self-exam correctly? • How often do I need a Pap smear or gynecological check-up? • How do I know if my period is normal? • Should I be tested for AIDS or other STIs?

22. s e x u a l i t y a n d u . c a What Your Healthcare Provider May Ask You • Be prepared to answer questions about: • Medical history (surgeries, vaccines, menstrual cycle, etc) • Medications you are taking • Allergies • Family history (medical conditions like diabetes, heart problems) • Lifestyle • Sexual practices • Don't be embarrassed to tell the truth or ask a question. They are professionals and the information is required to give you the best care possible.