Contraception I. Contraception Overview II. Effectiveness III. Contraception Methods

I. Contraception Overview Unprotected sex results in: PREGNANCY and transmission of STDs

Age Class Percent distribution Using contraception (contraceptors) Female sterilization Male sterilization Pill Implant Injectable Intrauterine device (IUD) Diaphragm Condom Female condom Periodic abstinence Natural family planning Withdrawal Other methods

II. Birth Control Methods Effectiveness Effectiveness =  Theoretical effectiveness –  Use-effectiveness –

III. Contraception Methods A. Fertility awareness methods B. Hormonal methods C. Barrier methods D. Permanent methods E. Other forms

A. Fertility Awareness Method Calendar Method, Natural Family Planning  An understanding of the female menstrual cycle is essential as a foundation for using this method  Advantage: no side effects, can be used by anyone  Disadvantages: Effectiveness = ~ pregnancies occur over 1 year out of 100 women using this method (for women who are properly trained)

B. Hormonal Methods 1) Oral Contraceptives (birth control pills) Most common used non-surgical method (17% of women) Suppresses natural ovarian cycle and endometrial cycle Creates an artificial cycle via synthetic estrogen and progestin Effectiveness -

Risks of Birth Control Pills Oral antibiotics may decrease the effectiveness of birth control pills. Therefore, a backup method of contraception should be used while taking antibiotics and until the next menstrual period after completion of the antibiotic Positive Side effects – less painful periods, decreased symptoms of PMS, increased bone density, potential protection from PID, ovarian cancer & endometrial cancer, increased cardiovascular protection Lack of protection against STDs

Types of Birth Control Pills 30 different brands available  monophasic –  biphasic - These have a fixed amount of estrogen, but there are two different strengths of progestogen in the dispenser. The first seven to 10 days are one strength (and one color). The next 11 to 14 tablets are another strength (and another color).  Triphasic –  Patch –

Minipills – Slightly less effective - ~ 3 pregnancies occur over a 1 year period in 100 women

2) Hormonal Implants a) Norplant – contains no estrogen, consists of six 1-2 inch flexible rods filled with synthetic progesterone  Effectiveness = Less than 1 pregnancy occurs over 1 year out of 100 women  Norplant is no longer available in the US due to insertion and removal complications… b) Now we have Implanon - single, thin, polymer rod, no bigger than a matchstick, that is inserted under the skin of a woman's upper arm  removal of the rod takes slightly longer than the insertion — about two minutes — but with the use of local anesthetic, most women describe "mild discomfort."

c) Depo-Provera – Effectiveness - Less than 1 pregnancy occurs over 1 year in 100 women Lack of protection against STDs

C. Barrier Methods 1) Spermicidal – cream, foam, film, suppository or gel Work as a mechanical barrier in that they are spread over the surface of the cervix & block access to cervical opening Effectiveness - ~ 26 pregnancies occur over 1 year out of 100 women

Spermicides should be inserted deep into the vagina, and the product should be left in place for at least 6 hours post intercourse

2) Diaphragm – Dome shaped latex cup, coated with spermicidal agent before being inserted into the vagina  Requires proper fitting by clinician 3) Cervical Cap – works like a small, deep diaphragm, fits snugly over the cervix

4) Condom  Thin sheath (preferably latex to also protect from transmission of disease-causing organisms) placed on the penis or, in the case of the female condom, within the vagina prior to intercourse  Male Condom – permits the male partner to take an active role in birth control Condoms are The only methods effective at preventing STDs  Lubrication may help reduce risk of irritation and increase pleasure  Effectiveness - About 14 pregnancies occur over 1 year out of 100 couples using male condoms, and about 21 pregnancies occur over 1 year out of 100 couples using female condoms

5) Contraceptive sponge - Soft synthetic sponge, saturated with a spermicide, which is moistened and inserted into the vagina, over the cervix, before intercourse Effectiveness - ~18 to 28 pregnancies occur over 1 year out of 100 women  This method was removed from the market due to contamination problems at the manufacturing facility a few years ago,

D. Permanent Methods Female sterilization  Tubal ligation Male Sterilization  Vasectomy Lack of protection against STDs

E. Other forms of contraception 1) Abstinence – 2) Coitus interruptus  This is an unreliable method. Lack of protection against STDs

3) Intrauterine Devices (IUD)  A small plastic or copper device, placed inside the woman's uterus by her health care provider, which changes the uterine environment to prevent pregnancy  Effectiveness = 1 to 3 pregnancies occur per year out of 100 women  Risks –  Lack of protection against STDs

4) Emergency Birth Control “morning-after pill” may prevent pregnancy by temporarily blocking  The morning-after pill is reserved for emergency situations and not as a regular method of birth control.  Emergencies include

Plan B (levonorgestrel) RU-486 (mifepristone) –Blocks progesterone, binds to progesterone receptors in the endometrium

Summary of effectiveness Abstinence100% Sterilization99.9% Estrogen + Progesterone Pill98% Progesterone Only Implant, injection95% IUD93% Sponge90% Diaphragmw/jelly 90% Cervical Cap85% Male Condom85%* Female Condom85%* NFP78% Spermicidal products75% Coitus interruptus75%