1. Contraception
Chapter 6

2. Principles of Contraception
Types of contraception:
Hormonal methods work by suppressing ovulation, thickening the cervical mucus, or thinning the endometrium
Barrier methods are physical barriers to conception
Natural methods make use of a woman’s fertile time of the month
Surgical methods involve a medical visit and whole body or local anesthetics

3. Effectiveness
Contraceptive failure rate- % of women experiencing an unintended pregnancy in the 1st yr. of contraceptive use
Continuation rate- % of people who continue to use the method after a specified period of time

5. hormonal Methods

6. Oral Contraceptives: The Pill
Hormonal contraceptive
Mimics the corpus luteum
releases estrogen & progestin (combination pill)
Most common type of birth control
Advantages: Easy to use, effective, fertility returns after use
Disadvantages : no protection against STD’s, exp. symptoms of pregnancy, prescription required, stroke, blood clots in older women who smoke

7. Contraceptive Skin Patch
Hormonal contraceptive
Releases estrogen and progestin into bloodstream
Prevents pregnancy the same way as OCs
Worn for 1 week, replaced on the same day for 3 consecutive weeks. 4th wk. no patch
Advantages: same as OC’s, week long protection
Disadvantages: same as OC’s; skin irritation

8. Vaginal Contraceptive Ring
Hormonal contraceptive
Flexible vaginal ring molded w/ progesterone and estrogen
releases estrogen and progestin into bloodstream
Worn for 3 wks., removed at start of 4th wk. (ring free) new ring inserted same day, following wk.
Advantages : 1 month of protection, no daily/weekly action required
Disadvantages : similar to OCs and patch

9. Contraceptive Implants
Hormonal contraceptive
Placed under skin of upper arm/leg
Delivers progesterone over a period
of 4 years
Advantages: Highly effective, no further action required after insertion, contains no estrogen, so no estrogen related side effects
Disadvantages: no protection against STDs, menstrual irregularities, uncomfortable appearance, requires medical visit to start or stop use

10. Injectable Contraceptives
Depo-Provera
Injectable progestin every 12 weeks
Provides protection like implants
Advantages: Highly effective, requires little action on part of user ; No estrogen- related side effects, minor injection
Disadvantages: requires medical visit to start or stop use (every 3 months), weight gain, infertility after stopping use

11. The Intrauterine Device (IUD)
Small plastic device placed in the uterus
ParaGard (copper; protects up to10 yrs.)
Mirena (protects up to 5 yrs.)
Releases small amounts of progestin
Advantages: highly reliable, once inserted a simple check of string is all that’s needed; reduced risk of endometrial cancer; fertility restored after use
Disadvantages: heavy menstrual flow, uterine cramping, backache, spontaneous expulsion, requires medical visit to start or stop use

12. Emergency Contraception
“Morning-after Pill”, Plan B
Should not be used as a contraceptive but can be used if birth control has failed, if forced to have sex, etc.
Most common is the two dose regimen
Needs to be taken within 72 hrs. but best when used within 24 hrs.
May inhibit/delay ovulation or altering the transport of sperm/egg; does not affect a fertilized, implanted egg

13. Figure 6.1 An IUD properly positioned in the uterus
Figure 6-1: An IUD (Copper T-380A) properly positioned in the uterus.

14. Barrier Methods

15. Male Condoms Thin latex, or polyurethane
Most widely used barrier method
Advantages: Protects against pregnancy and STD’s, easy to purchase, no prescription
Disadvantages: Most common complaints are reduced sensitivity and having to apply it right before intercourse

16. Female Condoms Polyurethane sheath with two flexible rings
Advantages: offers potentially more protection against genital warts and herpes b/c it covers base of penis
Disadvantage: more expensive, more difficult to use

17. Figure 6.3 The female condom
Figure 6-3 The female condom properly positioned

18. Natural Methods

19. Abstinence Abstinence
Without sexual intercourse for a chosen period of time
Benefits
Less worry about STDs and Pregnancy

20. The Fertility Awareness Method
Only one egg released each month
Lives for ~ 24 hrs. unless fertilized
Sperm can live in the body for 6-7 days
Approximately 5 days/month when conception can happen
Fertility Awareness method (FAM)
Calendar method
A woman releases an egg days before her next period
Temperature method
A woman’s BT drops slightly before ovulation and rises slightly after
Withdrawal
Coitus interruptus

21. surgical Methods

22. Vasectomy Severing of the vas deferentia
Semen still produced, but w/o sperm
Takes ~ 30 min. and can return to work in 2 days.

23. Tubal Sterilization
Tubal sterilization (laparoscopy) is most commonly known as tubal ligation
An invasive surgical procedure that can have severe side effects like heavy bleeding, weight gain, decreased sex drive, etc.

24. Figure 6.8 Tubal sterilization

25. Which Contraceptive Method is Right for You?
Key considerations include:
Health risks
Implications of an unplanned pregnancy
STD risk
Convenience and comfort level
Type of relationship
Ease and cost of obtaining and maintaining each method
Religious or philosophical beliefs