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 4 th 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/powders on 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 - Depo Provera “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 1 st 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 for 3 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 1 st 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 years of 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