1. Birth Control: what works best for YOU? Slides adapted from Ruth Lesnewski MD; FMDRL.org Katy Kropf DO Heritage College of Osteopathic Medicine November 28, 2012 For The Birth Circle, Athens, OH

2. Nearly half of pregnancies in the United States are unintended. 52 % Intended 25 % Unintended Used Contraception 23 % Unintended No Contraception Henshaw SK. Fam Plann Perspect. 1998;30(1):24-9, 46. Rosenberg MJ, Waugh MS, Long S. J Reprod Med. 1995;40(5):355-60. Potter L, et al. Fam Plann Perspect. 1996;28(4):154-8.

3. If no method is used to prevent pregnancy, what is the typical risk of pregnancy after 1 year?

4. Emergency Contraception: Levonorgestrel (Plan B One-Step) Take at once up to 5 days after unprotected sex. Lowers risk of pregnancy by 58-89%

5. Levonorgestrel EC: Mechanism of Action Inhibits ovulation Does NOT cause abortion

6. Ulipristal acetate: Ella a new emergency contraceptive option Decreases risk of pregnancy by about 90% Nearly full efficacy up to 5 days after unprotected intercourse Requires Prescription

7. Why do women experience unintended pregnancies?

8. Half of women at risk are not fully protected from unintended pregnancy.

9. Fertility Awareness Methods (aka natural family planning) As commonly used: approx. 25 pregnancies per 100 women using this method. BUT with correct and consistent use, pregnancy rates can range from 1-9 per 100 women using this method. Calendar based methods (tracking your cycles) Symptom based methods (cervical secretions, temperature)

11. Cyclebeads.com

12. Highly Effective Methods 0.3% Hormone shot Perfect-Use Rate of Pregnancy Typical-Use Rate of Pregnancy Family Planning Method 0.6%-1.5%0.8%-2% Intrauterine devices 0.1% Implants 0.1%-0.5%0.2%-0.5% Male and female sterilization NOT USER DEPENDENT

13. Vasectomy Condoms Withdrawal

14. Tubal Ligation - “tubes tied” Essure

15. Intrauterine Devices

16. IUD Myths Debunked IUDs DO NOT raise risk of Pelvic infection IUDs DO NOT raise risk of infertility. IUDs DO NOT raise risk of ectopic pregnancy. IUDs can be used safely by women who’ve never been pregnant and teens

17. IUD Myths Debunked IUDs DO NOT cause abortion. OK to insert IUD at any point in the menstrual cycle. OK to insert immediately after delivery (post-partum) or following surgical abortion

18. Progestin IUD (MIRENA)

19. Progestin Implant: Nexplanon Highly effective and rapidly reversible Discreet Not user-dependent Contain no estrogen Can be used during lactation

20. Features of Progestin Implants Can cause spotting Requires certified clinician visits for insertion and removal

21. Progestin-Only Injection Hatcher, R et al. A Pocket Guide to Managing Contraception, 2007-2008

22. Depo Provera & Bone Density “No need to restrict Depo Provera use because of bone density concerns” -ACOG

23. LAM: Lactational Amenorrhea Method A woman can use LAM if: 1.Her period has NOT returned 2.She is breastfeeding on demand (at least every 4 hours during the day, every 6 hours at night) and not pumping 3.Her baby is less than 6 months old If any of these factors are not in place, risk of pregnancy increases and additional methods should be used Risk of pregnancy < 2% (and may be lower)

24. Hormonal Contraceptives What is needed before prescribing? Medical history REQUIRED Blood pressure RECOMMENDED Pap smear Pelvic/breast exam STI testing Hemoglobin NOT REQUIRED

25. Progesterone Only: Mini Pill ONE pill every day –No breaks between packs Safe for breastfeeding women & babies Adds to the contraceptive effect of breastfeeding –Together, they provide effective pregnancy protection Bleeding changes are common but not harmful

26. Hormonal Contraception: Benefits Birth Control Decreased bleeding Decreased anemia Decreased menstrual pain Decreased PMS Decreased ACNE Decreased endometrial and ovarian cancer Decreased benign breast conditions Decreased ectopic pregnancies

27. Hormonal Contraceptives Who can’t use estrogen? Estrogen contraindications: Migraine with aura Uncontrolled high blood pressure Postpartum < 6 weeks History of blood clot Smoking: NOT a contraindication in women/teens under age 35

28. When can you start the pill?

29. Extended Cycle Regimens

30. Estrogen/progestin vaginal ring Active for at least 3 weeks May remove for up to 3 hours Can do “QuickStart” same as with pills

31. Estrogen / Progestin Patch 1 patch weekly for 3 weeks, then one week off OK to shower, swim, exercise with patch on Failures in trials were in women over 198 pounds, but still rare Gallo MF, et al. Cochrane Reviews. 2003, Issue 1. Art. No. CD003552. Jick S, et al. Contraception 73 (2006)

32. Getting the most out of your next provider visit Start thinking about and discussing your next method of birth control before your baby is born Do some research (ex. My Method at Planned Parenthood) http://www.plannedparenthood.org/all-access/my-method-26542.htm http://www.plannedparenthood.org/all-access/my-method-26542.htm Come prepared: Write down what you want from your birth control Write down your questions Ask about side effects Ask your provider for a full year prescription

33. References and Resources Hatcher et al, Contraceptive Technology 2007 Managing Contraception – book online @ www.managingcontraception.org Medical Eligibility Criteria for Contraceptive Use 2010 by WHO www.who.int/reproductive-health Association of Reproductive Health Professionals www.arhp.orgwww.arhp.org Alan Guttmacher Institute www.agi-usa.orgwww.agi-usa.org Planned Parenthood www.plannedparenthood.orgwww.plannedparenthood.org The Cochrane Collaboration www.cochrane.orgwww.cochrane.org www.Not-2-Late.com Reproductive Health Access Project www.reproductiveaccess.orgwww.reproductiveaccess.org