1. Contraception Today: What’s new? Carol E. Peterson, MS, RN Wyoming Health Council

2. Contraception Today: Lots of Options!

3. Contraception Today: Lots of Choices! Pills (combined and progesterone only) Injections Contraceptive Devices (patch, ring) IUD / IUS Barrier Methods (condoms, diaphragm) Spermicides Implants Sterilization

4. Oral Contraception - Review Combined Hormonal (various doses) – estrogen and progesterone (1960s) Progesterone only / mini pills (1973) must be taken within 1 -2 hour window every day Rx only; Must take daily; Still the most popular method No protection against STDs Combined failure rate: perfect use 0.3% / typical use 8% (Progesterone only has higher failure rate)

5. Injections Depo Provera IM (1992)(Depo Sub Q – (2005) may allow for self-injection at some point) Repeat injections every 3 months; must be given on time Irregular bleeding at first – mostly amenorrhea after a few months Concerns about bone de-mineralization with teens and long term users Rx only; No protection against STDs Failure Rate: perfect use 0.3% perfect use / typical use 3%

6. Transdermal Patch (2001) Patch applied to skin Useful for those who have difficulty remembering to take a daily pill Apply new patch ever week for three weeks Hormone is in the adhesive – so must stick – must replace if comes off No protection against STDs Failure Rate: perfect use 0.6% / typical use 8%

7. Emergency Contraception– Plan B AKA – “morning after pill” / prevents release of / fertilization of egg (not to be confused with RU 486 – the “abortion pill”) Actually two progesterone only pills ( equal to 20 mini pills) Most effective the sooner it is taken / up to 5 days after unprotected intercourse 75 - 89% effective Advanced provision increases effectiveness ~ 1.7 million unintended pregnancies per year could be averted

8. Vaginal Ring (2001) Estrogen and progesterone imbedded in soft, flexible ring; slow continuous release Added benefit - improves vaginal flora Inserted into vagina – stays in place for 3 weeks & removed for one Woman doesn’t feel it – most male partners don’t either No protection against STDs RX only; one size fits all Failure Rate: perfect use 0.3% / typical 8%

9. IUD / IUS Paraguard (copper) IUD –RX / good for 10 years; In-office procedure –May make periods heavier –Failure rate (0.8%) Mirena (progestin) IUS (2001) –RX / good for 5 years; In office procedure –Makes periods very light / 80% amenorrhea –Failure rate 0.1% (nearly perfect) No protection against STDs with either

10. Barrier Methods Offer some protection against STDs –Male condom Research is clear -YES they are effective for birth control and STD prevention if used consistently and correctly Failure Rate: Perfect use 2% / typical use 15% –Female condom Used more by MSM Failure Rate: Perfect Use 5% / typical use 21%

11. Others Diaphragm –Insert up to two hours prior to intercourse – leave in for 6 hrs after –Use with spermicide (and a condom to increase effectiveness and protection) –Rx only – must be fitted –Failure Rate: 20% Spermicides – contraceptive foam, jelly, suppositories, film – OTC –Use with a condom as their failure rate can be as high as 50% when used alone

12. Sterilization Tubal Ligation - female Vasectomy - male Essure – (2003) Device inserted into fallopian tubes – causes overgrowth of tissue and scaring in tubes; takes special training – not widely available here

13. So What’s New? Continuous Contraception – Continuous delivery of hormonal contraception to prevent ovulation All human beings miss some pills from time to time; extended use keeps the ovaries “asleep” Continuous use of pills and ring already being promoted by some practitioners (off-label) Do not use the patch for this purpose

14. Continuous Use Added benefit of Menstrual Suppression; allows women some control over when or if they menstruate Studies show many women interested in this! No known long term consequences – studies continue. Seasonale / Seasonique – approved pills; periods only 4 times a year Lybrel – Pills formulated for one year continuous use; currently under review of FDA

15. Menstrual Suppression Mirena IUS and Depo - provide suppression for most women Implanon – Implant with progesterone only; just received FRD approval Nuvaring – Combined hormonal method under FDA review for this purpose (ring has enough hormone to last for 35 days); Ortho Evra Patch – Combined method NOT Recommended for this purpose; rate for hormone deliver too high

16. Implanon Single rod implant – 40mm x 2mm Easy to insert and remove Lasts for three years Progesterone only Causes amenorrhea Delivers a steady level of hormone FDA approved July 2006 Used in Australia for over four years now Failure rate 0%

17. What Else is New? Today Sponge – back by popular demand nonoxynol - 9 spermicide – available OTC New Spermicide / Microbicide Gels in clinical trials; offer some protection against STDs, including HIV (non n-9 products) –Ushercell –BufferGel & Buffer Gel Duet (gel with a diaphragm-like device).

18. Finally … Male Contraception Males have not had a lot of options for sharing the responsibility for contraception Male contraceptive pill/injection has been elusive In Clinical Trials: –Reversible Inhibition of Sperm Under Guidance (RISUG) –Injectable gel coats wall of vas and kills sperm –Azoospermia in 12 men 5 days after injection –Intra Vas Device (IVD) – also reversible –Soft hollow silicone plugs implanted in the vas; complete blockage in 27 / 30 men with very low counts in the other 3

19. Family Planning Clinics Wide variety of FDA approved contraceptives available on a sliding fee scale STD and HIV testing Confidential Services; Title X required adolescent services Local experts – presentations, resources about sex education, contraceptives and STDs Health maintenance / prevention / referral To find a Family Planning Clinic near you go to www.wyhc.org

20. Questions? Carol Peterson, MS, RN Wyoming Health Council 2120 O’Neil Ave. Cheyenne, WY 307-632-3640 carol@wyhc.org