Birth Control Methods/Forms

Mrs. FarverHealth

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.

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

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 dayEffectiveness:• 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)

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

Hormonal – Ortho Evra (The Patch)

• 1 Patch a week, for 3 weeks• 4th week patch free, Menstruation• Usually worn lower abdomen or buttocksEffectiveness:• Perfect Use Failure Rate in First Year: 1

women of every 1,000 women will become pregnant in the first year

• Overall Failure Rate: ?

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

Ortho Evra – The PatchSpecial 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

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

Nuva RingAdvantages: 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

Hormonal - Depo Provera “The Shot”

• Injected intra-muscularly into the deltoid or gluteus-maximums every 11 to 13 weeks.

• Progestin only• Four times a yearEffectiveness:• Perfect use failure rate in first year:

0.3% • Typical use failure rate in first year: 3%

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 1st 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

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

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%

IUD - MirenaAdvantages: 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

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%

IUD - ParaguardAdvantages: 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

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

ImplanonAdvantages:• Insertion only takes a few

minutes• Protection against

pregnancy is immediate if you get the implant during the 1st 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

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 yearsof 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).

Plan B – Morning After PillAdvantages 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

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