CONTRACEPTION CONTRACEPTION EFFECTIVENESSEFFECTIVENESS

Different types of contraception

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CONTRACEPTIVE CHOICESCONTRACEPTIVE CHOICES

ABSTINENCECalendar methodHit and miss method

◦ Body temperatureWithdrawl methodBarrier Method

◦ Spermicides◦ Condoms ◦ Diaphragm◦ Cervical Cap

Hormonal◦ Oral Contraceptives◦ Norplant◦ Depo- Provera

IUDEmergency

Contraception (plan b)Sterilization

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ABSTINENCEABSTINENCE3

CALENDAR METHODCALENDAR METHOD

Also referred to as the rhythm methodThis requires abstinence during ovulationShould be supplemented with another option if

pregnancy cannot be toleratedThis could be effective if a women knew the exact

day of her ovulationTo be safest abstinence is necessary from day11 to

21 of woman’s cycleThe egg can by fertilized anytime between the

release by the ovary and its exit from the fallopian tube

There is a 30% failure rate

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BASAL BODY TEMPERATURE BASAL BODY TEMPERATURE METHODMETHOD

Designed to determine when a woman is ovulating

BBT drops slightly 1 to 2 days before ovulationThen rises sharply by approximately ½-1

degrees during ovulationSexual activity should be stopped for 4 to 5

days before and after temperature changesIntercourse before ovulation carries a greater

risk than post ovulationSperm can remain viable for up to 72 hours

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WITHDRAWALWITHDRAWAL

Also referred to as coitus interruptusLeads to many unintended pregnanciesPre ejaculate carries sperm that may be released

before withdrawalThis method requires an unreasonable amount of

self control by both partnersHas an extremely high failure rate

CONTRACEPTION AND PREGNANCY

BARRIER METHODSBARRIER METHODS

Barrier methods have become increasingly popular because of the protection they provide against HIV and other STD’s

High failure rates among young womenSPERMACIDESCONDOMSDIAPHRAGMSCERVICLE CAPS

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SPERMACIDESSPERMACIDES

Are a chemical method of contraceptive useCome in a variety foams, creams, and gelsPrevent contraception by killing sperm before

they reach uterusCan be used alone or with another barrier

methodHighly effective when used with a condomContain nonoxynol-9 which is somewhat

effective in preventing gonorrhea, HIV, Chlamydia, herpes simplex 2,

Need to be reapplied before every sexual act to insure effectiveness

MALE CONDOMMALE CONDOM

Increased use of latex typesProtect against HIV, herpes simplex 2,

Chlamydia, and cytomegalovirusReduce transmission of gonorrhea, HBV2,

trichomonas vaginalisIs 86-90% effective when used alone and

98% effective when used with spermicideUse can cause possible allergic reaction

FEMALE CONDOMFEMALE CONDOM

One size fits all barrier methodConsists of a pre-lubricated pouchOne ring is inserted into the vagina to cover the

cervixThe other ring partially covers the labiaLab tests demonstrate that the HIV and other

STD viruses cannot permeate the polyurethane pouch

Controlled by the womanFailure rate is @ 26% usually user failure

DIAPHRAGMDIAPHRAGM

An oval dome shaped device with a flexible spring at the outer edge

Needs to be fitted by a clinicianA spermicide is applied into the dome and

a small amount is spread around the rim Should be left in place for 6-8 hrs after

intercourse and then removedFailure rate ranges from 15-20%

CERVICAL CAPCERVICAL CAP

It is designed to fit tightly over the cervixShould be filled with spermicide before

intercourseA clinician must fit the cap to fit each

womanCan remain in place up to 48 hrs. with no

additional spermicideThe smaller size makes it more difficult to

ensure coverage of cervix

HORMONAL METHODSHORMONAL METHODS

THEY INCLUDE: Oral contraceptivesNorplantDepo-ProveraThey provide no protection against HIV

and other STI’s

ORAL CONTRACEPTIVESORAL CONTRACEPTIVES

They are the second most popular form of birth control in the US

Most women use the pill with both synthetic estrogen and a derivative of progesterone

A progestin only pill is available to women who cannot take estrogen

They provide protection against ovarian and endometrial cancer

Risks of ectopic pregnancy and PID are lowered Reduced menstrual flow with shorter periods Side effects include nausea, breast soreness, fluid

retention, breast cancer, CVD, and liver cancer, and death

NORPLANTNORPLANT

A progestin only implant (levonorgestrel)Consists of flexible, matchstick-like capsules filled

with LVG Inserted under the skin of the upper armDissipate after 5 years and need to be removed and

replacedSuppresses ovulationMajor side effects include irregular menstrual periodsHeadaches, nausea, dizziness, acne, hair loss,

increase in facial or body hair and breast tenderness

DEPO-PROVERADEPO-PROVERA

Most widely used progestin injectionInjected into the gluteal or deltoid muscle

every 3 monthsLike Norplant is has a very low failure rate

and also suppresses ovulationSide effects include amenorrhea, weight

gain, headache, nervousness, dizziness, stomach cramps and decreased sex drive

Intrauterine DeviceIntrauterine Device

Device placed in the uterusSmall, plastic, T-shaped device with a

string attached to the end Prevents sperm from reaching the egg

◦Disrupts the lining of the uterus

Advantages / Disadvantages IUDAdvantages / Disadvantages IUD

Advantages It can prevent pregnancy for up to 5 to 10 years It's inexpensive. It's convenientAn IUD can be removed by your doctor at any time. It starts working right away.

DisadvantagesBleeding and pain for a couple of weeks after the IUD

is inserted. May experience heavier period if you are using the

copper IUD. Rarely, the uterus can be injured when the IUD is put

inside. The IUD does not protect you from any sexually

transmitted infections (STIs).

Emergency Contraception – Plan BEmergency Contraception – Plan B

The morning-after pill — a form of emergency birth control — is used to prevent a woman from becoming pregnant after she has had unprotected sex.

Human conception rarely occurs immediately after intercourse. Instead, it occurs as long as several days later, after ovulation.

During the time between intercourse and conception, sperm continue to travel through the fallopian tube until the egg appears.

Taking emergency birth control the "morning after" isn't too late to prevent pregnancy.

CONTRACEPTION AND PREGNANCY 20

Plan B continuedPlan B continued

The active ingredients in morning-after pills are similar to those in birth control pills, except in higher doses.

Some morning-after pills contain only one hormone, levonorgestrel (Plan B), and others contain two, progestin and estrogen.

Progestin prevents the sperm from reaching the egg and keeps a fertilized egg from attaching to the wall of the uterus (implantation).

Estrogen stops the ovaries from releasing eggs (ovulation) that can be fertilized by sperm.

The morning-after pill is designed to be taken within 72 hours of intercourse with a second dose taken 12 hours later.

According to the manufacturer, the morning-after pill is more than 80 percent effective in preventing pregnancy after a single act of unprotected sex.

CONTRACEPTION AND PREGNANCY 21

Method Typical Use Rate of Pregnancy Hormonal Methods:     

◦ Implant (Norplant) 0.09%   ◦ Hormone Shot (Depo-Provera) 0.3%     ◦ Combined Pill (Estrogen/Progestin) 5%     ◦ Minipill (Progestin only) 5 -7%

Intrauterine Devices (IUDs):     ◦ Copper T 0.8%     ◦ Progesterone T 2%

Barrier Methods:     ◦ Male Latex Condom1 15%     ◦ Diaphragm2 20%    ◦ Cervical Cap (no previous births)2 20%     ◦ Cervical Cap (previous births)2 40%     ◦ Female Condom 26 %

Spermicide: ◦ (gel, foam, suppository, film) 26%

Natural Methods:     ◦ Withdrawal 45% and higher    ◦ Natural Family Planning

    (calendar, temperature, cervical mucus) 25 -30%

No Method: 85%