Contraception

I. Contraception Overview

II. Effectiveness

III. Contraception Methods

I. Contraception Overview

Unprotected sex results in: PREGNANCY and transmission of STDs

Age Class

15-44 15-19 20-24 25-29 30-34 35-39 40-44

Percent distribution

Using contraception (contraceptors) 64.2 29.8 63.4 69.3 72.7 72.9 71.5

Female sterilization 17.8 0.1 2.5 11.8 21.4 29.8 35.6

Male sterilization 7.0 - 0.7 3.1 7.6 13.6 14.5

Pill 17.3 13.0 33.1 27.0 20.7 8.1 4.2

Implant 0.9 0.8 2.4 1.4 0.5 0.2 0.1

Injectable 1.9 2.9 3.9 2.9 1.3 0.8 0.2

Intrauterine device (IUD) 0.5 - 0.2 0.5 0.6 0.7 0.9

Diaphragm 1.2 0.0 0.4 0.6 1.7 2.2 1.9

Condom 13.1 10.9 16.7 16.8 13.4 12.3 8.8

Female condom 0.0 - 0.1 - - - -

Periodic abstinence 1.5 0.4 0.6 1.2 2.3 2.1 1.8

Natural family planning 0.2 - 0.1 0.2 0.3 0.4 0.2

Withdrawal 2.0 1.2 2.1 2.6 2.1 2.3 1.4

Other methods1 1.0 0.3 0.9 1.2 1.3 0.9 1.8

II. Birth Control MethodsEffectiveness Effectiveness =

Theoretical effectiveness –

Use-effectiveness –

III. Contraception Methods

A. Fertility awareness methods

B. Hormonal methods

C. Barrier methods

D. Permanent methods

E. Other forms

A. Fertility Awareness Method Calendar Method, Natural Family Planning

An understanding of the female menstrual cycle is essential as a foundation for using this method Advantage: no side effects, can be used by anyone Disadvantages:

Effectiveness = ~ 15 - 20 pregnancies occur over 1 year out of 100 women using this method (for women who are properly trained)

B. Hormonal Methods1) Oral Contraceptives (birth control pills) Most common used non-surgical method (17%

of women) Suppresses natural ovarian cycle and

endometrial cycle Creates an artificial cycle via synthetic estrogen

and progestin

Effectiveness -

Risks of Birth Control Pills Oral antibiotics may decrease the effectiveness of birth

control pills. Therefore, a backup method of contraception should be used while taking antibiotics and until the next menstrual period after completion of the antibiotic

Positive Side effects – less painful periods, decreased symptoms of PMS, increased bone density, potential protection from PID, ovarian cancer & endometrial cancer, increased cardiovascular protection

Lack of protection against STDs

Types of Birth Control Pills 30 different brands available

monophasic –

biphasic - These have a fixed amount of estrogen, but there are two different strengths of progestogen in the dispenser. The first seven to 10 days are one strength (and one color). The next 11 to 14 tablets are another strength (and another color).

Triphasic –

Patch –

Minipills –

Slightly less effective - ~ 3 pregnancies occur over a 1 year period in 100 women

2) Hormonal Implantsa) Norplant – contains no estrogen,

consists of six 1-2 inch flexible rods filled with synthetic progesterone

Effectiveness = Less than 1 pregnancy occurs over 1 year out of 100 women

Norplant is no longer available in the US due to insertion and removal complications…

b) Now we have Implanon - single, thin, polymer rod, no bigger than a matchstick, that is inserted under the skin of a woman's upper arm

removal of the rod takes slightly longer than the insertion — about two minutes — but with the use of local anesthetic, most women describe "mild discomfort."

c) Depo-Provera – Effectiveness - Less than 1 pregnancy

occurs over 1 year in 100 women

Lack of protection against STDs

C. Barrier Methods

1) Spermicidal – cream, foam, film, suppository or gel

Work as a mechanical barrier in that they are spread over the surface of the cervix & block access to cervical opening

Effectiveness - ~ 26 pregnancies occur over 1 year out of 100 women

Spermicides should be inserted deep into the vagina, and the product should be left in place for at least 6 hours post intercourse

2) Diaphragm – Dome shaped latex cup, coated with spermicidal agent before being inserted into the vagina

Requires proper fitting by clinician

3) Cervical Cap – works like a small, deep diaphragm, fits snugly over the cervix

4) Condom Thin sheath (preferably latex to also protect from

transmission of disease-causing organisms) placed on the penis or, in the case of the female condom, within the vagina prior to intercourse

Male Condom – permits the male partner to take an active role in birth control

Condoms are The only methods effective at preventing STDs

Lubrication may help reduce risk of irritation and increase pleasure

Effectiveness - About 14 pregnancies occur over 1 year out of 100 couples using male condoms, and about 21 pregnancies occur over 1 year out of 100 couples using female condoms

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5) Contraceptive sponge - Soft synthetic sponge, saturated with a spermicide, which is moistened and inserted into the vagina, over the cervix, before intercourse

Effectiveness - ~18 to 28 pregnancies occur over 1 year out of 100 women

This method was removed from the market due to contamination problems at the manufacturing facility a few years ago,

D. Permanent Methods

Female sterilization Tubal ligation

Male Sterilization Vasectomy

Lack of protection against STDs

E. Other forms of contraception1) Abstinence –

2) Coitus interruptus

This is an unreliable method. Lack of protection against STDs

3) Intrauterine Devices (IUD) A small plastic or copper device, placed inside the

woman's uterus by her health care provider, which changes the uterine environment to prevent pregnancy

Effectiveness = 1 to 3 pregnancies occur per year out of 100 women

Risks – Lack of protection against STDs

4) Emergency Birth Control “morning-after pill” may prevent pregnancy by temporarily

blocking

The morning-after pill is reserved for emergency situations and not as a regular method of birth control.

Emergencies include

Plan B (levonorgestrel)

RU-486 (mifepristone) –Blocks progesterone, binds to progesterone receptors in the endometrium

Summary of effectivenessAbstinence 100%

Sterilization 99.9%

Estrogen + Progesterone Pill 98%

Progesterone Only Implant, injection 95%

IUD 93%

Sponge 90%

Diaphragm w/jelly 90%

Cervical Cap 85%

Male Condom 85%*

Female Condom 85%*

NFP 78%

Spermicidal products 75%

Coitus interruptus 75%