Methods of Contraception

Dr. Azhari, SpOG(K)

Unwanted Pregnancy
-Increased risk of child abuse and neglect -Decreased likelihood of continued education for mother -More likely to live in poverty -Numbers in the Navy are similar to civilian numbers

-60% of enlisted members pregnancies are unplanned - used no form of birth control -pill is the most failure prone

Results of Navy Survey

Reasons for Unwanted Pregnancy Rhythm or Withdrawal works well I am not sexually active I/partner have been sterilized or not fertile Religious beliefs Other reason

29% 24% 7% 2% 38%

Annually, nearly half of the 6.3 million pregnancies in the United States are unintended.

Adequate instruction in how to use a method, provision of a back up method and information on emergency contraception could reduce the risk of unintended pregnancy. Hatcher et al, Contraceptive Technology

Oral Contraception THE PILL

In the early 1900s inhibition of ovulation was linked to pregnancy and the corpus luteum.
1960 ENOVID was approved for contraception, through efforts from the Worcester Foundation for Experimental Biology. Early pill was thought to be progestion only but had incidental large amounts of estrogen. The combination pill-progestion suppresses luteinizing hormone and prevents ovulation while the estrogen suppresses FSH which prevents the selection of the dominant follicle.

Potential Side Effects

Thrombosis(means

blood clot)Smoking significantly increases this risk. Hypertension(increased blood pressure)-small increases may be observed. No significant clinical changes with any of the multiphasics(tricyclic pills) Migraines/headaches

Other metabolic effects

Nausea weight

gain breast discomfort chloasma (increased facial pigmentation, or discoloration on the face)

Absolute contraindications
(Reasons you may not take the pill)

Thrombophlebitis,ce rebral vascular disease, coronary occlusion

Any history of blood clots, heart attack, stroke

markedly impaired liver function(lproblems with

your liver)

known or suspected breast cancer

Undiagnosed abnormal vaginal bleeding(please see your medical provider) pregnancy smokers >35 years old

Special Uses
Minipill

taken in continuous dosage

Emergency

Contraception-large estrogen dose to prevent implantation

Benefits of Oral Contraception

Effective Less

endometrial cancer Less ovarian cancer Fewer ectopic pregnancies(tubal pregnancy) More regular periods with less flow, less pain and less anemia And more..

What to know about the pill

Persistent

pain anywhere, vision changes, or trouble breathing should be evaluated ASAP. When starting a pill brand, it takes at least 3 full cycles for your body to get used to it, so wait 3 pilllpacks before you think about switching.

Taking the pill

Most women start the first Sunday after your period starts, whether you are still bleeding or not. Take it the same time approximately every day If you forget, take it as soon as you remember or double up the next day. You may double up until you catch up unless you start bleeding. Then stop that pillpack, wait until Sunday and start a new pill pack. Anytime you are late or miss a pill, you may ovulate and get pregnant, so USE A CONDOM THE REST OF YOUR CYCLE

SPOTTING

You may have spotting the first 3 cycles You may spot if you are late or miss a pill You may spot if you have an STD, or if you are pregnant. If you are over 35 and are spotting, you need to see your medical provider or MD. Persistent spotting needs evaluation, maybe just a pill change, but maybe more.

So many pills.

There are many different brands of oral contraceptives on the market, and new ones just released. Some are approved to treat acne too. There are pills that have the same dosage for 3 weeks(monophasic), and there are pills with a different combination each week.(tricyclic)

Be patient-there most likely is one for you!

How do I eliminate my period?

Some women skip the placebo, or sugar pill week, and start a new pill pack on day 21. This can be done for several months, if you start spotting, finish that pill pack, and take the placebo week too so you have a period. Its a nice benefit if you are practicing safe sex, and dont want your period. You will need more pill packs than usual.

Estrogen/Progestin Injectable

Lunelle-this was FDA approved in 2001 and is a great form of birth control for those women who just cannot take their pill faithfully and cannot tolerate Depo Provera. Once a month injection! You get your period mid cycle. You may have lots of spotting at first. There may be weight gain associated with this, but not as much as with Depo Provera.

The Contraceptive Patch

Contains Estrogen and Progestin like the pill

ANOTHER NEW PRODUCT FOR YOU! This is a once weekly patch that you apply to your skin (not on your breasts), which will stay on in the shower, swimming, etc. There may be some spotting especially in the first few months. This is a good product for unfaithful pill takers who dont want an injection.

Norplant and Depo Provera

Is continuous, highly Effective, long term protection

Injected progestin with 12 weeks of protection

Norplant is no longer available, however.

Norplant was the 5 tubes containing progestin that were inserted under the skin, usually on the underside of your upper arm. There will be a new product available most likely in 2002, with more flexible, less visible tubes, and with easier insertion and withdrawal. It will be 3 tubes instead of 5 and last for 3 years instead of 5 years.

Depo Provera
Depo Provera is a progestin only contraceptive like the minipill. It is the injectable form, and lasts approximately 12 weeks. Benefits: -dont have to remember daily pill Side effects: -depression -delayed fertility(some women are have delayed conception for a year or longer) -spotting/irregular bleeding(it is normal to have lots of spotting with the first 2-3 injections
And for 2/3rds of women no periods after the 2nd injection)

-no periods -acne -weight gain

IUD (Intra Uterine Device)

This is a small object that is placed into the uterus. This is best for women who have already had a child. One IUD has copper in it, so dont get this one if you are allergic to copper. Most IUDs are associated with heavier and longer periods. They usually will give you 10 years of protection. There is a new IUD called Mirena that has a progestin in it which helps to decrease bleeding and make lighter or no periods. Expect spotting the first few months. This IUD

If you think an IUD is for you

You need an initial appointment in medical to evaluate if you are indeed a good candidate and to have an exam with cultures. You must be in a long term monogamous relationship because you are at increased risk for STDs with an IUD. You may not get one if you have a history of PID, tubal pregnancy, allergy to its components, etc. You will need to read the information pamphlet and review it with you medical provider or MD.

The Diaphragm

This is a barrier method of birth control. It requires planning because you must insert it before sexual intercourse, and leave it in for at least 6 hours afterwards. You need to be fitted for it in medical. Both you and your diaphragm need to be checked each year and after more than 10 lbs weight change or after a pregnancy.

More about your diaphragm

This method is as effective as the pill when you use it with spermicide and a condom. You must use it every time you have intercourse and add more spermicidal jelly if you have sex again in less than 6 hours. It does require some practice, but dont worry we wont let you leave our office until you get it right!

Other Barrier Methods:

Vaginal Spermicidal Inserts Jellies,creams,suppositories and films -nonosynol-9,octoxynol-9 Principal foam products are Emko,Ortho-Gynol,Delfen Common suppositories include Encare Oval,Semicid and Vaginal Contraceptive Film

Instructions: -Insert high in the vagina so that it will cover the cervix -Use 30 minutes or less prior to NOT AFTER intercouse -DO NOT DOUCHE for at least 6 hours after intercourse -Keep extra condoms on board!!!!!

Barriers continued
CONDOMS CONDOMS CONDOMS These offer protection from pregnancy and STD!!! Failures: The condom broke!! It stayed inside He doesnt want/She doesnt want

Next step: EMERGENCY CONTRACEPTION High dose birth control pill taken within 72 hours of the mishap and repeated the dose 12 hours after the first dose
Cervical Caps-may be left in place 24-48 hours(not available at NH YOKO)

GYN INFECTIONS

You may or you may not have any sign that YOU are infected.

If you have been in contact-(any body cavity) you are at risk. Annual exams are essential, and ask for cultures.

Herpes simplex

Molluscum contagiosum Scabies Gonorrhea

Syphilis

Chanchroid

HIV

Chlamydia

Genital warts

And more where these came from