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DESCRIPTION
Choosing a method of birth control is a highly personal decision, based on individual preferences, medical history, lifestyle, and other factors. Each method carries with it a number of risks and benefits of which the user should be aware.
Each method of birth control has a failure rate -- an inability to prevent pregnancy over a one-year period. Sometimes the failure rate is due to the method and sometimes it is due to human error, such as incorrect use or not using it at all. Each method has possible side effects, some minor and some serious. Some methods require lifestyle modifications, such as remembering to use the method with each and every sexual intercourse. Some cannot be used by individuals with certain medical problems.
(The following information is adapted in part from the "FDA Consumer", the magazine of the U.S. Food & Drug Administration.)
- Spermicides Only
- Barrier Methods
- Hormonal Methods
- Other Temporary Methods
- Surgical Sterilization
- Contraception & Pregnancy Prevention/Fertility Links
Contraception Methods Compared - Chart
SPERMICIDES ONLY
Spermicides, which come in many forms - foams, jellies, gels, and suppositories - work by forming a physical and chemical barrier to sperm. They should be inserted into the vagina within an hour before intercourse. If intercourse is repeated, more spermicide should be inserted. The active ingredient in most spermicides is the chemical Nonoxynol-9. The failure rate for spermicides in preventing pregnancy when used alone is from 20 to 30 percent. Spermicides are available without a prescription. People who experience burning or irritation with these products should not use them.
VAGINAL CONTRACEPTIVE FILM (VCF):
Vaginal Contraceptive Film (VCF) is a square (2 inch by 2 inch) of very thin material that dissolves quickly in the vagina (and releases a spermicide that kills sperm. No applicator is needed. VCF is washed away with the natural vaginal fluids. The film is translucent in appearance permitting light to go through it. It contains a spermicidal chemical called Nonoxynol-9.
It is important that there is no contact between the vagina and penis before VCF is inserted because sperm is present in the pre-ejaculate. Remove one film from the package with dry fingers. Fold it in half and place over fingertip. Slide your finger, covered with the VCF film, into the vagina as far as you can go so the film rests on or near the cervix (at the top end of your vagina). It is placed on or near the cervix opening.
Insert VCF not less than 15 minutes and not more than 1 hour before intercourse. It dissolves quickly and provides spermicidal protection after 15 minutes. The protection then lasts for about 2 hours and 45 minutes. If more than one hour passes since the VCF was inserted, insert another film. Use one VCF for each act of intercourse. VCF can be inserted by a woman or her partner. (Placing the film on the tip of the penis is not recommended because the film will not have enough time to dissolve, and because the film may not end up covering the cervical opening.)
VCF is approximately 80% effective in preventing pregnancy which is about the same as other spermicides. Among typical couples who initiate use of vaginal spermicide, about 1/4 (25 to 26 percent) will experience an accidental pregnancy in the first year. If vaginal spermicide is used consistently and correctly, about 6 percent will become pregnant. If VCF is used with another contraceptive method such as condoms, there will be better protection against pregnancy. Condoms also help in preventing sexually transmitted infections.
Vaginal contraceptive films seldom causes vaginal or penile irritation. Rare side effects may include itching, burning on urination, slight inflammation of the vagina, pain, and increased white discharge. If discomfort does occur at a time when you are using VCF, discontinue use. Should the irritation continue, consult your health care provider.
Advantages:
- Film is simple to use. It is not messy. No discharge. It is virtually undetectable. Discreet! You can't tell it is there.
- It can be bought at CVS pharmacy and most drug stores. No prescription is needed.
- Your partner does not need to help.
- May be used alone or with a diaphragm or a condom.
- It reduces the risk of getting some sexually transmitted infections.
Disadvantages:
- May interrupt sex. You need to use another one each time you have intercourse.
- You should wash your hands with soap and water before putting your film in. Dry your hands carefully or the film will stick to your fingers.
- Some people may be sensitive to film or find it causes irritation.
- Not as effective as some other contraceptives.
- Contraceptive film does not adequately protect you from the AIDS virus or other infections. Use a condom if you or your partner may be at risk. Film may reduce the risk of getting some sexually transmitted infections.
It is important to follow the instructions on the package insert. It may take some practice to use this method and you need to feel comfortable with your body to insert it properly. VCF can be purchased at a drug store without a prescription and is found with other contraceptive/birth control products.
For more information about spermicides, visit the links below:
BARRIER METHODS
There are five barrier methods of contraception:
In each instance, the method works by keeping the sperm and egg apart. Usually, these methods have only minor side effects. The main possible side effect is an allergic reaction either to the material of the barrier or the spermicides that should be used with them. Using the methods correctly for each and every sexual intercourse gives the best protection.
A male condom is a sheath that covers the penis during sex. Condoms are made of either latex rubber or natural skin (also called "lambskin" but actually made from sheep intestines). Only latex condoms have been shown to be highly effective in helping to prevent sexually transmitted diseases (STDs). Latex provides a good barrier to even small viruses such as the human immunodeficiency virus (HIV) and hepatitis B. Each condom can only be used once. Condoms have a birth control failure rate of about 15 percent. Most of the failures can be traced to improper use.
Some condoms have spermicide added. This may give some additional contraceptive protection. Vaginal spermicides may also be added before sexual intercourse.
Some condoms have lubricants added. These do not improve birth control or STD protection. Non-oil-based lubricants can also be used with condoms. However, oil-based lubricants such as petroleum jelly (Vaseline) should not be used because they weaken the latex. Condoms are available without a prescription.
Male condoms come in variety of sizes, colors (some even glow in the dark), styles (ribbed, studded and smooth), lubricated or unlubricated, and some have novelty attributes like feathers (called the French Tickler) and some come in a variety of flavors. They vary in quality, thickness and price. Some of the novelty condoms are not to be used to prevent pregnancy, but are more "fun items". Be sure to check the brand of condom you use and make sure it is designed to be used as a contraceptive device.
For more detailed information about male condoms and how to use them, visit the link below:
The Reality Female Condom was approved for use in the United States in 1993. It consists of a lubricated polyurethane sheath with a flexible polyurethane ring on each end. One ring is inserted into the vagina much like a diaphragm, while the other remains outside, partially covering the labia. The female condom may offer some protection against STDs, but for highly effective protection, male latex condoms must be used.
In a six-month trial, the pregnancy rate for the Reality Female Condom was about 13 percent. The estimated yearly failure rate ranges from 21 to 26 percent. This means that about 1 in 4 women who use Reality may become pregnant during a year.
For more detailed information about the female condom and how to use it, visit the link below:
The contraceptive sponge was approved in 1983. In 1995, the only company in the U.S. manufacturing the sponge discontinued its production. It may become available again at some future date. The sponge is made of white polyurethane foam. It is shaped like a small doughnut and contains the spermicide Nonoxynol-9. Like the diaphragm, it is inserted into the vagina to cover the cervix during and after intercourse. It does not require fitting by a health professional and is available without prescription. It is to be used only once and then discarded. The failure rate is between 18 and 28 percent. An extremely rare side effect is toxic shock syndrome (TSS), a potentially fatal infection caused by a strain of the bacterium Staphylococcus aureus and more commonly associated with tampon use.
Currently, two contraceptive sponges -- called Protectaid and Pharmatex -- are available, primarily in Canada and Europe. A third, the Today sponge, was introduced to the U.S. market in 1983, was removed in 1995, but is expected to return. Clinical trials of the contraceptive efficacy of a fourth sponge, called Avert, are planned and may begin soon.
All four sponges are manufactured in one size, allowing women to buy them over-the-counter without the help of a provider. All four have the common contraceptive qualities of blocking the cervix, trapping sperm and releasing spermicides. All sponges are designed to be effective for many hours -- some as long as 24 hours -- regardless of the number of acts of sexual intercourse during this period. Being able to insert them hours in advance is considered an important feature to many women who use them. However, the sponges must be left in place at least six hours after last intercourse, and women should avoid leaving them in beyond the maximum recommended time.
The Pharmatex sponge, marketed in Europe, contains 60 mg of the spermicide benzalkonium chloride (BZK). The Today sponge, containing 1,000 mg of the spermicide Nonoxynol-9 (N-9), was a popular device on the U.S. market until its owner discontinued making it for financial reasons unrelated to the product itself. However, concentrations of spermicides found in these two sponges -- while capable of killing pathogens that cause many sexually transmitted diseases -- can irritate the vaginal lining. Theoretically, women exposed frequently and for long periods of time to such spermicide concentrations may develop vaginal abrasions that could facilitate HIV transmission. Thus, researchers are studying sponges with less spermicide.
The Protectaid sponge, marketed in Canada since 1996 and recently approved for marketing in Europe, contains three spermicides (N-9, BZK, and sodium cholate) in relatively small concentrations. The Avert sponge is expected to have 100 mg of N-9. The Protectaid and Avert sponges have the advantage of being wet -- water is not needed before they are used.
Clinical studies to determine the effect of contraceptive- sponge use on STD infection are limited. Only the results of studies of the Today sponge are available. An FHI study in Thailand of 225 women at high-risk for STDs indicated that women using the N-9-containing Today sponge were less likely to have contracted chlamydia infection and gonorrhea than women not using the sponge. Another study, conducted among 138 sex workers in Nairobi, Kenya, found that the risk of contracting gonorrhea was reduced by 60 percent among women using the sponge containing N-9, compared with placebo users. However, significantly more women using the N-9 sponge developed genital ulcers (an important risk factor for HIV infection), and 45 percent of 60 women in the N-9 group, versus 36 percent of 56 women in the placebo group, became infected with HIV. Notably, women in the study used the N-9 sponge repeatedly each day for long periods. "It is possible that less frequent use might be associated with a lower risk of adverse effects or even with protection against HIV infection," the authors concluded.
Estimated 12-month pregnancy rates for the typical use of the N-9-impregnated Today sponge are 17 percent (14 percent for nulliparous women and 27 percent for parous women). Reported 12-month pregnancy rates for women -- regardless of parity -- using the Protectaid sponge are 23 percent for typical use.
For more information about the contraceptive sponge, visit the link below:
A diaphragm is a latex or silicone cup with a firm flexible rim and shallow dome that can be coated with spermicidal gel and folded for insertion into the vagina.
Studies involving some 2,800 U.S. women suggest that, during typical use, the diaphragm may be somewhat more effective than the contraceptive sponge or cervical cap. However, disadvantages of conventional diaphragms are that they must be fitted by a health care provider and the correct size prescribed to ensure a snug seal with the vaginal wall. Although they can be unwieldy to insert and remove, they are easier for some women to use than a cervical cap device because of their size. They don't sit directly on the cervix itself, but is kept into place by the pubic bone and rear wall of the vagina, blocking sperm from entering the uterus. The diaphragm should not be left in place for longer than 24 to 48 hours (some sources state 24 hours, others state 48 hours).
The diaphragm is a flexible disk with a rigid rim. Diaphragms range in size from 2 to 4 inches in diameter, depending on the brand, come in a variety of sizes. They are designed to cover the cervix during and after intercourse so that sperm cannot reach the uterus. Spermicidal jelly or cream must be placed inside the diaphragm for it to be effective. The spermicide kills live sperm and prevents them from fertilizing an egg if they should happen to make it past the barrier. If intercourse is repeated, additional spermicide should be added with the diaphragm still in place. The diaphragm should be left in place for at least six hours after intercourse.
Women who have intercourse infrequently, or whose fertility is low because of age, will find the diaphragm a good choice for contraception. Couples who have intercourse frequently (more than three times weekly) may find the diaphragm less effective than those who have sex sporadically, mostly due to inconsistent and incorrect use. The diaphragm is also very effective for women who have not had children, but higher failure rates apply for women who wait to begin using the diaphragm until after they have given birth. The diaphragm used with spermicide has a failure rate of from 6 to 18 percent.
The diaphragm is small and portable (can be dropped into a woman's handbag or purse) and is a good option to hormonal contraception. It offers some protection against certain types of sexually transmitted infectious disease such as gonorrhea, chlamydia, and certain precancerous conditions of the cervix, however, the diaphragm does not prevent the transmission of many other STDs, including herpes, HPV or HIV.
In addition to the possible allergic reactions or irritation common to all barrier methods, there have been some reports of bladder infections with this method. As with the contraceptive sponge, toxic shock syndrome (TSS) is an extremely rare side effect. Some women may experience a disruption of the vaginal skin from the frequent use of spermicides, increasing the risk of infections and abnormal pap results.
Types of Diaphragms & Diaphragm-like Devices:
Ortho-McNeil All-Flex® Latex Diaphragm:
( Ortho-McNeil Pharmaceutical)
The All-Flex® is a latex diaphragm with a shallow dome and a flexible rim with an arcing spring. It is available in nine diameter sizes, from 55 to 95mm, in 5mm increments. The All-Flex® diaphragm is available in the United States and elsewhere. It is the world market leader in diaphragm sales and distribution.
Ortho Coil Spring® Diaphragm:
( Ortho-McNeil Pharmaceutical)
The Coil Spring® is a latex diaphragm with a shallow dome and a flexible rim with a coil spring. It is available in nine diameter sizes, from 55 to 95mm, in 5mm increments. The Coil Spring® diaphragm is available in the United States and elsewhere. It is a popular method in the United Kingdom.
Milex Wide Seal® Diaphragm:
( Milex Products, Inc.
The Milex Wide Seal® is a silicone diaphragm with a shallow dome and a wide rim with an arcing or omniflex spring. It has a small skirt around the rim intended to hold gel in place and improve the seal. It is available in eight diameter sizes, from 60 to 95mm, in 5mm increments. The Wide Seal® diaphragm is available from the manufacturer and is distributed in the United States, Canada, Europe, Asia, and the Middle East.
Semina Diaphragm:
( Semina Industries and Commerce Ltd.)
The Semina is a clear, silicone diaphragm with a visible coil spring. It is available in six diameter sizes, from 60 to 85mm, in 5mm increments. The Semina diaphragm is available in Brazil.
Reflexions Flat Spring® Diaphragm:
( Williams Medical Supplies)
The Reflexions Flat Spring® is a latex diaphragm with a rim that is similar to the coil spring but thinner and more delicate. It is available in seven sizes, from 65 to 95 mm, in 5mm increments. The Flat Spring is manufactured in Britain.
SILCS Barrier Diaphragm (under development):
SILCS, Inc.
SILCS is an intravaginal barrier device (pronounced "silks") currently under development. It is made of silicone with an arcing ring. SILCS has a pre-shaped rim to cling high in the vaginal vault and a finger cup on one edge for easy removal. It will be a one-size-fits-all device.
The SILCS intravaginal barrier is developed by the U.S.-based Program for Appropriate Technology in Health (PATH) and a private company called SILCS, Inc. and is being compared with the standard latex diaphragm in a CONRAD clinical trial. The SILCS barrier has a shape and dimpled surface intended to make insertion and removal easier. Its cost is expected to be relatively low, and its manufacturer has an agreement to develop it for use in developing countries.
BufferGel Duet (under development): ReProtect, LLC.
The BufferGel Duet is a disposable, one-size-fits-all, clear diaphragm made of dipped polyurethane. It will be marketed pre-filled with BufferGel, a candidate microbicide and contraceptive.
Lea's Shield:
Available through LadyToBaby.com
The Lea's Contraceptive, called Lea's Shield does not compare with any other mechanical device on the level of form, volume or matter. Unlike other barrier contraceptives, it does not depend on vaginal dimensions or cervical size, which varies from woman to woman. Its exclusive design also eliminates discomforts associated with other barriers. Lea's Shield is a one-size-fits-all reusable vaginal barrier contraceptive device. Approximately the size of a diaphragm, it is composed entirely of medical grade silicone rubber. The device is washable and reusable.
Lea's Shield is a cup-shaped barrier with a loop for removal, can be left in place for up to 48 hours. It also features a one-way valve to allow for the passage of cervical secretions and assure a tight fit. It is available over-the-counter in Germany. In the U.S. it has recently been approved by the U.S. Food and Drug Administration (FDA), but is available at this time by prescription only. A study conducted by the U.S.-based Contraceptive Research and Development (CONRAD) Program and FHI indicated that pregnancy rates compared favorably with those reported in other studies of barrier contraceptive methods, including the cervical cap, sponge and diaphragm. CONRAD research found 12-month pregnancy rates associated with the use of Lea's Contraceptive to be 15 percent, compared with 10 percent to 21 percent for the use of a diaphragm with spermicide.
Research about the potential of diaphragm devices to reduce STD transmission is limited. Whether it protects against HIV is unknown. However, a diaphragm may provide some protection by covering the cervix, which may be the principal site of HIV transmission.
For more information about the diaphragms and diaphragm-like contraceptives, visit these links:
The cervical cap, approved for contraceptive use in the United States in 1988, is a dome-shaped rubber cap in various sizes that fits snugly over the cervix. Like the diaphragm, it is used with a spermicide and must be fitted by a health care professional. It is more difficult to insert than the diaphragm, but may be left in place for up to 48 hours. In addition to the allergic reactions that can occur with any barrier method, 5.2 to 27 percent of users in various studies have reported an unpleasant odor and/or discharge. There also appears to be an increased incidence of irregular Pap tests in the first six months of using the cap, and TSS is an extremely rare side effect. The cap has a failure rate of about 18 percent.
Types of Cervical Caps:
Prentif Cavity-Rim Cervical Cap:
Cervical Cap Ltd.
The cervical cap is a small cup-like device (thimble shaped made of soft rubber (or rigid plastic) about 1.5 inches long with a rounded rim. The cap acts as a barrier that blocks only the entrance into the cervix. Suction holds it in place. A cervical cap is considered a barrier method of birth control because it provides a mechanical barrier to sperm transport. It is used with a spermicide that helps the suction and inactivates (kills) any sperm that might get by the cap, thus preventing the sperm from fertilizing an egg if they should get past the cap barrier. Conventional caps can be worn up to 48 hours. However, they are made of latex, must be fitted by a provider, and can be difficult to insert or remove.
Is generally effective for contraceptive (82-94%). Proper and consistent usage increases the effectiveness. Some reports say that with consistent and correct use, the cap is about 91% effective, however, most couples will find the cap to be, on the average, about 75% effective at preventing pregnancy.
You can have intercourse multiple times while wearing the cervical cap. You don't need to reapply spermicide, but you should check to make sure the cap is still in place. The cap is effective for up to 48 hours, and must be left in place for at least six hours after intercourse.
The cervical cap is most effective for women who have never given birth vaginally. Higher failure rates apply for women who wait to begin using the cap until after they have given birth.
It is less effective for women who have given birth vaginally. This may be because the shape of the cervix changes after a baby has passed through the opening of the cervix. Also the muscles around the vagina become less firm. For these reasons, the cervical cap may not fit women who have given birth vaginally as well as it fits women who have never given birth.
Unfortunately, the Prentif Cavity-Rim Cervical Cap has just recently been discontinued in the United States for financial reasons. For more information about the Prentif Cavity Rim Cervical Cap, see this link:
Two new cervical caps are under development. The first, called FemCap, is made of silicone and can be worn up to 48 hours. Shaped like a hat with an upturned brim (that lies against the vaginal walls around the cervix), it is easier to insert than conventional caps. It places no pressure on the urethra, unlike conventional diaphragms. This may explain why it has been associated with significantly fewer urinary tract infections than the conventional diaphragm, although these fewer infections may be due to the fact that FemCap uses less spermicide than the diaphragm. A strap recently has been added to the FemCap to facilitate removal, and the redesigned device is being tested by CONRAD, with FHI collaboration.
In a CONRAD and FHI study, FemCap used with spermicide was found to be somewhat less effective as a contraceptive than a conventional diaphragm with spermicide.9 FemCap also appears to be less effective than a conventional cap. CONRAD research indicates a 12-month pregnancy rate, based on reported six-month pregnancy rates, of about 23 percent for FemCap. The estimated 12-month pregnancy rate for the conventional cap is 18 percent (ranging from 15 percent for nulliparous women to 30 percent for parous women).10
The second new cervical cap, the Oves Cap, is a silicone device that can be left in place for three consecutive days (72 hours). Equipped with a removal loop, it is disposable after one use. Although sold in France, it is not FDA-approved. CONRAD is conducting a clinical trial to study this cap's acceptability, ease of placement, and how likely it is to dislodge during sexual intercourse.
All cervical caps have the disadvantage of requiring a fitting because they come in at least two sizes. Research is needed to determine whether cervical caps provide any protection against STDs, although it is theorized that HIV entry via the cervix may be impeded by cap use.
FemCap Cervical Cap:
Available through LadyToBAby.com
FemCap is a non-hormonal, latex-free contraceptive device. It is made of silicone rubber, a non-allergenic, durable material which is easy to clean. The FemCap was designed to conform to the anatomy of the cervix and the vagina to ensure maximum fit and comfort. It includes a brim, a dome, a groove between the dome and the brim, and a removal strap. It is considered safe, effective, and highly acceptable to women and men. It is fast to learn how to use and easy to use. It can be inserted several hours before sexual intimacy. It doesn't interrupt spontaneity or reduce sexual pleasure.
It comes in 3 sizes to fit almost any woman: 22mm, 26mm, 30mm. The inner diameter of the rim determines its size. The smallest rim diameter (22mm) is intended for women who have never been pregnant. The medium (26mm) cap is intended for women who have been pregnant but have not had a vaginal delivery. The largest (30mm) is intended for women who have had a vaginal delivery of a full-term baby.
It is inexpensive, reusable for 2 years and environmentally safe. It doesn't interfere with the woman's natural menstrual cycle and has instant reversibility when pregnancy is desired. It does not interfere with breast feeding. It gives the woman full control with no need of male involvement. It is small and is carried in a discreet make-up-like container to enhance portability. It is more acceptable to health care providers because there is a minimum training time. A step-by-step brochure is provided with each FemCap kit.
The FemCap was extensively tested and compared with the vaginal diaphragm in multicenter clinical trials in the United States, according to FDA regulations. In these clinical trials 75% of women who had used the diaphragm preferred The FemCap. It is to be used with spermicide. The FemCap costs approximately $72.95 from LadyToBaby.com (price as of July, 2006 - Subject to change). It is FDA approved for use in the U.S. and CE approved in Europe.
Oves Contraceptive Cervical Cap:
Available through LadyToBAby.com
The Oves contraceptive silicone device that is a revolutionary new design. It is a disposable after one use female cervical cap, equipped with a removal loop and designed to provide a comfortable and effective barrier against sperm. Its ease of use and it's softness and flexibility have contributed to a high level of acceptability from both the women who use it and their partners. Oves is an effective protection against pregnancy, up to 96% effective when used correctly and consistently with a spermicide. The distributor recommends Gynol II.
Advantages:
- Up to 96% effective
- Hormone free
- Non Latex
- No serious health risks associated with use.
- Very few contra-indications or special precautions for use
- Affords women full control over their contraception
- Allows for spontaneity, can be inserted well in advance of sex.
- It can be left in place continuously for 72 hours.
- No need to add more spermicide over the 72 hours.
The Oves cap has additional advantages over traditional cervical caps and diaphragms. It has a unique design - it is very small and discreet, thin and flexible and fits snugly over the cervix like a membrane, adhering principally by surface tension. It is suitable for women with poor vaginal muscle tone or shallow pubic bone ledge. An integral loop facilitates easy removal. It is manufactured from medical-grade silicone elastomer, which reduces bacterial growth thus eliminating unpleasant odors. The material also allows for an ultra thin, soft shell that is strong yet flexible. Oves is disposable, thus making it more hygienic and more convenient to use.
Oves is available in 3 sizes - 26mm (Mini - for women who have never been pregnant), 28mm (Midi - the size suitable for most women) and 30mm (Maxi - for women who have experienced one or more vaginal births).
Women are advised to purchase a specially priced introductory fitting pack prior to first use. This pack includes 3 Oves caps, one of each size, which you can take to your GP or family planning adviser for an initial fitting.
For more information about the Oves Cervical Contraception Cap, visit this link:
All cervical caps have the disadvantage of requiring a fitting because they come in at least two sizes. Research is needed to determine whether cervical caps provide any protection against STDs, although it is theorized that HIV entry via the cervix may be impeded by cap use.
CERVICAL CAPS USED FOR CONCEPTION
New uses for the cervical cap, primarily the Oves Contraceptive cap, has been put together in a Conception Kit available through www.conceptionkit.com. The cap is used as a means of holding pooled sperm ejaculate and placing it over the cervix so that the sperm has direct and continuous contact with the cervix. For more information about this kit and it's use, check out this link:
The Conception Kit™ - Contents & Use
HORMONAL CONTRACEPTION
Hormonal contraception involves ways of delivering forms of two female reproductive hormones estrogen and progesterone -- that help regulate ovulation (release of the egg), the condition of the uterine lining, and other parts of the menstrual cycle. Unlike barrier methods, hormones are not inert, they do interact with the body and have the potential for serious side effects. When properly used, hormonal methods are also extremely effective. Hormonal methods are available only by prescription.
There are several major types of hormonal contraception:
- Oral Hormones: Birth Control Pills
- Emergency Oral Contraception
- Hormone Implants: Norplant & Implanon
- Hormone Injections: Depo-Provera
- Contraceptive Patch
- Hormone Rings
The Pill is the most popular type of birth control. There are many different brands of The Pill and they come in packs of 21 or 28 pills. One pill is taken every day. The first 21 pills have a combination of synthetic estrogen and progesterone hormones. The Pill stops ovulation, preventing the ovaries from releasing eggs. The Pill also thickens cervical mucus, making it harder for sperm to enter the uterus. The hormones in the Pill prevent fertilization. The last 7 pills of a 28-day pack have no hormones and are called spacer pills. The Pill is 92-99.7% effective as birth control. It does not protect against reproductive tract infections, including HIV/AIDS.
There are two main types of birth control pills: combination pills, which contain both estrogen and "mini-pills," which contain only progestin. The combination pill prevents ovulation, while the mini-pill reduces cervical mucus and causes it to thicken. This prevents sperm from reaching the egg. Also, progestins stop the uterine lining (endometrium) from thickening. This prevents the fertilized egg from implanting in the uterus. The failure rate for the mini-pill is 1 to 3 percent; for the combination pill it is 1 to 2 percent.
When started within 6 days of the start of a period or within 6 days after an abortion, The Pill is effective immediately. If the Pill is started at other times, it will be effective after one month. To lower the risk of pregnancy and sexually transmitted infections, condoms can be used while taking The Pill. Continue to take one pill every day until you finish an entire pack. Try to link taking The Pill with a regular activity that you do at the same time every day, like eating a meal or brushing your teeth. If you have a 28-day pack, start a new pack immediately after you finish the old one. If you have a 21-day pack, take one pill every day for 21 days, no pills for 7 days, then start the new pack immediately.
The most common way women get pregnant while using The Pill is starting late.
- 1 day late starting the next package: Take 2 pills as soon as you remember and one pill each day after. Use a backup form of birth control for two weeks.
- 2 days late starting the next package: Take 2 pills per day for 2 days, then continue as usual. Use a backup form of birth control for two weeks.
- 3 or more days late starting the next package: Call the clinic for instructions.
Missed Pills: During the Cycle
- 1 pill missed: Take it as soon as you remember and take your next pill at your usual time. This may mean taking two pills in one day.
- 2 pills missed in a row in the first two weeks: Take two pills on the day you remember and two pills the next day. Finish the rest of the pack as usual. Use a backup form of birth control for one week.
- 2 pills missed in a row in the third week: Keep taking one pill every day until Sunday. On Sunday, set aside the rest of the pack, including the spacers, and start taking a new pack of pills. Use a backup form of birth control for one week.
- 3 or more pills missed in a row anytime: Keep taking one pill every day until Sunday. On Sunday, set aside the rest of the pack and start taking a new pack of pills. Use a backup form of birth control for two weeks.
Missing any of the last 7 pills of a 28-day package will not raise your risk of pregnancy. Skip the pills you missed, but be sure you start your next pack on time.
Combination oral contraceptives offer significant protection against ovarian cancer, endometrial cancer, iron-deficiency anemia, pelvic inflammatory disease (PID), and fibrocystic breast disease. Women who take combination pills have a lower risk of functional ovarian cysts.
The decision about whether to take an oral contraceptive should be made after consultation with a health care provider. Some women may not be able to take The Pill because of the risk of serious health problems. Smokers, especially women over 35 who smoke, and women with certain medical problems should not take the pill. These conditions include:
- A history of blood clots.
- Heart attacks, strokes, or angina.
- Known or suspected cancer of the breast, vagina, cervix, or uterus.
- Known or suspected pregnancy.
- Any undiagnosed, abnormal vaginal bleeding.
- Liver tumors and liver disease.
- Jaundice due to pregnancy or use of birth control pills.
Women with the following conditions should discuss with a health care provider whether the benefits of the pill outweigh its risks for them:
- Woman under 35 and smoke.
- High blood pressure (hypertension).
- Heart, kidney, liver or gallbladder disease.
- A family history of heart attack or stroke.
- History of blood clots.
- Severe headaches, such as migraines, or depression.
- Elevated cholesterol or triglycerides.
- Epilepsy.
- Diabetes.
- Sickle cell disease.
- Elective surgery.
Serious side effects of the pill include blood clots that can lead to stroke, heart attack, pulmonary embolism, or death. A clot may, on rare occasions, occur in the blood vessel of the eye, causing impaired vision or even blindness. The pills may also cause high blood pressure that returns to normal after oral contraceptives are stopped.
Minor side effects, which can subside after a few months of use and allowing the body to adjust to the hormonal changes created by The pill, include:
- Nausea.
- Headaches.
- Breast swelling & tenderness.
- Fluid retention and/or weight gain.
- Irregular bleeding or spotting.
- Mood changes and/or depression.
- Spotty darkening of the skin.
Sometimes taking a pill with a lower dose of hormones can reduce those side effects. Side effects usually disappear after 2-3 cycles. If your side effects are bothersome after 2-3 cycles of if heavy bleeding occurs, continue taking your pills and call your health care provider to discuss your concerns and prescription.
The pill may or may not have effects on the incidence of breast cancer. More research needs to be done on this matter. The pill may lower a woman's chance of developing ovarian cancer, endometrial cancer, and pelvic inflammatory disease.
The effectiveness of birth control pills may be reduced by a few other medications, including some antibiotics, barbiturates, anti-seizure, tuberculosis, migraine, and antifungal medications. On the other hand, birth control pills may prolong the effects of theophylline and caffeine. They also may prolong the effects of bensodiazepines such as Librium (chlordiazepoxide), Valium (diazepam), and Xantax (alprazolam). Because of the variety of these drug interactions, women should always tell their health care providers when they are taking birth control pills. When taking medications that may interfere with birth control pills, consider adding a backup method of birth control, like condoms and spermicide. As with all drugs, it is useful to inform all of your health care providers if you are using hormonal birth control.
Danger Signs:
Women who experience any of the following symptoms while taking The Pill should call their health care provider immediately:
- Abdominal pains (severe).
- Chest pain or shortness of breath.
- Headaches (severe).
- Eye problems, such as blurred vision.
- Severe leg or arm pain or numbness.
Missing a period does not always mean that you are pregnant. If you do miss a period, think about how likely a pregnancy is. Also consider the risks related to continuing birth control pills. Pregnancy is more likely:
- In the first few months of Pill use.
- If you missed taking any Pills.
- If you are taking another medication (especially antibiotics).
- If you have been sick (vomiting and/or diarrhea).
If you forgot one or more pills and do not have a period that month, we recommend that you have a sensitive pregnancy test done by your health care provider.
If you miss two periods in a row, it could either be normal or a sign of pregnancy. Pregnancy tests are recommended right away. If you become pregnant while on The Pill, there is probably no risk of birth defects, but discontinue use immediately.
Future Fertility: Women who want to become pregnant may stop using The Pill at any time. Fertility may return immediately or usually after a few months.
Advantages of The Pill:
- Periods may be lighter or more regular.
- Easy to use.
- Does not harm future fertility.
- Does not interrupt sex play.
- May protect against uterine and ovarian cancers.
- May reduce acne.
- Can be used for Emergency Contraception.
Disadvantages of The Pill:
- Does not protect against sexually transmitted infections/diseases (STIs/STDs) including HIV/AIDS.
- Must be taken every day.
- Less effective when taken with some drugs.
- Raised risk of heart attack and stroke.
- Requires a prescription.
Further References:
- Safer Sex Info
- Sexually Transmitted Diseases
- Coalition for Positive Sexuality
- Our Bodies, Ourselves. Boston Women's Health Collective. New in 2005.
- NoPeriod.com - information about using birth control pills to not ever have a period.
- Menstrual Suppression - Do women need to have a period?
- Emergency Contraception
- Info for Health.org - about birth control, HIV, abortion and women's health - from the Information & Knowledge for Optimal Health (INFO) Project at Johns Hopkins Bloomberg School of Public Health
These methods are used for emergency contraception only. If you had an incident of unprotected sexual intercourse and you are concerned about becoming pregnant, these methods are possible solutions. Research them and know side effects and success possibilities before use. It is always better to be prepared and prevent a potential problem than to try to resolve a problem after the fact.
Norplant (Levonorgestrel) is the first contraceptive implant and was approved by FDA in 1990. In a minor surgical procedure, six matchstick-sized capsules made of silicone rubber containing progestin, a synthetic progestin hormone long used in birth control pills, are placed (inserted) just underneath the skin of the upper arm in a fan-like arrangement. The implant, once in place, steadily release a low dose of hormone into the bloodstream. It is effective within 24 hours after insertion and provides progestin for up to five years or until it is removed. Both the insertion and the removal must be performed by a qualified health care provider.
The hormone usually inhibits ovulation so that eggs are not produced regularly, and causes the mucus of the cervix to thicken, making it more difficult for sperm to reach the egg. Other ways that Norplant may provide contraceptive effects have been proposed but not proven.
Each Norplant capsule is 2.4 millimeters (about one-tenth of an inch) in diameter and 34 millimeters (just under one-and-a-half inches) long, and holds 36 milligrams of powdered crystals of the progestin levonorgestrel. The tubes are made of Silastic, a silicone material long used in surgical implants such as heart valves and hip joints.
The hormone seeps through the permeable tubes into the bloodstream, initially at a rate of about 85 micrograms a day. The amount declines gradually to about 50 micrograms by nine months, 35 by 18 months, and about 30 micrograms at the end of five years. In comparison, birth control pills that contain levonorgestrel provide about 50 to 150 micrograms of the progestin a day, plus estrogen. (The only progestin-only contraceptive available in the United States contains 75 micrograms of norgestrel, a progestin similar to levonorgestrel.)
When the hormone supply dwindles, usually in about five years, a new implant can be inserted if desired. On the other hand, if a woman wishes to become pregnant earlier, she can have the implants removed at any time, and fertility is restored very soon. Blood levels of the progestin are undetectable within 5 to 14 days.
Studies are being done for Norplant II for male contraception to inhibit sperm formation (spermatogenesis) in men. See this NcIB Abstract about this study.
Because of contraception is automatic and does not depend on the user, the failure rate for Norplant is less than 1 percent for women who weigh less than 150 pounds. Women who weigh more have a higher pregnancy rate after the first two years.
In the studies, the contraceptive's effectiveness approached that of sterilization in the first year. Pregnancy rates were slightly higher in heavier women, increasing after the third year of use in those who weighed more than 69 kilograms (153 pounds). Nevertheless, the protection is still quite good. For example, among 100 women of all weights using the implant for five years, it is expected that four would become pregnant during that time. By contrast, of 100 women using the pill for the same time, at least 15 might be expected to become pregnant.
Norplant's effectiveness does not depend on patient compliance -- a feature shared by only one other type of reversible contraceptive -- the intrauterine device, or IUD. This particularly appeals some women for the convenience it affords. Unlike the pill, you don't have to remember to take it every day, and, unlike the diaphragm, there's no problem with sexual spontaneity.
Because Norplant is not a barrier contraceptive, however, it offers no protection against sexually transmitted diseases (STDs) such as AIDS, herpes, chlamydia, and gonorrhea. For optimum protection from both disease and pregnancy, couples may choose to use both Norplant and a condom.
Side Effects:
Women who cannot take birth control pills for medical reasons should not consider Norplant a contraceptive option. As with virtually any drug or medical device, Norplant isn't entirely trouble free and may produce side effects in some women. The potential side effects of the implant include:These side effects may subside after the first year.
- Irregular menstrual bleeding.
- Headaches.
- Nervousness.
- Depression.
- Nausea.
- Dizziness.
- Skin rash and/or acne.
- Change of appetite.
- Breast tenderness.
- Weight gain.
- Enlargement of the ovaries or fallopian tubes.
- Excessive growth of body and facial hair.
Some Norplant users have also reported:These effects, however, may not be linked to use of the implant because the complaints are common among the general population and could stem from many other causes. There is no known biological reason to link the complaints specifically to use of the contraceptive.
- Breast discharge.
- Vaginal discharge.
- Inflammation of the cervix.
- Abdominal discomfort.
- Muscle and skeletal pain
By far, the most common side effect is menstrual cycle irregularity. To determine the percentage of women with menstrual irregularities is complex because it changes with time and age. Over a five-year period of use, about 45 percent of women will have irregular periods and another 45 percent will have normal periods. The remaining 10 percent will have long periods of time (three to four months) with no bleeding. This is an average. Basically what happens is you have more women with irregular periods in the first year and that tends to diminish with continuing use.
The bleeding irregularities result from the continuous hormone release. With the oral contraceptive pills, estrogen and progestin are taken for three weeks and withdrawn for one week, causing regular bleeding. Norplant, on the other hand, provides no cyclic withdrawal, and thus each individual creates her own bleeding pattern.
In the multi-center trials, more women had increases in their hemoglobin concentrations than decreases, indicating that they lost less menstrual blood when using Norplant. (Hemoglobin is the oxygen-carrying pigment of red blood cells that gives them their red color and serves to transport oxygen to tissues.) The reason for this, on average, even if the number of bleeding days increases in the first year of use, the total amount of blood lost may be less than would be lost without hormonal contraception.
Most women who use Norplant do not perceive bleeding as a problem. If women are interviewed about this issue and are asked what is the biggest complaint that they have about Norplant, the most common response is that it's the bleeding irregularities. But if they are asked if bleeding irregularities bother them, approximately 60 percent will respond with "No ". Some women experience spotting and a lighter flow with Norplant and sometimes they may have no discernible cycle at all.
Nevertheless, the major reason women give for discontinuing Norplant is bleeding problems, accounting for about 9 percent of those who stop in the first year. Another 5 percent stop for other medical reasons, from headaches to dizziness, and perhaps another 5 percent stop for other reasons, including to have a baby. Estimates are that about 60 to 65 percent of women continue with the implant longer than two years.
Norplant is NOT for Everyone:
More serious complications are possible as well, and Norplant is not recommended for everyone. As with oral contraceptives, women with acute liver disease or liver tumors (whether malignant or benign), unexplained vaginal bleeding, breast cancer, or blood clots in the legs, lungs or eyes should not use the implant.
Norplant contains only progestin, whereas most oral contraceptives contain both progestin and estrogen. Some side effects of the pill, such as eye disorders and increased risk of cardiovascular problems among women who smoke, are believed to be related to the estrogen component. Nevertheless, the FDA advises health care providers to consider the possible increased risks associated with oral contraceptives, including elevated blood pressure, thromboembolic disorders (blood clots obstructing blood vessels), and other vascular problems that might occur with use of the contraceptive implant.
Norplant will be most attractive to women who:On the other hand, the implant to be less popular among women who:
- Wish to use highly effective low-dose hormone contraception.
- Want long-term contraception after completing their family, but don't want sterilization.
- Want to delay childbearing for an extended period of time.
- Cannot use estrogens.
- Are unhappy with other forms of contraception.
- Are happy with their present form of contraception.
- Cannot or do not want to pay the up-front cost of Norplant.
- Will not tolerate irregular menstrual bleeding if it should occur.
- Do not want to use a method that requires a visit to a health-care professional to discontinue. Some women feel that they do not want to have to visit a health care provider when they decide to quit using Norplant and that they may want to discontinue it any time they choose. This is why some women like using the pill or barrier methods since they have more control over when they use them or not use them.
Surgical Insertion:
The woman being considered for hormone implants will most likely have a pelvic and breast examination, a Pap test (a microscopic examination of cell samples taken from the cervix), blood pressure check, weight check, and a review of her medical history.
If approved for this method, a site of implantation will be selected (usually the inside of the upper arm), and the area prepared for minor surgery. The skin will be washed with soap and water, and an antiseptic, such as iodine solution, will be applied. The health care provider will use a local anesthetic to numb the area, a small incision will be made, the capsule(s) will be inserted, and the incision sewn up (sutured).
Successful use of the Norplant system depends on careful insertion of the capsules. Wyeth-Ayerst markets the implant as a kit with detailed instructions for insertion and removal, and, through the Association of Reproductive Health Professionals, offers health care provider training programs as well.
The firm describes the insertion as a minor, outpatient surgical procedure requiring only 10 to 15 minutes. The area is numbed with a local anesthetic, and a small incision, less than an eighth of an inch long, is made. Using a special instrument called a trocar, the health care provider places the six capsules just under the skin. The incision is then covered with protective gauze and a small adhesive bandage. Stitches are not required.
When the anesthetic wears off, there may be some tenderness or itching, and perhaps some temporary discoloration, bruising and swelling. Infection at the site of insertion has also been reported.
It takes a bit longer to remove the implant than to insert it. Removing them usually takes from 15 to 20 minutes, according to the distributor. As with insertion, a small incision is made under a local anesthetic. Then the health care provider removes the capsules and, again, the incision is covered with an adhesive bandage. Sometimes, some capsules may be more difficult to remove than others. When this happens, the woman may have to return a second time, after the area has healed, for removal of the remaining capsules.
The reason for suggesting the second visit is to let the health care provider know that if they have trouble removing the capsules that they shouldn't cut a big hole in the woman's arm and go fishing around looking for it them. If the anesthetic has caused the area to swell it may be difficult to feel the implant. The health care provider should Wait until the next week, or whenever the woman can come back in again, to be able to see the implants and take them out with minimal trauma to the woman.
If desired, a new set of implants can be inserted at the same time the old set is removed, either in the same arm and through the same incision, or in the other arm.
The price to the medical professional for a single Norplant system, which includes all the necessary apparatus for insertion and removal as well as the set of six capsules, has been set at $350 (prices may change over time). Fees for insertion and related costs, such as counseling and removal, vary, depending on the health care provider.
Some women may not want to get new implants later or may take a break from them for awhile if they may want to get pregnant in the near future or have concerns about hormone therapy and the risks associated with it (more with the pill and estrogen than with Norplant). They may want to research what other contraceptive alternatives may be available after the implants are removed. Some women who are satisfied with the implants would recommend Norplant for women planning on using hormone therapy anyway.
Update Information: IMPLANON
A new contraceptive that is implanted in the upper arm and remains effective for three years will be made widely available in the United States early next year (2007), filling a gap in birth control options for women since Norplant was taken off the market in 2002.
The new contraceptive, called Implanon, is a matchstick-size device that health care providers inject into the underside of a woman's arm, where it releases a continuous dosage of the synthetic hormone progestin over three years. The device is 99 percent effective at preventing pregnancy.
Implanon, made by Organon of Roseland, N.J., joins the ranks of increasingly advanced birth control options on the market for women. In the past five years, new birth control devices have included a skin patch that is changed once a month, an intrauterine device that releases low-dose hormones and lasts five years, and a product called the NuvaRing, also made by Implanon, that is inserted into the vagina once a month and releases progestin.
Implanon won approval from the Food and Drug Administration in July 2006, nearly three years after Organon submitted an application to the agency. Implanon has been available in Europe and elsewhere since 1998 and has been used by about 2.5 million women. The company has not announced what Implanon will cost, but a spokeswoman said the device would be competitive with other hormonal forms of contraception. Birth control pills cost $20 to $35 a month and often are covered by insurance. When Norplant was available, it cost about $500 for the initial implantation and $100 to $200 to remove the implants.
Norplant was taken off the market by manufacturer Wyeth Pharmaceuticals after women complained of uncomfortably heavy or irregular menstrual cycles and difficult removal. Organon officials said they don't anticipate similar problems with Implanon, in part because Norplant involved the implantation of six small devices, compared with the one for Implanon. Also, Implanon uses a different form of progestin than Norplant. Organon will be developing a nationwide training program to teach health care providers proper techniques for implanting and removing the device. Only health care providers who receive the training will be able to prescribe Implanon.
The Implanon device is loaded with 68 milligrams of progestin, which is released slowly and regularly during the lifetime of the device. Progestin stops the ovaries from releasing eggs and, at the same time, thickens cervical mucus, preventing sperm from fertilizing any released eggs. Side effects can include irregular menstrual cycles and, in some cases, no monthly periods at all, as well as pain and swelling at the insertion site in rare cases. Implanon is considered to be more effective than the older implant brands and insertions/removals are faster, with fewer complications.
The women most likely to show interest in Implanon are young people who are not interested in having children for several years at least. Implanon does not affect long-term fertility, and after having the device removed, women should be able to get pregnant within a month. Implanon is available in Australia, Indonesia, and 11 European countries, including The Netherlands and the UK.
OTHER TYPES OF HORMONE IMPLANTS:
Nestorone:
One type consists of a single rod that lasts up to two years, while another type is a small capsule that lasts for six months. The six-month system is available in Brazil under the brand name Elcometrine. It is used to treat endometriosis.
Jadelle (Norplant II):
Jadelle consists of two implantable rods that also contain only one hormone (a progestin with 140 mg levonorgestrel). In the U.S. it is called Norplant II. The rods are implanted by a health care provider under the skin of the inner upper arm and can be left in place for up to 5 years. The particular advantages of using Jadelle are that its effectiveness is not affected by the user's weight and it has fewer removal complications. The particular disadvantage of Jadelle is that weight gain is seen in about 50 percent of the users by the end of 5 years. Jadelle is available in Europe. It has also received FDA approval in 1996, but it's not currently being marketed in the U.S. Jadelle is manufactured by Schering Oy.
Uniplant:
Uniplant is a single-rod implant that contains only one hormone, a progestin (nomegestrol acetate). It may be left in place for up to one year. There are no commercialization plans at this time.
Depo-Provera (Depot-medroxyprogesterone acetate) is a synthetic progesterone hormone similar to the one that a women's body produces. It is an injectable form of a progestin that is used about 4 times per year. It was approved by FDA in 1992 for contraceptive use. Previously, it was approved for treating endometrial and renal cancers. Depo-Provera has a failure rate of only 1 percent.
Each injection provides contraceptive protection for 14 weeks. The injections are done on a regular schedule (every 12 weeks). It is injected every three months into a muscle in the buttocks or arm by a trained health care provider. If given during the first 5 days of menstrual bleeding, no additional protection is needed. However, this does not protect the user from STD's (sexually transmitted diseases). For protection from STD's, condoms (male or female) must be used.
Like most forms of hormonal birth control, Depo-Provera keeps the ovaries from releasing an egg and thickens the cervical fluids so sperm have a difficult time swimming in it. If no egg is released, or if no sperm can reach the egg, pregnancy cannot occur. Depo-Provera is over 99 percent effective (failure rate of only 1 percent).
The side effects are similar to those for Norplant listed above. Some of the most common side effects are:
- Irregular bleeding and spotting during the first months followed by episodes of amenorrhea (no menstrual period). Menstrual periods may be heavier than usual or lighter than usual. About 50 percent of the women who use Depo-Provera for one year or longer report their periods stop completely (amenorrhea).
- Weight gain.
- Headaches.
- Nervousness.
- Depression.
- Nausea.
- Dizziness.
- Abdominal pain.
- Breast tenderness.
- Hair loss.
- Skin rashes.
- Increased or decreased sexual desire.
- Development of dark spots on the skin.
- Tiredness or weakness.
Serious side effects should be reported to your health care provider immediately if you have any of the following:
- Marked weight gain.
- Heavy vaginal bleeding.
- Frequent urination.
- Blurred vision.
- Fainting.
- Severe abdominal pain.
- Severe depression.
- Migraine headaches.
- Lump in either breast.
- Heavy or continuous bleeding.
- Yellowing of the eyes or skin.
- Sudden shortness of breath.
- Sharp chest pains.
- Coughing up blood.
Because the effects of Depo-Provera may last up to 12 weeks, it may take a longer time for women trying to conceive to become pregnant after discontinuing the injections. One of the drawbacks to using Depo-Provera is that it can take up to 8 months, or longer, for the medication to leave your system. Regular periods may not return for up to a year after the last injection. Return of fertility and achievement of pregnancy can take up to 18 months or longer. This is not the birth control to use for a short time if you want to achieve pregnancy after stopping it.
There are many women that think Depo-Provera is a great contraception since they don't have to worry about unintended pregnancy, forgetting a pill, or worrying if the condom broke. Some like it because they only have to see their health care provider every 3 months instead of more frequent visits and the injections makes it an excellent choice for women that know that they don't want to get pregnant in the near future. It is easy to use and one of the most effective forms of birth control available today.
Other women disliked this form of contraception because of the inconvenience of having to see their health care provider every 3 months and some don't like getting injections (shots). The side effects involved with it, such as the weight gain and change in their period patterns are also reasons why some women do not like the injections. They also did not like the amount of time it would take for the hormones to leave the body.
The cost of Depo-Provera is comparable to the pill. Depo-Provera costs on average between $120 and $300 each year (four shots), while the pill costs between $240 and $420 each year (twelve packs). Norplant costs as much as $750 (five years of protection) and that does not include the cost of removing it. Of course, if you visit your local women's health clinic or Planned Parenthood office, the cost of your birth control method will be income based. This makes all methods available at your local clinic affordable for everyone.
LUNELLE CONTRACEPTION INJECTIONS
Lunelle (Cyclofem/CycloProvera) is another injectable contraceptive that is administered monthly (every 28 to 30 days) and is a monthly combination birth control injection. Lunelle was approved by the Food and Drug Administration (FDA) in October 2000. The hormone in Norplant and Depo-Provera is progestin, a synthetic hormone similar to one found naturally in a woman's body; Lunelle contains the hormones progestin and estrogen.
The purpose of these hormones is to prevent pregnancy; they are about 99% effective in achieving this goal. No hormonal contraceptive methods provide protection from AIDS or other sexually transmitted diseases.
The hormones in Lunelle works similarly Depo-Provera. The shot has 2 hormones: an estrogen and a progestin (5.0 mg estradiol cypionate and 25 mg medroxyprogesterone acetate). The the egg (ovum) is prevented from maturing and being released. The mucus in the cervix (opening into the uterus or womb) becomes thicker, making it difficult for the sperm to enter. It also causes the lining of the uterus to become thinner, making implantation of a fertilized egg unlikely.
As with an injection of Depo-Provera or Lunelle must be given within the first five days of a normal period. Depo-Provera provides protection against pregnancy for three months, while Lunelle provides similar protection for one month. Ovulation (release of a mature egg) typically occurs within 60 days of the last injection of Lunelle, about twice as fast after use of Depo-Provera. Also, because Lunelle is a combined hormone contraceptive as opposed to progestin-only Depo-Provera and Norplant, it is less likely to cause irregular or absent menstruation.
The woman being considered for Depo-Provera or Lunelle will have a pelvic and breast examination, a Pap test (a microscopic examination of cell samples taken from the cervix), blood pressure check, weight check, and a review of her medical history. Women who have diabetes mellitus, major depression, blood clotting problems, liver disease, or weight problems should use these methods only under strict medical supervision. Depo-Provera or Lunelle should not be used if the woman is pregnant, has unexplained vaginal bleeding, suffers from severe liver disease, has breast cancer, or has a history of blood clots or stroke. One benefit of Lunelle, however, is that its effects wear off more quickly than Depo-Provera, an important factor in the event that a woman has serious side effects or wants to become pregnant.
Depo-Provera contains only one hormone, a progestin. Also, you only get this shot once every three months rather than monthly, and the advantages and disadvantages of using it differ from those of Lunelle. The particular disadvantages of Lunelle are:
- The need for a monthly visit to a doctor's office to receive the shot.
- Weight gain.
- Headache.
- Nausea.
- Breast pain.
Lunelle was approved for use in the U.S. in 2000. However, in October 2002 it was voluntarily recalled from the market, due to plant manufacturing problems. The maker doesn't plan to reintroduce it in the U.S. Since Lunelle was the only combination shot available in the U.S., once again American women are left without an alternative. For women in the rest of the world, the alternatives to Lunelle are: Mesigyna, Perlutal, Yectames, and Chinese Injectable No.1.
ORTHO-EVRA®
Ortho-Evra® (Norlegstromin/ethinyl estradiol) is a birth control patch about the size of a half-dollar. It contains both an estrogen and a progestin (0.75 mg ethinyl estradiol and 6.0 mg norelgestromin). You wear the patch on the arm, abdomen or buttock for 7 days in a row. Then you exchange it for a new patch, which you wear for another week, and so on. After three weeks (and three patches), the fourth week is patch-free.
The specific advantages of using Ortho-Evra are:
- Convenient, once-a-week dosing.
- You can use it to control the timing and start of your periods.
The Ortho-Evra® Contraceptive Patch works by passing estrogen directly into the bloodstream, through the skin. Because oral contraceptives are taken daily, users of the Pill have estrogen levels that will rise and fall over time, whereas women wearing the Ortho Evra®Patch will experience a more constant, and potentially unsafe level of exposure to estrogen. The particular disadvantages of Ortho Evra are:
- It does not stick in about 5% of women.
- It can become partially or completely detached.
- it may cause an allergic skin reaction or irritation at the application site.
- More severe menstrual cramps and breast pain vs. pill users.
- The patch is less effective in women who weigh more than 90 kg (198 lbs)
Side effects from excess exposure to hormones in the patch include:
- Breast tenderness and enlargement.
- Headaches.
- Nausea.
- Vomiting.
- Shortness of breath.
- Dizziness.
- Jaundice (yellowing of skin).
- Rash.
- Chest pain.
- Fever.
- Fatigue.
- Vision problems, blurring of vision.
- Difficulty with speech.
- Loss of appetite.
- Numbness in extremities.
- Pain in the legs, head, or stomach.
- Abdominal cramps and bloating.
- Menstrual changes.
- Vaginal discharge.
The Ortho-Evra Patch® has been associated with increased risk of Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE). Estrogen exposure can cause blood clots to form in the circulatory system, usually in the legs. When the blood clot becomes dislodged, it can travel to the heart, lungs, brain or other organs, causing hemorrhage, heart attack, stroke and death.
If you are wearing the Ortho-Evra Patch® and have experienced any of these warning signs, you should notify your physician immediately. Additionally, women over 35 and/or women who smoke are already at higher risk of blood clot-related problems - for this population, special care should be taken in the choice of contraceptive methods, and use of the Patch is particularly dangerous.
Cigarette smoking increases the risk of serious adverse effects on the heart and blood vessels from the use of hormonal birth control methods. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. Women who use hormonal birth control methods should not smoke.
Ortho-Evra® should not be used by women who have a history of:
- Heart attack or stroke.
- Blood clots in the legs, lungs (pulmonary embolism), or eyes.
- Blood clots in the deep veins of the legs.
- Chest pain.
- Known or suspected breast cancer or cancer of the lining of the uterus, cervix or vagina.
- Current unexplained vaginal bleeding.
- Yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or during previous use of hormonal contraceptives.
- Liver tumor (benign or cancerous).
- Current or suspected pregnancy.
- Severe high blood pressure.
- Diabetes with complications of the kidneys, eyes, nerves, or blood vessels.
- An allergy to Ortho Evra or to any of its ingredients.
The Ortho-Evra patch may be less effective in preventing pregnancy in women weighing more than 198 pounds.
Reports of new information after Ortho Evra became available: As a result of further analysis by the FDA and the manufacturer, it has been found that users of Ortho Evra are exposed to about 60% more total estrogen in their blood than if they were taking a typical birth control pill containing 35 micrograms of estrogen. However, the highest blood level of estrogen (peak blood levels) is about 25% lower with Ortho Evra than with typical birth control pills. In general, increased estrogen exposure may increase the risk of blood clots. However, it is not known whether women using Ortho Evra are at a greater risk of experiencing these serious side effects. ( Patient Information Sheet)
For more information:
FDA Updates Labeling for Ortho Evra Contraceptive Patch
Ortho Evra - Associated Press (7/16/05): AP Finds More Fatalities Than Expected
New York Post (5/8/05): Contra-Deception
2006 Ortho Evra Side Effects Lawsuit News
Lawsuit Against J&J Alleges Ortho Evra Contraceptive Patch...
Ortho Evra Web Site
NuvaRing®
NuvaRing® (Etonogestrel-Ethinyl Estradiol) is a vaginal contraceptive ring. It is a thin, flexible doughnut-like vaginal ring that contains two hormones - an estrogen and a progestin (2.7 mg ethinyl estradiol and 11.7 mg etonogestrel).
You insert the ring into the vagina yourself. Because it's not a barrier method, you don't need to place it exactly over the cervix. It releases hormones that keep you from getting pregnant. These hormones are the same ones used in most birth control pills. The ring is left in the vagina for 3 weeks. It doesn't have to be in a specific position in the vagina. After 3 weeks, you remove the ring, and your period will start. After 7 days, you insert a new ring.
If the ring is out of your vagina for more than 3 hours, it may not work effectively when you put it back in. To protect against pregnancy, you will need to use another form of birth control until the ring has been in all the time for 7 days in a row.
The estrogen and progestin hormones are similar to the natural hormones produced by the ovaries. The progestin component is absorbed in small amounts and prevents the ovary from releasing an egg (ovulation). The uterine lining also becomes thinner than usual, which would inhibit implantation of a fertilized egg. In addition, the cervical mucus also becomes thicker and this helps prevent sperm from entering the uterus. When properly placed, the ring is held in place by the vaginal muscle structure, even during exercise or intercourse. The NuvaRing® cannot "get lost" in the vagina. The vagina is flexible, but no longer than the palm of your hand. The cervix forms the back wall of the vagina so the ring remains in the vagina.
According to studies provided to the Food and Drug Administration (FDA) during the approval process, effectiveness ratings are listed at 99% when used according to label instructions. This is comparable to the patch and better than the Pill's effectiveness ratings.
The particular advantages of using NuvaRing® are:
- Convenient, once-a-month dosing.
- The ring doesn't need to be fitted by a doctor.
- You can use it to control the timing and start of your periods.
The particular disadvantages of NuvaRing® are:
- Headaches.
- Vaginal irritation, discharge, or infection.
- The ring may accidentally slip out during sex.
- You, or your partner may feel the ring during sex.
Benefits:
- Medication is absorbed directly into the blood stream through the vaginal wall membrane providing a consistent level of medication in the blood, which improves effectiveness and helps limit side effects. Oral contraceptives take time to be absorbed into the blood stream and this causes peaks and valleys in the hormone blood levels.
- Once monthly insertion eliminates the need to think about birth control on a daily or weekly basis; usually neither partner is aware of its presence during intercourse.
- Very discreet and private; no one can see it or know that you are wearing it.
- Easily reversible - ovulation returns quickly when use of the ring is discontinued; however, women who have irregular menstrual cycles will probably return to the irregular cycle.
- Provides a regular menstrual period, but menses are usually lighter and may be shorter than a normal period.
- Thickened cervical mucus helps decrease the risk of pelvic inflammatory infections.
- Reduces the chances of ovarian cysts and tubal pregnancy.
- Vomiting and diarrhea should not interfere with the effectiveness of the ring.
Other Considerations:
- Insertion and removal require that a woman insert her finger inside the vagina; therefore she must be comfortable touching her genitalia and vagina.
- NuvaRing® does not offer any protection against transmission of sexually transmitted diseases (STDs), such as chlamydia, gonorrhea, syphilis, hepatitis or HIV. Condoms may be used with the ring to reduce the risk of STIs.
- Always inform your health care provider that you are using the ring. It is a medication just like any others that you are taking.
- Disposal is easy - Keep the original foil package and when the ring is removed just place it back in the foil pack, seal and throw away.
- NuvaRing® is nonabsorbent, odorless, and contains no latex.
- Do not breast feed while using NuvaRing®.
If for any reason, the ring is removed or slips out, it may be rinsed in cool water and reinserted. If it is out for three hours or more, there will be reduced contraceptive protection and an alternative method of birth control must be used until the ring has been in place for seven consecutive days. Emergency contraception is available if it is out three hours or longer.
Unopened NuvaRing® packs will expire in four months unless stored in the refrigerator. (Refer to the package insert for additional information or talk with the pharmacist.)
If unopened NuvaRing® packs are stored in temperatures greater than 86° the effectiveness may be lessened.
It is safe to use other vaginal medications/lubricants with the NuvaRing®.
Side Effects & Contraindications
Contraceptive effectiveness may be reduced when hormonal contraceptives are administered at the same time other drugs are being taken. Break through bleeding or unintended pregnancy can result. Examples of drugs that potentially interfere with contraceptive hormones include antifungals, seizure medications and, potentially, antibiotics. For additional information please refer to the handout Pill Interactions with Other Drugs or see Hormone Rings on this web site.
Women who use the vaginal ring should not smoke. Smoking cigarettes/using tobacco while using hormonal birth control (pill/patch/ring) increases your risk of heart problems and stroke. Do not smoke. The risk of heart problems increases with age (especially in smokers over 35) and also with frequent smoking (15 or more cigarettes a day).
You should not use this product or consult with your health care provider before using this hormonal contraceptive device if you have any of the following:
- Depression.
- Tobacco Smoking.
- A Blood Clot within the Blood Vessels of the Eye.
- Metabolic Syndrome X.
- Toxic Shock.
- Worsening Headache Disorder.
- Long Period of being Bed-Ridden after Major Surgery.
- Diabetes with Blood Vessel Disease.
- High Blood Pressure.
- Severe Uncontrolled High Blood Pressure.
- Heart Attack.
- Non-Q Wave Heart Attack.
- Disease of the Arteries of the Heart.
- Heart Valve Disease.
- Stroke.
- Any Disorder of the Blood Vessels of the Brain.
- Obstruction of a Blood Vessel by a Blood Clot.
- Blood Clot in Vein.
- Blood Clot in a Deep Vein.
- Liver Problems.
- Disease of the Gallbladder.
- Bleeding Not Related to Menstrual Period.
- Jaundice associated with Pregnancy.
- Pregnancy.
- Benign Tumor of Liver Cells.
- Liver Cancer.
- Cancer of Epithelial Tissue in the Breast.
- Cancer in the Lining of the Uterus.
- Tumor that is Dependent on Estrogen for Growth.
- Diabetes.
- High Cholesterol.
- High Amount of Triglyceride in the Blood.
- Water Retention.
- Overweight.
- Allergies to estrogen and/or progestin compounds.
Inserting & Removing the NuvaRing®
The NuvaRing® may be inserted while standing, squatting or lying down.
Holding NuvaRing® and Pressing the Sides Together
Using your thumb and index finger, press the sides of the ring together.
Gently push it deep into the vagina.
Side effects may be severe or mild and include:
- Acute infection of the nose, throat or sinus.
- Sinus irritation and congestion.
- Inflammation, discomfort, irritation or infection of the vagina.
- Increased discharge from the vagina.
- Bleeding not related to menstrual period.
- Nausea.
- vomiting.
- Headache.
- Stomach cramping and/or bloating.
- Dizziness.
- Breast tenderness and/or enlargement may occur.
- Weight gain.
- Mood changes.
For more information about Hormone Contraceptive Rings (NuvaRing®) see:
For more information, please visit the NuvaRing® site, maintained by the manufacturer, Organon.
www.nuvaring.com: NuvaRing®.
OTHER TEMPORARY CONTRACEPTIVE METHODS
NATURAL METHODS OF BIRTH CONTROL
These methods involve no hormones, medications, contraceptive devices, or other outside influences. To use these methods, it is important to know your own body, it's cycle and signs of fertility or infertility. Awareness is the key to these methods. There is very little, if any, side effects to these methods, inexpensive, and are safe to use and are surprisingly effective if used correctly for each and every sexual encounter. For more information about these methods, see the links below:
(Total Abstinence is listed under Natural Methods)
Periodic abstinence entails not having sexual intercourse during the woman's fertile period. Sometimes this method is called natural family planning (NFP) or "rhythm." Using periodic abstinence is dependent on the ability to identify the approximately 10 days in each menstrual cycle that a woman is fertile. Methods to help determine this include:
The Basal Body Temperature Method - based on the knowledge that just before ovulation a woman's basal body temperature drops several tenths of a degree and after ovulation it returns to normal. The method requires that the woman take her temperature each morning before she gets out of bed.
The Cervical Mucus Method - also called the Billings Method, depends on a woman recognizing the changes in cervical mucus that indicates ovulation is occurring or has occurred. There are now electronic thermometers with memories and electrical resistance meters that can more accurately pinpoint a woman's fertile period.
Maintaining a calendar record of menstrual cycles is an additional step women can take to help determine ovulation.
The periodic abstinence method has a failure rate of 14 to 47 percent. Total abstinence from any sexual activity has a failure rate of 0 percent, if used at all times, instead of just during certain times of the menstrual cycle. However, total abstinence is not usually a optimal choice if you are in a sexual relationship and have a partner. It is a great choice if you are not having a sexual relationship with anyone for an extended period of time and are not planning on having one in the near future. It has none of the side effects of artificial methods of contraception.
IUDs are small, plastic, flexible devices that are inserted into the uterus through the cervix by a trained health care provider. IUDs made of metal and/or plastic that prevent pregnancy when inserted into a woman's uterus through her vagina. Nearly 15 percent of women of reproductive age-approximately 160 million women-currently use IUDs. Much of their popularity stems from their effectiveness combined with their long duration. The most widely used IUDs are copper-bearing IUDs. Inert (unmedicated) and progestin-releasing IUDs (levonorgestrel or progesterone) are less widely available. IUDs are a safe and effective method of reversible, long-term contraception for most women. They do not affect breast feeding, interfere with intercourse, or have hormonal side effects; only some gynecologic and obstetric conditions and infections preclude use of the method. One drawback of IUDs is their tendency to cause heavy menstrual bleeding. Unless otherwise stated, the following information applies to copper IUDs.
Three IUDs are presently marketed in the United States: ParaGard T380A, a T-shaped device partially covered by copper and effective for 8 to 12 years (resources vary in length of time, average is about 10 years); and Progestasert, which is also T-shaped but contains a progestin released over a one-year period. Mirena IUD also contains progesterone hormone and is good for about 5 years. After that time, the IUD should be replaced. Both IUDs have a 4 to 5 percent failure rate. It is not known exactly how IUDs work. At one time is was thought that the IUD affected the uterus so that it would be inhospitable to implantation. New evidence, however, suggests that uterine and tubal fluids are altered, particularly in the case of copper-bearing IUDs, inhibiting the transport of sperm through the cervical mucus and uterus.
The risk of pelvic inflammatory disease (PID) with IUD use is highest in those with multiple sex partners or with a history of previous PID. Therefore, the IUD is recommended primarily for women in mutually monogamous relationships.
In addition to PID, other complications include perforation of the uterus (usually at the time of insertion), septic abortion, or ectopic (tubal) pregnancy. Women may also experience some short term side effects -- cramping and dizziness at the time of insertion; bleeding, cramps and backache that may continue for a few days after the insertion; spotting between periods; and longer and heavier menstruation during the first few periods after insertion.
MIRENA IUD
Mirena is an older, frame Intrauterine Device (IUD). The newer IUDs, like FibroPlant, and GynePlant don't have a frame. Mirena, the hormonal IUD available in the U.S., is a small, plastic, T-shaped device that also contains a progestin hormone (52 mg levonorgestrel) in its frame. Mirena is inserted into the uterus by a medical professional, in a matter of minutes. Once in place, it releases a very low dose of the hormone locally, for up to 5 years. Of course, if you don't want to use it for the full 5 years, you can have it taken out at any time. The removal is also done by a medical professional and lasts even less than the insertion.
The advantages of using Mirena are:
- You can use it continuously for up to 5 years.
- Lighter, shorter and less painful periods.
- The hormone mostly acts inside the uterus, so there are no wide-spread body effects quick return to fertility.
- Effectiveness rate comparable to sterilization.
Mirena can also be used to manage your menstrual period.
The particular disadvantages of Mirena are:
- Irregular periods, during the first few months of use.
- Headaches.
- Nausea.
- Breast pain.
- Mood changes.
- Other hormone related side effects (see above) may occur.
Like with the other methods discussed, because Mirena is part of the IUD group of birth control methods, there are certain general characteristics associated with the use of any IUD that you need to discuss with your health care provider. Some of these characteristics are:
- The risk of Pelvic Inflammatory Disease (PID).
- Ectopic pregnancy
- Infertility.
Using Mirena is considered very safe. It has been used in Europe for over 10 years, with no serious problems reported. For more information, please visit the Mirena site, maintained by the manufacturer, Berlex. See www.mirena-us.com
Surgical sterilization must be considered permanent. Male sterilization is called a vasectomy. A vasectomy involves closing off a man's vas deferens so that sperm will not be carried to the penis. A woman's sterilization method is called a tubal ligation. A tubal ligation seals a woman's fallopian tubes so that an egg cannot travel to the uterus.
MALE STERILIZATION - VASECTOMY
Vasectomy is considered safer than female sterilization. It is a minor surgical procedure, most often performed in a doctor's office under local anesthesia. The procedure usually takes less than 30 minutes. Minor post-surgical complications may occur. The failure rate is less than 1 percent and although there has been some success in reopening the vas deferens, the success rate is low, and sterilization should be considered irreversible.
FEMALE STERILIZATION - TUBAL LIGATION
Tubal ligation is an operating room procedure performed under general anesthesia. The fallopian tubes can be reached by a number of surgical techniques, and, depending on the technique, the operation is sometimes an outpatient procedure or requires only an overnight stay.
Following vaginal delivery, patients often choose to have their tubal ligation performed as a mini-laparotomy. A 2-inch incision is made in the abdomen. The surgeon, using special instruments, lifts the fallopian tubes and, using clips, a plastic ring, an electric current or sutures, seals the tubes. Another method, laparoscopy, involves making a small incision above the navel, and distending the abdominal cavity so that the intestine separates from the uterus and fallopian tubes. Then a laparoscope - a miniaturized, flexible telescope - is used to visualize the fallopian tubes while closing them off.
Both of these methods are replacing the traditional laparotomy. Major complications, which are rare in female sterilization, include: infection, hemorrhage, and problems associated with the use of general anesthesia. It is estimated that major complications occur in 1.7 percent of the cases, while the overall complication rate has been reported to be between 0.1 and 15.3 percent.
The failure rate of laparoscopy and mini-laparotomy procedures is less than 1 percent. Although there has been some success in reopening the fallopian tubes, the success rate is low, and sterilization should be considered irreversible.
Other non-surgical methods of female sterilization include:
Quinacrine Method - This involves placing 2 intrauterine administrations of 252 mg pellets of quinacrine a month apart into the fallopian tubes during the proliferative phase of the menstrual cycle. which then develops scar tissue (occlusion) of the fallopian tubes that prevents fertilization of the egg by the sperm.
Essure System - This involves the placement of two coils (one in each fallopian tube) that blocks the tubes and prevents conception.
NOTE:
For many people, the prevention of sexually transmitted diseases (STDs), including HIV (human immunodeficiency virus), which leads to AIDS, is a factor in choosing a contraceptive. Only one form of birth control -- the latex condom, worn by the man -- is highly effective in helping protect against HIV and other STDs. The female condom, made of polyurethane, may give limited protection against STDs but has not been proven as effective as male latex condoms. People who used another form of birth control but who also want a highly effective way to reduce their STD risks, should also use a latex condom for every sex act from start to finish.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You want additional information on contraception or you experience any side effects with the particular form of contraception you choose.
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