Methods of Contraception

Ground Rules We respect: That any question is OK That it is OK to pass That we all have different points of view Each other by listening The right to privacy That we all need to be listened to

Why Do Unplanned Pregnancies Happen? Embarrassed to talk about sex with partner or to get birth control supplies Not knowing or understanding about using birth control to prevent pregnancy Individual or religious beliefs about birth control Birth control method not used correctly or consistently Spontaneous act and not prepared Use of substances that affect decision making (alcohol/drugs) Difficulties accessing health care Birth control supplies are too expensive

Contraceptive use among women of reproductive age: Results of a National Survey Contraceptive Methods 15-19 20-29 30-39 >40 All Women Condom 74.3 55.5 48.8 42.5 54.3 Oral contraceptive 66.6 58.3 31.5 17.1 43.7 Withdrawal 17.3 12.0 10.3 8.1 11.6 Male sterilization 0.2 1.4 9.6 19.6 7.4 Female sterilization 0.0 0.7 16.4 6.0 Rhythm 1.5 2.8 3.0 6.6 3.5 Contraceptive film 2.1 6.5 2.7 Natural family planning 1.3 5.2 2.4 2.5 Injection: DMPA 1.8 3.4 2.6 1.0 IUD 0.5 5.8 0.8 2.3 Levonorgestrel IUS 2.2 3.8 2.0 Morning after pill (Plan B) 4.4 1.7 Contraceptive Patch (Evra) 1.6 0.3 1.2 Hysterectomy Contraceptive Sponge Contraceptive Ring (Nuva Ring) 0.9 0.6 Female condom 0.4 Diaphragm Implant 0.1 Cervical cap Black, A., Yang, Q., Wen, S.W., Laonde, A.B., Guilbert, E. & Fisher, W. (2009, July). Journal of Obstetrics and Gynecology, 627-639.

Unintended Pregnancies Per 1000 women during first year of use Adapted from Trussell et al., 2004

Abstinence Abstinence means different things to different people Abstinence can mean not having any physical contact Abstinence can also mean having some physical contact but no sexual activity that involves the genitals (e.g., masturbation, sexual intercourse) How does it work? To be abstinent, you and your partner have to set some limits. These limits are different for everyone You can’t get pregnant or get a sexually transmitted infection (STI) if you are abstinent - with no genital to genital, skin to genital and body fluid to genital contact You CAN get pregnant without having sexual intercourse if sperm is near the opening of the vagina. You can get some STIs by touching the genital area of your partner

Male Condom Provides a barrier for skin to skin contact and body fluids which can help protect against pregnancy and STI Available at pharmacies, grocery stores and health clinics Use a condom for oral, vaginal and anal sex or when sharing sex toys Most condoms are latex. Non-latex types include polyurethane, and polyisoprene (synthetic rubber) Check expiry date and keep in dark, cool place Do not use with oil-based products like Vaseline, baby oil or hand cream. This increases the chance of the condom breaking Use a new condom every time you have sex. Never use two condoms at once

Female Condom Provides a barrier for skin to skin contact and body fluids which can help protect against pregnancy and STI Available at pharmacies, grocery stores and health clinics Inserted prior to any vaginal contact. Can be inserted up to 8 hours prior to intercourse Soft thin plastic quickly warms to body temperature, which allows for natural feeling and sensitivity Safe to use for people with latex allergies Can use water and/or oil based lubricants Do not use with the male condom, this increases the chance that both will break Use a new condom every time you have sex

Contraceptive Spermicides Vaginal spermicides are products containing an ingredient (Nonoxynol 9) that kills sperm on contact Can be purchased at pharmacies and grocery stores Inserted into the vagina before sex to help prevent pregnancy Effectiveness varies greatly. The failure rate is about 26% Spermicide should be used with a condom every time It is an effective method of birth control when used with condoms Spermicides can cause vaginal irritation which can increase the risk of getting STIs including HIV - Work to kill sperm before they reach the egg. - When used with a condom are 97% effective. Never use this method alone. Always use with a condom. - Foam needs to be inserted in the vagina about ½ hour prior to intercourse. A gel called Advantage 24 can be inserted up to 24 hours in advance. - You do not need a prescription. You can buy it at a drugstore/pharmacy over the counter. They cost $13-22 at the pharmacy and $10-15 at the THC/FPC.

Hormonal Contraception (Pill/Patch/Vaginal Ring) How do they work? Stop the release of a mature egg Thicken cervical mucus making it difficult for sperm to get to the egg Change the lining of the uterus making implantation difficult

Things to Consider… With perfect use, hormonal birth control is 99% effective With typical use, it is 92-97% effective Makes your period more regular, with less bleeding and pain Protects you against some types of cancers (ovary and uterus) Does not protect you from sexually transmitted infections (STIs)

Side Effects? Side effects that may occur during the first few months include : irregular bleeding, spotting Nausea, mood swings Bloating, breast tenderness Headaches Most symptoms are normal and will decrease or stop in the first 2-3 months In rare cases, women using hormonal contraception can develop blood clots. Talk to your doctor about whether hormonal birth control is right for you

Common myths and misconceptions about hormonal contraception It causes weight gain It causes acne It causes cancer It causes infertility It causes birth defects You need to take breaks from it All smokers should not be taking it All women over age 35 should not use hormonal contraception No need for condoms if are using hormonal contraception WRONG INFORMATION

Birth Control Pills (BCP) Combined oral contraceptive pills contain two hormones; estrogen and progestin One hormone pill is taken at the same time each day to prevent pregnancy Traditional cycles of BCP are 21 days of hormones followed by a 7 day hormone free break New regimes include: 24 days of hormones followed by a 4 day hormone free break 84 days of hormones followed by a 7 day hormone free break - The pill contains hormones that keeps the body from releasing an egg. - If used correctly is 98% effective in preventing pregnancy. No STI protection. - Take one pill at the same time every day. - Some females take the pill to regulate their menstruation (period), reduce cramps or decrease acne. - The cost is approx. $16.00 for a month supply, $7 at the THC or FPC and cheaper if you have a drug plan. Need a Dr. prescription. Ask the students: What kinds of things have you heard about the pill that concerns you?

Birth Control Patch Hormonal contraceptive patch worn on the skin that contains two hormones; estrogen and progestin A patch is worn for one week at a time. A new patch is put on once per week for three weeks. The fourth week is a hormone free break There might be a higher risk of getting pregnant for women who weigh more than 195 lbs May cause skin irritation - Works like the pill. - Approximately 98-99% effective. - Wear one patch for a week, then change it every week for 3 weeks. The 4th week you wear no patch and get your period. - Good for people who forget to take a pill everyday. - About $17 a month with a prescription or $10 at the THC/FPC.

Vaginal Contraceptive Ring Hormonal contraceptive ring is worn inside the woman’s vagina. It contains two hormones; estrogen and progestin A ring is worn for three weeks (21 days). The ring is removed for one week. The fourth week is hormone free May cause vaginal discharge or irritation - Works like the pill and the patch. - 98-99% effective. - Insert the ring inside the vagina for 3 weeks, then remove it and use nothing for 7 days while menstruating. - Good for people who forget to take a pill everyday. - The cost is about $24 a month with a prescription and $10 at the THC/FPC.

Continuous and Extended Use of Hormonal Contraception Traditional use (28 day cycle) 21 days of active hormones followed by 7 days of hormone free pills or hormone free break (period begins during the hormone free break) Continuous use uninterrupted use of hormonal contraception. No planned hormone free break Extended use prolonged use (2 or more cycles) of hormonal contraception with planned hormone free breaks, no longer than 7 days Which products can be used for continuous or extended use? any combined hormonal product with < 50 ug ethinyl estradiol Most types of birth control pills, vaginal ring, contraceptive patch

Emergency Contraception (Morning After Pill, Emergency Contraception) Used to prevent pregnancy after unprotected sex or contraceptive failure (ie. condom breaking or forgetting to take birth control) If taken within 24 hours of unprotected sex prevents 95% of possible pregnancies Can be taken up to 120 hours (5 days) after unprotected sex preventing 58% of possible pregnancies Does not affect a pregnancy that has already implanted Available by prescription from a doctor, sexual and reproductive health clinic or some pharmacies (call ahead to see if they offer this service) - Prevents the ovaries from releasing an egg or prevents implantation of the fertilized egg on the uterus lining. - 95-98% effective – can be taken up to 5 days after unprotected sexual intercourse; most effective within the first 24 hours – minimal side effects. - Take 2 hormone pills that are like the BC pill. - Cost is $15 at THC/FPC, $28 at family Dr., $28-40 without prescription at the pharmacy (usually a pharmacist consultation is need). Soon some pharmacies may offer EC without consultation soon.

Birth Control Injection (Depo- Provera®, “The Shot”) Progestin injection into arm or hip every 12 weeks by a health professional Is 99.7% effective Stops body from releasing an egg each month After 12 months of use, 55% of women stop having periods. After 24 months, 68% of women stop having periods May cause irregular spotting/bleeding and delay the return of regular cycles after stopping injections Can increase bone mineral loss. Getting regular weight bearing exercise and Calcium+ and Vitamin D in your diet is important - Inhibits the release of an egg. - 99.7% effective. - Receive an injection (shot) every 3 months in your arm or hip. - Good for people who forget to take a pill every day. Most will stop having periods after 6 months – 1 year of use. - While on Depo Provera, the strength of your bones can be reduced. This is proven to reverse after you come of this method. While you take it , you need to make sure there is enough calcium and Vit. D in your diet to keep your bones strong. - Should not use this method if you are planning to get pregnant quickly after you stop taking Depo. Can take 1-2 years to get pregnant. - Costs $21 at the THC/FPC or $36 with a prescription for a 3 month supply.

Copper IntraUterine Device (IUD) Long-acting contraceptive; can be left in place for 3 to 5 years 98.7% effective Does not contain hormones Copper affects how sperm move and helps prevent embryo implantation Needs to be inserted by a trained health professional

Mirena IntraUterine System (IUS) Contains a hormone called levonorgestrel (progestin) 99% effective Long acting contraceptive, can be left in place for 5 years Hormone acts on the lining of the uterus and thickens the cervical mucus making it difficult for sperm to reach the egg. May prevent ovulation Decrease in menstrual blood loss by 74-97% Needs to be inserted by a trained health professional

Diaphragm and Cervical Cap F e m a l e b a r r i e r m e t h o d s s e x u a l i t y a n d u . c a Diaphragm and Cervical Cap What are they? • Intravaginal barrier methods that are used together with a spermicide • The diaphragm is a latex dome with a flexible steel ring around its edge (a non-latex diaphragm is also available) • The cervical cap is thimble-shaped silicone cap • Positioned into the vagina (diaphragm) or over the cervix (cervical cap) before intercourse • Must be left in the vagina for 6–8 hours after intercourse Cervical Cap Diaphragm How do they work? • A pelvic examination by a qualified health care professional is required for fitting diaphragms and cervical caps • Inserted into the vagina and fit over the cervix • When positioned properly, they block the entry to the uterus so sperm cannot enter and fertilize the egg • Spermicide should be reapplied for each repeated act of intercourse Failure rate: 160-320 per 1000 women per year

Key Messages Hormonal birth control does not protect against STIs Use a condom AND another form of birth control Talk to your partner about your sexual history and safer sex practices

Where can I go for help? School Counsellor Teacher School Nurse Walk in Clinic Family Doctor Sexual Health Clinic