Contraceptives Review The Johnson County Health Department Tabitha Wagoner, Health Educator, BSE Mischelle Robertson, Health Educator, RN

ABSTINENCE is the only 100% effective method that protects against unwanted pregnancy and sexually transmitted diseases

Categories of Contraceptives Hormonal Non-Hormonal Emergency Contraception With all of the effectiveness rates we have to figure in whether or not they were used properly so you will see the range of effectivness

Hormonal contraceptives Review Hormonal Contraceptives work by preventing the release of an egg from a women’s ovaries into the uterus. Types The Patch Oral Contraceptives Contraceptive Injections Progestin-Releasing IUD Vaginal Ring Implants Also by thickening the cervical mucus to make it harder for sperm to swim

The Patch -Ortho Evra® Effectiveness: 92-99% A small thin patch that is placed on the skin of the buttocks, stomach, upper outer arm, or torso. The Patch is replaced once a week for three weeks. The Patch is not used on the fourth week of the cycle. Effectiveness: 92-99% Prescription Required: yes Cost: $30-40 for a months supply

The Patch –cont. Advantages: Simple, convenient, and safe Comfortable and discreet Does not prohibit from certain activities (swimming, bathing, exercising) Don’t have to remember to take a daily pill Disadvantages Offers no protection against STDs May cause headaches, mood changes, bleeding between periods, breast tenderness Exposure to higher levels of estrogen than with the pill, which may cause blood clots. About 60% more estrogen than the pill

Oral Contraceptives (Alesse, Micronor, Desogen, Mircette, Ortho Tri-Cyclen, Ovral, Yasmin, Seasonale) Two basic types both of which are made of hormones: combination pills (progestin & estrogen) and progestin pills. The pills work by preventing the ovaries from releasing an egg and/or thickening the cervical mucus. This keeps the sperm from joining with an egg, and preventing fertilized eggs from implanting in the uterus. A clinician will prescribe the level of dosage. Start the pill the Sunday following your period, take one pill a day until the packet is finished. Effectiveness: 92-99% Prescription Required: yes Cost: $15-35 for a months supply

Oral Contraceptives cont. Advantages Simple, safe, and convenient More regular periods Offers some protection against PID, non-cancerous breast growths, ovarian cysts, cancer of the ovaries, cancer of the lining of the uterus, troublesome menstrual cramps, iron deficiency anemia that is a result of heavy menses, acne, PMS, excess body hair and osteoporosis. Disadvantages Offer no protection against STDs Must be taken daily Temporary irregular bleeding, weight gain or loss, breast tenderness, nausea, changes in mood Rare but serious health risks, including blood clots, heart attack, and stroke – women who smoke have an increased risk

“Newer” options Seasonale – Three month pill Estrogen & progestin pill Taken for 3 months straight followed by one week of inactive pills Women have periods about 4 times a year Must be taken daily Similar risks to other birth control pills, however some women may have more spotting between periods At this point discuss media and Yaz or Yazmin

Injections-Depo Provera ® An injectable contraception which is injected every 11-13 weeks by your doctor. The injection is a long acting hormonal contraceptive similar to the female hormone progesterone. The shot works by keeping the ovaries in a “resting” state so that eggs are not released. Effectiveness: 97-99.7% Prescription Required: yes Cost: $30-75 for injections About every 3 months Another thing to remember about the costs is that this is just for the contraceptive, this does not include what an office visit would cost.

Injections-Depo Provera ® Advantages: Effective for 12 weeks Very effective No pill to take daily Helps prevent some types of cancer and PID Disadvantages Offers no protection from STDs Must receive injection every 3 months No period- due to very little lining building up in the uterus Possible bone mineral loss Irregular bleeding patterns Nausea, dizziness May cause change in appetite, weight gain, headaches, depression, hair loss, nervousness, skin rash

Progestin Releasing IUD- Mirena A soft flexible plastic that delivers continuous small amounts of hormone directly to the uterus Effectiveness: 99% Prescription Required: yes Cost: $175-$400 for exam, insertion, and follow up visit Advantages Can be left in place for 5 years No pill to take daily Hormones may reduce menstrual cramps Extremely effective Disadvantages No protection against STDs Requires an office procedure Only women who have completed child bearing years should use this method

Vaginal Ring- Nuvarings ® A small, flexible ring that is inserted into the vagina for three weeks and taken out for the fourth week. It releases combined hormones that protect against pregnancy for one month. Effectiveness: 92-99% Prescription Required: yes Cost: $30-35 a month Advantages No daily routine required Does not require physician placement Reduced menstrual cramps Disadvantages No protection against STDs May cause vaginal infections, headache, weight gain, and nausea

Implants – Implanon A thin flexible plastic rod approximately 40 mm in length and 2mm in diameter that contains the hormone Progestin which prevents pregnancy by stopping ovulation. It also affects the mucus produced by the cervix which prevents implantation of a fertilized egg. Inserted just under the skin on the inner side of the upper arm Effectiveness: 94-99% Prescription Required: yes Cost: $20 a month Advantages: Can be removed at any time. Lasts three years. Convenient and hassle free-once inserted you don’t have to do anything. Disadvantages: Headaches, removal can be difficult if the implant has moved Used to be norplant

Non-hormonal Contraceptives review Non-hormonal Contraceptives prevent pregnancy by providing a barrier against sperm or by interfering with sperm movement, or by creating an “unfriendly environment” for sperm. Non-hormonal Contraceptives Male Condom Female Condom IUD Spermicides Diaphragm & Cervical Cap Vaginal sponge

Male Condom One of the worlds oldest and most popular methods of contraception. Comes in all sizes, colors, and varieties. This is the only contraceptive method that protects against STD’s and HIV/AIDS. The condom is placed on the penis before it has any contact with the opening of the vagina, mouth, or anus. Effectiveness: 85-97% Prescription Required: No Cost: free or $7 - $14 for a box of 12

Male Condom cont. Advantages Allows men to take responsibility for birth control and protection from STDs Has no side effects Easy to obtain Can be a reliable backup or second method Can help relieve problems with premature ejaculation Disadvantages If allergic to latex, use polyurethane instead

Male Condom Don’ts Do not use oil based lubricants Do not use a condom with an expired date of use Do not unroll the condom before placing it on the erect penis Do not flush condoms down the toilet Do not leave condoms in hot places (cars, wallets) Do not reuse the condom Do not use more than one condom at a time

Female condom Made of polyurethane, it fits inside the vagina completely covering the vulva, walls of the vagina and cervix. Effectiveness: 81-95% Prescription Required: No Cost: $2.50

Female condom cont. Advantages: Provides added protection against all STDs Can be used during a women’s period, Can be used when a male partner can’t or won’t use a condom Disadvantages: Exact placement can be difficult and uncomfortable Not as easily accessible as the male condom

Non-hormonal IUD- Paragard The intra uterine device is made of flexible plastic with fine copper wire wound firmly around it. The device is placed in a women’s uterus. Because the copper IUD is toxic to sperm it prevents fertilization of the egg, or implanting of an egg in the uterine wall to create a pregnancy. Effectiveness: 92-99% Prescription Required: Yes Cost: $175-$400/ exam, insertion, and follow up visit

Paraguard cont. Advantages Disadvantages Nothing to be put in place before sexual intercourse Can be left in for 10 years Disadvantages Spotting between periods Does not protect against STDs and HIV Must remember to check string once a month Only women who have completed child bearing years should use this method

Spermicides (foams, films, creams, suppositories) Vaginal Contraceptive Films and Suppositories Dry but melt when inserted into the vagina. Create a barrier over the cervix. Insert no longer than thirty minutes prior to intercourse. Creams and Jellies Used with diaphragms and cervical caps, though they are applied with an applicator. They can be put on the inside of an unrolled condom. Effectiveness: 75-90% if used alone. 94% when used with a vaginal barrier Prescription Required: No Cost: $8 for 12 uses

Spermicides cont. Advantages Disadvantages Act as a lubricate Kills sperm Disadvantages Bitter, strong smell Possible burning sensation

Diaphragms & Cervical Caps A reversible barrier method of birth control. Both are soft rubber barriers that are intended to fit securely over the cervix. Used with a contraceptive cream or jelly. Blocks the entrance to the uterus, and jelly or cream immobilizes sperm, preventing it from joining the egg. The diaphragms can be inserted up to 6 hours before intercourse and left in place for 24 hours The cervical cap may be left in place for up to 48 hours Effectiveness: 84-94% Prescription Required: Yes Cost: $15-75

Diaphragms and Cervical Caps cont. Advantages No hormonal side effects No major health concerns Disadvantages Can be messy Allergies to latex, silicone, or spermicidal creams Can not be used during vaginal bleeding or infections Increases risk of bladder infections Difficult for some women to use

Vaginal Sponge Small donut shaped foam sponge saturated with a spermicide. Prior to intercourse the sponge is moistened, inserted into the vagina and placed over the cervix. Must stay in place for 6-8 hours after intercourse. It works by holding spermicide against the cervix while blocking the cervical opening. Effectiveness: 72-84% Prescription Required: No Cost: $9-15 Advantages: Don’t have to be sized for the vaginal sponge More effective for women who have not had children May be inserted up to 24 hours before sexual intercourse Disadvantages Offers no protection against STDs Exact placement may be difficult Irritation and allergic reaction may occur.

Emergency Contraception Pills (ecp) A one time pill taken within 72 hours (3 days) of unprotected sex that can decrease the chance of pregnancy by 75-89%. Emergency contraception does not work if you are already pregnant. Also called the Morning After Pill or Plan B pill, it contains higher levels of hormones that work by temporarily blocking eggs from being produced and by stopping fertilization, or by keeping fertilized eggs from becoming implanted in the uterus. Prescription Required: If 17 years or older no prescription is required. If younger than 17 years old, a prescription is required by a health care provider Cost: $45- 65

ABSTINENCE is the only 100% effective method that protects against unwanted pregnancy and sexually transmitted diseases