Contraception and Birth Control Rik Papagolos, RN

Risk and Responsibility  If intercourse occurs the day before ovulation, the chance of pregnancy is about 30%.  If intercourse occurs the day of ovulation, the chance of pregnancy is about 15%.  Over the course of one year, couples who do not use contraception have a 90% chance of pregnancy.

Contraception We use our knowledge of reproductive physiology to promote or avoid pregnancy.

Preventing Sexually Transmitted Diseases (STD’S)  Most STD’s are treatable if diagnosed early.  AIDS is one exception> AIDS is FATAL.  Some contraceptive methods work to help prevent disease and pregnancy.  Latex and polyurethane condoms provide barrier protection against virus and bacterial infection: such as Herpes virus, chlamydia, gonococcus, and HIV.

Preventing Sexually Transmitted Diseases (STD’S)  Not 100% effective at preventing infection or pregnancy.  Spermicides - Chemicals that kill sperm offer protection against some STD’s, foam or film can provide extra protection.  Use of spermicides with barrier methods increase the effectiveness of both the infection and pregnancy protection of the method.

Contraception  Three general strategies:  Prevent ovulation;  Prevent fertilization;  Keep sperm & oocyte away from each other.  Prevent implantation.

Contraceptive methods  Hormonal methods  Barrier methods  Intrauterine devices  Natural methods  Permanent methods

Birth Control and Contraception  What is the difference  Birth Control: Preventing birth from taking place  IUD  Emergency contraceptive pills  RU-486  Surgical Abortion

Birth Control and Contraception  Contraception: Preventing conception (preventing the sperm and the egg from uniting)  Barrier methods  Condoms, diaphragms  Spermicides  Hormonal methods  Pill  Shot (depo)  Implants

Methods of Contraception and Birth Control  Choosing a Method  The best method is the one you will use consistently and correctly  Know the reliability of method  Know the advantages and disadvantages  Side effects  Risks

Methods of Contraception and Birth Control  Abstinence  Choosing not to have intercourse  Outercourse  Sexual activity without penetration

Methods of Contraception and Birth Control  Hormonal Methods  The pill  Implants  Injections

The Pill  Combination of estrogen and progestin (some progestin only)  Inhibits ovulation  Thickens the cervical mucous  Changes the lining of the uterus to inhibit implantation of the fertilized ovum  Alter the rate of ovum transport  99.5 % effective (if used correctly) 92 %

Hormonal Prevents ovulationovulation Thickens mucus at the cervix so sperm cannot pass throughcervix Changes the environment of the uterus and fallopian tubes to prevent fertilization or implantation should fertilization occurfallopian tubes

Hormonal Contraception: Combination OCP’s  Contain Synthetic Estrogen/Progestin  Modern E 2 Dosage ≤ 50 Mcg  Despite Diversity, Side Effects and Efficacies are Similar  Requires Patient Compliance

Combination OCP’s: Mechanism of Action  Suppresses LH / FSH Release (E 2 FSH, P LH)  Progestin Thickens Cervical Mucus and Alters Endometrium  Major Effect Is Anovulation and Impairment of Sperm Transport and Oöcyte Implantation

Contraception  Prevent ovulation.  “The Pill”  Synthetic “progestins” mimic effect of progesterone.  Inhibits FSH & LH, and their effects on follicle development  Norplant  Depo-provera

The Pill Advantages  Easy to use  Dependable  No additional appliances  Can regulate menstrual flow and decrease cramps and other symptoms of menses

Combination OCP’s: Additional Benefits  Menstrual Regulation  Decreased Risk of Anemia  Ovarian, Endometrial CA: Risk  Lower PID Risk  Prevention of Benign Breast Disease

The Pill  Problems  Side effects  Changes in menstrual flow  Breast tenderness  Nausea  Vomiting  Wt. gain or loss

The Pill  Contraindications  Heart disease  Kidney disease  Asthma  High blood pressure  Diabetes  Epilepsy  Gall bladder disease  Sickle-cell anemia  Migraine headaches  depression,

The Pill  ACHES  Abdominal pain  Chest pain or shortness of breath  Headaches (severe)  Eye problems (blurred vision, flashing lights and blindness)  Severe leg pain

The Pill  Smoking and the Pill  DO NOT TAKE THE PILL IF YOU SMOKE

Implants  Progestin only (Norplant)  Prevents ovulation  More effective than the Pill

Norplant:  Implantable for ≤ 5 Years  Similar Side Effects as Depo-Provera  Avg. Yearly Failure Rate: 0.8/100 (Increases : > 2/100 after 5 years)  Occasionally Difficult to Remove

Implant  Advantages  Convenience  Eliminate user error  No menses or very light  Decreased cramping

Implant  Problems  Difficulty in removing  Side effects  Similar to the pill  Changes in menstrual bleeding  Headaches  Side effects  wt. gain  Acne  breast tenderness  hair growth  ovarian cysts

Implant  Contraindications  Liver disease  Breast cancer  Cardiovascular disease  Unexplained vaginal bleeding  Pregnant  Smokers

Injectable Contraceptives  Depo-Provera (DMPA) Progesterone  Can stop menses  Side effects include  Spotting, wt. gain, headaches, breast tenderness, dizziness, loss of libido and depression  Lunelle Progestin and estrogen  Similar to the pill in all aspects

Barrier Methods  The condom  Female condom  Diaphragm  Cervical cap  Sponge

Barrier methods  Male / Female condom  Diaphragm Block sperm from reaching the egg Some are used with spermicides, which kill sperm.

Barrier Methods:  Diaphragm: High Failure Rates –Must Remain in ~6 Hrs post-coitus –Best if Combined with Spermicide – UTI Potential  Condom: STD Protection, Inconsistent Use by Men  Female Condom: Cumbersome, Learning Curve

Spermicides  Nonoxynol-9  Use in combination with barrier methods of contraception  Foam  gel  Film  Creams, jellies and suppositories

IUD  Intrauterine device  Copper and plastic (Copper T-380A) 10 years  Plastic and Progesterone (progestasert IUD) 1 year  % effective in use  Increased risk of PID

Barrier methods  Male / Female condom  Diaphragm Block sperm from reaching the egg Some are used with spermicides, which kill sperm.

Intrauterine device (IUD)  COPPER-T  MULTI LOAD  MIRENA The progestin released by the levonorgestrel (LNg) IUD prevents fertilization by making the mucus in the cervix thick and sticky, so sperm can't get through to the uterus. The progestin and IUD change the uterine lining, preventing implantation in the rare case that fertilization occurs.uterus The copper in the copper IUD is toxic to sperm. It causes changes in the uterus and fallopian tubes that kill sperm

IUD: Mechanisms of Action  NOT ABORTIFACIENT!!!!!!!!  Prevents Conception: –Sperm Transport Inhibited –Sperm Survival / Capacitation Diminished  Prevents Implantation: hCG Levels = 0

IUD: Complications  PID: Usually 2 0 Insertional Contamination –Unproven Role for Prophylactic ABx  Hypermenorrhea  Expulsion  Perforation (< 0.1%)  Failure: IUD Should be Removed  ??Ectopic

Fertility Awareness Methods  Calendar or rhythm method  Midway in cycle  Basal body temperature (BBT) method  Increase in body temperature  Cervical Mucous Method  Clear slippery mucous  Symptothermal method  Combination of BBT and Cervical Mucous methods

Fertility awareness (natural family planning ) Identifies the time during a woman's cycle when she is most likely to become pregnant (fertile). An additional method or abstinence should be used during this time of fertility.

Contraception  Prevent fertilization.  Coitus interruptus Least effective of all  Rhythm 50% failure rate  Avoid intercourse during woman’s likely fertile period  ~ 1 week before ovulation to ~ 4 days after ovulation

Basal Body Temperature Method (BBT) Fertility Awareness Methods The lowest body temperature of a healthy person during awaking hours OVULATORY CYCLE BBT IS BIPHASIC

Sterilization  For Women  Tubal ligations  Cut and seal the fallopian tubes  Hysterectomy  Removal of the uterus  For Men  Vasectomy  Vas deferens are cut and sealed

Emergency Contraception  Emergency Contraception Pill (ECP)  Copper IUD

Abortion  Spontaneous abortion (miscarriages)  Induced abortion

Induced Abortion  Drug induced  Mifepristone (RU-486)  Surgical Methods  Vacuum aspiration  Dilation and evacuation  Hysterectomy  Saline, prostaglandins and urea (after the first trimester)