1. Understanding Contraception Information about the most common methods of birth control for administrative staff in healthcare settings

2. Introduction From the very first interaction, the patient should know that her contraceptive knowledge and choice is our priority Each staff member plays an important role in a woman’s contraceptive visit and should have a working knowledge of all forms of birth control “Know what you don’t know”—refer patient to counselor or clinician if she asks you a question beyond your training level

3. Hi! I’d like to make an appointment to get on birth control. Okay, so you’re interested in getting on the pill…let me see when we can get you in… PATIENT MEDICAL RECEPTIONIST One assumption could affect her entire family planning visit!

4. Objectives Equip administrative staff with working knowledge of contraception by: Reviewing the most common, reversible contraceptive methods Preparing them for frequently asked questions about each method

5. Long-Acting Reversible Contraception (LARC) Most effective reversible contraception Over 99% effective, or 3 out of 1000 women will get pregnant in the first year Includes 2 intrauterine devices (IUDs) and a subdermal arm implant Fertility returns once device is removed Considered first-line options for all women, including teens

6. Hormonal IUD (Mirena®) Over 99% effective Inserted by a clinician into uterus Lasts up to 5 years—can have it removed sooner T-shaped device made out of plastic Releases small dose of the hormone progestin primarily into the uterus May experience some irregular bleeding – Greatest 3-6 months after insertion – After this time, periods become much lighter, much shorter – 20% of women stop having their period after the first year

7. A Sample of Frequently Asked Questions: Hormonal IUD QuestionAnswer I’ve never been pregnant before. Can I still use an IUD? Absolutely! Many women who have never been pregnant use IUDs. At the time of your visit you and your clinician can decide if the IUD is a good method for you. Can I use tampons with an IUD? Sure. We encourage women to wait 24 hours after their IUD insertion to use tampons. This will allow some time for the strings to soften and make it less likely for the accidental removal of your IUD. Is it safe to stop having a period with the hormonal IUD ? It is completely healthy and safe to stop having a period when using the hormonal IUD. This IUD makes the uterine lining very thin; there is nothing built up that needs to shed

8. Non-Hormonal IUD (Copper IUD or ParaGard®) Over 99% effective Inserted by a clinician into uterus Lasts for up to 10 years-can have it removed sooner T-shaped device made out of plastic and copper— contains no hormones May experience some spotting for the first few months after insertion Some women experience heavier or crampier periods – Greatest 3-6 months after insertion – May get better over time

9. A Sample of Frequently Asked Questions: Copper IUD QuestionAnswer How soon after the copper IUD is placed is it effective? T he copper IUD is effective immediately once it is placed. That’s why it can also be used as emergency contraception. However, many clinicians recommend using a condom during the first 21 days after insertion to prevent infection. In fact, barrier methods like condoms are always recommended to prevent infection. It’s been a month and I’m having heavy, crampy periods. Is there anything I can do? You can take over-the-counter ibuprofen (Advil or Motrin) or Naprosyn(Anaprox or Aleve) to help with the cramping. Feel free to give us a call back if that doesn’t help. Will my partner feel the strings during sex? The strings usually get soft and lay next to your cervix so it should not be a problem for you or your partner during sex.

10. Implant (Implanon®/Nexplanon® ) Over 99% effective A small single rod, about the size of a matchstick, placed by a clinician on underside of arm Releases the hormone progestin Unable to see the rod, should be able to feel it Lasts up to 3 years—can have it removed sooner May experience irregular bleeding – some women have irregular bleeding for a month, six months, a year, or even the entire three years – some women have no bleeding at all – Unable to predict who will experience irregularity

11. A Sample of Frequently Asked Questions: Implant QuestionAnswer I just had my implant placed. How long do I need to use a condom for back up protection ? You should use a back up method of birth control for a week after getting the implant placed. Remember, the implant will not protect you from sexually transmitted infections, so you can continue to use condoms for protection from sexually transmitted infections. Why an I having all of this irregular bleeding? It can be normal to experience irregular bleeding with the implant. This method releases a small amount of progesterone that keeps the lining of the uterus thin. Although it may be somewhat annoying, it is not harmful. If the bleeding persists for a long time and is bothersome, discuss this with your clinician. There are some medications that may help. Will people know I’m using the implant? The implant is about the size of a matchstick. You should be able to feel the implant under your skin but you usually can’t see it. Most likely, no one will know unless you tell them.

12. Birth control shot (Depo-Provera®) 94% effective, meaning that 6 out of 100 women will become pregnant in the first year with typical use Shot given in muscle of butt or arm Must be given every 3 months by health care provider May experience some irregular bleeding – usually improves after third injection – 50% of women stop having their period after the first year

13. A Sample of Frequently Asked Questions: Birth Control Shot QuestionAnswer I just had my first birth control shot. How long do I need to use a condom for back up protection? You should use condoms for a week after getting your shot. Remember, the shot will not protect you from sexually transmitted infections, so you can continue to use condoms for protection from sexually transmitted infections. My mom said it is not safe to not have a period. My body needs to clean itself out. It is completely healthy and safe not to have a period when using the birth control shot or “Depo.” The shot makes the lining of your uterus very thin, so there is nothing built up that needs to shed. How often do I need to return to get a shot? You should return to the clinic every 3 months (12-14 weeks) to get your shot.

14. Pills, Patch, and Vaginal Ring 91% effective, meaning that 9 out of 100 women will become pregnant in the first year with typical use Combined hormonal contraceptives—contain both estrogen and progestin Side effects may include the following: – nausea – headache – moodiness – breast tenderness

15. Combined Hormonal Birth Control Pills Contains the hormones estrogen and progestin To be most effective, a pill needs to be taken every day at the same time On the 4 th week, a woman takes a row of placebo pills—this is the week a woman has her period

16. Patch (Ortho-Evra®) Apply the patch on the skin of the upper arm, shoulder, upper back, abdomen, hip or buttock. Do not place on genitals or breasts Replace patch on the same day of every week Don’t wear a patch on the 4 th week—this is the week a woman will have her period Should check it every day for placement

17. Vaginal Ring (NuvaRing®) Inserted by patient high into vagina. Leave in for 3 weeks then remove for the 4 th week— this is the week a woman will have her period Comfortable for both partners during sex May remove for up to 3 hours in a 24-hour period then rinse off with cool water and reinsert

18. A Sample of Frequently Asked Questions: Pills, Patch and Ring QuestionAnswer I just started my pill/patch/ring. How long do I need to use a condom for back up protection? You should use a back up method of birth control for a week after starting your method. Remember, these methods will not protect you from sexually transmitted infections, so you can continue to use condoms for protection from sexually transmitted infections. What should I do if I miss a pill? You should take the pill as soon as you remember and use a back up method for seven days. If you had sex and did not use a condom, you may want to consider taking emergency contraception.

19. Progestin-Only Pills 91% effective, meaning that 9 out of 100 women will become pregnant in the first year with typical use Contains the single hormone progestin To be most effective, a pill needs to be taken every day at the same Take an active pill every day of the month If you are 3 or more hours late taking your pill, you must use a back-up method, such as condoms for 48 hours

20. A Sample of Frequently Asked Questions: Progestin-Only Pills QuestionAnswer Will I be able to predict or schedule my bleeding times? Probably not. You may experience irregular bleeding with POPs, such as spotting in between periods, or may stop having your period altogether. This is completely normal. How do I take a POP? You should use a back up method of birth control, such as condoms, for a week after starting POPs. With POPs it is also important to take the pill at the same time every day to make it most effective. You also will not have a “pill –free” week or a placebo week. When you finish with one pack you simply start another pack. If you are late taking you POP or if you miss a day, take a pill when you remember, take your next pill on time, and use a back-up method of birth control for one week.

21. Condoms 82% effective meaning 18 out of 100 women will become pregnant the first year with typical use Only use one condom at a time Never use the same condom twice Always look for an expiration date Never use an expired condom Can be purchased without a prescription Only method that protects against STIs

22. A Sample of Frequently Asked Questions: Condoms QuestionAnswer What can I do if I’m allergic to latex?You can use latex-free condoms or female condoms. The condom broke when we were having sex. What should we do? You can take emergency contraception up to five days after an act of unprotected sex, although the sooner you take it the better. You may also want to make an appointment to get tested for sexually transmitted infections.

23. Emergency Contraception (EC) Two types – EC Pills (E xamples include; Plan B®, Next Choice®, ella® ) Plan B® or Next Choice® available over the counter ella® available with a prescription – Copper IUD (ParaGard®) needs to be inserted by a clinician Pills most effective when taken ASAP after unprotected sex – can be taken as much as 120 hours or 5 days after Copper IUD can be placed up to 5 days after unprotected sex and can continue to use as highly effective contraception

24. A Sample of Frequently Asked Questions: Emergency Contraception QuestionAnswer Is emergency contraception the same as the abortion pill? No, emergency contraceptive pills prevent or delay the release of an egg, and thus prevent the sperm and egg from coming together (or fertilization). Emergency contraceptive pills will not harm a pregnancy that has already occurred. Where can I get emergency contraception?Anyone can purchase emergency contraceptive pills without a prescription from a pharmacy. When should I take emergency contraception? You can take emergency contraception up to five days after an act of unprotected sex, although the sooner you take it the better. The copper IUD is actually the most effective form of emergency contraception. The copper IUD can be placed up to five days after unprotected sex and you can continue to use it to provide highly effective contraception.

25. Hi! I’d like to make an appointment to get on birth control. Great! In our practice, we make sure women are aware of all of their birth control options, especially the most effective, reversible long-acting methods, which includes 2 IUDs and the implant. Let’s get you scheduled for your appointment with our contraceptive counselor. PATIENT MEDICAL RECEPTIONIST One informed statement can affect her entire family planning visit!