1. Methods of Contraception DISCLAIMER: By using teachingsexualhealth.ca (the "Service") you acknowledge that you understand and agree that the information contained in or provided through this Service is intended for general understanding and education only and that this Service is not intended to be and is not a substitute for professional medical advice. Copyright© 2010 Alberta Health Services

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

3. 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

4. Contraceptive Methods 15-1920-2930-39>40All Women Condom 74.355.548.842.554.3 Oral contraceptive 66.658.331.517.143.7 Withdrawal 17.312.010.38.111.6 Male sterilization 0.21.49.619.67.4 Female sterilization 0.00.78.116.46.0 Rhythm 1.52.83.06.63.5 Contraceptive film 1.52.10.76.52.7 Natural family planning 1.51.35.22.42.5 Injection: DMPA 1.83.42.61.02.4 IUD 0.51.85.80.82.3 Levonorgestrel IUS 0.51.52.23.82.0 Morning after pill (Plan B) 4.41.71.50.01.7 Contraceptive Patch (Evra) 1.60.30.70.01.2 Hysterectomy 0.0 2.31.71.0 Contraceptive Sponge 0.21.00.71.00.8 Contraceptive Ring (Nuva Ring) 0.91.20.0 0.6 Female condom 0.40.20.00.80.3 Diaphragm 0.30.50.0 0.2 Implant 0.00.20.0 0.1 Cervical cap 0.20.0 Black, A., Yang, Q., Wen, S.W., Laonde, A.B., Guilbert, E. & Fisher, W. (2009, July). Journal of Obstetrics and Gynecology, 627-639. Contraceptive use among Canadian women of reproductive age: Results of a National Survey

5. 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 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’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 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

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

7. 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

8. Male Condom Demonstration Click here for demonstration

9. 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

10. Female Condom Demonstration Click here for demonstration

11. 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

12. 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)

13. Side Effects?  Side effects that may occur during the first few months include : irregular bleeding, spotting irregular bleeding, spotting Nausea, mood swings Nausea, mood swings Bloating, breast tenderness Bloating, breast tenderness Headaches 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

14. 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

15. 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

16. 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

17. 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

18. Continuous and Extended Use of Hormonal Contraception  Traditional use (28 day cycle) 21 days of active hormones followed by 21 days of active hormones followed by 7 days of hormone free pills or hormone free break 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 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 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 any combined hormonal product with < 50 ug ethinyl estradiol Most types of birth control pills, vaginal ring, contraceptive patch Most types of birth control pills, vaginal ring, contraceptive patch

19. 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)

20. 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

21. 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

22. 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

23. 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

25. Safer Sex  The only safe sex is no sex (abstinence)  If you choose to be sexually active: Talk to your partner about your sexual health histories Talk to your partner about your sexual health histories Choose to protect yourself from both pregnancy and sexually transmitted infections (STIs) Choose to protect yourself from both pregnancy and sexually transmitted infections (STIs) Limit your number of partners Limit your number of partners Get tested regularly for STIs Get tested regularly for STIs Get more information Get more information

26. 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

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

28. Questions ??