2. Contraception Choices Adolescent Clinic NNMC

3. Objective   Discuss the different options   Important counseling points   Review by playing a game

4. Options n Abstinence n Timing schemes n Barrier methods n Hormonal preparations MethodTypical UsePerfect Use Implant0.09 Injection-combo0.1 Injection- progestin 0.3 IUD0.1-2.00.1-1.5 OCP-combo2.5-6.00.1 OCP-progestin3.0-10.00.5 Patch-0.1 Vaginal ring-0.65 Male condom12.03.0 Diaphragm/Cerv cap 16.0-18.06.0 Withdrawal19.04.0 Periodic abstinence -2.0-9.0 Female condom21.0-26.05.0 Spermicides40.06.0 No method85.0

5. Abstinence/Timing n n While some groups encourage “The rhythm method” as a form of birth control we do not recommend it n n Temperature, cervical mucus and record keeping are needed to do it right.

6. Barrier n 2nd most popular n STD protection n Inexpensive n Failure rate: 3-18% n Proper wear important

7. Hormonal n Combination OCPs –Monophasic –Biphasic –Triphasic –Failure rate 0.1% (2-6%) n Progestin only –Failure rate 0.5% (3-10%)

8. Depo-Provera, DMPA n Depo medroxyprogesterone acetate –Prevents egg release –Failure rate: 0.3% –Shot every 3 months

9. The Patch n Ortho Evra n Combination preparation n 20% bleeding in first cycle n Change patch once per week n May not be as effective if >90kg

10. Vaginal Ring n NuvaRing n Combination preparation n Worn for 3 weeks at a time n Low breakthrough bleeding rate

11. Vaginal Ring n NuvaRing –Low failure rate –Can wear during menses –Can wear during intercourse –Can remove for intercourse –Does not have to be fitted –Vaginal position does not matter –No increased risk of infection

12. Choosing a Method What myths have you heard? What side effects have you heard about?

13. Common Myths n 2/3 women believe OCPs unsafe n Causes cancer n Causes heart disease n Leads to infertility n Body needs break from OCPs n ALL FALSE

14. Advantages n Less dysmenorrhea n Shorter, lighter menses n Less Mittelschmerz n Acne & hirsutism improved n Prevents ovarian & endometrial cancer n Reduction in PID

15. Possible side effects n Nausea/vomiting n Edema/leg cramps n Bloating n Vascular headaches n Clear vaginal d/c n Cystic breast changes n Chloasma Chloasma n Androgenic –Oily skin –Hirsutism –Acne –Increased appetite n Mastalgia n Inreased breast size n Bloating n Depression ESTROGENPROGESTERONE

16. Do not use if: n n You have had a blood clot n n You have had cancer n n You have liver disease n You have high blood pressure n You are on seizure medicine n You have bad migraines

17. If you miss a pill n n Missed pills n n 2 per day until caught up n n Condoms if miss >2 pills per month

18. Headaches n n Contact us if you get frequent headaches or headaches during the reminder pills

19. Some things that can Interact n n Seizure medicine n n St. John’s Wort n n Rifampin, griseofulvin n n Vitamin C – –Irregular bleeding

20. Time to Play……

22. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. Oral Sex B. Intercourse C. Adultery D. Coveting Which is not sexual activity $100

23. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. Oral Sex B. Intercourse C. Adultery D. Coveting Which is not sexual activity $100

24. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. Monogamy B. Abstinence C. Withdrawal D. Rhythm Method What is the best way to prevent pregnancy $500

25. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. Monogamy B. Abstinence C. Withdrawal D. Rhythm Method What is the best way to prevent pregnancy $500

26. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. 1 month B. 3 months C. 1 year D. Never Most OCP side effects resolve by $1,000

27. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. 1 month B. 3 months C. 1 year D. Never Most OCP side effect resolve by $1,000

28. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. Weight gain B. No period C. Thin bones D. Acne Depo causes this side effect, and thus a 2 year use recommendation $5000

29. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. Weight gain B. No period C. Thin bones D. Acne $5000 Depo causes this side effect, and thus a 2 year use recommendation

30. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. The Pill B. The Patch C. The Shot D. The Ring The easiest method of birth control to keep private $10,000

31. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. The Pill B. The Patch C. The Shot D. The Ring $10,000 The easiest method of birth control to keep private

32. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. Monthly B. 6 months C. 3 months D. Annually How often does a patient need Depo Provera $25,000

33. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. Monthly B. 6 months C. 3 months D. Annually $25,000 How often does a patient need Depo Provera

34. $50,000 A. Rashes B. Falling off C. Pregnancies D. Clots 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 What side effect of the Patch is in the news

35. $50,000 A. Rashes B. Falling off C. Pregnancies D. Clots 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 What side effect of the Patch is in the news

36. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. 1% B. 10% C. 5% D. 25% What percent of teens 15-19 get pregnant each year $100,000

37. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. 1% B. 10% C. 5% D. 25% What percent of teens 15-19 get pregnant each year $100,000

38. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 $250,000 A. Condom B. Diaphragm C. Dental dam D. Female condom Which item does not decrease STIs?

39. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 $250,000 A. Condom B. Diaphragm C. Dental dam D. Female condom Which item does not decrease STIs?

40. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. 15% B. 85% C. 50% D. 99% What percent of teens not using birth control become pregnant in a year $500,000

41. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. 15% B. 85% C. 50% D. 99% $500,000 What percent of teens not using birth control become pregnant in a year

42. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. 20 B. 50 C. 35 D. 67 What percentage of 10 th grade girls have had sex $1,000,000

43. 1,000,000 500,000 250,000 100,000 50,000 25,000 10,000 5,000 1,000 500 100 A. 20 B. 50 C. 35 D. 67 $1,000,000 What percentage of 10 th grade girls have had sex

44. Conclusion n We are here to help you in any way we can n Please feel free to contact us with any questions or concerns you have

45. Questions?