Contraceptives

1. Contraceptives Mr. Prall

2. What is contraception? • Contraception - A chemical, physical, or surgical method of preventing fertilization of an ovum. • Contraception will help prevent fertilization: • Fertilization – The union of a sperm and ovum.

3. Introduction • Birth control methods – Ways to alter the conditions necessary for conception or pregnancy to occur. • Knowing facts about birth control methods DOES NOT give you permission to be sexually active as a teen if you or your partner use birth control methods. • Two major risks of unprotected sexual intercourse are: • 1. Unwanted pregnancy/parenthood • 2. STIs

4. Introduction • The best way to prevent pregnancy is… • ABSTINENCE! • Birth control methods might involve contraception or interception. • Contraception – A chemical, physical, or surgical method of preventing fertilization of an ovum. • Interception – A chemical or physical method of preventing implantation of the fertilized ovum in the uterine lining.

5. Kinds of Birth Control Methods • Abstinence from Sex • Oral Contraceptives • The Combination Pill • The Progestin-Only Pill • The Extended-Cycle Pill Vaginal Ring Injectable Contraceptives • Injectable progestin • Skin Patch

6. Kinds of Birth Control Methods cont. • Barrier Methods • Spermicides • The diaphragm • The cervical cap • Male condom • Female condom • Intrauterine Devices • Fertility Awareness Methods • The basal body temperature method • The calendar method • The mucus method

7. Kinds of Birth Control Methods cont. • Sterilization Methods • Tubal ligation (female sterilization) • Vasectomy (male sterilization)

8. Facts to know about birth control methods • How it works: The way the birth control method works to prevent pregnancy. • Instructions for correct use: Directions for using the birth control method the right way. • Effectiveness: How well the birth control method works for adult users stated as a percentage. • Theoretical Effectiveness: The percentage that tells how well the birth control method works for adult users if it is used every time, always used in the correct way, and used by adults who have no preexisting conditions that reduce how well it works.

9. Facts cont. • Actual user effectiveness: The percentage that tells how well the birth control method works for most adult users; this percentage takes into consideration adults who do not use it every time, adults who do not use it in the correct way, and adults who have conditions that reduce how well it works. • Other benefits from correct use: Benefits the user gets from the birth control method that are in addition to its use to prevent pregnancy. • Side effects: Unwanted changes, including health risks, that might occur when the birth control method is used.

10. Facts cont. • Who should not use: A list of cautions that identifies users who should not use the birth control method because it might cause health risks or might be inappropriate. • Cost: An estimate of how much money the birth control method will cost.

11. Oral contraceptives • Different types of oral contraceptives: • The Combination Pill • The Progestin-Only Pill • The Extended-Cycle Pill

12. The Combination Pill • The Combination Pill – A pill that combines estrogen and progesterone to change the natural menstrual cycle and to prevent ovulation. • If a female stops taking the Combination Pill a female will resume her menstrual cycle. • *The Combination Pill will: • Help prevent ovulation • Change the uterine lining…If fertilization does occur the change makes it difficult for the fertilized ovum to implant itself in the uterine lining. • Thicken the cervical mucous making it difficult for sperm to travel through the cervix into the uterus.

13. The Combination Pill cont. • In theory it is effective 99.7% of the time. In reality it is effective 92% of the time…because females forget to take one or more pills, or they don’t follow directions. • *The Combination Pill will keep the menstrual cycle constant…28 days. • The pill reduces risk of ovarian and uterine cancers. • The pill also lowers cramps and menstrual flow. • Who should not use it? • Heavy smokers • Females who experience migraines • Females who suffer from depression • The cost varies from $10-$35 depending on brand, insurance, and where the pill pack is purchased.

14. Instructions for proper use • A physical exam occurs. Health history, pap smear, pelvic exam, tests for HIV and STIs. • A prescription is obtained from a physician. • Back-up pills should be used for the 1st month. • The first pill is taken either the Sunday after her period begins, or the same day her period begins. • 28-day pill pack = One pill is taken each day for 28 days. There are 21 pills, and 7 reminder pills. Once the pills run out, she starts the next pack.

15. What to do if you forget to take a pill? • If one pill is missed use the back-up birth control pill as soon as the female remembers. • If two pills are missed the back-up birth control should be used while the rest of the pill pack is continued to be used. • If three or more pills are missed a back-up birth control method should be used.

16. The Progestin-Only Pill • The Progestin-Only Pill is also called the mini-pill. • Progesting-Only Pill – A pill that contains progesterone, which changes the natural menstrual cycle and prevents ovulation. • It differs from the Combination-Pill because it contains no estrogen. • How does it work? • Prevents ovulation • Changes uterine lining • Thickens lining of cervical mucus

17. Progestin-Only Pill cont. • In theory it is effective 99.7% of the time. In reality it is effective 92% of the time…because females forget to take one or more pills, or they don’t follow directions. • The pill reduces risk of ovarian and uterine cancers. • *This is the preferred pill for mothers who breast feed. • The cost varies depending on brand, where the pill pack is purchased, and insurance, but can be anywhere from $10-$25.

18. Instructions for proper use… • A physical exam occurs. Health history, pap smear, pelvic exam, tests for HIV and STIs. • A prescription is obtained from a physician. • Back-up pills should be used for the 1st month. • The first pill is taken either the Sunday after her period begins, or the same day her period begins. • 28-day pill pack = One pill is taken each day for 28 days. There are 21 pills, and 7 reminder pills. Once the pills run out, she starts the next pack.

19. What to do if you forget to take it? • If one pill is missed use the back-up birth control pill as soon as the female remembers. • If two pills are missed the back-up birth control should be used while the rest of the pill pack is continued to be used.

20. Extended-Cycle Pill • Extended-Cycle Pill – Combines estrogen and progesterone to change the natural menstrual cycle and to prevent ovulation. • It differs from the Combination-Pill because the pills with active ingredients are taken for a longer period of time. This delays the menstrual cycle. • This pill will allow a female to have her period 4 times a year, instead of 13. • How does it work? • Prevents ovulation • Changes uterine lining • Thickens cervical mucus

21. Extended-Cycle Pill cont. • In theory it works 99% of the time, but in actuality it works 95% of the time. • Why is it lower? • Because females forget to take pills! • This pill can be beneficial to women because it cuts down their period meaning less menstrual cramps (dysmenorrhea) • This pill costs anywhere from $100-$120 for three months.

22. Instructions for proper use… • A female has a traditional physical or pelvic examination. A prescription is then obtained. • A back-up birth control should be used for the first 7 days before beginning the extended-pill. • The first pill is taken either the Sunday after her period begins, or the same day her period begins. • One pill with active ingredients is taken at the same time each day for 84 days. After 84 days one pill with inactive ingredients is taken for 7 days. After the 7 inactive are up, she takes the other 84 active ingredients again.

23. What to do if you forget to take it? • 1 pill is missed; take it as soon as you remember. The next pill is still taken at the regular time. • 2 pills are missed; the female should take two pills the day she remembers, and two pills the next day. Then restart your one-pill a day cycle. • 3 or more are missed; don’t take the pills that were missed. Take one pill a day until all the remaining pills are taken.

24. Vaginal Ring • Vaginal ring…

25. Vaginal Ring • Vaginal Ring- A small, flexible, plastic ring that is about 2 inches wide. • The ring is placed inside the vagina each month, and it releases hormones similar to those in birth control. • When used properly it works 99-98% of the time. • The vaginal ring will help keep a women’s menstrual cycle regular. Periods may also last shorter, and less blood flow. • Each ring costs between $30-$35. A new one is needed each month.

26. Vaginal ring instructions for use… • A female has a traditional physical and pelvic examination. A prescription is then obtained. • The female picks a day, usually during her menstrual period to insert the ring. The day should be recorded, or remembered. • The ring can be inserted in any position, just as long as the female feels comfortable. • The ring is left in place for 3 weeks, and after the third week the female will remove it on her own. • During the 7 days when it is removed the female should experience her menstrual cycle. Then a new ring is inserted.

27. Injectable contraceptives • Injectable progestin

28. Injectable Progestin • Injectable progestin – A shot of synthetic progesterone that is given every 3 months to change the natural menstrual cycle and prevent ovulation. • A female will usually begin her menstrual cycle 6-12 months after she stops having shots of injectable progestin. • How does it work? • Prevents ovulation • Changes uterine lining • Thickens the cervical mucus

29. Injectable Progestin cont. • The actual user effectiveness for adults is 99%. • Reduces menstrual cramps, risks of ovarian and cervical cancer. • The approximate cost for these shots throughout the year ranges anywhere from $215-$545.

30. Instructions for correct use… • Physical exam that includes health history, pap smear, a pelvic exam, HIV and STI tests, etc. • A prescription is then obtained. • A shot is given within a week after a female’s menstrual period begins. A back-up birth control should be used for first 7 days after the first injection. • A repeat shot of injectable progestin is needed every 3 months.

31. Skin Patch • Skin Patch – A soft, thin, plastic patch that is worn on the skin to prevent pregnancy. • The patch is beige in color and the size of a match book. • How does it work? • The patch will release hormones to prevent ovulation from occurring. • Mucus in the cervix thickens. • Ovulation will begin again within three menstrual cycles after the patch is last used. • The patch is 99% effective when used properly in women under the weight of 198 pounds.

32. Skin Patch cont. • Using the patch will help regulate the menstrual cycle once a month. • Menstrual periods will also be shorter in duration and lighter in flow. • A month’s supply of patches costs anywhere from $30-$35.

33. Instructions for correct use… • A female has a traditional physical or pelvic examination. A prescription is then obtained. • The female uses the patch on the first day of her menstrual period. The patch is placed on clean dry skin on the buttocks, hip, abdomen, or upper outer arm. • Remove the patch after 7 days. Replace it with a new one, but on a different part of the body. • In total, a new patch is used for 3 total weeks, and then one week off. In the off week menstrual flow should occur. • The patch should stay on while showering, exercising, or swimming.

34. What to do if you forget to change the patch? • If within 24 hours a female forgets to replace a patch, replace it as soon as she remembers. • If she forgets after two days; put a new patch on and this day becomes the new patch day. Back-up birth control should be used. • If a female forgets to take off the patch after the third week, the patch should be removed as soon as the female remembers.

35. Barrier methods • Spermicides • The diaphragm • The cervical cap • The male condom • The female condom

36. Spermicides • Spermicides – A foam, cream, jelly, film, or suppository that forms a barrier and contains a chemical that kills sperm. • How doe they work? • They form a barrier to reduce the risk that sperm will enter the uterus. • They are effective 74% of the time. Spermicide used by itself is not an effective birth control method. • Spermicidesdo not prevent against STIs and HIV. • Cost for a pack of 12 suppositories or film is $4. Cost for tube of cream and jelly or a dispenser of foam is anywhere from $8-$17.

37. Spermicides foams, jellies, and creams • Always use another form of birth control with these spermicides! • For foams, jellies, and creams; insert them up to one hour before having sexual intercourse. • Fill the applicator, and then insert the applicator 3-4 inches into the vagina. • Additional spermicide must be inserted if sexual intercourse occurs after an hour. • These spermicides must be left in place for at least 6 hours after sexual intercourse.

38. Spermicides film and suppositories • Always use another form of birth control with these spermicides! • Insert these spermicides 10-15 minutes before sexual intercourse. (Instructions vary for different brands) • Position the film or suppository against the cervix in the vagina. • Additional film or suppository must be inserted if intercourse takes place after 1 hour. • These spermicides must be left in place for at least 6 hours after sexual intercourse.

39. Diaphragm • Diaphragm – A dome-shaped cup that fits over the cervix to provide a barrier that helps prevent sperm from entering the uterus. • The diaphragm is made of soft rubber or latex. • *A spermicide should ALWAYS be used with it! • In theory the diaphragm works 94% of the time, but in actuality it works 84% of the time. • Lower because females don’t use it every time, don’t insert it properly, and don’t use spermicides. • The cost of the diaphragm is $75-$250. The cost includes a physical examination, the diaphragm itself, visit for fitting, and the spermicide.

40. Diaphragm cont. • How does it work? • It provides a barrier that reduces the risk sperm will enter the uterus. • The spermicide that is used with it also creates a barrier. • The spermicide provides additional protection in case the diaphragm is inserted wrong, or becomes dislodged during sexual intercourse.

41. Instructions for correct use… • A female has a physical examination. • A physician then determines the correct size, and gives a prescription to the female’s Dr. • The diaphragm and spermicide are inserted before any sexual contact. Approx: 1 tablespoon of spermicidal cream or jelly is squeezed into the dome. Additional spermicide is spread throughout the rim. • The diaphragm can be inserted up to 6 hours before sexual intercourse. • The diaphragm must be folded and inserted deeply into the vagina. The front rim must be behind and above the pubic bone.

42. Instructions for correct use cont. • More spermicide should be inserted with an applicator for each act of sexual intercourse. • The diaphragm must be left in place for 6-8 hours after sexual intercourse. • A diaphragm that is used properly will last 2-3 years. The fit should be checked each year.

43. Cervical cap • Cervical cap – A rubber or plastic dome that fits snugly over the cervix to provide a barrier that helps prevent sperm from entering the uterus. • A spermicide should always be used with a cervical cap. • For females that have not had a child the effectiveness is 80%-90%, and for those that have had children it is 60%-80%. • How does it work? • It provides a barrier that stops sperm from entering the uterus. • The spermicide used with it also forms a barrier. • The approx: cost is $75-$250. This includes an exam, the cap, a visit for fitting, and spermicide.

44. Instructions for correct use. • A female has a routine physical exam. The physician then determines the correct size. • The physician determines correct size and gives a prescription. • The cap with spermicide must be inserted into the vagina 30 minutes before sexual intercourse. • The spermicidal cream or jelly is squeezed into the dome, and the cap is inserted deeply into the vagina so it covers the cervix. • It must be left in place for 6-8 hours after intercourse, and no longer than 48 hours because of the risk for TSS (Toxic Shock Syndrome)

45. The Male Condom • Male Condom- A thin sheath of latex, natural skin, or polyurethane that is placed over the erect penis to collect semen during ejaculation. • Also called a rubber or prophylactic. • A spermicide should ALWAYS be used with it. • Other than abstinence from sex, the male condom with spermicide is the most effective way or preventing HIV or STI transmission. • *The male condom, even when used with spermicide, IS NOT 100% effective in preventing STI’s, HIV, or pregnancy.

46. The Male Condom cont. • In theory, when used with a spermicide the male condom is 98% effective. In actuality it is 85%. The ratings is for reducing the risk of conception, not STIs. • Some males are allergic to polyurethane or latex, and some females, which can lead to irritation and burning. These individuals should seek out other contraceptives. • The cost for a male condom is $5-$15 for a package of 12. • Should be used before ANY sexual contact because of pre-ejaculation, and the risk of sperm.

47. Instructions for correct use… • The male condom should be purchased from a pharmacy, and stored in a cool, dry place. • The condom is placed on an erect penis before sexual contact. • The tip of the condom should be pinched as it is placed on the erect penis. The tip will collect semen during ejaculation. The tip should not contain air because it increases the likelihood that the condom will break. • The condom is then unrolled towards the shaft. • A spermicide should be inserted into the female vagina before intercourse.

48. Instructions for correct use cont… • The vagina should be lubricated before insertion. Petroleum based products and oils should not be used for lubrication since they can damage the condom. • After intercourse, the rim of the condom should be grasped at the base, and withdrawn before erection is lost. • Never re-use a male condom. Never use a male condom at the same time of a female condom.

49. The Female Condom • Female condom – A soft, polyurethane pouch that is inserted deep into the vagina to collect semen during ejaculation. • It is about 7 inches long and has flexible rings at both ends. • The female condom should always be used with spermicides. • By combining both it reduces the risk of developing some STIs and HIV, as well as pregnancy. • The female condom with use of a spermicide is not as effective as a male condom with the use of a spermicide.

50. Female condom cont… • In theory if used with a spermicide it is 95% effective. In actuality it is 79% effective.These rates are for reducing the risk of conception. • The proper use of the female condom will reduce the risk of transmitting STIs. • Some females and females are allergic to polyurethane which can lead to irritation, burning, and an allergic reaction. These individuals should seek out other contraceptives. • The approximate cost for the female condom is a package of three is $7-$14.