Contraceptives and Birth Control

1. Contraceptives and Birth Control LCHS Mark Ewoldsen, Ph.D.

2. Remember The total risks of birth control are much less than the total risks of a pregnancy

3. Current US Pattern - 1990 • Family size - 2.2 children • Reproductive years 17-47 (30) yrs • 5-6 methods over life span • 6 million pregnancies (57% unintended) • 53% failure to use birth control • 47% failure of birth control • Birth control • 92% adults • 63% of teens • Adults use more reliable methods

4. Birth Control Choices • Single life without children • Living together • Married life without children • Married life with children • Adoption of child

5. Teens & Birth Control • “It was unromantic and planned” • “I would feel guilty” • “It is against my religion” • “We used the withdrawal method” • “Doctor will blab to my mom” • “It won’t happen to me” • “Condoms break and don’t work”

6. Birth Control Methods • 1 million teens became pregnant in 2010 • 409,000 of these teens gave birth • 6 of 10 U.S. pregnancies are unplanned • Most teens do not plan to have sex the first time forget to use a birth control method • Majority of teen pregnancies in California result from men over age 21 !

7. No Method

8. Effectiveness (one year) • Hepatitis B – none • Hepatitis C – none • Herpes – none • HPV – none • HIV/AIDS – none • Pregnancy – 15% (85% of women get pregnant in the first year of use) • Pubic Lice – none • Scabies – none • Chlamydia – none • Gonorrhea – none • Syphilis – none

9. Types of Birth Control Hormonal Barrier IUD Methods based on information Permanent Sterilization

10. Hormonal Pill

11. Birth Control Pills • Pills can be taken to prevent pregnancy • Pills are safe and effective when taken properly • Pills are over 99% effective • Women must have a pap smear to get a prescription for birth control pills

12. How does the pill work? • The pill prevents ovaries from releasing an egg each month. • The pill thickens the cervical mucous making it more difficult for sperm to travel up through the uterus and into the fallopian tubes • They also alter the lining of the uterus making it thinner and less able for an egg to implant in the endometrium. • If taken properly (same time every day) this method can be up to 97-99% effective.

13. Taking the Pill • Once a day at the same time everyday • Use condoms for first month • Use condoms when on antibiotics • Use condoms for 1 week if you miss a pill or take one late • The pill offers no protection from STD’s

14. Positive Benefits • Prevents pregnancy • Eases menstrual cramps • Shortens period • Regulates period • Decreases incidence of ovarian cysts • Prevents ovarian and uterine cancer • Decreases acne

15. Side-effects • Breast tenderness • Nausea • Increase in headaches • Moodiness • Weight change • Spotting • Increased risk of cardiovascular complications for some women • If a smoker may increase risk of blood clots • Women who are over 35 and who smoke should not take the pill

16. Effectiveness (one year) • Hepatitis B – none • Hepatitis C – none • Herpes – none • HPV – none • HIV/AIDS – none • Pregnancy – 92% • Pubic Lice – none • Scabies – none • Chlamydia – none • Gonorrhea – none • Syphilis – none

17. Hormonal Pill Patch

18. ORTHO EVRA® aka “The Patch” • Thin, match-box sized patch • worn on the buttocks, abdomen, or outer upper arm • 98-99.3% effective • prevents the ovaries from releasing an egg for fertilization • thickens the mucus on the cervix to make it more difficult for sperm to enter the uterus • worn for one week at a time • three consecutive weeks • fourth week is patch free

19. Disadvantages of the Patch • Side effects include: • Breast tenderness • Headache • Nausea • Upper respiratory infections • Menstrual cramps • Abdominal pain.

20. Disadvantages of the Patch • Does not protect against STI’s • Requires a doctor’s prescription. • Less effective for women with a body mass greater than 200lbs • Not recommended for women who are breastfeeding

21. Effectiveness (one year) • Hepatitis B – none • Hepatitis C – none • Herpes – none • HPV – none • HIV/AIDS – none • Pregnancy – 99.7% • Pubic Lice – none • Scabies – none • Chlamydia – none • Gonorrhea – none • Syphilis – none

22. Hormonal Pill Patch Norplant

24. Effectiveness • Hepatitis B – none • Hepatitis C – none • Herpes – none • HPV – none • HIV/AIDS – none • Pregnancy – 99.9% • Pubic Lice – none • Scabies – none • Chlamydia – none • Gonorrhea – none • Syphilis – none

25. Hormonal Pill Patch Norplant Injectable Hormones

26. Depo-Provera “The Needle” • A synthetic hormone is injected into your arm or buttocks every 12 weeks • Similar to the progesterone that is made by the women’s body • Prevent the ovaries from releasing an egg (ovulation) • Also less often used to thicken cervical mucus to prevent sperm from joining an egg

27. Advantages • This method is effective for 12 weeks. • No pill to take daily. • Helps prevent cancer in the lining of the uterus. • Can be used by women who are unable to take estrogen. • Nothing has to be put in place before vaginal intercourse. • Can be used while breastfeeding. • This method is 97-99.7% effective against pregnancy

28. Disadvantages • Must receive injection every three months. • Physical side effects • Loss of monthly period • Change in appetite • Weight gain • Depression • Hair loss or increased hair on face or body • Nervousness • Skin rash or spotty darkening of skin • Change in sex drive. • Side effects are not reversed until medication wears off (up to 12 weeks).

29. Disadvantages • May also cause • Irregular bleeding patterns • Headache • Nausea • Dizziness • Sore breasts • Long-term use of Depo-Provera may lead to decreased calcium in the bones. • The younger you are when you begin using Depo-Provera, the more at risk you are of developing osteoporosis. • NOT EFFECTIVE AGAINST STI’s.

30. Effectiveness • Hepatitis B – none • Hepatitis C – none • Herpes – none • HPV – none • HIV/AIDS – none • Pregnancy – 97% • Pubic Lice – none • Scabies – none • Chlamydia – none • Gonorrhea – none • Syphilis – none

31. Hormonal Pill Patch Norplant Injection Ring

32. NuvaRing ® • NuvaRing is also known as the contraceptive ring • The NuvaRing is a soft, flexible, clear plastic ring that measure 54mm in diameter. • The ring is inserted into her vagina • The first day of her period where it remains for three weeks • Slowly releases estrogen and progestin • After three weeks the ring is removed for a week at which menstruation should occur

34. Advantages of NuvaRing ® • The method is 99% effective in preventing pregnancy. • Good option for women who cannot remember to take a pill daily. • The ring does not need exact positioning to be effective as long as it is inserted into the vagina.

35. Disadvantages of NuvaRing ® • The NuvaRing is available through prescription only. • Side effects are very similar to the pill. • May feel the ring during intercourse • Worry about the ring falling out • Not recommended for women breastfeeding

36. Effectiveness • Hepatitis B – none • Hepatitis C – none • Herpes – none • HPV – none • HIV/AIDS – none • Pregnancy – 99.7% • Pubic Lice – none • Scabies – none • Chlamydia – none • Gonorrhea – none • Syphilis – none

37. Barrier

38. Barrier Method • Prevents pregnancy by blocking the egg and sperm from meeting • Barrier methods have higher failure rates than hormonal methods due to design and human error

39. Barrier Male Condom

40. The Male Condom • A male condom is a thin, skin-tight sheath that is made of latex, plastic, or animal tissue • A condom is placed on an erect penis to prevent sperm from entering a partners body.

41. Advantages of Condoms • 86-97% effective • Lubricated latex and polyurethane (plastic) protect against STI’s, including HIV • Cheap and disposable • Allow men to share responsibility • Easy to buy in drugstores and supermarkets

42. Polyurethane and “Natural” Condoms • Polyurethane condoms • Are very similar to the latex condom • As effective in preventing pregnancy and STI’s • Can be used by those individuals who are allergic to latex • More expensive • “Natural membrane” or Sheepskin” condoms • Made from the intestinal lining of the sheep • Somewhat porous • Not recommended for protection against hepatitis and HIV • Does protect against pregnancy and bacterial STI’s

43. Disadvantages • Can tear or slip off • May reduce sensation • May cause an allergic reaction in people allergic to rubber

44. Putting on a condom

45. 1 Wait for the penis to go hard. Put on the condom before there is any contact between the two bodies. http://www.brooklondon.org/youngdisabledpeople/sti_illustration.html

46. 2 Open the packet carefully to avoid damaging the condom. http://www.brooklondon.org/youngdisabledpeople/sti_illustration.html

47. 3 Unroll the condom very slightly before putting on the penis to check it is not inside out. http://www.brooklondon.org/youngdisabledpeople/sti_illustration.html

48. 4 Pinch the top of the condom to squeeze out any air. This will leave enough space for the sperm. http://www.brooklondon.org/youngdisabledpeople/sti_illustration.html

49. 5 Then put the condom on the end of the penis and unroll it all the way down to the base of the penis. http://www.brooklondon.org/youngdisabledpeople/sti_illustration.html

50. 6 It is safer to withdraw the penis while it is still hard. Hold the condom tight at the base of the penis as you pull it out to prevent spilling any sperm. http://www.brooklondon.org/youngdisabledpeople/sti_illustration.html