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Contraception Today: What’s new?
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  1. Contraception Today:What’s new? Carol E. Peterson, MS, RN Wyoming Health Council

  2. Contraception Today: Lots of Options!

  3. Contraception Today: Lots of Choices! • Pills (combined and progesterone only) • Injections • Contraceptive Devices (patch, ring) • IUD / IUS • Barrier Methods (condoms, diaphragm) • Spermicides • Implants • Sterilization

  4. Oral Contraception - Review • Combined Hormonal (various doses) – estrogen and progesterone (1960s) • Progesterone only / mini pills (1973) must be taken within 1 -2 hour window every day • Rx only; Must take daily; Still the most popular method • No protection against STDs • Combined failure rate: perfect use 0.3% / typical use 8% (Progesterone only has higher failure rate)

  5. Injections • Depo Provera IM (1992)(Depo Sub Q – (2005) may allow for self-injection at some point) • Repeat injections every 3 months; must be given on time • Irregular bleeding at first – mostly amenorrhea after a few months • Concerns about bone de-mineralization with teens and long term users • Rx only; No protection against STDs • Failure Rate: perfect use 0.3% perfect use / typical use 3%

  6. Transdermal Patch (2001) • Patch applied to skin • Useful for those who have difficulty remembering to take a daily pill • Apply new patch ever week for three weeks • Hormone is in the adhesive – so must stick – must replace if comes off • No protection against STDs • Failure Rate: perfect use 0.6% / typical use 8%

  7. Emergency Contraception– Plan B • AKA – “morning after pill” / prevents release of / fertilization of egg (not to be confused with RU 486 – the “abortion pill”) • Actually two progesterone only pills ( equal to 20 mini pills) • Most effective the sooner it is taken / up to 5 days after unprotected intercourse • 75 - 89% effective • Advanced provision increases effectiveness ~ 1.7 million unintended pregnancies per year could be averted

  8. Vaginal Ring (2001) • Estrogen and progesterone imbedded in soft, flexible ring; slow continuous release • Added benefit - improves vaginal flora • Inserted into vagina – stays in place for 3 weeks & removed for one • Woman doesn’t feel it – most male partners don’t either • No protection against STDs • RX only; one size fits all • Failure Rate: perfect use 0.3% / typical 8%

  9. IUD / IUS • Paraguard (copper) IUD • RX / good for 10 years; In-office procedure • May make periods heavier • Failure rate (0.8%) • Mirena (progestin) IUS (2001) • RX / good for 5 years; In office procedure • Makes periods very light / 80% amenorrhea • Failure rate 0.1% (nearly perfect) • No protection against STDs with either

  10. Barrier Methods • Offer some protection against STDs • Male condom • Research is clear -YES they are effective for birth control and STD prevention if used consistently and correctly • Failure Rate: Perfect use 2% / typical use 15% • Female condom • Used more by MSM • Failure Rate: Perfect Use 5% / typical use 21%

  11. Others • Diaphragm • Insert up to two hours prior to intercourse – leave in for 6 hrs after • Use with spermicide (and a condom to increase effectiveness and protection) • Rx only – must be fitted • Failure Rate: 20% • Spermicides – contraceptive foam, jelly, suppositories, film – OTC • Use with a condom as their failure rate can be as high as 50% when used alone

  12. Sterilization • Tubal Ligation - female • Vasectomy - male • Essure – (2003) Device inserted into fallopian tubes – causes overgrowth of tissue and scaring in tubes; takes special training – not widely available here

  13. So What’s New? • Continuous Contraception – Continuous delivery of hormonal contraception to prevent ovulation • All human beings miss some pills from time to time; extended use keeps the ovaries “asleep” • Continuous use of pills and ring already being promoted by some practitioners (off-label) • Do not use the patch for this purpose

  14. Continuous Use • Added benefit of Menstrual Suppression; allows women some control over when or if they menstruate • Studies show many women interested in this! No known long term consequences – studies continue. • Seasonale / Seasonique – approved pills; periods only 4 times a year • Lybrel – Pills formulated for one year continuous use; currently under review of FDA

  15. Menstrual Suppression • Mirena IUS and Depo - provide suppression for most women • Implanon – Implant with progesterone only; just received FRD approval • Nuvaring – Combined hormonal method under FDA review for this purpose (ring has enough hormone to last for 35 days); • Ortho Evra Patch – Combined method NOT Recommended for this purpose; rate for hormone deliver too high

  16. Implanon • Single rod implant – 40mm x 2mm • Easy to insert and remove • Lasts for three years • Progesterone only • Causes amenorrhea • Delivers a steady level of hormone • FDA approved July 2006 • Used in Australia for over four years now • Failure rate 0%

  17. What Else is New? • Today Sponge – back by popular demand nonoxynol - 9 spermicide – available OTC • New Spermicide / Microbicide Gels in clinical trials; offer some protection against STDs, including HIV (non n-9 products) • Ushercell • BufferGel & Buffer Gel Duet (gel with a diaphragm-like device).

  18. Finally … Male Contraception • Males have not had a lot of options for sharing the responsibility for contraception • Male contraceptive pill/injection has been elusive • In Clinical Trials: • Reversible Inhibition of Sperm Under Guidance (RISUG) • Injectable gel coats wall of vas and kills sperm • Azoospermia in 12 men 5 days after injection • Intra Vas Device (IVD) – also reversible • Soft hollow silicone plugs implanted in the vas; complete blockage in 27 / 30 men with very low counts in the other 3

  19. Family Planning Clinics • Wide variety of FDA approved contraceptives available on a sliding fee scale • STD and HIV testing • Confidential Services; Title X required adolescent services • Local experts – presentations, resources about sex education, contraceptives and STDs • Health maintenance / prevention / referral • To find a Family Planning Clinic near you go to www.wyhc.org

  20. Questions? • Carol Peterson, MS, RN Wyoming Health Council 2120 O’Neil Ave. Cheyenne, WY 307-632-3640 carol@wyhc.org