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10.6: Contraception

  • Page ID
    13396
  • Purpose and Effectiveness of Contraceptives

    Using Contraceptives has two main purposes:

    1. Reduce the chance of unwanted pregnancies

    2. Reduce the transmission of Sexually Transmitted Diseases

    Some birth control methods may be more effective for reducing unwanted pregnancies, whereas other methods may be more effective for reducing the transmission of STD’s.  There are many different types of contraceptives, it is important to know and understand the effectiveness from both perspectives in order to make the best decision.

    In terms of reducing unwanted pregnancies, the effectiveness is also impacted by the way in which the contraceptive method is used.  If a person uses the method perfectly, Perfect Use Effectiveness, it will have a higher effectiveness than those who are considered typical users, Typical Use Effectiveness

    The contraceptive effectiveness rate, or failure rate, is calculated based on typical use as the percentage of typical couples who use the method for one full year and experience an unintended pregnancy.

    There are two main categories for birth control methods, reversible methods and permanent methods.  Reversible methods may use hormones, a barrier, or fertility awareness to reduce the chance of pregnancy.

    Reversible Methods for Birth Control

    Reversible methods for birth control refer to birth control methods where users can stop using the method and become pregnant. There are three main types of reversible contraceptives, hormonal methods, barrier methods, and Fertility-Awareness Methods.

    Hormonal Methods

    When a woman is pregnant they no longer release an egg each month and if there is no egg released, they cannot become pregnant.  Hormonal methods reduce the chance of pregnancy by providing hormones to the woman that tricks the woman’s body into thinking they are pregnant, thus the egg is not released each month.  There are several different hormonal methods that each provide the hormones to the woman in a different way.

    Note

    HORMONAL METHODS DO NOT PROTECT AGAINST SEXUALLY TRANSMITTED DISEASES BUT ARE EFFECTIVE FOR BIRTH CONTROL.

    Barrier Methods

    In order for pregnancy to occur the egg from a woman and the sperm from a man must meet.  If the sperm fertilizes the egg then conception, or pregnancy, occurs. Barrier methods of birth control work by creating a barrier in which the egg and sperm cannot meet.

    Permanent Methods of Birth Control

    Permanent methods of birth control are also referred to as sterilization. These methods are for those who are sure that they do not want to conceive a child.  Women choosing a permanent method can have their fallopian tubes tied or closed off, called a tubal ligation, or they can choose to have a small tube inserted into the fallopian tubes, called transcervical sterilization, which irritates the fallopian tubes causing scar tissue to form and close off the tubes.  Men commonly get a vasectomy which is an outpatient procedure in which the tube that carries sperm it cut.

    Highly Effective Reversible Birth Control Methods

    • Abstinence

      • Description:  The only 100% effective means of unintended pregnancy and STD transmission is abstinence from oral, anal, or  vaginal intercourse

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: 0%

    • IntraUterine Device (IUD), Copper IUD (ParaGard), Levonorgestrel-Releasing IUD (Mirena)

      • Description:  As the name suggests, this is a device that goes inside (intra) the woman’s uterus.  There are two types of IUD’s, one contains hormones and the other does not. The IUD is a T-shaped device that is inserted into the uterus. The Copper IUD can stay in the uterus up to 10 years and the hormonal IUD, the levonorgetrel-releasing IUD, can remain in the uterus for 5 years.

      • Type:  Reversible, some are hormonal methods

      •  Use:  The IUD is inserted into the Uterus by a physician during a routine office visit through a non-surgical procedure.

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: less than 1%

    • The Implant, Implanon

      • Description: The hormonal implant is a small match sized stick that is inserted into the woman’s upper arm and releases hormones (progestin only) for 3 years.

      • Type:  Reversible, hormonal method

      • Use: The implant is a minor surgical procedure. Woman choosing the implant must make an appointment with their doctor for the procedure.  The stick is inserted into the inside upper arm just under the skin.

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: 0.05%

    Moderately Effective Reversible Birth Control Methods

    • The Pill, combination pill, mini-pill

      • Description: The pill is an oral contraceptive.  The combination pill includes both estrogen and progestin, however the mini-pill contains only progestin.  The Progestin only mini-pill may be a good option for woman who cannot take estrogen. Pill packs contain 28 pills. For three weeks, 21 days, the pills contain hormones and the fourth week the pills are placebo pills without hormones.  The week with no hormones is when the menstrual cycle occurs.

      • Type:  Reversible, hormonal method

      • Use:  Women who choose to use the pill swallow a single pill every day.  It is very important that the pill is taken at the same time each day.  The effectiveness of the pill is lowered if it is not used correctly. If the pill is ingested at different times each day or if the woman forgets to take a pill and takes two the next day it will not be as effective at reducing the chance for pregnancy.

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: 9%

    • The Shot, Injectable contraceptives, Depo-Provera 

      • Description: The shot is an injectable contraceptive which means the woman has to go to the doctor to receive an injection of hormones.

      • Type:  Reversible, hormonal method

      • Use: Woman who choose an injectable contraceptive get a shot either once every three months.

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: 6%

    • The Patch, dermal (placed on the skin for absorption), Ortho Evra

      • Description: The skin patch provides hormones to women by means of absorption through the skin.

      • Type:  Reversible, hormonal method

      • Use: Woman using the patch place it on their body typically on the buttocks, stomach, or upper body.  The patch is replaced every week for three weeks and the fourth week no patch is used.

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: 9%

    • The Ring, Hormonal Vaginal Contraceptive Ring, NuvaRing

      • Description: The vaginal ring is a soft silicon ring closely resembling a bracelet in size. The Ring contains hormones that are absorbed into the woman’s body for 3 weeks.

      • Type:  Reversible, hormonal method

      • Use: The ring is inserted into the vagina, similarly to the way a tampon is inserted, and stays in place for 3 weeks while slowly releasing hormones.  The ring is removed for the fourth week and menstrual flow begins.

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: 9%

    • Diaphragm or cervical cap

      • Description:  The diaphragm and Cervical Cap both have the same purpose, to cover the entrance to the uterus by providing a barrier to prevent sperm from entering the woman’s body. Both are shaped like a small cup and used along with spermicide.  A consultation with a doctor is important to ensure the proper size is used. If a woman gains or loses significant weight or gives birth the woman will need to see a doctor again to ensure the correct size is used.

      • Type:  Reversible, barrier method

      • Use: The woman inserts the diaphragm or cervical cap along with spermicide.

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: 12%

    Least Effective Reversible Birth Control Methods

    • Male Condom

      • Description:  The male condom is a thin sheath that covers the penis, thus creating a barrier that should not allow the sperm to enter the woman’s body. Male condoms are usually made from latex, however there alternative materials such as “natural” or “lambskin”.  Research shows latex are more effective for reducing STD’s and pregnancies.

      • Type:  Reversible, barrier method

      • Use: It is very important to use male condoms correctly!  Correct use means purchasing the appropriate size, checking to make sure they are stored correctly and used before the expiration date, putting the condom on before any penetration, opening the condom carefully and ensuring to pinch the tip of the condom prior to carefully rolling the condom onto the erect penis, not using oil based lubricants, not reusing a condom, and not using more than one condom at a time.

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: 18%

      • STD Protection: When used correctly, the male condom can be an effective method to reduce the transmission of STD’s.  Studies have been conducted comparing HIV infection rates between condom users and non-condom user and have shown high effectiveness in reducing the transmission of HIV.

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    • Female Condom

      • Description:  The female condom is a thin pouch that is inserted into the vagina in order to create a barrier to stop the sperm from entering the woman’s body.

      • Type:  Reversible, barrier method

      • Use: The female condom is used with a lubricant and can be inserted into the vagina up to 8 hours before intercourse.

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: 21%

      • STD Protection: In terms of HIV transmission, when used correctly, the female condom can be as effective as the male condom to reduce the transmission of STD’s. 

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    • Fertility Awareness Method (FAM)

      • Description: Fertility Awareness is a natural method of birth control that is based on understanding a woman’s reproductive cycle.  Beginning in puberty and until menopause, women typically release one egg each month from their ovaries. The time around when the egg is released is considered the fertile time of the month.  Couples who use the Fertility Awareness Method, and do not want to conceive a child, abstain from intercourse during the fertile days. Many couples use the Fertility Awareness Method when they are trying to conceive as well.

      • Type:  Reversible, Natural

      • Use:  Women who choose to use FAM must spend several months, or up to a year, tracking their menstrual cycle.  Two common ways to track fertility are the Calendar Method and Basal Body Temperature Method.

        • The Calendar Method:

          • Woman choosing the calendar method must track their menstrual cycle using a calendar to identify the length of their cycle.  Women typically track their cycle for 8-12 months. The average length of the menstrual cycle is 28 days, but normal cycles vary between 21 to 35 days. Day 1 of the menstrual cycle is the first day of menstruation (bleeding).    To calculate the day the egg is released take your total cycle length and subtract 14. For example, if the total cycle length is 28 days, then the date of ovulation (egg released) is on day 14. If the total cycle length is 31 days, ovulation occurs around day 17.  Abstaining from intercourse on day of ovulation is not enough, you must take into account days preceding ovulation and the days after ovulation. After the egg is released (ovulation) it has two days to become fertilized by a sperm. If the egg does not get fertilized by a sperm then it dies and is shed during menstrual flow.  Sperm can live inside a woman’s body about 4 days, so you must account for these possible fertile days prior to ovulation.

          • Because most women have varying cycle lengths, to calculate the fertile days, subtract 18 from your shortest cycle and subtract 11 from your longest cycle. 

        • Basal Body Temperature Method:

          • Basal Body Temperature is your body temperature when you wake up in the morning.  During ovulation a woman’s body temperature rises slightly. Women who use this method record their basal body temperature every morning and note then there is a slight increase.  The slight increase indicates ovulation, the release of the egg. Women using this method abstain from intercourse 2-3 days prior to ovulation and 12-24 hours after ovulation. 

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: 24%

      • STD Protection: There is no protection against STD’s.

    • Emergency Birth Control

    • The Morning After Pill, Emergency Contraception, Plan B

      • Description:  As the name suggests, Emergency Contraceptives are for emergencies and are not a regular method of birth control. If a woman has unprotected sex or if the birth control method used failed, emergency contraceptives may be a good option for reducing the chances of an unintended pregnancy. Emergency Contraception may include taking a pill or choosing to insert an IntraUterine Device, also called an IUD.

      • Use: Emergency Contraceptives can be obtained from a pharmacy.  Some emergency contraceptives can be taken up to 5 days after intercourse, but the sooner they are taken the more effective it will be. Plan B, a common Emergency Contraceptive, should be taken within 3 days, or 72 hours.

      • Contraceptive Effectiveness Rate, or Typical Use Failure Rate: varying

        • The effectiveness is impacted by the type of Emergency Contraceptive used and the time between taking the contraceptive and intercourse.

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