CONTRACEPTIONChapter 6

CONTRACEPTIVES

Definition:Conception: the fusion of an ovum

and sperm creating a fertilized egg (zygote)

Contraception: preventing conception by blocking the female’s egg from uniting with the male’s sperm

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PRINCIPLES OF CONTRACEPTION

Based on the physiology of reproduction Types of contraception:

BarrierHormonalNatural methodsSurgical

Factors affecting choiceAdvantages and disadvantages

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EffectivenessContraceptive failure rate- % of women

experiencing an unintended pregnancy in the 1st yr. of contraceptive use

Continuation rate- % of people who continue to use the method after a specified period of time

PRINCIPLES OF CONTRACEPTION

ORAL CONTRACEPTIVES: THE PILL Estrogen and progesterone taken orally Mimics the corpus luteum

Secretes progesterone & estrogen to suppress ovulation

Combination pillMost common

Advantages : Easy to use, effective, fertility returns after use

Disadvantages : exp. symptoms of pregnancy, no protection against STD’s; stroke, blood clots in older women who smoke

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CONTRACEPTIVE SKIN PATCH

Thin , tiny square patch Releases estrogen and progestin

slowly into the bloodstream Prevents the same way as OCs Worn for 1 week, replaced on the same

day for 3 consecutive weeks. 4th wk. no patch

Advantages: as effective as OCs Disadvantages: similar to OCs

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VAGINAL CONTRACEPTIVE RING

The NuvaRing 2 inch flexible vaginal ring molded w/

progestin and estrogen Slowly releases hormones into

bloodstream Inserted during cycle, kept in for 3

wks., removed during 4th wk. (ring free) new ring inserted at next menstrual

Advantages : 1 month of protection, no daily/weekly action required

Disadvantages : similar to OCs and patch

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CONTRACEPTIVE IMPLANTS Placed under skin of upper arm/leg

Delivers progesterone over a period of years

May inhibit ovulation & affect developmentof the uterine lining

Advantages: Highly effective, no further action required after insertion, contain no estrogen, so lower risk of estrogen related side effects

Disadvantages: no protection against STDs, menstrual irregularities, uncomfortable appearance

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INJECTABLE CONTRACEPTIVES Depo-Provera

Injectable progestin every 12 weeks Provides protection like implants

Advantages Highly effective, requires little action on part of user ; No estrogen-related side effects, minor injection

Disadvantages: visit to health care facility every 3 months, side effects similar to Norplant, weight gain, infertility after stopping use

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EMERGENCY CONTRACEPTION

“Morning-after Pill”, Plan BMost common is the two dose

regimenMay inhibit/delay ovulation or

altering the transport of sperm/egg; do not affect a fertilized, implanted egg

Needs to be taken within 72 hours. Best used within 24 hours

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THE INTRAUTERINE DEVICE (IUD)

Small plastic device placed in the uterusParaGard (copper;protects 10 yrs.)Mirena (protects 5 yrs.)

Releases small amounts of progestin May work by preventing fertilization Advantages: highly reliable, once inserted

a simple check of string is all that’s needed; reduce risk of endometrial cancer; fertility restored after use

Disadvantages: limited to genital tract: heavy menstrual flow, uterine cramping, backache, spontaneous expulsion, may puncture uterine wall

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FIGURE 6.1 AN IUD PROPERLY POSITIONED IN THE UTERUS

BARRIER METHODS

MALE CONDOMS

Thin latex, or polyurethane Most widely used barrier method Advantages: Protect against pregnancy and

STD’s, easy to purchase, no prescription Disadvantages: Most common complaints are

reduced sensitivity and interfering with sexual intercourse

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FEMALE CONDOMS

Polyurethane sheath with two flexible rings

Advantages: offers potentially more protection against genital warts and herpes b/c it covers base of penis as well

Disadvantage: more expensive, more difficult to use

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FIGURE 6.3 THE FEMALE CONDOM PROPERLY POSITIONED

ABSTINENCE

AbstinenceWithout sexual intercourse for a

chosen period of timeBenefits

More self respect and respect for others

Security that you are not being pursued for sexual reasons.

Less worry about STDs and Pregnancy.

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THE FERTILITY AWARENESS METHOD

Only one egg released each month Lives for ~ 24 hrs. unless fertilized Sperm can live in the body for 6-7 days Only 8 days/month when conception can

happen FAM

Calendar method A woman releases an egg 14-16 days before her

next period Temperature method

A woman’s BT drops slightly before ovulation and rises slightly after

Withdrawal Coitus interruptus

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MALE STERILIZATION: VASECTOMY

Severing of the vas deferensMay return to work in 2 daysReversal varies between 80% to

50%

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FIGURE 6.7 VASECTOMY

FEMALE STERILIZATION

Tubal sterilization (laparoscopy) is most commonly known as tubal ligation

Hysterectomy Complication rate: 6-11% Reversibility: Low

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FIGURE 6.8 TUBAL STERILIZATION

WHICH CONTRACEPTIVE METHOD IS RIGHT FOR YOU? Key considerations include:

1. Health risks2. Implications of unplanned pregnancy3. STD risk4. Convenience and comfort level5. Type of relationship6. Ease and cost of obtaining and

maintaining each method7. Religious or philosophical beliefs

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CONTRACEPTIVE EFFECTIVENESS

Most Effective (Perfect Use) Pill, Patch, Ring, Injectiable = 0.3% Implant =0.05% ParaGard = 0.6% Mirena = 0.1% Male Condom =2.0% Female Condom = 5.0% Withdrawal = 4.0 % Vasectomy = 0.1% Tubal sterilization = 0.5%