Contraception and Birth Control

Rik Papagolos, RN

Risk and Responsibility

If intercourse occurs the day before ovulation, the chance of pregnancy is about 30%.

If intercourse occurs the day of ovulation, the chance of pregnancy is about 15%.

Over the course of one year, couples who do not use contraception have a 90% chance of pregnancy.

Contraception

We use our knowledge of reproductive physiology to promote or avoid pregnancy.

Preventing Sexually Transmitted Diseases (STD’S)

Most STD’s are treatable if diagnosed early. AIDS is one exception> AIDS is FATAL. Some contraceptive methods work to help prevent

disease and pregnancy. Latex and polyurethane condoms provide barrier

protection against virus and bacterial infection: such as Herpes virus, chlamydia, gonococcus, and HIV.

Preventing Sexually Transmitted Diseases (STD’S)

Not 100% effective at preventing infection or pregnancy.

Spermicides - Chemicals that kill sperm offer protection against some STD’s, foam or film can provide extra protection.

Use of spermicides with barrier methods increase the effectiveness of both the infection and pregnancy protection of the method.

Contraception

Three general strategies:Prevent ovulation;Prevent fertilization;

Keep sperm & oocyte away from each other.

Prevent implantation.

Contraceptive methods Hormonal methods Barrier methods Intrauterine devices Natural methods Permanent methods

Birth Control and Contraception

What is the differenceBirth Control: Preventing birth from taking place

IUDEmergency contraceptive pillsRU-486Surgical Abortion

Birth Control and ContraceptionContraception: Preventing conception (preventing the

sperm and the egg from uniting)Barrier methods

Condoms, diaphragms

SpermicidesHormonal methods

Pill Shot (depo) Implants

Methods of Contraception and Birth Control

Choosing a MethodThe best method is the one you will use consistently

and correctlyKnow the reliability of methodKnow the advantages and disadvantagesSide effectsRisks

Methods of Contraception and Birth Control

AbstinenceChoosing not to have intercourse

OutercourseSexual activity without penetration

Methods of Contraception and Birth Control

Hormonal MethodsThe pill Implants Injections

The Pill Combination of estrogen and progestin (some

progestin only) Inhibits ovulation Thickens the cervical mucous Changes the lining of the uterus to inhibit

implantation of the fertilized ovum Alter the rate of ovum transport 99.5 % effective (if used correctly) 92 %

Hormonal Prevents ovulation

Thickens mucus at the cervix so sperm cannot pass through

Changes the environment of the uterus and fallopian tubes to prevent fertilization or implantation should fertilization occur

Hormonal Contraception: Combination OCP’s

Contain Synthetic Estrogen/Progestin Modern E2 Dosage ≤ 50 Mcg

Despite Diversity, Side Effects and Efficacies are Similar

Requires Patient Compliance

Combination OCP’s:Mechanism of Action

Suppresses LH / FSH Release

(E2 FSH, P LH)

Progestin Thickens Cervical Mucus and Alters Endometrium

Major Effect Is Anovulation and Impairment of Sperm Transport and Oöcyte Implantation

Contraception Prevent ovulation.

“The Pill” Synthetic “progestins” mimic

effect of progesterone. Inhibits FSH & LH, and their

effects on follicle development

Norplant Depo-provera

The Pill

AdvantagesEasy to useDependableNo additional appliancesCan regulate menstrual flow and decrease cramps and

other symptoms of menses

Combination OCP’s:Additional Benefits

Menstrual Regulation Decreased Risk of Anemia Ovarian, Endometrial CA: Risk Lower PID Risk Prevention of Benign Breast Disease

The Pill

ProblemsSide effects

Changes in menstrual flowBreast tendernessNauseaVomiting Wt. gain or loss

The Pill Contraindications

Heart disease Kidney disease Asthma High blood pressure Diabetes Epilepsy Gall bladder disease Sickle-cell anemia Migraine headaches depression,

The Pill

ACHESAbdominal painChest pain or shortness of breathHeadaches (severe)Eye problems (blurred vision, flashing lights and

blindness)Severe leg pain

The Pill

Smoking and the Pill DO NOT TAKE THE PILL IF YOU SMOKE

Implants

Progestin only (Norplant) Prevents ovulation More effective than the Pill

Norplant: Implantable for ≤ 5 Years Similar Side Effects as Depo-Provera Avg. Yearly Failure Rate: 0.8/100 (Increases : >

2/100 after 5 years) Occasionally Difficult to Remove

Implant

AdvantagesConvenienceEliminate user errorNo menses or very lightDecreased cramping

Implant

ProblemsDifficulty in removing

Side effectsSimilar to the pillChanges in

menstrual bleedingHeadaches

Side effectswt. gainAcnebreast tendernesshair growthovarian cysts

Implant

ContraindicationsLiver diseaseBreast cancerCardiovascular diseaseUnexplained vaginal bleedingPregnantSmokers

Injectable Contraceptives

Depo-Provera (DMPA) ProgesteroneCan stop mensesSide effects include

Spotting, wt. gain, headaches, breast tenderness, dizziness, loss of libido and depression

Lunelle Progestin and estrogenSimilar to the pill in all aspects

Barrier Methods

The condom Female condom Diaphragm Cervical cap Sponge

Barrier methods Male / Female condom Diaphragm

Block sperm from reaching the egg

Some are used with spermicides, which kill sperm.

Barrier Methods: Diaphragm: High Failure Rates

– Must Remain in ~6 Hrs post-coitus

– Best if Combined with Spermicide

– UTI Potential Condom: STD Protection, Inconsistent Use by

Men Female Condom: Cumbersome, Learning

Curve

Spermicides

Nonoxynol-9 Use in combination with barrier methods of

contraceptionFoamgelFilmCreams, jellies and suppositories

IUD

Intrauterine device Copper and plastic (Copper T-380A) 10 years Plastic and Progesterone (progestasert IUD) 1 year 90-96 % effective in use Increased risk of PID

Barrier methods Male / Female condom Diaphragm

Block sperm from reaching the egg

Some are used with spermicides, which kill sperm.

Intrauterine device (IUD) COPPER-T

MULTI LOAD

MIRENA

The progestin released by the levonorgestrel (LNg) IUD prevents fertilization by making the mucus in the cervix thick and sticky, so sperm can't get through to the uterus. The progestin and IUD change the uterine lining, preventing implantation in the rare case that fertilization occurs.

The copper in the copper IUD is toxic to sperm. It causes changes in the uterus and fallopian tubes that kill sperm

IUD:Mechanisms of Action

NOT ABORTIFACIENT!!!!!!!! Prevents Conception:

– Sperm Transport Inhibited

– Sperm Survival / Capacitation Diminished

Prevents Implantation: hCG Levels = 0

IUD:Complications

PID: Usually 20 Insertional Contamination

– Unproven Role for Prophylactic ABx Hypermenorrhea Expulsion Perforation (< 0.1%) Failure: IUD Should be Removed ??Ectopic

Fertility Awareness Methods Calendar or rhythm method

Midway in cycle Basal body temperature (BBT) method

Increase in body temperature Cervical Mucous Method

Clear slippery mucous Symptothermal method

Combination of BBT and Cervical Mucous methods

Fertility awareness (natural family planning)

Identifies the time during a woman's cycle when she is most likely to become pregnant (fertile). An additional method or abstinence should be used during this time of fertility.

Contraception

Prevent fertilization. Coitus interruptus

Least effective of allRhythm

50% failure rateAvoid intercourse during

woman’s likely fertile period

~ 1 week before ovulation to ~ 4 days after ovulation

Basal Body Temperature Method (BBT)

Fertility Awareness Methods

The lowest body temperature of a healthy person during awaking hours

OVULATORY CYCLEBBT IS BIPHASIC

Sterilization For Women

Tubal ligationsCut and seal the fallopian tubes

HysterectomyRemoval of the uterus

For Men Vasectomy

Vas deferens are cut and sealed

Emergency Contraception

Emergency Contraception Pill (ECP) Copper IUD

Abortion

Spontaneous abortion (miscarriages) Induced abortion

Induced Abortion

Drug inducedMifepristone (RU-486)

Surgical MethodsVacuum aspirationDilation and evacuationHysterectomySaline, prostaglandins and urea (after the first trimester)