Download Natural Methods – No medications involved

Contraception
• Contraceptive decisions are complex & can change
over time.
• Counseling & education to address individual needs
• Role of health care providers
• Woman’s choice
• Contraception & STIs.
Natural Methods – No medications
involved
• Abstinence “Outer Course”
– effectiveness 100%
• Withdrawal “Coitus Interruptus”
– effectiveness19-49%
• Fertility Awareness
– Basal Body Temperature
– Ovulation or Billings Method
– Symptothermal Method
– 20% pregnancy rate in 1st year of use
• Breastfeeding – Lactational Amenorrhea Method
(LAM) – 98%
Barrier Methods (Mechanical Barriers)
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Male & female condoms
– Effectiveness: Male 85-90%; Female 95%
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Cervical cap & diaphragm
– Cap 10-13% failure rate
– diaphragm 4-8% failure rate
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Cervical sponge
– 11% failure rate
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Cervical shield
– Effectiveness 8.7% with spermicide; 12.9% if used alone
Spermicides
• Foams
• Gel or cream
• Film (VCF)
• Suppositories
– Effectiveness 21%-26% failure rate if used alone
Intrauterine Contraceptive Device (IUCD)
• Cumulative pregnancy rate at 1 year:
– Nova T 0.8-2%
– Gyne T 380 slimline 0.3-1%
– Mirena 0-0.2%
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Primary Action
Absolute Contraindications
Risks
Advantages
Depo Provera (DMPA)
• Progestin only contraception- injectable
• Primary action
• Advantages
• Disadvantages
– Effectiveness 99.8%
– Typical use – 3 pregnancies/year
Emergency Postcoital Contraception
• 2 accepted methods
• hormonal methods “morning after pill” “MAP” “Yuzpe
method”
• Insertion of copper IUD
• Action of both methods
• Effectiveness:
– Probability of pregnancy from unprotected intercourse=25%
– 98% of women will begin bleeding within 21 days of using
Yuzpe method. If no bleeding – pregnancy test.
– IUCD almost 100%
Sterilization
• Vasectomy
– Effectiveness 0-2.2% failure rate. Recanalization happens in
2.6% of cases
• Tubal ligation
– 1-2.5% failure rate (based on pregnancy rates reported over
a 10 year period)
• Both methods considered permanent. Interruption of
tubes that carry either sperm or ova
• Reversal
Birth Control Pills (OCPs)
• 21 day; 28 day
• Monophasic; fixed amount of estrogen & progestin
– Ie Marvelon, Alesse, Cyclen
• Biphasic: fixed amount of estrogen. Progestin
increased in 2nd half of cycle.
– Ie Synphasic
• Triphasic: estrogen may be fixed or variable.
Progestin increased in 3 phases.
– Ie Tricyclen, Triphasil
• Effectiveness 99.9%. Typical 3-5% failure rate (noncompliance; drug interactions)
Action of OCPs
• Suppresses ovulation 90-95% of time
• Thickens cervical mucous
• Inhibits implantation
• Starting – most pills are any day starts
(negative pregnancy test)
• SOGC recommends Day 1 start
OCP Myths
• The pill causes cancer
– Breast, endometrial, ovarian, uterine, cervical
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The pill causes infertility
Women need to take a “pill holiday”
Weight gain
OC’s should be stopped on all women > 35.
More on OCPs
• Absolute contraindications
• Special Considerations
• Problematic side effects
• What to do about missed pills
Progestin Only Pill - Micronor
Action
Endometrial, cervical mucous, ovulation suppressed in 60% of
women
Effectiveness – 90-99%
Disadvantages
Irregular bleeding, must be taken at same time every day,
continuous
Indications
Contraindication to OCPs with estrogen, women > 35 who
smoke, women with migraines including focal varieties,
lactating women
Contraindications
No absolute