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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) • Male & female condoms – Effectiveness: Male 85-90%; Female 95% • Cervical cap & diaphragm – Cap 10-13% failure rate – diaphragm 4-8% failure rate • Cervical sponge – 11% failure rate • 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% • • • • 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 • • • • 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