Birth Control Information

What is it?
The 'Pill' is a prescription tablet which is taken once a day, in sequence, until every pill in the package is used up. There are two types of birth control pill; the combination pill and minipill. The combination pill contains both an estrogen and a progestin, whereas the minipill contains a progestin only. The "Patch" contains the same hormones and acts like the "Pill". The patch is exchanged once per week for 3 weeks.

As with the "Pill", the fourth week is hormone free, when menstruation occurs. The vaginal ring is inserted by the patient and remains in place for 3 weeks. After three weeks the ring is removed by the patient. As with the other methods, the 4th week is hormone free and menstruation occurs. After this, a new ring is inserted.

How it works:
These contraceptive methods contain hormones similar to the body 's own natural hormones that stop the release of a mature egg.

Benefits:
When used as directed, all these methods (except the minipill) have an annual effectiveness rate greater than 99%. The minipill is approximately 95% effective. These methods are easy to take and regulate menstruation. When these methods are discontinued, most women can expect to become pregnant within six months, and theoretically women can get pregnant immediately afterwards. The pill can be used back-to-back to avoid menstruation, if it is a monophasic (all pills one colour) 21 day package.

A 28 day package has one week of placebo (no medication) when menstruation occurs. The vaginal ring can also be used back-to-back every 21-28 days (but if left in over 28 days the device no longer is guaranteed to provide contraception).

Disadvantages:
The most common side effects are nausea, moodiness, bloating, spotting, and weight change. However, most women have no side effects.

Women must remember to take their contraceptive regularly, regardless of sexual activity. These methods are not recommended for women over 35 years old who smoke, have migraines with aura, liver disease, or are at risk of blood clots. These methods may not be suitable for women who suffer from depression, have high blood pressure, or high cholesterol.

Cost:
A typical birth control pill, patch and vaginal ring cost about $20-25 per month.

What is it?
A diaphragm is a flexible latex barrier that is intended to fit securely over the cervix. The correct size of diaphragm is fitted by a physician, and then bought at a drugstore for home use. The diaphragm should be used with spermicidal gel in order to maximize effectiveness.

How it works:
The diaphragm blocks sperm from entering the uterus and fertilizing an egg. The diaphragm can be put in place a couple of hours before intercourse and should be left in for six hours in order to allow the spermicide to kill sperm. Douching/bathing/hot tub use within 6 hours after sex weakens the spermacide and is not recommended. The diaphragm should be removed and cleaned within 24 hours of insertion or a foul odour will develop.

Benefits:
The effectiveness rates of the diaphragm are approximately 85%. No additional hormones are introduced into the body.

Possible Disadvantages:
The most common side effects are bladder infections in women who are prone to them. The diaphragm may become dislodged during intercourse, and women with poor muscle tone of the vagina cannot use them. Diaphragms are not recommended for women (or their partners) who may be allergic to latex or spermicide. Some women find the insertion technique difficult or messy.

Cost:
A diaphragm costs about $70 and can be used repeatedly for several years. Contraceptive Options

What is it?
Depo-Provera is a prescription medication that requires an injection into the upper arm or buttocks by a doctor or other health care provider once every three months. Unlike the "pill", it does not need to be taken every day and does not contain estrogen.

How it works:
Depo-Provera contains a hormone similar to the body's own natural progesterone that stops the release of a mature egg, thus preventing fertilization.

Benefits:
Depo-Provera is over 99% effective, and is injected four times a year. If administered within 5 days of starting a period, Depo-Provera is effective immediately. At any other time in a menstrual cycle, it becomes effective in 2 weeks. With continued use of Depo-Provera, menstrual bleeding generally decreases, and many women (55%) no longer have monthly periods after the first year. When the injections are discontinued, normal periods and fertility return gradually. Most women can expect to become pregnant within nine months of their last injection. Women who are breast feeding, or are smokers over 35 year of age are allowed to safely use Depo-Provera. Because Depo-Provera does not contain estrogen, there are no estrogen-related side effects (like breast tenderness, nausea, blood clots, or migraine headaches). Depo-Provera may relieve painful periods, cancer of the uterus, and cancer of the ovaries.

Possible disadvantages:
There is a link with lowering bone density, and you must take calcium and do weight bearing exercise while on this medication. Prolonged use is not advised due to the link with lower bone density. The most common side effects of this method are changes in the menstrual cycle (spotting is common for the first few doses) and change in weight (some women may lose weight while others may gain weight). If persistent spotting occurs, the doctor often prescribes short term estrogen pills to help. There is a 5 % risk of depression. Depo-Provera is not suitable for women who are at risk of osteoporosis (weakening of the bones) or women with a history of severe depression. Depo Provera does not protect against STDs.

Cost:
Each injection costs about $40, and they are given every 3 months.

What is it?
A condom is a latex, rubber or 'lambskin' sheath that fits over the penis. They are available over the counter with or without added spermicide.

How it works:
A condom prevents pregnancy by containing sperm during intercourse, preventing the sperm from entering the uterus and fertilizing the egg.

Benefits:
The effectiveness rate of the condom is approximately 97%, depending upon consistent and correct use. The condom protects against many STDs, such as HIV.

Possible Disadvantages:
Some people may be allergic to latex or spermicide. Condoms have been known to break or slip off during intercourse, and there is a possibility that sperm may spill out when the condom is being removed. A new condom must be used each time intercourse occurs.

Cost:
Condoms typically cost around 50cents

What is it?
The intrauterine device (IUD) and the intrauterine system (IUS) are small T-shaped flexible plastic devices that are inserted into the uterus. The insertion of the Flexi-T or Mirena is a simple procedure performed in a doctor's office, similar to a pap test. These devices have a thread that hangs down from the uterus into the vagina, which enables women to ensure that it is still in place after each menstrual period, and is used to remove it by the physician. The intrauterine system (MIRENA) is an IUD with progesterone impregnated into the device, which is how it got named the "intrauterine system". Both the Flexi-T and Mirena devices should be exchanged every 5 years. Either device can be removed easily by the physician at any time.

How it works:
The FLEXI-T contains copper and prevents pregnancy by causing a reaction within the uterus, so that a fertilized egg cannot be implanted. The MIRENA additionally has progesterone to increase the effectiveness of contraception, and reduce menstruation.

Benefits:
The effectiveness rate of the FLEXI-T is approximately 98%, and the MIRENA is over 99%. The MIRENA also changes the menstrual cycle dramatically, and after about 6 months patients can expect their menstruation to cease completely. Both the FLEXI-T and the MIRENA do not interfere with intercourse and are not felt after the insertion.

Possible Disadvantages:
The most common side effect is menstrual changes. The FLEXI-T may cause heavier menstrual periods. The MIRENA causes intermittent spotting for up to several months, then menses stop. FLEXI-T and MIRENA may only be used if one is in a monogamous relationship, as exposure to an STD can cause a serious pelvic infection. The insertion usually causes brief cramps. There is a risk of misplacement of the device during the insertion or with menses. For two weeks after the insertion there is a risk of developing an infection. One must present to the doctor immediately if they get symptoms such as heavy bleeding, pain, or a fever occurs. Neither FLEXI-T nor MIRENA protect against STDs.

Cost:
Mirena costs about $330 and is good for 5 years, the Flexi-T is good for 5 years and costs $65.

Explanation of insertion procedure
The insertion of an IUD is simple, and it feels like a pap test with cramps. The insertion is quick, and lasts about one minute. In order to reduce the cramping sensation you should take a few tablets (2-4 if tolerated) of ibuprofen (like Advil or Motrin). Tylenol will not likely reduce cramps, as it doesn't work the same on uterine pain.

You must NOT BE PREGNANT. Preferably, the IUD is inserted when you are menstruating, as the hole to your uterus is open, making the procedure simpler and less cramping is usually involved. However, if you don't menstruate, you must ensure you are not pregnant, and will be required to do a pregnancy test prior to the insertion.

Risks
The main risks include malposition (wrong position) of the IUD or infection. Malposition: The IUD in some patients does not fit correctly into position. This is very uncommon. However, during the procedure, the IUD theoretically could perforate through the uterus by the doctor applying too much pressure to the instrument. In order to make this risk very small, I personally stop the procedure if the IUD will not insert easily. Once the IUD is in place, it can move over time. Again, this is uncommon. Things that can occur include:

• The IUD strings can migrate into the uterus, making removal of the IUD a little more challenging
• The IUD can be expelled spontaneously (extremely rare)
• The IUD can migrate into or even through the wall of the uterus (exceedingly rare if you get your IUD exchanged as per the manufactures suggestions).

Infection:
A pelvic infection can occur in the two weeks following the procedure (risk is less than 0.5%). After this time, the risk of pelvic infection is the same as people without an IUD, provided that you do not catch a sexually transmitted infection, such as Chlamydia. You MUST present IMMEDIATELY for medical care if, following the insertion, you have heavy menstrual flow, severe cramping, fevers, or feel unwell. The doctor will examine you to decide if an infection is present. If there is an infection, complications can be minimized by pulling out the IUD and placing you on antibiotics. The sooner you get medical care for a pelvic infection, the lower the risk of complications. Once the infection settles, typically a new IUD can be inserted if you desire.

YOU MUST NOT CHANGE SEXUAL PARTNERS while this IUD is in place, prior to consultation with a doctor. Chlamydia is extremely common and most people who carry this infection don't know they have it. If you contract Chlamydia or another disease while the IUD is in place, this will likely cause a very serious pelvic infection, and you could become very ill and even infertile. If you accidentally do have sex with another partner, come in immediately, so that the doctor can prevent infection of your IUD.

Following the procedure:
Immediately following the procedure, most people have mild cramps and dizziness for a few minutes. After that, you may return to work if you like. Later that day, please go home to see if you can check your own strings. The strings are firm for the first week. Feel inside your vagina, which is soft, to find a firm round mass, much like your nose (this is your cervix). You should feel that your strings are coming out of your cervix. The IUD is effective immediately, and you can have sex the same day of insertion, if desired. You are able to wear tampons.

Follow up - one week following the procedure
Please come back for an examination. A doctor can examine you to ensure your IUD is in place and that there is no infection. At this time, your partner should no longer feel your strings. If he does, then the doctor can cut the strings and reposition them to not be felt. If you have chosen the IUS (Mirena) and have heavy bleeding, the doctor likely will prescribe an estrogen tablet in order to relieve this temporary side effect.

Long term management
Most IUD's can be left in place and exchanged every 5 years. AT ANY TIME THE IUD CAN BE REMOVED. This is a very simple office procedure, which lasts 1-2 seconds. IUD's are a reversible form of contraception, so you can get pregnant right after the IUD has been removed. The IUS (Mirena) occasionally is associated with a delay in establishment of normal menstruation. If this occurs, please consult your doctor for guidance. Finally, the pregnancy risk is very low (1-2% for plain IUD and approximately 0.3% for IUS). However, if you get pregnant, contact a doctor immediately, as the risk of tubal pregnancy is higher and the IUD should be removed.

See a doctor if you ever experience the following symptoms:

• Severe pelvic cramping
• Unusual menstrual bleeding
• You can not find your IUD string
• You have a fever with no known cause
• Foul smelling vaginal discharge
• You missed your period or have other signs of pregnancy