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emma goldman clinic title
Hormonal Contraception

BIRTH CONTROL PILLS
How do they work?

Birth control pills are made of artificial hormones like the estrogen and progesterone that are in women's bodies normally. The pills usually prevent release of an egg from the ovary. If an egg is released, the pills cause the vaginal discharge to be thick so sperm cannot function.

Hormone pills are taken for 3 weeks and then non-hormone pills are taken for 1 week. During the week of non-hormone pills, there is bleeding like a menstrual period only usually shorter and lighter.

It is very important to take pills within 2 to 6 hours of the same time every day or they will not work well. Some pills (ie low-dose hormone pills) have a shorter "late" grace period than others.

How effective are they?
Pills are 97% to 99.9% effective if taken on time.

Other things that can make pills less effective, besides taking them late are:

  • Bleeding on the 3 weeks of hormone pills (change to a stronger pill)
  • Taking antibiotics and some other medications on the 3 weeks of the
    hormone pills
  • Vomiting within 2 hours of taking the hormone pill
  • Diarrhea on the hormone pills

If not already using condoms for protection against sexually transmitted
infections (STIs), use condoms or spermicide while you have the problem and
for 7 days after it has stopped.

What's good about pills?

  • Menstrual periods are usually shorter and lighter with less cramping.
  • You don't have to remember to do something before you have sex.

What's not good about pills?

  • It is hard for many people to remember to take a pill at the same time everyday.
  • There is no protection against sexually transmitted infections. Use condoms.
  • Minor side effects are weight gain, nausea, vaginal infections, and acne.
  • Antibiotics and other drugs may decrease effectiveness BCP may increase the
    effect of alcohol. (You get drunk faster)
  • There are some small health risks for non-smoking healthy women but the risks
    are much larger for women who smoke or have certain health problems. These
    include:
    • Blood clots (heart attack and stroke)
    • Increase in migraine headaches and asthma
    • Women with diabetes or hypertension

DEPO PROVERA: THE BIRTH CONTROL SHOT
How does it work?

The shot of medroxyprogesterone acetate is an artificial female hormone progesterone. A shot is effective for 12 weeks.

How effective is it?
The shot is 99.7% effective.

What is good about the shot?

  • You only have to do something about birth control every 12 weeks.
  • It has no estrogen so can be used by those who smoke or have other reasons they
    cannot use estrogen.

What is not good about the shot?

  • It has side effects of weight gain and acne.
  • It has side effects of irregular bleeding in the first few weeks to months and
    then no periods
  • There is no protection against STIs.
  • The shots are somewhat expensive, depending on where you get them.

Effectiveness
The effectiveness rate of MPAR is greater than 99%. One in 400 women will get pregnant according to one study. It is currently used in approximately 90 countries.

How does it work?
MPAR is a synthetic hormone called medroxyprogesterone acetate, which is similar to a hormone naturally produced by your body called progesterone. It prevents ovulation by suppressing natural hormone production of the pituitary gland. It also thickens cervical mucus, making sperm penetration difficult. It prevents the uterine lining from building up, preventing implantation or growth of a fertilized egg.

Method of Administration
MPAR is an injection (shot) given into a muscle (arm or buttock) that contains 150 mg of a synthetic hormone similar to one your body produces naturally called progesterone. The first shot is given within 5 days of the beginning of a normal menstrual period. It must be given at the clinic every 12 weeks.

Advantages

  • Convenient.
  • Private.
  • Lighter menstrual periods or absence of menstrual periods.
  • Some women report fewer premenstrual symptoms and less menstrual cramping.
  • Extremely effective. (Cannot break, dislodge, or be expelled during intercourse).
  • Can be used 6 weeks after delivery by breast-feeding women.
  • Can be used 5 days after delivery if not breast-feeding.

Side Effects

  • irregular menstrual bleeding
  • weight gain
  • nervousness
  • dizziness
  • decreased sex drive
  • amenorrhea
  • headache
  • stomach pains/cramps
  • weakness/fatigue

Disadvantages

  • MPAR causes cancers in test animals and can cause birth defects (to heart or limbs) in humans if inadvertently administered to pregnant women. There is some concern that it can increase the risk of cancers of the breast, cervix, and liver.
  • Women with a family history of breast cancer are not advised to use this method of birth control. The highest risk of breast cancer was found in women who used MPAR for more than six years between the ages twenty five and thirty four. Not enough data is available to confirm that MPAR does not increase the risk of breast cancer.
  • The National Women's Health Network has received reports of blood clots, high blood pressure, excessive weight gain (more than 30 lbs), severe mental depression, hair loss, severe acne, vaginal infections, blurred vision, joint pain, diarrhea, skin rashes, swelling of the hands or feet, and infertility from women who have used MPAR.
  • Depression and decreased sex drive affects significant portion of women who must wait a few months for the drug to wear off.
  • Many population control groups and international agencies have used MPAR in the Third World and among poor and mentally retarded Americans--the most vulnerable groups in society as a coercive method of birth control.
  • Irregular bleeding is common the first 9 months of use. This bleeding or spotting can last up to 7 days at a time but usually subsides after a year.
  • Some women are afraid of injections. May have tenderness or bruising at site of injection.
  • Decreased bone density (osteoporosis) may occur while using MPAR that appears to reverse when it is discontinued.

Other Considerations
Fertility may take 6-24 months or longer to become established after MPAR is discontinued. Women who are planning to become pregnant within the next two years are not advised to use this method of birth control.

Amenorrhea (absence of periods) usually occurs after 9-12 months in about 50% of women.

Studies have shown that women gain an average of 4-5 lbs of weight per year
while using MPAR.

It is important to use condoms with spermicide to protect yourself from sexually transmitted infections such as gonorrhea, chlamydia, syphilis, venereal warts,
herpes, and HIV.

The long-term effects of MPAR on the infant have not been thoroughly studied.
It is excreted in human breast milk.

For MPAR to be effective, the woman needs to receive the injection every 12
weeks on a regular basis.

Danger signs: When to see a doctor immediately
A: Abdominal pain which is severe or tenderness in the lower abdominal area.
C: Chest pain that is sharp, coughing of blood, or sudden shortness of breath.
H: Headaches that are sudden or severe, accompanied by nausea, dizziness or fainting.
E: Eyesight problems such as blurred vision.

If you would like to read more about Depo, you can visit the company's website
at www.depoprovera.com.

ORTHO EVRA: THE "PATCH"
What is it?

Ortho Evra is a plastic patch containing hormones like the ones from women's ovaries. The estrogen is ethinyl estradiol and the progestin is norelgestromin. The patch releases 20 micrograms of estrogen and 150 micrograms of progestin each 24 hours.

These hormones usually prevent ovulation (release of an egg from an ovary). Even if an egg is released, the hormones make the vaginal discharge thicker so that sperm have a hard time getting to the egg to fertilize it. Also, the l ining of the uterus may be thinner. This decreases the chance that a fertilized egg will attach to the wall of the uterus and start growing.

How Well Does The Patch Prevent Pregnancy?
The patch is 99% effective for most people when used correctly. A research study done by Ortho found the patch to be slightly less effective (2 to 3%) in women who weigh 198 pounds and over.

How Do You Use The Patch?
Apply the first patch either during the first 24 hours of your menstrual period or on the first Sunday after your menstrual period begins. It may be easier to remember when to change your patch if you start using it on Sunday. If you do start patch use on Sunday, use an additional birth control method for the first 7 days of the first cycle to be sure you are protected against pregnancy.

Leave the patch in place for 7 days. Remove the patch and apply a new patch each week for the next 2 weeks. The 4th week, do not use a patch. Bleeding should start within 5 days. If it does not, have a pregnancy test to rule out pregnancy. Seven days after removing the 3rd patch, apply a new patch each week for the next 3 weeks. Continue this pattern each month. Never apply a patch to your breasts.

Check the patch each day to make sure it is sticking to your skin. Never have the patch off more than 7 days. It is not effective if not used correctly.

Apply the patch to clean dry skin without creams, lotions, oils, powder or makeup on or near the patch.

Remove adhesive from a previous patch with baby oil but be sure there is no oil where you apply a new patch.

What If The Patch Is Loose Or Falls Off?
If the patch is loose or comes off in:

  • Less than 1 day (less than 24 hours)
    Reapply the patch or replace it with a new patch. The patch change day will be the same. Back up birth control is not needed.
  • More than 1 day (24 hours or more or if unsure)
    Remove the old patch and replace with new patch. You will have a new Day 1 and a new Patch Change Day. If you wish to switch to another change day, do it on the week off the patch. Back up birth control is needed for this week (the first 7 days of the new cycle).

What If You Are Late In Changing The Patch?
If you leave the patch on more than 7 days:

  • At the start of any cycle (Week 1/Day 1), apply the first patch of the new cycle as soon as you remember. You will have a new Day 1 and a new Patch Change Day. Use back up birth control for the first 7 days of the new cycle.
  • In the middle of the cycle (Week 2 or Week 3)
    If it is 1 or 2 days (up to 48 hours) beyond 7 days: Remove the old patch and apply a new patch immediately. The patch change day remains the same. A back up birth control method is not needed.
  • If it is more than 2 days (over 48 hours): Remove the old patch and apply a new patch immediately. You will have a new Day 1 and a new Patch Change Day Use back up birth control for the first 7 days of the new cycle.
  • At the end of the cycle (Week 4)
    Remove the patch as soon as you remember. The Patch Change Day remains the same. Back up birth control is not needed.

What Are The Advantages Of The Patch?

  • Very effective.
  • You don't have to remember a pill every day, you don't have to get shots and you don't have to think about using a birth control method right before sex.
  • Depending on where you place the patch, it usually does not show in public.
  • Baths, showers, swimming, exercise or wet humid weather should not affect it.
  • Bleeding should occur regularly on the week you don't wear a patch.

What Are The Disadvantages Of The Patch?

  • Does not protect against sexually transmitted infections. Always use condoms.
  • Do not use if you smoke and are 35 years of age or older. As with other birth control methods containing estrogen, there is a dramatic increased risk of blood clots, including heart attack and stroke, in women 35 and older who smoke. Women who don't smoke can use the patch up to menopause.
  • You may need another birth control method if you have migraine headaches where you have visual changes at the beginning of the headache.
  • Not advised during breastfeeding as it may decrease milk supply and cause breast enlargement in the infant.

What Decreases Effectiveness Of The Patch?

  • Some antibiotics like penicillin, tetracycline, cephalosporin, metranidazole, chloramphinacol, sulfanamides, nitrofurantoin and the tuberculosis medication rifampin. Seizure medications like barbiturates, carbamazepine (Tegratol), phenytoin (Dilantin), ethosuxinide (Zerontin) and primidone (Mysoline).
  • Anti-inflammatory medication like phenylbutazone (Butazolodin).
  • Antidepressants including the herb St. John's Wort.
  • Anti-fungal medications like grisiofulvin.
  • Anti-cancer medication aminoglutethimide.

Use another method or an additional birth control method while on these drugs.

What Are The Side Effects of The Patch?

  • Skin irritation at the site of the patch.
  • Irregular bleeding, especially in the first few months of use. Use an additional birth control method (like condoms) if bleeding is more than spotting.
  • Missed periods. Get a pregnancy test if you are unsure about pregnancy.
  • Headaches.
  • Breast tenderness.
  • Nausea and vomiting.
  • Abdominal discomfort or cramps.
  • Irritability or depression.
  • Dizziness.
  • Hair loss.
  • Vaginal infections.
  • High blood pressure.
  • Blood clots (heart attack, stroke).
  • Fluid retention with swelling of hands, legs, breasts or abdomen.
  • It may make upper respiratory infections or asthma worse by causing fluid retention which interferes with breathing.
  • Brown discoloration of face which may or may not go away.

Drugs Or Medications That May Have An Increased Effect When Using The Patch
Alcohol, anti-depressants, prednisone, and seizure, anti-diabetic, anti-anxiety and asthma medications may have an increased effect. It may be necessary to take less of these drugs and medications to avoid toxic effects.

Medications That May Have A Decreased Effect When Using The Patch
Anticoagulants, anti-hypertensive and cholesterol lowering medications may have a decreased effect when using the patch. The dose may need to be increased although women on anticoagulants and high blood pressure meds should not use the patch.

Danger Signs - When To See A Doctor Immediately or Call 911
A:
Abdominal pain which is severe.
C: Chest pain which is sharp, coughing up blood or sudden shortness of breath.
H: Headache which is sudden or severe and causes dizziness, fainting or nausea.
E: Eye sight problems, such as blurred vision or loss of sight.

If you would like to learn more about the patch, visit the company's website at www.orthoevra.com.

NUVARING - VAGINAL RING BIRTH CONTROL
What is the Vaginal Ring?

The NuvaRing is a flexible, plastic ring, about 2 inches in diameter, that contains the same hormones in the birth control pills and the birth control patch. The ring is placed in the woman's vagina, where it stays for 3 weeks, and the hormones are slowly absorbed through the woman's vaginal walls.The ring releases 15 micrograms of estrogen and 150 micrograms of progestin each 24 hours.

The hormones usually prevent release of an egg from the ovary (ovulation) but even if an egg is released, the hormones make vaginal fluids thicker so that sperm have a hard time getting to the egg to fertilize it. Also the lining of the uterus may be thinner which may decrease the chance that the egg will attach to the wall of the uterus and start growing.

How do I use the Ring?
You start using the ring by putting it into your vagina within 5 days from the first day of a menstrual period, miscarriage, or abortion procedure, even if you are still bleeding. If you insert the ring during the first 5 days, you do not need to use an additional birth control method.

If you wait to insert the ring until a Sunday and it is more than 5 days since your period started, use an additional method of birth control (such as condoms or spermicide) for the first 7 days after you start using the ring. This only needs to be done for the first cycle of ring use.

Leave the ring in your vagina for 3 weeks. Then remove the ring and throw it away in the package it came in, to protect children and animals. After 1 week, put a new ring into your vagina. Again, leave the new ring in your vagina for 3 weeks, then remove it for 1 week. Continue this pattern for as long as you use the ring.

To be sure the ring is in place before having sex, check for it in your vagina.

Do not use more than 1 ring at a time. An overdose of hormones may cause nausea, vomiting, or bleeding.

What are the advantages of the Ring?

  • Very effective
  • No one except your partner will know you use it
  • You don't need to remember to take a pill every day, change a patch every week, get short or think about birth control right before sex
  • Bleeding should occur regularly each month when the ring is removed
  • If you don't smoke, you can use the ring until menopause
  • Antibiotics taken by mouth are not believed to decrease effectiveness of the ring
  • Water based lubricants do not decrease effectiveness of the ring

What are the disadvantages of the ring?

  • Like all birth control methods containing estrogen, you should not use the ring if you smoke and are age 35 or over because there is an increased risk of blood clots such as heart attack and stroke.
  • The ring does not protect you from sexually transmitted diseases - always use condoms and water based lubricants with the ring
  • You may need to use a birth control method without estrogen if you have migraine headaches where you have visual changes just before the headache
  • Consider another method of birth control if you are breastfeeding as it may decrease your milk supply or cause breast enlargement of the baby
  • Oil-based medications put into the vagina to treat vaginal infections may increase release of hormones from the ring but it has not yet been found to decrease effectiveness of the ring.

What are the side effects of the ring?
Side effects are:

  • Vaginal infections or irritation
  • Increased vaginal discharge
  • Irregular bleeding or spotting
  • Weight gain
  • Headaches
  • Nausea or vomiting
  • Abdominal cramps or bloating
  • Breast tenderness or enlargement
  • Irritability
  • Depression
  • Brown discoloration of the face, usually goes away after stopping hormone use
  • Temporary inability to get pregnant for a few months - others get pregnant the cycle after stopping ring use - use another birth control method for 3 to 6 months

If you would like to read more about the NuvaRing you can visit the company's website at www.nuvaring.com.

IMPLANON - BIRTH CONTROL IMPLANT
What is a birth control implant?

Implanon is a matchstick-sized rod that is inserted under the skin in the upper arm by a health care provider to prevent pregnancy.  It is safe, effective, convenient and protects against pregnancy for up to 3 years.

Implanon releases a hormone - progestin.  The hormones usually prevent release of an egg from the ovary (ovulation) but even if an egg is released, the hormones make vaginal fluids thicker so that sperm have a hard time getting to the egg to fertilize it. Also the lining of the uterus may be thinner which may decrease the chance that the egg will attach to the wall of the uterus and start growing.

What are the advantages of the implant?

  • Very effective and convenient.
  • The ability to become pregnant returns quickly when you stop using Implanon.
  • It can be used while breastfeeding
  • It can be used by women who cannot take estrogen
  • No one except your partner will know you use it
  • You don't need to remember to take a pill every day, change a patch every week, get short or think about birth control right before sex
  • Most women have fewer and lighter periods

Certain medicines can make Implanon less effective.  These include

  • the antibiotic rifampin - other antibiotics do not make Implanon less effective
  • certain medicines that are taken by mouth for yeast infections
  • certain HIV medicines
  • certain anti-seizure medicines
  • St. John's wort

What are the disadvantages of the Implant?

  • Keep in mind that Implanon doesn't protect against sexually transmitted infections
  • Irregular bleeding is the most common side effect
  • Some women have, longer heavier periods

What are the side effects of Implanon?
Side effects are:

  • acne
  • change in appetite
  • change in sex drive
  • cyst on the ovaries
  • depression
  • discoloring or scarring of the skin over the implant
  • dizziness
  • hair loss
  • headache
  • nausea
  • nervousness
  • pain at the insertion site
  • sore breasts

Many women have concerns about the possible risks of birth control with hormones.  Serious problems do not occur often and usually have warning signs.  Tell your health care provider immediately if

  • You have bleeding, pus, or increasing redness, or pain at insertion site
  • You have a new lump in your breast
  • You have no period after having a period every month
  • You have unusually heavy or prolonged vaginal bleeding
  • The implant comes out or you have concerns about its location

How Is Implanon Inserted and Removed?

After taking your medical history and giving you a physical exam, your health care provider will numb a small area of your arm with a painkiller. Implanon is inserted under the skin. Insertion takes only a few minutes.

After insertion, be sure to tell any health care provider you may see that you are using Implanon.

The implant is effective for three years after it is inserted. After that, it should be removed. Even though it stops working, it may interfere with your period.

Implanon can be removed at any time. Your health care provider will numb the area with a painkiller and will usually make one small cut to remove the implant. Removal usually takes just a few minutes, but it generally takes longer than insertion. A new implant may be inserted at this time. Pregnancy can happen anytime after the implant is removed.

If you would like to read more about the Implanon you can visit the company's website at www.implanon-usa.com

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