Contraception

Description

1. Contraceptives are used to delay and/or prevent pregnancy. If no contraceptive method is used, 85% of women will become pregnant within 1 year.
2. Birth control type depends on your needs. Many people need to prevent pregnancy and at the same time want to decrease their chance of catching sexually transmitted diseases (STDs).
3. Overall, 60% of pregnancies are unplanned and 80% of teen pregnancies are unplanned.

4. For any type of contraception to work it must be used every time when you have sex and used correctly
5. No method is 100% effective in preventing pregnancy unless one avoids sex (abstinence) altogether, so it is important to keep track of your periods and test for pregnancy if you have a lighter than usual period or miss your period completely. The earlier a pregnancy is terminated (abortion by medication or surgical procedure) the better; if you choose to continue the pregnancy, you must stop taking certain medications, drinking alcohol, and other behaviors that may harm the fetus.


Contraceptives methods and approximate failure rates (lowest expected-typical rates)

1. Barrier methods
a. Male condom: 2-12%*
b. Female condom: 5%
c. Diaphragms used in conjunction with spermicidal jelly or cream: 6-18%
d. Cervical cap: 6-18%
e. Spermicidal alone: 6-21%
f. Sponge (works better in women who have never been pregnant): 6-28%

2. Oral contraceptives with a combination of hormones* to imitate the menstrual cycle: 0.1-3%; or the least effective, progestin-only pills: 0.5-3%.

3. Injectable contraceptives, e.g., Depo-Provera: 0.3%

4. Surgically implanted hormones, e.g., Norplant: 0.2%

5. Intrauterine device (IUD) a. Progestasert: 0.5-3%
b. Copper T 380A: 0.8-3%

6. Natural methods:
a. Withdrawal (coitus interruptus): 4-18% b. Rhythm method: 9-20%. Requires abstinence during the midcycle (usual time of ovulation); however, up to 2% of women ovulate during their menses. The rhythm method is associated with a higher rate of birth defects if the pregnancy is allowed to continue because an old egg and/or old sperm may meet.

7. Voluntary sterilization
a. Tubal occlusion (female): 0.2-0.4%
b. Vasectomy (male): 0.1-0.15%

*Proper use of male condoms and oral contraceptives, at the same time, is more effective than either method used alone and provides good protection against STDs.


Emergency contraception

Emergency contraception, also called postcoital contraception, may prevent pregnancy after unprotected intercourse or when the condom broke or slipped off. Emergency contraception is not an abortion, because it does not work if the woman is already pregnant. Emergency contraception works by preventing the egg and sperm from meeting by delaying ovulation, altering the lining of the fallopian tubes so that the sperm and egg (ova) do not meet, or by changing the lining of the uterus (endometrium) so that a pregnancy cannot develop. Emergency contraception may not work so it is important to continue to monitor yourself for pregnancy and notify your physician at once if the pregnancy test turns positive.

1. Emergency Contraceptive Pills (ECPs)
a. The first pills must be taken within 72 hours of unprotected sex, and the second dose 12 hours later.
b. Side effects should decrease over the next 2days and disappear; if they do not, call your physician.
(1) Nausea in 30-50% of women and vomiting in 15-25% of women. Taking a drug to prevent nausea and vomiting 1 hour before taking the first and second dose of pills is recommended.
(2) Your breasts may become tender and you feel more tired and irritable than usual.

2. Intrauterine device (IUD)
a. Must be inserted within 5 days of unprotected intercourse
b. Complications:
(1) Increase risk of infection particularly if cervix infected with harmful organism, e.g., chlamydia.
(2) Ectopic pregnancy occurs more frequently so report any abdominal pain.