CONTRACEPTIVE OVERVIEW
Excerpt from Modern Birth Control
Contraceptive Use in the United States
Modern contraceptives are very effective in preventing pregnancy when used correctly, but the only way to assure you will not become pregnant is to avoid intercourse. Permanent surgical sterilization is also effective. Some methods of contraception are better than others, but all have failings. Using two methods simultaneously increases the likelihood of successful pregnancy prevention.
Condoms are recommended as an adjunct to most contraceptives, not only to reduce pregnancy risk, but to reduce the risk of Sexually Transmitted Diseases (STDs).
Female Contraceptives
Women of all religious denominations commonly use contraceptives (89% of Catholics and 90% of Protestants). Information source: Guttmacher Institute, October 2015. www.guttmacher.org
Long-Acting Reversible Contraception Overview (LARC)
The following three options provide continuous contraception over variable periods of time, from three months to ten years. For convenience of not taking daily pills or using other contraceptive choices, these have been found very effective for reversible hormonal contraception.
In addition, the American Academy of Pediatrics recommends LARC contraceptives for use by adolescents as a first-line choice for those who choose not to be abstinent. Use with condoms is recommended to reduce risk of STDs.
IUDs are small T-shaped devices inserted into the uterus by healthcare providers. They are very effective and provide continuous contraception. An IUD must be removed by a provider when contraception is no longer desired.
To insert an IUD, a pelvic examination is performed and a small plastic tube containing the IUD is inserted into the opening of the cervix and into the uterus. The IUD is placed within the uterus and the insertion tube removed.
Hormonal IUDs are commonly used and depending on which is chosen, are effective for 3-5 years.
ParaGard is a copper-releasing IUD that contains no hormones and is effective for up to ten years. Copper ions interfere with sperm movement, egg fertilization, and may prevent implantation.
Most women tolerate IUDs with few symptoms other than heavier menstrual flow for a couple months. Read all the guidelines and discuss concerns with your provider.
IUDs can be placed immediately after childbirth, a miscarriage or an abortion. They are considered more effective than the birth control pill (BCP).
Some insurances cover IUD placements. Prices vary widely, so check around. Exam and insertion may be free at some clinics including Planned Parenthood.
Hormone Implant (numerous options)
A slender hormone-embedded flexible rod, about the size of a wooden matchstick, is inserted beneath the skin in the upper arm. The process takes a few minutes. A special insertion device is used to place the implant after the tissue has been anesthetized. The implant works continuously for 3+ years by slowly releasing progestin and blocking ovulation. To remove the implant, your provider again numbs the area, makes a small incision and pulls it out. 99% effective. Prices vary: Implant placement ~ $300-$700; Removal ~$100-$200.
This is a continuous hormone releasing contraceptive injection that must be given by your healthcare provider every 12 weeks for uninterrupted coverage. Cost is about $50.
Female Barrier Methods Overview
Barrier methods provide some protection against venereal disease. Female and male condoms can be purchased widely and are recommended by practitioners and organizations around the world as a defense against STDs and HIV. Most instructions recommend leaving vaginal devices (diaphragms and cervical caps) in place for six hours following intercourse. If left in place for long periods, the risk for toxic shock syndrome rises. Insurances typically cover exams and fitting for cervical barrier contraceptives. Condom use by a partner further reduces STD and pregnancy risk.
A diaphragm has been in use for decades and is relatively reliable when used correctly and with a spermicide. This barrier method of birth control is a round soft dome made of latex or silicone with a firm flexible ring that holds it in place after vaginal insertion. The dome blocks sperm from entering the uterus and cannot be felt by your partner. It can be placed in position hours before intercourse and must be left in place for a least six hours following intercourse. The diaphragm comes is different sizes and must be fitted by a health practitioner. It can be used repeatedly with proper washing and storage. Cost of an exam is in addition to purchase price of a diaphragm, ~$15-$75 with a prescription. Spermicide (~$15) must be used with a diaphragm to be effective. Failure rate when used correctly: 6% (6 of 100 women will become pregnant/year).
This is a washable, reusable cervical barrier contraceptive device made of non-allergenic silicone rubber. It must be used with a spermicide and is available by prescription only, one-size-fits-all. Follow instructions for use carefully. Leave in place for six hours following intercourse. Failure rate of 14%. Cost ~ $70.
The reusable 1.5-inch cervical cap is a soft silicone cup inserted into the vagina to cover the cervix as a barrier to sperm. A practitioner must examine you and fit the cap. A spermicide must be used and the cap left in place for at least six hours following intercourse. Cost for exam variable. Average failure rate is 14%, less effective in women who have given birth. Cost ~ $90.
This loose sheath has a flexible ring at each end and is worn within the vagina, providing a physical barrier to semen. The inner ring at the closed end of the sheath is inserted into the vagina and placed over the cervix. The outer ring at the open end remains outside the vagina and partially covers the external genital area. Spermicide is used with this device. Follow instructions on the packaging. Failure rate 5%. Cost ~$3.
Today Sponge is a physical barrier product marketed in the U.S. to trap sperm and prevent passage through the cervix into the uterus and tubes. The manufacturer reports an 89-91% effective rate in preventing pregnancy when used correctly. Spermicide is in the sponge. About two tablespoons of water must be used to wet the sponge and activate the spermicide before use. The sponge can be inserted up to 24 hours before intercourse. It must be left in place at least six hours following intercourse. It cannot be reused once removed and should never be worn more than 30 hours due to risk of toxic shock syndrome. Cost ~$3.
Birth Control Pills, Patches and Ring Overview
Hormone-based contraceptives are highly effective when used correctly. Estrogen and progestin hormone combinations are formulated to stop ovulation. In addition, mucus in the cervix becomes thicker and less likely to allow sperm to pass into the uterus. Because the lining of the uterus is also altered by the hormones. Fertilized eggs are unlikely to implant and grow.
Birth control pills have been used for more than fifty years by millions of women worldwide. For most women they are a safe option but require a physician visit and a prescription. That is going to change later this year in Oregon. A new law passed recently, making it legal for hormonal contraceptive pills to be purchased over the counter without a prescription. Three years ago, California passed a similar law.
In Oregon, the woman must be over 18 years old and complete a health-risk questionnaire. Pharmacists will review the questionnaire and provide the education required for use. Women under eighteen need to provide proof of a previous prescription from a physician before purchase.
Any time you alter normal body processes, you need to know the health consequences. Discuss side effects, risks and benefits of taking hormones before making your decision.
Common side effects of hormone-based contraceptives: lighter periods, spotting between menses, nausea, weight gain, blood pressure elevation, sore breasts and mood changes.
Serious risks: Birth control pills (BCPs) and other hormone-based products are not recommended for women over the age of 35 who smoke cigarettes due to increased risks of heart disease. Strokes and blood clots in legs/lungs increase in some women who take hormones.
There are more than one-hundred different pill formulations that accomplish varied needs. Sometimes contraceptive pills or patches are used to treat irregular or painful menses and other problems. Most are taken for contraception on a three-week cycle with the fourth week of pills containing no hormones. During the off-week, hormonal withdrawal menstrual bleeding occurs. At the end of the week, the pill cycle begins anew. Extended-cycle products are available that reduce the number of menstrual periods/year. Cost 0-$50/month, depending on insurance coverage.
If you forget to take one pill or more, directions to compensate and maintain reliable contraception vary with the type of pill you are taking. Follow specific instructions for the product or consult your pharmacist or caregiver.
The patch can be worn on the skin of the chest, upper back or arm, abdomen or buttocks. Avoid placing a patch on your breasts. Wear a patch one week at a time, three weeks in a row. Wear no patch for the 4th week. During the 4th week, your menses will occur. After one week, start the cycle again. Beware, this product is less effective if you weigh 198 pounds or more. Cost 0-$80/month depending on insurance coverage.
“The Ring” is a contraceptive device containing estrogen and progestin like BCPs, that requires a prescription. NuvaRing is safe and convenient. It is placed in the vagina and left for three weeks, then removed. The hormones are gradually absorbed from the ring, preventing ovulation and making cervical mucus thicker to block sperm. During the week without the ring, withdrawal menstrual bleeding occurs. At the end of that week, insert another ring and follow the same cycle. Some medications and health supplements may interfere and reduce effect. Check with the pharmacist if you are taking other medications. Cost is 0-$80/ month. When used correctly, failure rate is 1%.
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Thank you for stopping by. Tomorrow’s excerpt is Male Contraception Overview. I hope you’ll check in for the currently available types.
Betty and Bev, The Lipstick Logic Sisters
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