Deciding about birth control

Careful and consistent use of a recommended birth control method will help prevent an unplanned pregnancy. Family Planning Associates offers this information to help you decide which method is best for you.

Birth control pills (Oral Contraceptives, "The Pill")
Birth control pills are made of synthetic hormones similar to the natural female hormones estrogen and progesterone. Since each woman is unique, it is important to get a check-up by your doctor or at a clinic to have the correct pill prescribed and all information about the pill explained.

HOW IT WORKS:
Hormone levels increase and work in various ways to prevent pregnancy. When the pill is taken correctly, ovulation (the releasing of an egg by the ovaries) is stopped. If an egg is released and fertilized it cannot implant in the lining of the uterus because estrogens and progesterones in high dosages will change the structure of the lining.

EFFECTIVENESS:
Effectiveness depends on the method of used. When used correctly and consistently, Birth Control pills are 99.6% effective.

IUD (Intra-Uterine Device)
The IUD is a small flexible plastic device that is placed in the uterus by a trained clinician. The IUD comes in different shapes and sizes both for women who have had children and for women who have not.

HOW IT WORKS:
Researchers and physicians are still not sure exactly how the IUD works to stop pregnancy. The IUD may cause a low-grade infection in the uterus that prevents the fertilized egg from growing. The IUD may dislodge the fertilized egg or in some other way keep it from implanting and growing. Some IUD's also contain copper or progesterone increasing effectiveness.

EFFECTIVENESS:
The IUD can be 98% effective. Occasionally, a pregnancy will occur with the IUD in place or because the IUD has come out. It is important to regularly check for the IUD string after every menstrual cycle to insure that the IUD is still in place.

Diaphragm
The diaphragm is a rubber, dome-shaped cup with a spring rim, which is worn deep in the vagina during intercourse. Because the vagina of every woman is unique, each must be "sized" for a diaphragm by a physician or trained clinician.

HOW IT WORKS:
The diaphragm is used with spermicidal (sperm killing) jelly or cream. It is inserted into the vagina to completely cover the cervix. The diaphragm works as a barrier and holds the spermicide in place. The diaphragm must be put in BEFORE intercourse and left in place at least 6 hours after intercourse.

EFFECTIVENESS:
The diaphragm with spermicidal jelly can be 97% effective when used properly and consistently. Many factors can lower this rate including too little or no spermicide, removing the diaphragm too soon and not using it with every intercourse. The actual effectiveness rate is about 80%.

Foam
Foam contains spermicidal chemical and comes in a pressurized can. It is used by the woman and inserted deep into the vagina each time she has intercourse. Foam can be bought at the drugstore without a prescription.

HOW IT WORKS:
The foam forms a barrier over the cervix and the spermicide kills sperm trying to reach the cervical canal. Foam should be inserted no more than 20 minutes before intercourse and additional foam must be used with each intercourse.

EFFECTIVENESS:
Effectiveness can vary. When used correctly and consistently, foam can be 75-85% effective. Please read the instructions on the package and follow carefully.

Condoms (Rubber, Prophylactic)
A condom, used by the male partner, is a thin cover which fits smoothly over the erect penis. Condoms are usually made of rubber and can be purchased without a prescription.

HOW IT WORKS:
The condom acts as a barrier to keep the semen (containing millions of sperm) from going into the vagina by holding the semen in the condom.

EFFECTIVENESS:
The condom can be up to 95% effective if used in conjunction with foam. Effectiveness is dependant upon correct consistent use. The condom must be put on with a small space left at the end to catch semen before contact near vagina. Before the penis becomes less erect, the male partner should withdraw holding onto the rim of the condom to prevent it from slipping off and spilling. To increase effectiveness, the female can use foam at the same time. Foam and condoms should be considered a single form of contraception.

Vaginal sponge
The vaginal contraceptive sponge is a polyurethane sponge containing a spermicide that is placed into the vagina prior to intercourse.

HOW IT WORKS:
The sponge works much like the diaphragm by acting as a barrier and spermicide over the cervix.

EFFECTIVENESS:
Rate seems to be from 75% - 85%.

Morning After Pill or Emergency Contraceptive Pills (ECPs)
These pills have been in use for many years. In February 1997, the FDA acknowledged that ECPs are effective and safe.

The Emergency Contraceptive Pill is to be used when an episode of unprotected sex has occurred. For maximum effectiveness, ECP's must be started within 72 hours after the episode of unprotected sex. It is believed that these pills work by stopping or delaying the release of an egg from the ovary (ovulation) or the lining of the uterus (endometrium) is altered so that the fertilized egg cannot implant.

The Emergency Contraceptive Pills WILL NOT terminate an existing pregnancy and may be harmful to the fetus. However, we are not aware of any published reports indicating the ECP cause fetal abnormalities. A patient who is pregnant is not a candidate for the ECP. ECPs are to be used only if a termination of pregnancy will be done if the pill does not work. ECPs will not alter an "ectopic" pregnancy. An ectopic pregnancy is a medical emergency. If symptoms of an ectopic pregnancy occur, you must seek care through your private doctor or emergency room.

The most common side effects that occur after taking these pills include:

• Nausea - approximately 50% of patients will experience nausea.
• Approximately 20% of women will report vomiting. Some women may also experience breast tenderness, abdominal pain, headache or dizziness. Relief of the side effects should occur within a day or two after treatment is completed.
• Approximately 50% of patients will have menses within one week of taking the ECP. The remaining patients will have menses within 21 days. The first menses may be irregular and light or heavy.

If there is no menses within three weeks, the patient must return for an examination and pregnancy test.

Depo-provera
This fact sheet explains the positive and the possible negative effects of DMPA. If you do not understand all the information or if you have any questions, please ask your clinician.

You should choose this method of birth control only after reading this Fact Sheet discussing your birth control needs with a counselor.

What is it?
DMPA is a long-acting form of birth control using Progesterone. It is an injection (a shot) given every 12 weeks under a clinician's supervision.

How does DMPA prevent pregnancy?
Each of your ovaries contains thousands of unripe eggs. About halfway between the beginning of one period and the beginning of the next period, an egg ripens and is released into the Fallopian tube to the uterus. This is called ovulation. DMPA prevents the occurrence of ovulation. DMPA also causes changes in your cervical mucus that prevents sperm from entering the uterus.

How effective is DMPA?
Of one thousand women who use DMPA for a year, fewer than ten will become pregnant. With proper use, DMPA works as well as female sterilization and Norplant and is more effective than all other birth control methods, including the birth control pill and the IUD.

How is DMPA used?
DMPA is given as an injection once every 12 weeks. The first injection must be given within 5 days after the beginning of a period. DMPA starts working within 24 hours. The medication slowly wears off over time and you cannot rely on being protected against pregnancy after 12 weeks from the last injection. Therefore, if you want to continue to use DMPA, you must return for another injection in 10-12 weeks.

Who may take DMPA?
DMPA is most appropriate for women who want a long-acting method of birth control. With this method it is not necessary to take a pill every day or to use a method of protection prior to sex. DMPA may be a very good contraceptive choice for women who have completed childbearing and who do not want to have a sterilization procedure. DMPA also may be a good choice for women who cannot use other methods of birth control because of medical reasons, side effects with other methods, or other methods that were not satisfactory.

You should not take DMPA if:

• you suspect that you could be pregnant
• you have abnormal vaginal bleeding that has not yet been evaluated
• you presently have serious liver disease
• you have ever had any kind of growth in the liver
• you are being treated for or have a history of breast cancer
• you have had blood clots in the legs, lungs, or eyes
• you are allergic to DMPA

If you now have or have had a health problem such as migraine headaches or sudden and severe headaches (not relieved by over-the-counter medication) or mental depression, heart disease, stroke, high blood pressure, diabetes (sugar in the blood), liver disease (such as hepatitis), or a seizure problem, tell your clinician so that she can decide if it is safe for you to take DMPA. (Each of these problems can be made worse by the use of DMPA).

Common Problems:
DMPA, like all other hormonal methods of birth control, can have side effects in some women. Fortunately, the side effects are not usually serious. However, it is important to understand that once DMPA is injected, it cannot be neutralized or reversed should you experience side effects. You could continue to experience side effects until the DMPA ceases to be effective.

Menstrual changes:
All women who use DMPA notice changes in their menstrual periods such as irregularity and spotting or bleeding between periods. Some women also notice heavier or longer bleeding during their periods. This rarely causes serious medical problems. After using DMPA 6-12 months, most women have periods less often and many stop having periods altogether. This change is not permanent and the menstrual cycle will return after the DMPA is stopped.

Pregnancy symptoms:
Side effects similar to the symptoms of early pregnancy occur in many women after the first few injections. These symptoms usually subside. Some women notice tender breasts, nausea, fatigue, and abdominal discomfort. A spotty darkening of the skin, usually on the face, occasionally occurs and may not go away completely.

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