Methods and Effectiveness (Magill’s Medical Guide, Sixth Edition)
Contraception is defined as the avoidance of conception by either natural means (abstinence) or artificial means (physical barriers, chemicals, hormones). Pregnancy can be prevented by interfering with the process of conception at any number of sites in the male or female anatomy.
Barrier methods. A male condom, or prophylactic, is a thin sheath made to fit an erect penis. It can be made of latex (a type of rubber), polyurethane (a type of plastic), or natural products such as lamb’s intestines. A condom prevents semen, which contains sperm, from entering a woman’s vagina during intercourse. The latex or polyurethane condom is one of the few forms of contraception that can also protect against sexually transmitted diseases (STDs). Men who are not allergic to latex should use latex condoms, as they are the best at preventing pregnancy and STDs. Polyurethane condoms break more easily, and natural condoms are not as effective at preventing STDs.
Male condoms should be used any time a man has intercourse with his partner and desires to prevent STDs or pregnancy. If the condom does not have space at the end called a sperm repository, then 0.25 inches of the condom should be left at the tip of the penis to collect semen. To increase the protective birth control value, spermicidal foam or jelly can be used in addition to the condom. According to the American College of Obstetricians and Gynecologists,...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
Even though highly effective contraceptive techniques are available both over the counter and through health care providers, almost 60 percent of pregnancies in the United States are not planned, and many are unwanted. The contraception and reproductive branch of the National Institute of Child Health and Human Development (NICHD), which has as one of its goals to prevent acquired immunodeficiency syndrome (AIDS) and other STDs, is looking into the development of new microcides with spermicidal activity that can provide birth control as well as simultaneous protection against major STDs. One of the top objectives is to link contraceptive technology to HIV-AIDS prevention.
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Connell, Elizabeth B. The Contraception Sourcebook. Chicago: Contemporary Books, 2002. Provides a history and explanation of contraception, from oral contraceptives to male contraception.
Global Campaign for Microbicides. http://www.global -campaign.org. An organization working to combine birth control with protection against STDs.
Keyzer, Amy Marcaccio. Family Planning Sourcebook. Detroit, Mich.: Omnigraphics, 2001. Contains excellent information on all types of contraception and family planning.
Porter, Robert S., et al., eds. The Merck Manual Home Health Handbook. Whitehouse Station, N.J.: Merck Research Laboratories, 2009. A comprehensive book of medical knowledge, including information on contraception.
Thornton, Yvonne S. Woman to Woman: A Leading Gynecologist Tells You All You Need to Know About Your Body and Your Health. New York: E. P. Dutton, 1998. Divided into six sections covering topics from female physiology to contraception.
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Contraception (Encyclopedia of Medicine)
Contraception (birth control) prevents pregnancy by interfering with the normal process of ovulation, fertilization,
and implantation. There are different kinds of birth control that act at different points in the process.
Every month, a woman's body begins the process that can potentially lead to pregnancy. An egg (ovum) matures, the mucus that is secreted by the cervix (a cylindrical-shaped organ at the lower end of the uterus) changes to be more inviting to sperm, and the lining of the uterus grows in preparation for receiving a fertilized egg. Any woman who wants to prevent pregnancy must use a reliable form of birth control.
Birth control (contraception) is designed to interfere with the normal process and prevent the pregnancy that could result. There are different kinds of birth control that act at different points in the process, from ovulation, through fertilization, to implantation. Each method has its own side effects and risks. Some methods are more reliable than others....
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Contraception (Encyclopedia of Science)
Contraception, also called birth control, is the deliberate effort to halt conception a child (to keep a woman from becoming pregnant). Attempts to prevent pregnancy date back to ancient times and cultures. Some form of contraception is used by more than half the women in the United States. Although widespread, contraception remains controversial, with some religious and political groups opposed to distribution of contraceptives.
Ancient methods in use today
Some early methods of contraception involved techniques still used today. Gum arabic substance with which Egyptians coated tampons to kill sperms used to make spermicides contained in modern contraceptive jellies and foams. The ancient practice of prolonged nursing of infants to prevent conception of future children remains in current use, although it is by no means 100 percent effective. The modern diaphragm has its origin in a device made from bamboo that Asian women used as a barrier to the cervix (the opening to the uterus, or womb). The Chinese promoted "coitus interruptus," the withdrawal of the man's penis from the woman's vagina before ejaculation. Probably the most common contraceptive method in the world, this practice has resulted in numerous accidental pregnancies. The rhythm method (in which intercourse is avoided on the days of the month when a woman is most likely to become pregnant) was and remains...
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Contraception (Encyclopedia of Children's Health)
Contraception (birth control) prevents pregnancy by interfering with the normal process of ovulation, fertilization, and implantation. There are different kinds of birth control that act at different points in the process.
Every month a woman's body begins the process that can potentially lead to pregnancy. An egg (ovum) matures, the mucus that is secreted by the cervix (a cylindrical-shaped organ at the lower end of the uterus) changes to be more inviting to sperm, and the lining of the uterus grows in preparation for receiving a fertilized egg. Any woman who wants to prevent pregnancy must use a reliable form of birth control. Birth control (contraception) is designed to interfere with the normal process and prevent the pregnancy that could result. There are different kinds of birth control that act at different points in the process, from ovulation through fertilization to implantation. Each method has its own side effects and risks. Some methods are more reliable than others.
Although there are many different types of birth control, they can be divided into a few groups based on how they work. These groups include:
- Hormonal methods: These use medications (hormones) to prevent ovulation....
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Contraception (Encyclopedia of Nursing & Allied Health)
Contraception is the use of a method, device, or medication to prevent pregnancy by interfering with ovulation, fertilization, and/or implantation. Another term for contraception is birth control.
The purpose of contraception is to allow individuals to engage in sexual intercourse without it resulting in pregnancy.
There are many methods of contraception. Factors to consider in choosing a method include:
- Safety. What are the risks of using this method? Can its use result in any damage to the female or male reproductive tract? Is its use associated with a higher risk of certain cancers? What are the consequences of its long- term use? Does its use affect future fertility?
- Access. Is a prescription needed to gain access to this method?
- Cost. How expensive is this method?
- Is the cost of this method covered by my health insurance?
- Effectiveness. If this method is used as directed, what is the likelihood that it will fail to prevent a pregnancy?
- Ease of use. Is this method easy or difficult to use correctly?
- Timing. Is this method effective the first time it is used or put in place, or is it necessary to use it for a while before it will be effective?
- Frequency. How frequently will the individual engage in sexual intercourse?
- Temporary versus permanent. Does this method provide temporary birth control, or is it considered a permanent method? If permanent, could it be reversed in the future?
- Ethics. Is this method acceptable within the context of the individual's religious or ethical beliefs?
- Benefits. Other than its ability to provide contraception, does its use have any benefits to the individual's health?
- Postpartum. How soon after pregnancy can this method of birth control be used? Is it safe while breastfeeding? Does fertility return?
During a woman's reproductive years, from its onset at menarche to its termination at menopause, an egg, or ovum, is released each month from one of her two ovaries, and it travels through the adjacent fallopian tube and into the uterus. If the egg is fertilized, it implants into the lining of the uterus and undergoes changes that eventually lead to the development of a fetus. In tandem with the release of the egg, the lining of the uterus, called the endometrium, undergoes changes that will enable it to support a pregnancy should the released egg become fertilized. When the egg is not fertilized, the endometrium that has built up in preparation for the pregnancy is shed. This tissue and the non-fertilized egg leave the uterus through the cervix and exit the body through the vagina in the form of menstrual secretions.
Birth control methods vary in targeting different aspects of this monthly process. The primary methods of birth control are hormonal, barrier, spermicides, intrauterine devices (IUDs), surgical, and periodic abstinence. In choosing a form of birth control it is important to understand how each method works, as well as its associated risks, benefits, and side effects.
- Hormonal. Hormonal methods of birth control include oral birth control pills. Birth control pills, sometimes called the Pill, come in two forms: combination, containing both estrogen and progestin, and progestin only, referred to as the mini-pill. Both forms suppress ovulation
- thicken cervical mucus, and prevent implantation. Both require prescriptions. The hormone doses in the pills are kept as low as possible, while still being effective as a contraceptive. For this reason it is extremely important that they are taken on a daily basis. Skipping doses can put a woman at risk of becoming pregnant and she should supplement the pill with the use of a barrier method. In the first month a woman begins oral contraception, she may not be fully protected, so a barrier method should be used as a back-up. In a survey conducted by Planned Parenthood, only 28% of women take the Pill correctly, and only 42% actually take it on a daily basis. Because of the hormones used, women who suffer from migraines, diabetes, have had breast or uterine cancer, or who smoke, may need to choose another method. Women should always mention their use of birth control pills to their primary health care provider, as some medications prescribed for other conditions may interact with oral contraceptives. Use of the Pill can make other medications less effective, or exaggerate their effectiveness. Serious potential side effects of the combined pill include the formation of blood clots, myocardial infarction, and stroke. Because oral contraceptives suppress ovulation, their use can decrease a woman's risk of getting ovarian cancer. Some women find that their oral contraceptive improves skin problems. Hormonal contraception can be used by breastfeeding mothers, but usually not until the milk supply has been well established. In the case of the mini-pill, it can usually be started earlier, as it does not decrease milk volume. The combination pill can decrease the volume and lower the protein content of the breast milk. Oral contraceptives do not protect against any sexually transmitted diseases, so a condom should be used for that purpose in addition to taking the Pill.
- Depo-Provera and Lunelle are two brands of contraception given by injection. Depo-Provera is the trade name for the contraceptive depot medroxyprogesterone acetate (DMPA). Lunelle is a combination of estrogen and progesterone. They provide protection for about 12 weeks. They may be a good choice for women who have trouble remembering to take the Pill on a daily basis, for those for whom privacy of using a contraceptive is important, and for those engaging frequently in sexual intercourse. They work by suppressing ovulation, fertilization, and implantation. This method may not be a good choice for women who have had breast cancer, blood clots, heart attack or stroke, major depression, high cholesterol or blood pressure, diabetes, migraines, or abnormal results on liver function tests. If given within the first five days of a woman's menstrual cycle, they are considered protective against pregnancy during the first month of use. Side effects include irregular vaginal bleeding, loss of menstruation after one year of use, nausea, breast tenderness, depression, weight gain, vaginal dryness, and increased facial hair. After a woman stops using DMPA, it may take 18 months before a woman is able to become pregnant. They do not provide protection against sexually transmitted disease.
- Barrier methods. Barrier methods work by preventing the sperm from reaching and fertilizing the egg. Male and female condoms, diaphragms, and cervical caps work by creating a membrane through which the sperm cannot travel. Spermicides and the contraceptive sponge contain chemicals that decrease the sperm's ability to travel towards the egg. Condoms, diaphragms and caps should be used in conjunction with spermicides to increase overall effectiveness. Spermicides come in several forms: foam, cream, gel, sponge, and vaginal suppository. Condoms provide the most protection against sexually transmitted diseases. The diaphragm and cervical cap require fitting by a health care practitioner and a prescription. The other barrier methods are available without a prescription. Barrier methods are used at the time of sexual intercourse. They are less effective than hormonal methods of contraception. Individuals who have latex allergies, or who have had an allergic reaction to bananas, avocados or chestnuts, should speak with their health care provider before trying a condom, diaphragm, or cap. The allergic reaction may be mild, with symptoms such as runny nose, itching or a rash, or may be severe, resulting in anaphylaxis in which breathing can be obstructed by swelling. Early signs of anaphylaxis include rash, flushed skin, dizziness, or a tingling sensation. Medical help should be sought right away. A condition called toxic shock syndrome (TSS) has been occasionally reported with diaphragm use. Signs of TSS include high fever, vomiting, diarrhea, flu-like symptoms such as aching joints or sore throat, dizziness, and rash. The diaphragm should be removed right away and the woman should call her practitioner. Diaphragm and cervical caps need to be refitted with weight gain or loss, and after a few years need to be replaced because the rubber begins to tear or decompose, rendering them ineffective.
- Intrauterine devices (IUDs). The IUD is a small, plastic device that is inserted by a health care practitioner into a woman's uterus. While in place it seems to prevent implantation by altering the endometrium. It is also thought that the consistency of the cervical mucus is changed, affecting sperm motility, preventing fertilization. It is easy to have it inserted and can be removed at any time by a practitioner. One brand contains copper and can be left in place for ten years, another contains progestin and needs to be replaced after one year. IUDs have a string attached at one end that hangs into the vagina. This not only assists in its ultimate removal, but also allows a woman to check periodically that it is still in its proper place. If the string appears to be shorter or longer than when inserted, the woman should have its placement checked by her practitioner. The string does not function as a wick, so it does not draw fluid up into the uterus. The IUD is not a good choice for a woman with a sexually transmitted disease or a history of pelvic inflammatory disease (PID). It is usually inserted during a menstrual period by a health care provider. Some practitioners may require the woman to have a negative pregnancy test done just prior to insertion. Some women may experience spotting between periods, or heavier periods with more cramping while using the copper IUD. Because the IUD was inserted through the cervix, a woman may be at a somewhat higher risk of infection, until the cervix closes tightly again (around three weeks). Two rare side effects can occur: the IUD imbedding into the uterus and the migration of the IUD into the abdominal cavity, requiring surgery to remove it. There is also a higher risk of pelvic inflammatory disease and infection of the reproductive organs, which could result in sterility, or require removal of the uterus. IUDs do not protect against sexually transmitted diseases.
- Surgical sterilization. Individuals who have completed their childbearing may choose a permanent form of contraception: surgical sterilization. In the male, this is known as a vasectomy. The vasectomy blocks the sperm from mixing with the seminal fluid. Sperm continue to be produced, but are reabsorbed by the body. Vasectomy does not affect the man's ability to have an erection, to ejaculate, nor does it affect the production of male hormones. It is not effective immediately, as some sperm are still present in the unblocked portion of the tubes. A sperm analysis needs to be done to check for the presence of sperm. Until this process is completed, the man and his partner need to use another form of contraception to prevent a pregnancy. For the woman sterilization is known as tubal ligation, tubal sterilization, or having one's tubes tied. In tubal ligation the fallopian tubes are cut or blocked, preventing the egg from passing through towards the uterus. The ovum will continue to be released each month, but will be reabsorbed by the body after being blocked in the fallopian tube. Menstrual cycles continue as usual, and hormone production is not affected. It is effective immediately. Surgical sterilization is considered permanent and irreversible, although some individuals have been successful at having the process reversed. In a small percentage of cases, the surgery is not successful and the woman becomes pregnant. Both surgeries are done through small incisions, and on an outpatient basis. This form of birth control is not recommended for very young individuals, or those who have not yet had families. Because they involve surgery, complications associated with surgery, such as infection, bleeding, or a reaction to the anesthesia, can occur. Tubal ligation and vasectomy do not provide protection against sexually transmitted diseases. For the individual under- going the sterilization, the surgery must be voluntary.
- Periodic abstinence. Periodic abstinence, or fertility awareness, is a technique of birth control based on abstaining from sexual intercourse on those days when a woman might become pregnant. The same techniques can be used by couples trying to conceive, by identifying the days when a woman is most likely to become pregnant. Using periodic abstinence often requires taking a class to learn the techniques used. The techniques employed are basal body temperature (BBT), cervical mucus identification, and a calendar method. The most effective use is the combination of all three techniques to predict which are the safe and which are the unsafe days for intercourse. Couples may then use this information to abstain from intercourse or use a barrier form of contraception on unsafe days. The calendar method keeps track of a woman's menstrual cycle. The cervical mucus identification method teaches the woman the differences in the vaginal secretions at various times of her cycle, which helps to identify when ovulation is most likely taking place. The BBT method charts the first temperature of the morning. Just prior to ovulation there is a slight dip in the basal temperature, followed by a slight temperature elevation when the woman ovulates. This method requires the use of a special thermometer that is more finely calibrated than one used for checking the presence of a fever. This combination of techniques requires that a woman's menstrual cycles are quite regular, that she has the ability to keep careful records, and that she and her partner(s) can abstain from intercourse or use a barrier method for much of the month. The readings are not accurate when the woman is sick, and may be affected by certain medications.
- Post-coital contraception. No method of contraception is 100% effective. If birth control was not used or if it failed during intercourse, or in the event of rape, the possibility of pregnancy exists. Some reproductive health centers and physicians offer emergency contraception that is used within 72 hours of unprotected sex, failed contraception, or rape. It involves taking oral doses of progestin or an estrogen-progestin combination, similar to that used in oral contraceptives. Some women experience dizziness or nausea and vomiting following the treatment. If a woman has had a positive pregnancy test and wishes to terminate the pregnancy, she may choose between surgical or medical abortion. Medical abortion involves the use of hormonal therapy, referred to in the United States as RU486. Planned Parenthood offers more information about these options through the telephone number listed below in Resources, and on their web site.
Preparation and aftercare
Preparation for the different contraceptive choices varies. Oral contraceptives need to be taken on a daily basis, and require a prescription, a thorough health history, and a visit to a health care provider. Injected hormonal contraception requires periodic visits for the injection. Barrier methods must be used every time there is intercourse, these methods differ in how long they may remain in the vagina, and whether ejaculation can be repeated without the use of a new barrier device. The IUD requires insertion and removal by a practitioner. Surgical sterilization is usually done in an outpatient facility. Patients will be given post-surgical instructions to follow, including which symptoms necessitate contacting their physician. Practitioners will want to be sure that this irreversible decision was made carefully and competently and that the patients are aware that there is a failure rate. Some follow-up care may be necessary. Periodic abstinence requires careful monitoring of a woman's fertility and the ability to abstain from intercourse or use barrier methods on unsafe days.
Complications of contraception vary according to the method used. Hormonal complications involve a response to the particular hormone and dosage used. Bleeding between periods or difficulty regaining regular menstruation or fertility following their discontinuance may occur. Oral contraceptives can interfere with the effectiveness of other medications. Women over 35 who smoke should not use oral contraceptives, as smoking places them at greater risk of heart attack or stroke. Barrier methods may produce a local reaction to the spermicide use. Spermicide packages should be checked for an expiration date. If used after expiration, they are not reliable. Diaphragm use is associated with the risk of toxic shock syndrome. Individuals unaware of their latex allergy may have a small allergic reaction, or could go into anaphylaxis. IUDs do have a serious but rare risk of puncturing the uterine wall, and also carry a risk of pelvic inflammatory disease with potential complications such as sterility if untreated. IUDs may be expelled from the uterus, so it is important to periodically check for the string that is attached to it. Women who become pregnant while using the IUD are at greater risk of an ectopic preg- nancy. Surgical sterilization involves the risks of surgery, such as bleeding, or infection due to the anesthesia used. Vasectomy is only effective once all stored sperm has been ejaculated. Fertility awareness carries a higher risk of pregnancy, and if hands are not washed prior to checking the cervical mucus, bacteria could be introduced into the vagina and spread.
The end result of effective contraception is prevention of pregnancy. Individuals choosing contraception must weigh the risks of the method against its ease of correct use and its success rate of preventing pregnancy. Hormonal methods are usually at least 95% effective. Barrier methods range from 600% effective. The IUD is considered 99% effective. Sterilization is about 99% effective. Fertility awareness is about 85% effective. Of course, effectiveness depends on consistent, careful use.
Health care team roles
Pharmacists are involved in filling the prescriptions of various forms of birth control. Having prescriptions filled at the same pharmacy provides protection against the possibility of interactions between different medications. Nurses provide education to patients on the various forms of birth control the individual is considering. Nurses are also involved in the care of patients seeking surgical contraception, as well as triaging calls from patients when they call their health care providers with questions and concerns about possible side effects. If a patient suspects an IUD has been dislodged, a radiology technician may take an imaging scan to locate the IUD.
Anaphylaxis serious allergic response that can be fatal if not treated. In anaphylaxis the individual undergoes a hypersensitive reaction to a substance. Initial signs may include itching, wheezing, coughing and shortness of breath. If left untreated, the individual's respiratory passages may begin to swell, blocking the flow of air. Anaphylaxis is a medical emergency, and can result in death.
Ectopic pregnancy pregnancy that implants outside of the uterus, most commonly in a fallopian tube. An ectopic pregnancy can cause the fallopian tube to rupture, causing severe internal bleeding and pain. A woman with an ectopic pregnancy must seek medical care right away.
Triageo organize or sort patients according to the degree or severity of their condition.
Vaginal suppositoryedication that is bullet- shaped, and is inserted into the vagina, where it melts and is absorbed.
Ammer, Christine. The New A to Z of Women's Health, 4th
Edition. New York: Facts on File, Inc., 2000.
Knowles, John and Marcia Ringel. Planned Parenthood. All About Birth Control: The Complete Guide. New York: Three Rivers Press, 1998.
Spencer, Paula. Parenting: Guide to Pregnancy and Childbirth. New York: Ballantine Books, 1998.
Croxatto H. B. "Progestin implants."Steroids.
(October/November 2000): 681-685.
Massai, R., S. Diaz, T. Jackaniez, and H. B. Croxatto. "Vaginal rings for contraception in lactating women."Steroids. (October/November 2000): 703-707.
Shulman, L. P. "Contraception 2000: Lunelle, an injectable combination contraceptive option."Journal Womens Health Gender Based Medicine (September 2000): 725-729.
Planned Parenthood Federation of America. 810 Seventh Ave.
New York, NY 10019. (212) 541-7800. (800) 230-PLAN(7526). (888) NOT-2-LATE.
Esther Csapo Rastegari, R.N., B.S.N., Ed.M.
Contraception (Encyclopedia of Public Health)
Contraception is the use of any of various methods to prevent pregnancy. Family planning, in contrast, involves the use of contraception or other measures to limit the number of children and plan the timing and spacing of births. Contraception has been used throughout history. Early methods, however, were ineffective (drinking potions or douching) or dangerous and not available to all people. By the middle of the twentieth century, only 13 percent of couples worldwide used effective methods of contraception. By the year 2000, UNICEF estimated that this figure had risen to 50 percent.
Contraceptive use is not equally distributed throughout the world. Most of western Europe, the United States, parts of Latin America, and Oceania demonstrate high levels of use. India, Pakistan, Nigeria, Sudan, Oman, Yemen, Haiti, Guatemala, Bolivia, and nations in sub-Sahara Africa demonstrate low contraceptive use and high fertility. In the past, family planning programs in some countries were, in effect, population control programs. They were often coercive and did not allow families choice. This is changing, as more people want to limit their family size. In some places, such as China, a strict population control policy is still in place.
In l994, the global attendees at the International Conference on Population and Development (ICPD) in Cairo, Egypt, placed family planning within a holistic context of reproductive health, and family planning is now considered to be a human right. Family planning helps save women's lives. Over 585,000 women die every year from unsafe abortion, childbirth, and pregnancy, with 90 percent of the deaths occurring in developing countries. These deaths are largely preventable; and contraception could play a role in preventing them.
Despite advances in contraceptive technologies, there is no single method that suits everyone. In some places, choice is limited and access is difficult, resulting in an unmet need for contraception (the condition of wanting to avoid or delay childbearing, but not using a contraceptive method).
One way to categorize contraceptive technologies is by the duration of protection. There are permanent, long-term, and short-term methods. In addition to these technologies, there are also behavioral methods of contraception. What follows is a list of all contraceptive technologies and behaviors, how they prevent pregnancy, their effectiveness, potential problems or side effects, and whether they also prevent reproductive tract infections (RTIs), hepatitis C, or sexual transmission of HIV (human immunodeficiency virus).
The two permanent surgical methods of contraception are 99 to 99.5 percent effective. They do not prevent RTIs, or HIV transmission, and they both involve a risk of infection or bleeding. In male sterilization, or vasectomy, the vas deferens (the tubes that carry the sperm from the testicles to the penis) are blocked or cut. Female sterilization, or tubal ligation, is a surgical procedure in which a woman's fallopian tubes are cut, burnt, or blocked to prevent sperm from reaching and fertilizing the egg.
None of the long-acting methods protect against RTIs or HIV transmission. IUDs, implants, and injections are 99 percent effective. Oral contraceptive pills are theoretically 99 percent effective, but pregnancies do occur if pills are missed or not taken on time.
IUD. An intrauterine device (IUD) is most often a nonhormonal method of contraception. The IUD is a small plastic or plastic and copper device placed inside a woman's uterus by a trained health care provider, and it protects against pregnancy for up to twelve years. The IUD may increase the risk of RTIs for women who have more than one partner. Side effects include increased cramping and bleeding during monthly periods. Some IUDs contain a hormone (progesterone) to increase their pregnancy protection while decreasing the risk of heavy bleeding. All of the other long-acting contraceptive methods are hormonal method.
Oral Contraceptive Pill. "The Pill" was introduced in the United States in the 1960s. It contains one or two hormones (either estrogen and progesterone together, or progesterone alone) that prevent ovulation and create a hostile environment for sperm. Although there was originally controversy over the health risks of the pill, it is now considered to be relatively safe for nonsmokers. In fact, it may protect against cancer of the ovaries and uterus. Side effects include nausea, breast tenderness, spotting, weight gain, mood changes, and headaches. Women who smoke should not take the pill as it may cause fatal blood clots. The pill's effectiveness is 99.5 percent if used perfectly, but 95 percent in real use.
Contraceptive Implants. Manufactured under the brand name Norplant®, contraceptive implants are silicone rods containing the hormone progesterone. Six of these matchstick-sized rods are placed under the skin of a woman's upper arm. The progesterone is released over time, and the implants remain effective for five years. While the effectiveness of implants is 99 percent, side effects include irregular monthly periods, spotting, acne, headaches, weight gain, and hair loss. Newer implants use one or two rods and may contain more than one hormone.
Hormonal Injections. Progesterone injections are given every two to three months, while those containing estrogen and progesterone are administered monthly. Injections work by stopping ovulation and making the cervical mucus hostile to sperm. Side effects include irregular periods, spotting, weight gain, headaches, depression, loss of libido, and hair loss.
Somewhat less effective than long-lasting methods, these contraceptives have fewer side effects. They are primarily physical or chemical barriers that also prevent or decrease the chances of transmitting RTIs and HIV.
Male Condom. This type of condom consists of a latex or animal intestine sheath that is placed over the erect penis before intercourse. Effectiveness is about 86 percent, as condoms can tear or slip off. Some people are allergic to latex and cannot use this type of condom. Latex condoms protect against RTIs and HIV infection, while those made from animal intestine do not.
Female Condom. The thin, female condom is plastic, tunnel-shaped device that is closed on one end. The closed end is placed over the cervix. It protects against both RTIs and pregnancy. One advantage of the female condom is that is it controlled by the woman. This feature is particularly important in a relationship where the woman cannot negotiate for safe sex. There are no medical limitations or side effects. At 80 percent effectiveness, the female condom is slightly less effective than the male condom.
Spermicides and Vaginal Barriers. Spermicides are chemicals that kill sperm or immobilize them. They come in many forms, including foaming tablets or suppositories, melting suppositories, foam, melting film, creams, and jellies. All are placed in the vagina prior to intercourse. Some women have allergic reactions to spermicides. Effectiveness is 80 percent. Spermicides can be used alone or in combination with condoms or vaginal barriers. These devices may also protect against RTIs and HIV, but their effectiveness in this regard is as of yet unknown.
Vaginal barriers (diaphragm, cervical cap, and sponge) are inserted in the vagina before inter-course and must be used with spermicides to be effective. A diaphragm is a soft rubber cup that covers the cervix, a cervical cap is a smaller rubber cup that fits right over the cervix, and a contraceptive sponge is a sponge impregnated with spermicide.
Emergency Contraceptive Pills. Also known as morning-after pills or post-coital pills, these are either estrogen and progesterone or progesterone-only pills that are taken within seventy-two hours of unprotected intercourse or in cases of contraception failure (e.g., forgotten pills, condom breakage, or slippage). Taken as directed they reduce the risk of pregnancy by 75 percent. They provide no RTI or HIV protection.
There are a number of ways to prevent pregnancy that rely on human behavior rather than contraceptive technology.
Abstinence. Abstaining from sexual inter-course, whether completely or periodically, is 100 percent effective, but may be difficult to maintain.
Fertility Awareness. There are a variety of methods a woman can use to tell the fertile time of her menstrual cycle. These include calendar calculation, cervical secretions, basal body temperature (BBT), chemical ovulation prediction kits, and cervical changes. All of these methods are used in combination with either barrier methods (during the fertile time) or periodic abstinence (not having intercourse during the fertile time). Effectiveness is approximately 75 to 80 percent. Fertility awareness can also be used to time intercourse in order to facilitate pregnancy.
Lactational Amenorrhea Method (LAM). This is a behavioral method used by women who have recently given birth. It involves simply the use of breastfeeding during the first six months postpartum, and requires that 85 percent of the baby's food be breast milk. During this period and under these conditions, LAM is 100 percent effective. It is also inexpensive, has no hormonal side effects, and benefits the baby.
Methods of contraception being developed include both variations of existing methods and new concepts. Among the modifications of current methods are biodegradable hormonal implants, subdermal hormonal pellets, injectable hormonal "microspheres" (hybrids of injectables and implants), and intravaginal hormonal rings. New methods include male hormonal contraceptive pills, hormonal patches for men and women, and vaccines against sperm, ovum, or hormones. Microbicideshemicals that kill bacteria and virusesre also being tested for use alone, or in combination with spermicides for dual protection.
(SEE ALSO: Abstinence; Condoms; Contraception; Family Health; Family Planning Behavior; Maternal and Child Health; Menstrual Cycle; Planned Parenthood; Pregnancy; Reproduction; Sexually Transmitted Diseases; Women's Health)
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