OB-GYN NORTH is the practice of

Christina Sebestyen, MD, FACOG, Tesa Miller, MD, FACOG, April Schiemenz, MD,
Siobhan Kubesh, CNM, Lisa Carlile, CNM, Kathy Harrison-Short, CNM and Katherine Davidson , FPNP

Tuesday, February 11, 2014

Contraception and Family Planning Options


Choosing a contraceptive option is not an easy task. Before choosing the method right for you, you must consider several things including: method of delivery and your comfort level with that method, benefits, risks, side effects, and efficacy. Always consult your healthcare provider if you have any underlying medical conditions to see which methods are safe for you. This is meant as a brief overview. Each method could be discussed for pages upon pages, so always discuss the option that sounds the most suitable for your life with your provider prior to initiation.

Natural Family Planning:

Natural Family Planning is when you do not have sex or use a barrier method on the days you are most fertile. A woman choosing this method needs to keep record of her cycles, cervical mucous and basal body temperature. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. To record your basal body temperature, you need to chart your temperature daily first thing in the morning. Your temperature will rise 0.4 to 0.8° F on the first day of ovulation. Pregnancy rate: 25/100. Side effects/Risks: None

Barrier Methods:

The sponge is a soft, disk-shaped device with a loop for taking it out. It is made out of polyurethane foam and contains the spermicide nonoxynol-9. Pregnancy rate: 16-32/100. Side effects/Risks: Irritation, Allergic reactions, Hard time taking it out, Toxic shock if left in too long

The diaphragm is a shallow latex cup. The cervical cap is a thimble-shaped latex cup. It often is called by its brand name, FemCap. For both, you must be "fitted" for the method. Both must be left in place for 6 to 8 hours after having sex to prevent pregnancy. Pregnancy rate: 15/100. Side effects/Risks: Irritation, Allergic reactions, Urinary tract infection, Toxic shock if left in too long

A female condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, manmade rubber and is packaged with a lubricant and can be inserted up to 8 hours before sex.Pregnancy rate: 20/100. Side effects/Risks: Irritation or Allergic reactions

Male condoms are a thin sheath placed over an erect penis to keep sperm from entering a woman's body. Condoms can be made of latex, polyurethane, or "natural/lambskin". The natural kind do not protect against STIs. Pregnancy rate: 11-16/100. Side effects/Risks: Allergic reaction

Oral Contraceptives:

Combined oral contraceptive pills contain the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg. Pregnancy rate: 5/100. Side effects/Risks: Dizziness, Upset stomach, Changes in your period, Changes in mood, Weight gain, High blood pressure, Blood clots, Heart attack, Stroke, New vision problems

Progestin only pills are also available to patients unable to take estrogen due to an underlying medical condition or breastfeeding. Pregnancy rate: 5/100. Side effects/Risks: Spotting or bleeding between periods, Weight gain, Sore breasts

The Patch:

The patch, Ortho Evra, is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don't use a patch the fourth week in order to have a period. Pregnancy rate: 5/100. Side effects/Risks: Similar to side effects for the combination pill but a greater exposure to estrogen

Injection:

Depo-Provera is an injection of the hormone progestin in the buttocks or arm every 3 months. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg. Pregnancy rate: less than 1 per 100. Side effects/Risks: Bleeding between periods, Weight gain, Sore breasts, Headaches, Bone loss with long-term use (more than 2 years)

Vaginal Ring:

NuvaRing is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring.
Pregnancy rate: 5/100. Side effects/Risks: Similar to side effects for the combination pill, Swelling of the vagina, Irritation, Vaginal discharge

Implantable Rod:

Nexplanon is a matchstick-size, flexible rod that is put under the skin of the upper arm by your healthcare provider. The rod releases a progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to 3 years. Pregnancy Rate: Less than 1/100 Side effects/Risks: Acne, Weight gain, Ovarian cysts, Mood changes, Depression, Hair loss, Headache, Upset stomach, Dizziness, Sore breasts, Changes in period, Lower interest in sex

Intrauterine Device:

An intrauterine device (IUD) is a small device shaped like a "T" that goes in your uterus. IUDs are placed by your healthcare provider. Pregnancy rate: Less than 1/100. Side effects/Risks: Cramps, Bleeding between periods, Pelvic inflammatory disease, Tear or hole in the uterus, Expulsion

Paragard is a copper IUD. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. If fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. It can stay in your uterus for up to 10 years.

Mirena releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can't reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. It can stay in your uterus for up to 5 years.

Sterilization:

Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. The device works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops the egg and sperm from joining. It can take about 3 months for the scar tissue to grow, so it's important to use another form of birth control during this time. Then you will have to return to your doctor for a test to see if scar tissue has fully blocked your tubes. Pregnancy rate: Less than 1/100. Side effects/Risks: Pain, Ectopic (tubal) pregnancy

For women, surgical sterilization closes the fallopian tubes by being cut, tied, or sealed. This stops the eggs from going down to the uterus where they can be fertilized. Pregnancy rate: Less than 1/100. Side effects/Risks: Pain, Bleeding, Complications from surgery, Ectopic (tubal) pregnancy

For men, having a vasectomy keeps sperm from going to his penis, so his ejaculate never has any sperm in it. Sperm stays in the system after surgery for about 3 months. During that time, use a backup form of birth control to prevent pregnancy. A simple test can be done to check if all the sperm is gone; it is called a semen analysis. Pregnancy rate: Less than 1/100. Side effects: Pain, Bleeding, Complications from surgery