Birth Control Options Think about the whole picture

Birth Control Options Think about the whole picture Personal and Public needs

Many Choices • When picking out a contraceptive program for an individual patient or for a public health program you need to understand the goals and objectives • What do they want to accomplish? • What are the resources, limitations, assets, and cultural restrictions to consider?

The choice on campus is very different than elsewhere • Birth Control Pills are one of the most common methods of contraception on the UVM campus • This is an option that would not be appropriate for a different population • Consider the age, health, cost, culture, religion, STD rates, education level, health care access, and emotional needs of the consumer

The Pill • Effectiveness: • This guide gives effectiveness percentages for two categories of contraceptive use: typical use, which includes people who may not always use a method exactly how and when they were supposed to use it, and perfect use, which indicates how effective the method would be if it were always used correctly. • Perfect use: Out of 100 women who use the pill correctly at all times, maybe 1 and probably no one in the group might become pregnant in one year. • Typical use: For typical users, 8 women out of 100 might become pregnant when using the pill for one year.

Available Pills • The combination pill. This contains two synthetic hormones, estrogen and progestin. The combination pill comes in varying doses. The low-dose combination pill commonly used today is generally considered safer than higher estrogen-dose pills used years ago. Pills containing 20 mcg of estrogen are the most often used, but dosage is not a one-size-fits-all women issue. The combination pill can be prescribed as a monophasic product, which means that it delivers the same levels of estrogen and progesterone throughout the month. Or it can be prescribed as multiphasic, which means it delivers differing amounts of estrogen and progesterone during different times of the menstrual cycle. Some women cannot use pills containing estrogen (e. g. , those with medical conditions such as high blood pressure, or those over age 35 who smoke). • The mini-pill. This contains progestin only-it does not contain any estrogen at all.

The Pill • • • Pros: You do not have to do anything right before, during, or after sex. The pill helps protect against cancer of the ovaries and uterus. It protects against infections of the fallopian tubes and ovaries. Most women have lighter periods and fewer and less severe cramps. Cons: Some women have trouble remembering to take the pill at about the same time every day. You must plan in advance to have refills on hand when you need them. Side effects such as nausea, breast tenderness, spotting, mood changes, and headaches vary by estrogen dose and the type of pill used. Some women may have minor menstrual changes, such as spotting between periods.

The pill is NOT without serious complications and limitations -this is not a good for older obese hypertensive women, much higher incidence of complications -blood clots, pulmonary emboli, heart attack, hypertension, or stroke -liver disease, gall stones, gall bladder disease, or cirrhosis -Should not be used in women with history of migraine headaches, or cancer

Abstinence means choosing not to have intercourse. There all kinds of ways to accomplish this-- you may abstain from all sexual contact, or you may kiss and pet and even have oral sex. The important point is that there is no penis-to-vagina contact. None.

The Vaginal Ring

The Vaginal Ring • The vaginal ring (brand name Nuva. Ring®) is a flexible ring worn in the vagina. It is folded and inserted high into the vagina, where it slowly releases estrogen and progestin. These hormones are absorbed into the bloodstream. Each ring is made of a type of vinyl and should be worn for three weeks out of the month. The ring is about two inches in diameter, and one size fits all women.

Vaginal Ring • Pros: • You do not have to do anything right before, during, or after sex. • The exact positioning of the ring within the vagina is not critical for it to work because it is not a barrier method and therefore cannot be incorrectly inserted within the vagina. • Cons: • Side effects may include vaginal discharge, infection, or irritation in small numbers of women.

Vaginal Ring • Perfect use: Out of 100 women who use the vaginal ring correctly at all times, maybe 1 and probably no one in the group might become pregnant in one year. • Typical use: Because the ring is relatively new in the United States, we do not know the "typical use" rates.

Transdermal Contraceptive Patch ("the patch") • The patch (brand name Ortho Evra®) is a highly effective, weekly hormonal birth control patch that is worn on the skin to prevent pregnancy. It is worn for one week and replaced on the same day of the week for three consecutive weeks, with the fourth week "patch-free. " The patch is a very thin, beige, smooth square that measures 1 -3/4 inch on each of its four sides. It uses a combination of the hormones estrogen and progestin to prevent pregnancy-like most birth control pills. It can be worn on the arms, buttocks, or abdomen. About 4 in 100 patches will partially or completely come off.

Hormones by Patch • Pros: • You do not have to do anything right before, during, or after sex. • Menstrual periods are regulated, occurring during the "patch-free" week. • Cons: • A few women have mild skin irritation from the patch adhesive. • A few women may have side effects such as breast tenderness, headaches, or mood change.

Hormone Patch • Perfect use: Out of 100 women who use the patch correctly at all times, maybe 1 and probably no one in the group might become pregnant in one year. • Typical use: Because the patch is relatively new in the US, data is not yet available

Norplant • Implants (brand name Norplant®) are matchsticksize tubes placed in a woman's upper arm just under her skin. Implants are not currently available in the United States. They contain a hormone that prevents pregnancy for up to five years. However, implants can be removed at any time, and you then can become pregnant.

Norplant • Pros: • Convenient-lasts for five years. • Safe, highly effective; no user action needed before, during, or after sex. • Helps protect women from cancer of the lining of the womb. • Cons: • Putting implants in or taking them out requires a small cut in the skin, and scarring may occur. • If implants fail, there is a greater chance of a pregnancy in your fallopian tubes. • Side effects may include acne, headaches, weight gain, and hair loss

Depo-Provera • Pros: • Convenient - injection is needed only 4 times a year • Safe, highly effective, long lasting; no need for action before, during, or after sex. . • Can be used safely right after childbirth and while breastfeeding. • Helps protect women from cancer of the lining of the womb. • Reduces monthly bleeding and anemia (low blood count). • Cons: • Long acting; not a good method for women who want less than a year of birth control. • Side effects may include bloating/weight gain, headaches, depression, loss of interest in sex, or hair loss. • Side effects can go on for eight months after you stop having injections.

Hormonal manipulation • Multiple delivery methods, but the goal is all the same to suppress or alter ovulation – Skin-patch – Mouth-pill – Injection-injections monthly or 4 x per year – Suppository in the vagina – Surgical reservoir sewn into arm – IUD chemical release

Barrier Methods • Pros: • Most barrier methods are easy to get; some are sold widely without a prescription. • There is no need for special medical procedures or examinations. • Side effects are uncommon. Almost anyone can use them (except those sensitive or allergic to the ingredients). • Cons: • Barrier methods are often not used correctly, which can lead to unintended pregnancies. Couples should learn about Emergency contraception before to using any of the barrier methods. Sometimes called the "morning after pill, " Emergency contraception reduces the chance of getting pregnant after unprotected sexual intercourse. • Condoms sometimes break.

The Diaphragm

The Diaphragm • Diaphragms are soft, dome-shaped rubber cups that fit inside the vagina and are placed against the cervix. The diaphragm must be fitted by a health care professional (not every time you use it) and used with a spermicide.

Most widely used-Male Condom • Latex is most widely used, cheapest and most accessible • Provides some protection from STD • Easy to use, fairly easy to distribute, does not require sophisticated education • Largest barrier is male acceptance and compliance; cultural barriers; religious barriers; storage/breakage rates

The Cervical Cap • Cervical caps are soft rubber cups with a round rim that fits snugly around the cervix. It is smaller than a diaphragm and uses suction to stay in place. The cap must be fitted by a health care professional before it can be prescribed for you (not every time you use it) and used with a spermicide. The cervical cap prevents sperm from entering the uterus. It is inserted into the vagina, anytime before intercourse.

Cervical Caps are individually fit

The Female Condom • • • • FC Female Condom: Provides women and men with an additional choice to protect themselves from both unintended pregnancy and the transmission of STIs, including HIV/AIDS. With correct and consistent use, is as effective as other barrier methods. Protects the vagina, cervix and external genitalia, affording extensive barrier protection. Loosely lines the vagina; it is not tight or constricting. Has no serious side effects associated with its use. Can be inserted before intercourse and is not dependent on the male erection, so it will not interrupt sexual spontaneity. Does not need to be removed immediately after ejaculation. Does not require a prescription or the intervention of a health care provider.

Spermicide, foams, creams, etc. • These are chemicals that can directly limit the sperms ability to survive and swim, so as to limit fertilization • Used in the vaginal prior to intercourse • Can give several hours of decreased fertility • Usually combined with another method of barrier contraception

The IUD (Intrauterine Device) • The Intrauterine device (IUD) is small, Tshaped pieces of plastic, which contains copper (brand Para. Gard®). Your health care provider puts the IUD in the uterus, also known as the womb, where it can remain for up to 10 years, depending on the type you and your health care provider select.

IUD • Pros: • This is the longest lasting method (copper IUD lasts up to 10 years). • You do not have to do anything right before, during, or after sex. • The ability to get pregnant will return soon after the device is removed. • Cons: • This method is best for women who have one (faithful) partner. • The copper IUD may increase cramps and bleeding during monthly periods.

IUD • Perfect use: In a group of 100 women using IUDs, maybe 1 woman and probably no one in the group might become pregnant in one year. • Typical use: In a group of 100 women using IUDs, maybe 1 woman and probably no one in the group might become pregnant in one year.

Female Surgical Sterilization • A tubal ligation is a surgical operation performed to make a woman sexually sterile. There are two common methods of tubal ligation; minilaparotomy and laparoscopy. A minilaparotomy involves making a small incision in the abdomen and locating the fallopian tubes, which conduct the eggs from the ovaries to the uterus. After the tubes are found and drawn outside the body through the incision, a portion of each tube is removed and the ends are tied.

Vasectomy

Male Surgical Sterilization (Vasectomy) • Vasectomy is a minor surgical procedure to cut and close off the tubes (vas deferens) that deliver sperm from the testes; it is usually performed as a means of contraception. The procedure typically takes about 30 minutes and usually causes few complications and no change in sexual function. About 500, 000 vasectomies are performed annually in the United States. A vasectomy is less invasive than a tubal ligation (i. e. , the procedure used to prevent a woman’s eggs from reaching the uterus) and more easily reversed. An increasing number of couples choose it as a means of permanent birth control.

Emergency Contraception (the "morning after" pill • This is regular birth control pills that are taken after intercourse to prevent ovulation or implantation • You can use the same birth control pills that you normally would have been taking on daily to accomplish this • Pharmacists in some areas have refused to dispense all birth control prescriptions for fear women may be using them to prevent implantation, and using religious beliefs as justification for this

Natural Family planning • Also known as the rhythm method • Rhythm is a great way to increase the chances of achieving a pregnancy, but not as reliable at deceasing the chances of preventing a pregnancy • The theory is to time intercourse around when the female is not fertile. • Based on mucus readings, and basal body temperatures

Population Case Study This will be an essay on the exam. Think of many creative ways to help this small island culture develop in a sustainable way that will support human and health and a healthy ecosystem.

Case Study • Case study, you design the public health contraceptive program Island if Hula, a rural pacific island with limited Natural Resources. Presently the population is living within the limits of the resources and the ecosystem is not degraded. Food is from fishing, small farming, sustainable economy There is very limited travel around the island interior, most people move by boats Using the Royal Family and taxes as tools Eco-tourism and alternative economies Transportation and communication infrastructures to support health, options, commerce and education Designing a sustainable community is a complex challenge, population is only a piece of it, and contraception is only one type of tools you need to use in your design