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HCET Home > On-line Training > Family Planning – The Basics > 4. Contraception

Abstinence

Before discussing physical methods such as pills, condoms, etc. commonly used by sexually active individuals to prevent pregnancy, a word about abstinence. The decision to abstain from (not engage in) vaginal intercourse is one sure way to prevent pregnancy, but many people disagree as to whether abstinence should be discussed as a form of birth control in a discussion of contraceptive methods. Many people advocate abstinence for young teens for multiple reasons in addition to prevention of pregnancy and sexually transmitted infections.

Another definition of abstinence involves the decision to abstain from (not engage in) intercourse and/or other behaviors that put one at risk for AIDS and other sexually transmitted diseases. In reaching a decision about whether, and at what age, one should engage in sexual practices, each individual must weigh cultural, ethical, religious, moral, physical health, and psychological factors.

Sexual intimacy that does not include intercourse may range from holding hands, hugging, kissing, and dancing to mutual masturbation, petting, oral-genital sex and the use of stimulating devices such as vibrators. Oral-genital sex carries no risk of pregnancy, but it can contribute to the spread of sexually transmitted infections.

It is important for family planning providers to:

• Give accurate information
• Allow patients to discuss and ask questions about their options and their personal sexual decisions
• Provide support for patients’ decisions that are healthy and protect against infection and/or unintended pregnancy
• Be aware of the various points of view on these issues

Common Birth Control Methods
(click below for informational chart in PDF format)

1. Combination Hormonal Methods (estrogen and progestin)

2. Progestin-only Methods
   • Progestin only pills: “the mini-pill”
   • Depo-Provera® “DMPA or the shot” which is Medroxyprogesterone (injectible)
   • Mirena® IUD (Levonorgestrel-releasing intrauterine system)

3. Non-hormonal Methods
   • Paragard® IUD
   • Condoms
   • Spermicides
   • Diaphragm
   • Cervical Cap
   • Lea’s Shield®

4. Sterilization
   • Tubal Ligation - Most widely used method, very effective (99.9%) & not easily reversed
     Different Methods of Tubal Ligation
     
     • Laproscopic: outpatient procedure, costs ~ $2500
     • Essure®: 45 minute office procedure, no general anesthetic, costs ~ $2500.  Coils placed in the tubes create scarring, takes three months for scarring to occur, use back up method first 3 months

   • Vasectomy - 2 methods, both outpatient procedures:
     • Surgical - involves cutting and cautery, 30 minute procedure
     • Non surgical - FDA approved Vasclip® (costs ~ $350), A clip the size of a grain of rice which blocks the flow of sperm: less painful, 10 minute procedure, easier to reverse

5. Standard Days Method
   • Similar to Natural Family Planning but easier
   • Can only be used if menstrual cycle is between 26-32 days every month, it is recommended that the patient write down the 1st day of her cycle
   • Sex is avoided between days 8-19 of every cycle
   • CycleBeads™ can help women keep track of the cycle – must remember to use beads daily
   • 88-95% effective, no side effects

6. Emergency Contraception (EC)
   • Combination hormonal methods, or progestin-only methods are also used as emergency contraception (sometimes ECP).

   • EC is not RU486. It was once called “the morning after pill”.

   Research now shows that widespread availability and use of EC has lowered the abortion rate dramatically!

   • 3 common types of EC
     1. Estrogen/progestin products such as Nordette (Levonorgestrel 0.15mg, ethinyl estradiol 30mcg) or Preven (Levonorgestrel 0.25mg/Ethinyl Estradiol 0.05 mg tablets)
     2. Progestin only products such as Plan B® (Levonorgestrel)
     3. IUD insertion

   • How does EC work?
     • Stops the ovary from releasing an egg, especially if taken in the 1st half of the menstrual cycle
     • Thickens cervical mucus
     • Creates an unreceptive uterine lining
     • Does not cause an abortion

   • EC Efficacy
     • 75-89% effective, depending on when in the menstrual cycle they are taken
     • The risk of pregnancy with 1 act of unprotected intercourse is 8%; this drops to 1% if EC is used
     • EC is most effective if taken as soon as possible after unprotected sex

   • EC Risks
     • Very safe: No long term serious risks
     • No effect on the fetus if EC fails
     • The only contraindication is pregnancy

   • Danger Signs (similar to combination oral contraceptives)
     • A - Abdominal pain, severe
     • C - Chest pain, shortness of breath
     • H - Headaches, severe or changes in frequency or severity
     • E - Eye problems: blurred, double or loss of vision
     • S - Severe arm or leg pain
     • Jaundice
     • Severe depression
     • Unusually heavy vaginal bleeding
     • Lump in the breast
     • No period after having a period every month

   • EC Side Effects
     • Short duration of nausea, vomiting and cramping
     • Short duration of breast tenderness, headache, dizziness
     • Menses may be early and a bit heavier or irregular

   • How to use EC
     • Most effective if used within 120 hours of unprotected sex (may be given before the fact)
     • Plan B: take 1 tab as soon as possible, then 1 tab 12 hours later or take both tabs as soon as possible
     • Nordette: take 4 tabs as soon as possible, then 4 tabs 12 hours later (use this for waiver patients)
     • Return to clinic in 4 weeks if no menses or if symptoms of pregnancy

   • What to do
     • To decrease nausea - take with food and use over-the-counter Dramamine
     • If vomiting occurs - if it has been less than 30 minutes, repeat the dose; more than 30 minutes, do not repeat the dose

Providing Contraception and Counseling

Prescribing Hormonal Methods in Advance of an Exam
Check with your clinic to review its policies and procedures for providing hormonal methods in advance of an exam. In many clinics, protocols allow all of the hormonal methods to be provided in advance of an exam for 6 months. There are usually forms that the patient must complete and sign.

Give the patient:

• Informed consent for whichever method they choose
• Informed consent specific to using hormonal methods of birth control without having a physical exam
• Patient must complete a health history form
• Blood pressure must be taken
• Must give patient instructions regarding use of their method

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©2005 Health Care Education & Training, Inc.
URL: http://65.163.14.21/training/FPbasics/4contra.htm
 Last update: 03/05/08