Preventing Pregnancy

- Contraceptive Choices - Birth Control Methods and Options

Several factors come into play when deciding which method of birth control is best for you. Your overall health, age, frequency of sexual intercourse, the number of partners you have, and whether you desire to have children in the future must all be considered before deciding upon a birth control method.

The Pill

The pill is the first contraceptive that most women think of when considering birth control. Today the pill is available as combined oral contraceptives (COC) which contain both estrogen and progestin, or in progestin only pills (POP) which contain only progestin.

COCs work by suppressing ovulation and may make periods more regular. According to an FDA Consumer report, they also offer a protective effect against pelvic inflammatory disease (PID), as well as ovarian and endometrial cancers. These pills are considered safe for most women, however women who smoke and are over 35 or who have a significant family history of cardiovascular disease should not use oral contraceptives due to an increased risk of cardiovasculardiseases.Women with a medical history of blood clots, or breast or endometrialcancers also should not use combined oral contraceptives.

Possibleside effects which may subside after a few months include nausea,headache,breast tenderness, weight gain, irregular bleeding, and depression.

POPs work by reducing and thickening the cervical mucus to prevent sperm from reaching the egg, and by keeping the uterine lining from thickening to prevent implantation of a fertilized egg. Because these pills contain no estrogen the risk of blood clots is not present as with the combined oral contraceptives. This type of birth control pill is a good option for women who cannot take estrogen because they are breast feeding or because of headaches or high blood pressure problems associated with estrogen. The progestin only pill may cause menstrual changes, weight gain, and breast tenderness.

Injectable Progestins

Pregnancy can be prevented up to three months by injection of Depo-Provera. Depo-Provera prevents pregnancy by inhibiting ovulation, changing the cervical mucus to prevent sperm from reaching an egg, and by changing the uterine lining so that a fertilized egg will be unable to implant. This method is extremely effective since all that's required of a woman is to return to her health care provider for a shot every three months. Benefits and side effects of Depo-Provera are similar to those of progestin only pills.

Interuterine Devices (IUD)

The IUD has experienced some bad publicity in the past when the Dalkon Shield was associated with a high incidence of pelvic infections, infertility, and some deaths. However, today's IUDs have one of the lowest failure rates of any contraceptive method. An IUD is a T-shaped device that is inserted into the uterus by a health care professional. There are two types of IUD available, the Paragard CopperT 380A which protects against pregnancy for 10 years, and the Progestasert Progesterone T which must be replaced every year. The IUD is an appropriate choice for those in long term monogamous relationships who are not at high risk for sexually transmitted diseases or infections.

The Sponge

AllendalePharmaceuticals was recently given approval by the FDA to manufacturethe Today Sponge again in the US. The sponge works by releasing spermicidal gel over the vaginal mucus while the sponge forms a barrier to kill or immobilize sperm before it can reach the cervix and enter the uterus. The sponge can be inserted several hours before intercourse and can be left in place up to 12 hours after sex. It does not need to be replaced if sexual intercourse is repeated. Women who are allergic to nonoxyl-9 or who have had toxic shock syndrome should not use the sponge. Protectaid® is currently available in Canada, and US residents can expect to find the Today Sponge on pharmacy shelves in the fall.

Diaphragm

The diaphragm is available by prescription and is sized by a health care professional to ensure a proper fit. The diaphragm works by covering the cervix with a dome-shaped rubber disk with a flexible rim to prevent sperm from entering the uterus. A spermicidal is applied to the diaphragm before insertion to kill sperm. The diaphragm may be left in place for 6 hours, however for repeated sexual intercourse or intercourse after 6 hours spermicide should be inserted into the vagina while the diaphragm is still in place. Diaphragms should never be left in for more than 24 hours due to risk of toxic shock syndrome (TSS).

Cervical Cap

The cervical capis similar to the diaphragm. It is a soft rubber cup with a roundedrim and is sized to fit, by a health car professional, tightly around the cervix. Like the diaphragm, spermicide is required with the cervical cap. It protects against pregnancy for 48 hours and for multiple acts of sexual intercourse during this time. Prolonged use (over 48 hours) may increase the risk of TSS and can produce a foul odor or discharge.

Vaginal Spermicides

Vaginal spermicides are available over the counter in the form of cream, jelly, foam, film, vaginal suppository or tablets. These products contain a sperm killing chemical. There is debate about the effectiveness of using vaginal spermicides alone but it is thought that they have a failure rate of approximately 21% per year. Women who choose this method of contraceptive should be sure to follow the package directions exactly as each product is different. Allow the spermicide to remain in the vagina for 6-8 hours following intercourse and do not douche or rinse the vagina during this time to ensure that all sperm are killed. Natural Family Planning Being aware of your fertility is another way of reducing your chances of getting pregnant.

Natural family planning is the only method accepted by some religions and it requires extreme attention and a highly motivated couple for it to be successful. It works by not having sexual intercourse on the days when you are most likely to ovulate. These methods estimate a woman's fertility based upon changes in the cervical mucus or changes in body temperature.

Withdrawal

The effectiveness of withdrawal depends upon the man's ability to withdraw his penis from the vagina before he ejaculates. This method does not guarantee that pre-ejaculatory sperm has not been released into the vagina and does not provide protection against AIDS, sexually transmitted diseases, or infections.

Lactational Amenorrhoea Method (LAM)

Women who are breast feeding exclusively may be protected against pregnancy for up to 6 months after the birth if her period has not returned. This method is highly effective when used correctly. LAM works by preventing an egg from being released from your ovary. Once you begin to feed your baby food other than breast milk, or when your period returns you need to choose another method of birth control.

Surgical Sterilization

When you are sure that your pregnancy days are over for good, sterilization is an option that may be considered. Either partner may choose surgical sterilization--tubal ligation for the woman, or vasectomy for the male. It's important that you do not consider this a temporary means of contraception that can be reversed if you change your mind. Sterilization reversal is major surgery which is often unsuccessful.

Emergency Contraception

Emergency contraception works by preventing pregnancy within a few hours or days of unprotected sex. Methods used for emergency contraception include combined oral contraceptives, progestin only pills, and insertion of an IUD.

When Unplanned Pregnancy Occurs

When birth control methods are practiced faithfully, most methods of contraception are highly effective against an unplanned pregnancy occurring. However, sometimes other factors come into play and contraception does fail. If you find yourself faced with and unplanned pregnancy you will need to make a decision about how you will proceed. Will you choose abortion, adoption, or parenting? It's a decision that no one can make for you and one that you will have to live with for the rest of your life. Be sure to choose what feels right for you, and don't let yourself be influenced by others feelings.

An Important Message About Condoms

Condoms should always be used, in addition to any other birth control methods, by anyone who is not in a long term monogamous relationship. Care should be taken not to use oil-based lubricants (petroleum jelly, lotions, or baby oil) with latex or lambskin condoms as they can weaken the material.

Women today have the choice of using the traditional male condom, or using the female condom. The Reality® condom is approved by the FDA and is shaped similar to the male condom. The closed end has a flexible ring that is inserted into the vagina, up to 8 hours before sexual intercourse, while the open end remains partly outside the vagina. The female condom should never be used at the same time your partner is using a male condom.

Condoms, whether male or female, are intended for one-time use and should never be reused. If the cost of condoms is an issue for you, visit your local family planning clinic. Many family planning clinics will happily give you as many condoms as you need.

Don't Be Fooled

Maybe you have heard that you cannot get pregnant on your period, or if you don't have an orgasm, or if your partner pulls out before ejaculation that pregnancy won't occur--these are not true! Perhaps someone has told you that douching will wash away the sperm before pregnancy can occur. Not only does douching not work to prevent pregnancy, it can also lead to pelvic inflammatory disease and increase your risk of other STDs and infections. Don't be fooled--the only 100% effective method of preventing pregnancy is abstinence.