Contraception | CDC

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Family planning services during COVID-19: Clinical considerations for service delivery and COVID-19 treatment and vaccination

The Reproductive Heath National Training Center has also compiled a list of suggestions and accompanying resources to help family planning providers meet their clients’ needs while keeping themselves and clients safe during this nationwide COVID-19 public health emergency.

• Birth Control Methods
• Resources for Providers
• Resources for Consumers

Birth Control Methods

Many elements need to be considered by women, men, or couples at any given point in their lifetimes when choosing the most appropriate contraceptive method. These elements include safety, effectiveness, availability (including accessibility and affordability), and acceptability. Voluntary informed choice of contraceptive methods is an essential guiding principle, and contraceptive counseling, when applicable, might be an important contributor to the successful use of contraceptive methods.

In choosing a method of contraception, dual protection from the simultaneous risk for HIV and other STDs also should be considered. Although hormonal contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect against STDs, including HIV. Consistent and correct use of the male latex condom reduces the risk for HIV infection and other STDs, including chlamydial infection, gonococcal infection, and trichomoniasis.

Reversible Methods of Birth Control

Intrauterine Contraception

Levonorgestrel intrauterine system (LNG IUD)—The LNG IUD is a small T-shaped device like the Copper T IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The LNG IUD stays in your uterus for up to 3 to 8 years, depending on the device. Typical use failure rate: 0.1-0.4%.¹

Copper T intrauterine device (IUD)—This IUD is a small device that is shaped in the form of a “T. ” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. Typical use failure rate: 0.8%.¹

Hormonal Methods

Implant—The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. Typical use failure rate: 0.1%.¹

Injection or “shot”—Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. Typical use failure rate: 4%.¹

Combined oral contraceptives—Also called “the pill,” combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. Typical use failure rate: 7%. ¹

Progestin only pill—Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It may be a good option for women who can’t take estrogen. Typical use failure rate: 7%.¹

Patch—This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. Typical use failure rate: 7%.¹

Hormonal vaginal contraceptive ring—The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. Typical use failure rate: 7%.¹

Barrier Methods

Diaphragm or cervical cap—Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes. Typical use failure rate for the diaphragm: 17%.¹

Sponge—The contraceptive sponge contains spermicide and is placed in the vagina where it fits over the cervix. The sponge works for up to 24 hours, and must be left in the vagina for at least 6 hours after the last act of intercourse, at which time it is removed and discarded. Typical use failure rate: 14% for women who have never had a baby and 27% for women who have had a baby.¹

Male condom—Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy, and HIV and other STDs, as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not provide protection against STDs, including HIV. Typical use failure rate: 13%.¹ Condoms can only be used once. You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break.

Female condom—Worn by the woman, the female condom helps keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It can be inserted up to eight hours before sexual intercourse. Typical use failure rate: 21%,¹ and also may help prevent STDs.

Spermicides—These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. They can be purchased at drug stores. Typical use failure rate: 21%.¹

Fertility Awareness-Based Methods

Fertility awareness-based methods—Understanding your monthly fertility patternexternal icon can help you plan to get pregnant or avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a barrier method of birth control on those days. Failure rates vary across these methods.^1-2 Range of typical use failure rates: 2-23%. ¹

Lactational Amenorrhea Methods

For women who have recently had a baby and are breastfeeding, the Lactational Amenorrhea Method (LAM) can be used as birth control when three conditions are met: 1) amenorrhea (not having any menstrual periods after delivering a baby), 2) fully or nearly fully breastfeeding, and 3) less than 6 months after delivering a baby. LAM is a temporary method of birth control, and another birth control method must be used when any of the three conditions are not met.

Emergency Contraception

Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.

Copper IUD—Women can have the copper T IUD inserted within five days of unprotected sex.

Emergency contraceptive pills—Women can take emergency contraceptive pills up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. There are three different types of emergency contraceptive pills available in the United States. Some emergency contraceptive pills are available over the counter.

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Permanent Methods of Birth Control

Female Sterilization—Tubal ligation or “tying tubes”— A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately. Typical use failure rate: 0.5%.¹

Male Sterilization–Vasectomy—This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is typically done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero. Typical use failure rate: 0.15%.¹

References

1. Trussell J, Aiken ARA, Micks E, Guthrie KA. Efficacy, safety, and personal considerations. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018.
2. Peragallo Urrutia R, Polis CB, Jensen ET, Greene ME, Kennedy E, Stanford JB. Effectiveness of fertility awareness-based methods for pregnancy prevention: A systematic review. Obstet Gynecol 2018;132:591-604.

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Resources for Providers

CDC Contraceptive Guidance for Health Care Providers

U.S. Medical Eligibility Criteria for Contraceptive Use (US MEC), U. S. Selected Practice Recommendations for Contraceptive Use (US SPR) and Providing Quality Family Services (QFP) can assist health care providers when they counsel women, men, and couples about contraceptive method choice and family planning services.

• Contraceptive Use Among Women at Risk for Unintended Pregnancy in the Context of Public Health Emergencies — United States, 2016
• American College of Obstetricians and Gynecologists (ACOG) Long-A cting Reversible Contraception Program
• Family Planning National Training Center (FPNTC)
• National Clinical Training Center for Family Planning (NCTCFP)
• Tips for Communicating with Female Patients with Intellectual Disabilities

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Resources for Consumers

• Birth Control Methods fact sheet
  Métodos anticonceptivos hoja de datos
• Emergency Contraception (emergency birth control) fact sheet
  Anticoncepción de emergencia hoja de datos
• Office of Population Affairs
• Planned Parenthood

• His Condom + Her Birth Control [PDF – 1 MB]

• Know Your Condom DOs & DON’Ts [PDF – 2 MB]
  En español [PDF – 1 MB]

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Contraception – choices – Better Health Channel

What is contraception?

Video – What is contraception?, Sexual Health Victoria

Contraception (also known as family planning or birth control) protects you from pregnancy. Contraception works so that an egg can’t be fertilised by sperm to conceive a baby.

There are many contraceptive options available in Australia. Their level of effectiveness and the way they work varies.

Types of contraception include:

• implants
• intrauterine devices (IUDs)
• injections
• oral contraceptive pills (combined pill and progestogen only pill)
• vaginal rings
• barrier methods (external and internal condoms, diaphragms)
• tubal ligation and vasectomy
• emergency contraception
• natural methods (also known as natural family planning or fertility awareness based methods).

Barrier methods of contraception (such as condoms) are highly effective to protect you and your sexual partners from sexually transmissible infections (STIs).

It is important to remember, that no method of contraception is 100% effective against pregnancy.

How to choose contraception to suit your needs

When choosing a method of contraception that is right for you, it is important to have accurate information. If you have a partner/s talk openly about your options.

Issues you may like to consider include:

• how well each method works
• why you need to use contraception – some people use contraception for hormonal benefits (such as for heavy menstrual bleeding, skipping periods, endometriosis or acne)
• possible side effects
• ease of use
• cost
• your general health – such as other health conditions and current medications or treatments
• your lifestyle and relationships
• your safety and risk of getting a sexually transmissible infection (STI)
• whether you want to get pregnant
• whether you can stop the method yourself or need to see a health practitioner
• the effort and time involved.

Some methods require more effort than others. Weigh the pros and cons and think about how each method meets your current and future needs. For example, if you decide on the pill, you need to remember to take it every day. If you choose an implant or IUD, once it has been inserted, it can last for a few years. Unless there are issues, you don’t need to think about it until it needs to be replaced.

Talk about your options with a GP or reproductive health nurse.

Contraceptive protection from STIs

As well as preventing an unintended pregnancy, it is also important to practise safer sex.

Not all methods of contraception give protection from STIs.

The best way to lessen the risk of STIs is to use condoms. Condoms (external or internal) can be used for vaginal, anal and oral sex to help stop infections from spreading.

Long-acting reversible contraception

Long-acting reversible contraception (LARC) gives safe, effective contraception over a number of years.

Their lifespan varies depending on the type of LARC you use.

LARC available in Australia includes:

• contraceptive implant
• copper and hormonal IUDs.

IUDs and implants are the most effective (more than 99%) contraception available to prevent pregnancy. They also require replacement less often than any other method.

LARC methods do not protect you from STIs. Practise safer sex by using condoms.

Contraceptive implants

A contraceptive implant is a LARC method, available in Australia as Implanon NXT™.

It is a small plastic stick (about 4 cm long) that is placed under the skin of your upper arm. It slowly releases a low dose of the hormone progestogen, which stops your ovaries releasing an egg each month.

You will notice a change to your period, or it may stop altogether.

The implant lasts for 3 years and is more than 99% effective at preventing pregnancy.

It can easily be removed and won’t stop you from getting pregnant in the future.

It is safe to use if you are breastfeeding and can be inserted straight after the birth of your baby.

Contraceptive intrauterine devices (IUDs)

An IUD is a small contraceptive device that is placed in your uterus. An IUD is also a LARC method. There are two kinds of IUD:

• copper IUD (Cu-IUD) – lasts 5 to10 years
• hormone-releasing IUD – last 5 years.

An IUD stops sperm from reaching and fertilising an egg. It also changes the lining of your uterus (womb), so a fertilised egg won’t stay in it to start a pregnancy.

The copper IUD can also be used as emergency contraception – as an alternative to the emergency contraceptive pill (morning after pill).

An IUD can easily be removed by a doctor or nurse and won’t stop your chance of getting pregnant in the future.

The copper IUD may make your periods heavier. The hormonal IUD will make your periods lighter or stop them completely.

IUDs are safe during breastfeeding and are not affected by other medications.

Contraceptive injections (Depo)

The contraceptive injection (Depo-Provera™ or Depo-Ralovera™, also known as Depo) is a hormonal injection. It contains the hormone progestogen, which is like the hormone produced by the ovaries.

When given on time, each injection is more than 99% effective at preventing pregnancy. This method stops ovulation and makes the fluid at the opening to the uterus (womb) thicker, stopping sperm from getting through.

The injection lasts 12-14 weeks, so you need to return to a clinic to have further injections by a doctor or nurse.

Injections tend to make periods less painful. You may find you have no vaginal bleeding or very light bleeding.

It can be given if you are taking other medications.

Injections do not protect you and your partners from STIs. To practise safer sex, you will need to use condoms.

Contraceptive injections can be used if you are breastfeeding and after a baby’s birth.

If you stop injections, it may take a while for your fertility to return.

Oral contraceptive pills

Contraceptive pills thicken the fluid around the cervix to block sperm from getting through. Most contraceptive pills stop ovulation by preventing the ovaries from releasing an egg each month.

Oral contraception needs to be taken around the same time each day. It is available on prescription (script) which you take to the pharmacy.

There are 2 types of contraceptive pills available in Australia:

• combined pill (or oral contraceptive pill) – contains 2 hormones similar to those produced by the ovaries – oestrogen and progestogen.
• progestogen only pill (sometimes called the ‘mini pill’) – only contains progestogen.

Oral contraceptive pills, if used correctly are very effective (up to 99%) at preventing pregnancy. However, if you make a mistake – such as forgetting or delay taking them their effectiveness reduces to 93%.

Vomiting, severe diarrhoea and some medications can also affect how well the pill works.

The pill does not protect you from STIs so use barrier protection (such as condoms) when having sex.

Some pharmacies may provide a small number of pills without a script if you run out and haven’t seen your doctor for a new prescription.

Combined pill

Combined oral contraception contains synthetic forms of hormones – oestrogen and progesterone. When taken correctly, the combined pill is more than 99.5% effective at preventing pregnancy.

There are many types of combined pills with different doses and hormones. Some brands are more expensive than others and if you have a healthcare card, cheaper brands are available. Ask your pharmacist for more information.

Most combined pills come in a 28-day pack that includes hormone and sugar pills. Sugar pills can be missed if you don’t wish to have your period.

The pill can take up to 12 days to start working if you have never used it before or had a break from taking it. Use another form of contraception if you decide to have sex.

Some medications (including natural remedies) can interfere with the pill and stop it from working.

Combined oral contraception can be used to treat various conditions including heavy menstrual bleeding, polycystic ovary syndrome (PCOS), endometriosis and acne.

The combined pill may not be a good option for some people. This includes people who:

• smoke (35 years and over)
• have a body mass index (BMI) over 35 kg/m2
• are at risk of deep vein thrombosis, heart disease or stroke
• have severe liver disease
• have received treatment for breast cancer.

If you are breastfeeding, do not use the pill until your baby is 6 weeks old. Also, after birth, the combined pill is generally not recommended until your baby is 3-6 weeks old.

Check with your doctor, nurse or pharmacist to find out what options will work for you.

Progestogen only pill

The progestogen only pill contains a synthetic form of only one hormone – progesterone. There are 2 types the:

• traditional low dose progestogen only pill
• new standard dose progestogen only pill.

Both types make the fluid at the opening to the uterus thicker, stopping sperm from getting through.

The traditional low dose progestogen only pill is different to the combined pill as you usually still ovulate (release an egg) each month. It may not be as effective (up to 99%) as the new standard dose progestogen only pill and the combined pill. It needs to be taken strictly every day at the same time.

The new standard dose progestogen only pill also prevents ovulation.

The progestogen only pill usually suits people who have side effects when they take oestrogen or cannot take oestrogen for health reasons.

The progestogen only pill can be used while breastfeeding. It is also safe to start the progestogen only pill after the birth of a baby.

Vaginal ring

The vaginal ring (or NuvaRing™) contains similar hormones to the combined pill – oestrogen and progestogen. It slowly releases hormones that move from the vagina into the bloodstream.

The vaginal ring prevents pregnancy by stopping the ovaries from releasing an egg each month. It is at least 99% effective when used correctly.

Some medications and natural therapies may interfere with their effectiveness.

Vaginal rings come in one size are available on prescription which you take to a pharmacy. They are self-inserted (a bit like inserting a tampon) and usually stay in the vagina for 3 weeks.

After this time, you take the ring out and wait 7 days before inserting a new vaginal ring. You usually get your period after the ring is removed.

You can also skip your period by avoiding the 7-day break and inserting a new vaginal ring straight away.

As well as offering contraception, the vaginal ring can be used to treat some conditions (such as heavy menstrual bleeding, acne, PCOS and endometriosis).

If you are breastfeeding, you cannot use the vaginal ring until your baby is 6 weeks old. Also, after birth, the vaginal ring is generally not recommended until your baby is 3-6 weeks old.

The vaginal ring does not provide protection STIs so use barrier protection (such as condoms) when having sex.

The combined pill may not be a good option for some people. This includes people who:

• smoke (35 years and over)
• have a body mass index (BMI) over 35 kg/m2
• are at risk of deep vein thrombosis, heart disease or stroke
• have severe liver disease
• have received treatment for breast cancer.

Check with your doctor, nurse or pharmacist to find out what options will work for you.

Barrier methods of contraception

Barrier methods of contraception stop sperm from getting into the uterus to to prevent pregnancy. Options include:

• external condom
• internal condom
• diaphragm.

Condoms also lessen the risk of STIs. They are very effective because they block the exchange of body fluids during anal, oral, vaginal, some skin-to-skin contact and sharing of vibrators and sex toys.

Use a new condom each time you have sex and when switching to a different kind of sex (such as from anal to vaginal).

To be effective, all barrier methods need to be used and stored correctly. Follow the instructions on the packet and check the use by date before any sexual contact.

External condom

The external (or male) condom is a is a strong latex (rubber) pouch that is put over the erect penis to stop sperm from getting into the vagina. Non-latex ones are available for people who have a latex allergy.

Condoms come in all shapes and sizes and can be used by anyone who is sexually active.

Condoms are up to 98% effective when used the right way to prevent pregnancy.

Use a new condom each time you have sex. Put it on before there is any contact between the penis and vagina.

Condoms are easy to use. Be gentle when putting them on to avoid accidental tears. Use water or silicone-based lubricants (lube) as oil-based ones can make them break.

Condoms can be used with other forms of contraception.

External condoms are cheap and available without a doctor’s prescription from pharmacies, supermarkets, sexual health clinics and vending machines in some venues.

Internal condom

The internal condom (also known as female condom or femidom) is a loose non-latex pouch with a flexible ring at each end that sits in the vagina, to stop sperm from getting into the uterus.

If the internal condom is used the right way each time you have sex, it is 95 % effective at preventing pregnancy.

Internal condoms come in one size. They are stronger than external condoms and can be put in several hours before having sex. Use a new condom each time you have sex.
Using this method may take some practice.

Internal condoms are more expensive than external condoms. They are available from some retail outlets and sexual health clinics.

Diaphragm

A diaphragm (sold as Caya™ in Australia) is a soft, shallow, silicone dome that fits in the vagina. It is used with a special gel. You need to insert the diaphragm into the vagina so that it covers the cervix (the opening to the uterus) to stop sperm from getting through.

It needs to stay in place for at least 6 hours after sex. Do not leave the diaphragm for any more than 24 hours.

It is available in one size and may not fit everyone (around 1 in 7 people).

If used the right way, this method is 86% effective.

A diaphragm does not protect you or your partners from STIs.

Do not use a diaphragm that is past its use by date or has been used for 2 years or more.

You do not need a script to get a diaphragm – it can be bought from some pharmacies, sexual health and family planning clinics and online.

Diaphragms can be tricky to insert. It is recommended that a doctor or a nurse checks that you are able insert it correctly before it is used as contraception. Check with a doctor or nurse to find out if the diaphragm is a good option for you.

If you have recently had a baby, it is best to wait 6 weeks before using a diaphragm.

Permanent methods of contraception

Sterilisation is a permanent method of contraception that involves having a surgical procedure. It is a very effective (more than 99%) method of contraception.

These forms of contraception will not protect you from STIs, so you will need to practise safer sex by using condoms.

As with any form of surgery, there is a small risk of injury.

Tubal ligation

Tubal sterilisation or ligation (known as ‘having your tubes tied’), is usually performed as a keyhole procedure called a laparoscopy under general anaesthetic.

A surgeon places a clip on each fallopian tube to block the sperm and egg from meeting. In some cases, you may have your fallopian tubes removed rather than clipped.

Your ovaries and periods are not affected.

Vasectomy

Vasectomy (known as sterilisation or ‘the snip’) is a quick and easy procedure usually done under local anaesthetic. It involves cutting the tubes that carry sperm from the testes to the penis.

Although highly effective at preventing pregnancy, it can take around 3 months for a vasectomy to begin working (that is, no sperm is present in the semen). Use another form of contraception during this time and have sperm tests with your doctor.

Natural methods of contraception

Natural family planning (or fertility awareness) methods are overall not as effective as other forms of contraception. They are built on trust between partners and not having sex at times when you could get pregnant.

Some of these methods rely on having a regular menstrual cycle. If you have irregular periods, you have a higher chance of getting pregnant.

Natural methods are based on monitoring your body each day. This may include watching changes to your body’s temperature and vaginal fluid to determine the time you are fertile during your menstrual cycle.

Natural methods include:

• rhythm (or calendar)
• cervical mucus (or Billings)
• temperature and symptothermal.
• fertility apps.

Natural methods do not protect you from STIs.

They are not recommended if you:

• have a fever, vaginal infection or polycystic ovary syndrome (PCOS)
• regularly travel through different time zones
• are under stress.

The effectiveness of natural family planning varies, depending on which method or combination of methods is used.

Withdrawal method

The withdrawal (or pulling out) is where the penis is withdrawn from the vagina before ejaculation (cumming).

This method is not recommended as a form of contraception due to the risks of sperm being present in the pre-ejaculate or not withdrawing the penis in time.

Emergency contraception

Emergency contraception can be used after unprotected sex (such as missing a pill, the condom broke, or you didn’t use any contraception). You need to get it quickly to avoid an accidental pregnancy.

Forms of emergency contraception available in Australia include:

• the copper IUD
• emergency contraceptive pill (or ‘morning after pill’).

Emergency contraception is not an abortion.

Copper IUD

The non-hormonal copper IUD is the most effective method (more than 99%) of emergency contraception. It works by making it difficult for a fertilised egg to stick to the uterus (womb) lining.

It can be inserted within 5 days of unprotected sex.

Once inserted the copper IUD can provide effective contraception for 5 -10 years.

Emergency contraceptive pill

The emergency contraceptive pill (or ‘morning after pill’) prevents or delays the ovaries releasing an egg. It should be taken as soon as possible after unprotected sex.

The emergency contraceptive pill is around 85% effective in preventing pregnancy.

Two types of emergency contraceptive pills are available at pharmacies (chemists) without a prescription:

• ulipristal acetate (sold as EllaOne) – taken up to 5 days (120 hours)
• levonorgestrel (various brands) – taken up to 4 days (96 hours).

Ulipristal has been clinically demonstrated to be more effective than levonorgestrel.

Emergency contraceptive pills are not recommended as your usual method of contraception. Ask your GP or reproductive health nurse for further advice.

The following is available from Health Translations DirectoryExternal Link:

Contraception – your choices (PDF)External Link by Royal Women’s Hospital, Victoria

• Arabic
• Chinese (simplified)
• Hindi
• Spanish
• Urdu
• Vietnamese

Contraceptive options – what can I choose (PDF)External Link by Sexual Health Victoria (formerly Family Planning Victoria)

• Easy English

Where to get help

• Your GP (doctor)
• Your school nurse or welfare coordinator. Some secondary schools provide access to an adolescent health trained GP on site
• Your local community health service
• Your pharmacist (including after hours Victorian Supercare Pharmacies)
• Some public hospitals have clinics including family planning, sexual health and women’s health
• 1800 My OptionsExternal Link – Victoria’s sexual and reproductive health information and phone line service Tel. 1800 My Options (1800 696 784)
• Sexual Health Victoria (SHV)External Link – book an appointment onlineExternal Link or call Melbourne CBD Clinic: (03) 9660 4700, Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952 (Monday to Friday 9 am – 5 pm). These services are youth friendly
• Melbourne Sexual Health CentreExternal Link (Monday to Friday 8:30 am – 5 pm) Tel. (03) 9341 6200 or 1800 032 017 or National Relay Service (for people with a hearing impairment) (03) 9341 6200
• Thorne Harbour Health (formerly Victorian AIDS Council)External Link Tel. (03) 9865 6700 or 1800 134 840 (toll free)
• The Centre ClinicExternal Link, St Kilda Tel. (03) 9525 5866
• Equinox Gender Diverse Health CentreExternal Link (Monday to Friday 9 am – 5 pm) Tel. (03) 9416 2889 or email: [email protected]
• PRONTO!External Link Clinic for men who have sex with men. Book online or Tel. Tel. (03) 9416 2889
• Ballarat Community Health Sexual Health ClinicExternal Link – book online or Tel. (03) 5338 4541
• Bendigo Community Health Sexual Health ClinicExternal Link – book online Tel. (03) 5406 1200 or (03) 5448 1600
• Gateway Health Sexual and Reproductive Health – Clinic 35External Link, Wodonga (Monday to Friday 9 am – 5 pm) Tel. (02) 6022 8888 and Wangaratta Tel. (03) 5723 2000 or email: [email protected]
• Sunraysia Community Health Services,External Link Mildura (Monday to Friday 8:30 am – 5 pm) Tel. (03) 5022 5444 or email to: [email protected]
• Barwon Health Sexual Health ClinicExternal Link (no GP referral, walk-in service Tuesdays 2 pm – 6:30 pm) Tel. (03) 5226 7489
• Victorian Aboriginal Health ServiceExternal Link Fitzroy: Tel. (03) 9419 3000 and Preston Tel. (03) 9403 3300 (Monday to Friday 10 am – 4 pm) and after-hours locum service Tel. 132 660 or Epping: Tel. (03) 8592 3920 (Monday to Thursday 9 am-5 pm, Friday 9 am-4 pm)

Safety Precautions: 13 Effective Contraceptive Methods

Contraception is not limited to condoms, pills, or coitus interruptus. Today, the choice of contraceptives is much larger. Modern medicine offers a huge selection of products: from those that can be bought at the nearest store to expensive surgical operations. Despite this, at least 16.7 million unwanted pregnancies occur worldwide each year. We have chosen the most popular methods of protection and arranged them in descending order of effectiveness, based on the Pearl index, which shows the effectiveness of a particular method of protection.

1 ABstinence

The only 100% way to avoid unwanted pregnancy and infections: however, it can be accompanied by side effects such as loss of libido or even depression.

SURGICAL TECHNIQUES

2 STERILIZATION

Female sterilization is also called tubal occlusion or “tubal ligation”. As a result of the operation, an artificial obstruction of the fallopian tubes is created: the female egg is isolated from the spermatozoa and fertilization becomes impossible. In Russia, this method of contraception is legally allowed only for women over 35 years old who have at least one child.

FOR Virtually 100% protection against unwanted pregnancy; the operation does not entail changes in health, in the hormonal background, does not affect sexual desire, and sometimes even increases it; reduces the risk of ovarian cancer.

NO Sterilization is almost irreversible, fertility restoration surgery is very expensive and there is no guarantee of a successful outcome; the operation is performed under anesthesia, and these are associated risks; does not protect against sexually transmitted diseases and HIV infection.

PEARL INDEX 0.15 (A very small percentage of women have a pregnancy in the first year after surgery).

3 VASECTOMY

Type of male sterilization. During the operation, a man’s vas deferens are bandaged or removed, so that spermatozoa do not enter the ejaculate.

FOR Relatively simple operation; local anesthesia; libido, erection, ejaculation, sexual desire, orgasm do not change.

Vs You need to think carefully about your decision, as reconstructive surgery is much more difficult, expensive and success is not guaranteed. Does not protect against sexually transmitted infections.

PEARL INDEX 0.4 pregnancies per 100 women.

4 INTRAUTERINE SPIRAL

The IUD is a fairly common method of contraception in women aged 25-30. This is a small device that is inserted into the uterine cavity to prevent conception. Today there are about 50 types of spirals: round, spiral, T-shaped, made of copper or silver, hormonal, etc. The IUD prevents the implantation of the egg in the uterine wall, has a detrimental effect on spermatozoa (copper-containing spirals), affects their ability to pass through the cervix (hormonal). The average period of use is 2-5 years.

FOR High protection against unwanted pregnancy. Using the IUD, you can forget about other methods of protection for several years. The spiral does not affect lactation, is easily removed by a doctor and is inexpensive.

Vs May cause heavy periods in some women. A long stay of a foreign body in the body reduces immunity, and can also cause inflammation. The spiral is not recommended for nulliparous girls.

PEARL INDEX 1 pregnancy per 100 women.

HORMONAL CONTRACEPTION

5 HORMONAL IMPLANTS AND CAPSULES

hormonal drugs and injected subcutaneously, usually into the inner side of the left forearm. Once implanted, implants regularly release a hormone that prevents ovulation and also changes the lining of the cervix, making it difficult for sperm to travel. In 2018, a new progressive product is expected on the American market – a hormonal contraceptive chip that will be implanted under the patient’s skin and controlled using a smartphone and a special application.

FOR No need to change the implant frequently. The effect lasts approximately 5 years. The operation is quite simple and painless.

Vs Side effects: nausea, headaches and possible allergic reactions. Implants are not widely represented on the Russian market, hence the high cost. In addition, gynecologists do not recommend installing implants for women who have not yet given birth.

PEARL INDEX 0.3 pregnancies per year per 100 women.

6 COMBINED ORAL CONTRACEPTIVES

Combined oral contraceptives are synthetic analogues of female sex hormones. The mechanism of their action is as follows: approximately in the middle of the menstrual cycle, a woman ovulates, and COCs do not allow the egg to mature and leave the ovary. Tablets must be taken strictly within three weeks, after a break for a week: during this period, menstruation should come. There are many myths about pills: a sharp increase in weight, an increase in hairline and others. Here is what Natalya Viktorovna says about this: “The reason for the myths is oral contraceptives of the previous generation. They did have a wide range of side effects. Today, a properly selected drug can avoid unpleasant consequences. Before use, be sure to consult a gynecologist: an experienced doctor will select the necessary drugs for you based on your age, number of sexual partners, contraindications, and medical history.

ZA Highly effective and proven – COCs have been widely used by women around the world for about 50 years. Some drugs help with acne.

VS There is a risk of developing thrombosis if there is a predisposition. It takes discipline and regularity. In addition, COCs can reduce libido, cause allergies, nausea, breast tenderness, pigmentation, and mood swings.

PEARL INDEX About 0.5 pregnancies per year per 100 women for combined oral preparations.

7 HORMONAL INJECTIONS

Hormonal injections are intramuscular injections of the female hormone progesterone into the buttocks or upper arms. 1 injection has a contraceptive effect for up to three months. A suitable option for those who have a regular partner and who do not want to bother with taking pills.

FOR High protection. No need for daily use.

AGAINST Injections do not protect against infections and may cause decreased libido, nausea, thrombosis and other side effects.

PERLE INDEX Approximately 1 pregnancy per 100 women per year.

8 VAGINAL RING

This contraceptive is a flexible plastic ring that is inserted into the vagina. The ring releases 2 main female hormones: estrogen and progesterone, and they have a contraceptive effect.

FOR Local action – the ring does not affect the body as a whole, like tablets, and is easy to use. It is enough to apply it once every few weeks.

CON Side effects – nausea, dizziness, headaches, irregular cycles – are difficult to avoid. In addition, the ring does not protect against infections.

PEARL INDEX Up to 1.18 pregnancies per 100 women per year.

9 EMERGENCY CONTRACEPTION

Emergency contraception is used in cases of force majeure, after unprotected intercourse or when a condom breaks. It should be remembered that emergency methods are not an alternative to other methods of protection!

FOR The risk of unwanted pregnancy after unprotected intercourse is minimized (although not completely eliminated).

Vs Side effects: Nausea, headache and severe shock to the female reproductive system. This method cannot be abused.

PEARL INDEX 2.4 pregnancies per 100 women per year.

BARRIER CONTRACEPTION

10 MALE AND FEMALE CONDOMS

The most common type of protection, one learns about it at school. In addition to latex, there is also a spermicidal condom: its lubricant contains a small percentage of chemicals that destroy spermatozoa. According to Natalia Trofimova, gynecologists most often advise patients to combine the use of condoms and oral contraceptives (in the absence of contraindications). This is the best option for protection against both infections and unwanted conception. It will not be superfluous to check the expiration date: for condoms, it should be strictly no more than 5 years. Australian scientists, with support from the Bill & Melinda Gates Foundation, are currently hard at work developing a new generation of polymer hydrogel condoms that, according to the developers, will be more durable and elastic, will be self-lubricating, biodegradable, more pleasurable, and will be able to deliver locally defined dose of drugs (for example, Viagra).

ZA Availability and ease of use, wide selection. Condoms are the best protection against sexually transmitted diseases.

NO Protection against pregnancy is only 82% for male and 79% for female condoms. Many women complain about the ridiculousness of female condoms and the fact that they can make inappropriate sounds during sex. Latex allergy is a contraindication.

PEARL INDEX 5 to 12 pregnancies per 100 women.

11 BIRTH CAP, VAGINAL DIAPHRAGM AND SPONGE

Contraceptive cap is a reusable contraceptive, which is a silicone cup with a loop that is put on the cervix. Caps are recommended to be used in conjunction with spermicides. The contraceptive is inserted immediately before sexual intercourse and can be worn for about 48 hours.

The vaginal diaphragm is in the shape of a cup with a metal spring around the edge, it is inserted before intercourse so that the rim is in the walls of the vagina and the dome covers the cervix. The spring slightly presses on the walls of the vagina and urethra. The selection of the diaphragm by size is done by the gynecologist, you can wear a contraceptive for no more than 24 hours.

Sponge soaked in spermicidal solution looks like a small donut with an indentation that should fit snugly against the cervix. The sponge combines both mechanical and chemical protection. The size of the sponge is universal, and in the USA it can be bought in a regular supermarket.

ZA Caps & Co. are reusable, they do not change the hormonal background, they are suitable for breastfeeding women and for those who are contraindicated in hormonal drugs.

AGAINST In case of incorrect administration, the effect is extremely weak. They do not protect against infections, and the quality of sex is sometimes reduced. In addition, there are a number of contraindications.

PERLE INDEX 6 to 20 pregnancies per 100 women.

12 SPERMICIDES

Spermicides are chemicals that destroy spermatozoa within a short period of time (up to 1 minute). They contain special creams, jellies, suppositories, vaginal tablets, foams and films – all of which are freely available in pharmacies. By themselves, spermicides have a low contraceptive effect, so gynecologists advise combining them with barrier methods of protection.

FOR Ease of use, protection against certain infections.

AGAINST Low contraceptive effect. Spermicides can adversely affect the flora of the vagina. And one more thing: make sure that you are not already pregnant, because in this case there is a high risk to the fetus.

PEARL INDEX 25-30 pregnancies per 100 women per year.

NATURAL CONTRACEPTION METHODS

13 COOPULATION AND OTHERS

Coitus interruptus, the calendar method, the basal body temperature monitoring method, monitoring the consistency of secretions, and other methods that we inherited from our grandmothers and mothers are all natural methods of contraception. Even modern methods of protection do not give a 100% guarantee, and the reliability of “folk” methods is all the more out of the question: out of 100 women who use coitus interruptus as protection, an average of 19 become pregnant within a year-20. In addition, none of the natural methods protect against sexually transmitted infections.

In conclusion, before choosing a method of contraception, be sure to consult your gynecologist.

Methods of contraception: the best way to protect yourself and what you need to know about the risks of contraception

Some contraceptives are more effective than others. Some also protect against STIs, while others do not. We explain in detail how the different methods work and what the difference is.

Attention: this article is for informational purposes only. We can talk about modern methods of contraception, but only a doctor can prescribe them for you. Choosing your option, first of all, consult with a gynecologist.

Which methods of contraception do doctors recommend?

For a contraceptive method to be recognized by medical organizations and the international medical community, it must meet several criteria. In a nutshell: be effective and safe. These parameters need to be proven by clinical trials and meta-analyses. For example, douching the vagina with citric acid is not a method of contraception, it does not protect against pregnancy. And spermicides are recognized as a contraceptive, although not the most reliable.

All contraceptives discussed below are official and are listed as contraceptives on international medical resources: CDC, NHS, Planned Parenthood and many others.

Effectiveness of contraceptive methods according to CDC

Barrier method

Available products that can be bought at a pharmacy without a prescription. They do not let the sperm of a man into the uterus of a woman, and therefore fertilization does not occur. Apply immediately before sex – no additional preparation is required. Suitable for everyone.

Barrier contraceptives include male and female condoms, spermicides, diaphragm, cap and contraceptive sponge.

Condoms

There are male and female condoms. The male should be put on the erect penis. At the head, the tip of the condom is pulled up, then the condom is unfolded to the base of the penis. If everything is done correctly, the efficiency will be 98%. But in real life, about 82% comes out. After all, condoms sometimes break, they are put on incorrectly, they are used twice, and so on.

The female condom is a cylinder with two rings at the ends. It looks like a menstrual cup in reverse: the closed part of the condom faces the vagina, the open part faces the external environment. Efficiency in ideal application – 95%, in practice – about 79%.

Only condoms are effective enough to protect against STIs – sexually transmitted infections.

Spermicides

Chemicals that slow down the movement of sperm and prevent them from entering the uterus and fertilizing an egg. Spermicides are available in the form of creams, gels, and suppositories. If you use only them, the risk of getting pregnant is 28%. It is better to combine with a condom or a diaphragm for greater reliability.

Diaphragm and cap

Injected into the vagina and covers the cervix – a real shield against unwanted pregnancy. They differ in size and composition: the diaphragm is often rubber or latex, the cap is rubber or silicone. 80-90% effective if no additional spermicide is used. With him – 92-96%, that is, 100 women will have 4-8 pregnancies per year.

Contraceptive sponge

Alternative to diaphragm and cap. It’s a polyurethane disc impregnated with spermicide. May be in the vagina for 24 hours. At the end of the sponge there is a loop, like a sanitary tampon. After use, the sponge is also pulled out by pulling the loop.

Convenient, but not effective: A Cochrane review reports that a sponge is less effective at protecting against pregnancy than a diaphragm or cap. Of the 100 women who used the contraceptive sponge for a year, 17 became pregnant.

Combined oral contraceptives (COCs)

These are pills with hormones inside that block ovulation – this is the name of the release of the egg into the uterine cavity to meet the sperm and conceive a child.

If you do everything according to the instructions and take the pills strictly at the same time and without gaps, the effectiveness is 99% secured. But in practice, about 91% comes out, because the pills are often forgotten to be taken on time. This significantly reduces the contraceptive effect.

Taking pills is more suitable for those who have a regular sexual partner – COCs do not protect against STIs.

You may have heard that COCs cause infertility. This is wrong. Modern medical articles and clinical studies suggest that after stopping the pills, a woman can give birth to a child.

2018 meta-analysis including scientific data from 1985 to 2017 (22 large studies, tens of thousands of women), showed a cumulative pregnancy rate of 83.1% during the first 12 months after COC withdrawal – the same pregnancy rate as among women who have never taken COCs.

For you to understand, meta-analysis for a doctor is like a Rolls-Royce or Maybach car, only a spaceship can be cooler than them, and only a new meta-analysis can be cooler than meta-analysis.

Obstetrician-gynecologist Olga Belokon in the book “I am a woman. All about women’s health, contraception, health, hormones and more.0310

Contraceptive ring

Small hormone ring (estrogen + progesterone) to be inserted into the vagina once a month and removed after 3 weeks. Withdrawal bleeding occurs at week 4. This is not menstruation, but bleeding, which is caused by drug withdrawal. It is more convenient to use the ring than tablets – you just need to inject the drug into the vagina and pull it out only after 3 weeks. On the other hand, the presence of a foreign object inside will not seem convenient to everyone. The ring may fall out, but this is rare.

Efficiency 99%, in practice 91% – like COCs. The contraindications are the same.

Intrauterine Device (IUD)

The IUD looks like a small, T- or O-shaped plastic device that is placed into the uterus. The spiral is copper and hormonal.

• Copper Navy . Copper creates a toxic environment for sperm inside the body – it starts the process of phagocytosis, or the devouring of sperm by cells of the immune system.

• Hormonal IUD. Works according to the scheme already known to us from COCs: it blocks ovulation. It also thickens the mucus in the cervix so that sperm cannot get to the egg. Instead of the familiar full-flowing river, they end up in jelly.

The efficiency of the method is 99%. It is hard to lower it, since the spiral is just inside and does its job. You have no influence on her. But the device must be inserted by a doctor: before installation, an examination is needed to understand how to properly position the IUD. The spiral is placed in 10-15 minutes, and it is usually painless, but it all depends on your pain threshold. It might be a little embarrassing.

Most women can use an IUD, but contraindications include pelvic inflammatory disease, cervical cancer, endometrial cancer, anatomical abnormalities, and others.

With such a coil, you can walk inside from 3 to 12 years – it all depends on the manufacturer and the hormonal composition of the coil. The IUD is considered one of the most effective methods of contraception on a par with the placement of an implant.

Implant contraception

Protection against unwanted pregnancy for 3 years by microchipping – insertion of a subcutaneous implant. It looks like a cotton swab, only without cotton wool at the ends. It is necessary to pierce the skin in the middle of the shoulder, in its inner part, and insert the device. The wand is located shallow and will be felt through the skin. She secretes the hormone etonogestrel – ovulation is canceled, pregnancy does not occur. Efficiency 99%, that is, less than one pregnancy per year among women who wear an implant under the skin.

Main contraindications: pregnancy, breast cancer. Common side effects: Amenorrhea occurs in 22% of patients – this is when there is no menstruation at all. Although it is safe, it is still uncomfortable and unusual for a woman.

Injectable contraception

A type of hormonal contraception that requires one injection every 3 months, either subcutaneously or intramuscularly. The injections contain the hormone progesterone, which blocks ovulation.

Injectable contraception is effective – 94% guaranteed. There are 6 pregnancies per 100 women who choose this contraceptive.

There are contraindications for use: migraine, uncontrolled hypertension, thrombosis, cancer. Migraine is not just listed first: injectable contraceptives have a side effect in the form of headaches. Strong and nasty. But if such a reaction does not occur within the first 8-13 weeks, most likely, everything will be in order.

Transdermal contraception

Sounds scary, but it’s just a skin patch. It looks like a patch for nicotine addiction, only it solves a completely different problem. The scheme is the same: hormones block ovulation and prevent the sperm from reaching the egg. Efficiency 99%, in practice 91% – like COCs. The instruction is simple: stick it on the skin on the first day of menstruation, and you are protected from unwanted pregnancy. But not from STIs – remember this.

The patch is recommended to be attached in the lower abdomen or on the shoulder, not recommended – on the chest. Every week the patch needs to be moved to a new place. It should be dry – do not apply lotion or cream. After 3 weeks, take a week break – menstruation occurs. It’s easy to stop taking hormones – remove the patch, and you can get pregnant again.

Contraindications are the same as for COCs – you can see them in the instructions for the drug, in the WHO application and on the Mayo Clinic website.

Calendar method

Also known as standard day method. Only suitable for women with regular menstrual cycles day to day.

Calculate unfavorable days for pregnancy on the calendar using the calendar. This is the time of ovulation and 5 days before and after it. It turns out that from the 8th to the 19th day of the cycle, you need to use contraception or not have sex at all. If you don’t keep notes or don’t use a calendar app, it’s going to be hard to figure it out. And if you have an irregular cycle, it’s easy to miscalculate in days.

With ideal calculations, the efficiency of the calendar method is about 95%. But in reality – a maximum of 75%.

Coitus interruptus

Method of contraception in which, immediately before ejaculation, the man removes the penis from the vagina and removes it from the external genitalia so that spermatozoa do not get inside and fertilize the egg.

This is the most risky method of contraception – it requires self-control and readiness for the appearance of a child in a couple.

PPA has a 20-30% chance of pregnancy. With perfect observance of all the rules, self-control of a man and in combination with the calendar method, it can be reduced to 4%.

Lactational amenorrhea method

Breastfeeding is a contraceptive given to a woman by nature. In the first months after childbirth, a nursing mother cannot become pregnant. The lactational amenorrhea method is 98–99% effective under three conditions:0003

Female sterilization

This is a surgical method of contraception. The point is to make the fallopian tubes impassable – ligate them. Surgical access and the technique of the operation are different: they are selected individually by operating obstetrician-gynecologists.

With closed tubes, the egg will forever be inaccessible to spermatozoa. This does not cancel menstruation and ovulation in women, but it makes the fertilization process impossible. Pregnancy can occur only if you resort to IVF – in vitro fertilization.

In Russia, according to the law, sterilization is carried out if:

• the woman has indications for sterilization,

• she is over 35 years old,

• she has two or more children .

Efficiency 99%. Not 100%, because there is a possibility of a medical error during the operation. Therefore, it is recommended to protect yourself for 3 months after the operation – suddenly the pipes remained passable. After 3 months, you need to come to the doctor, make sure that the pipes are blocked, and only then stop using protection.

Male sterilization

A radical method of contraception for men who have made the decision not to have children and qualify under the medical sterilization law. The procedure is called a vasectomy, and its purpose is to cut the vas deferens. Through it, seminal fluid with sperm enters the ejaculatory duct so that they and sperm can fertilize the woman’s egg. Transection of the duct deprives the seminal fluid of spermatozoa, and without them there is no fertilization. The operation can be performed on men even with prostate cancer, coronary heart disease and hypertension – it is safe. There are no absolute contraindications. Vasectomy can be surgical and without the use of a scalpel. In the first case, an incision is made, in the second – a puncture. A Cochrane review considers the no-scalpel method to be effective and safer, but more research is needed to confirm. Vasectomy Efficiency – 99.85%.

For some time after the operation, additional methods of contraception must be used – the rules are the same as for female sterilization. The difference between male sterilization and female sterilization is that vasectomy can be reversible. The chance of duct repair is 55% within 10 years after surgery and 25% 10 years after it.

Emergency contraception

Emergency contraception is used if:

• you have had unprotected sex in the last 5 days;

• you have not used your contraceptive method correctly.

For example, during sex, a man did not have time to remove the penis from the vagina in time, and the sperm got inside. Or the condom broke.

There are several options for emergency contraception:

• taking pills with the hormone – levonorgestrel or ulipristal acetate,

• insertion of a copper intrauterine device – copper destroys spermatozoa,

  90 329

• taking several COCs.

Taking emergency contraception protects against unwanted pregnancy and does not lead to complications and deaths: these fears are caused by a lack of knowledge about what is inside the pills. And inside is just a dose of a hormone that suppresses fertilization.

Taking hormonal pills is safe, but, like many drugs, they affect the whole body in one way or another. This means that there is a risk of side effects: nausea, dizziness and spotting may be disturbing. But it will pass in a day or two.

In terms of effectiveness, the intrauterine device is the champion here – 99%. But it is up to a specialist to decide what to drink or insert into the vagina. Therefore, at the risk of pregnancy, contact your obstetrician-gynecologist as soon as possible.

What is the most reliable method of contraception?

The most reliable way is abstinence.