Birth Control - Laney College

Birth Control
Biology 27, Laney College
Fall 2012
Adapted from the presentation “Birth Control and
Fertility,” © 2012 San Francisco Sex Information.
Contraception
•  To prevent conception (sperm and egg meeting)
•  Can do this by:
–  Causing absence of egg
–  Causing absence of sperm
–  Placing barrier (chemical/physical)
between egg & sperm
–  Changing body chemistry
–  Changing behavior
•  Effectiveness: chance of
pregnancy over a year
Levels of Effectiveness
Most Effective: < 1 per 100
• IUDs
• Implanon
• Sterilization
Very Effective: 2-9 per 100
• Injections
• Pill, Patch, Ring
Moderately Effective: 15-24 per 100
• Condoms
• Diaphragm
• Withdrawal
Effective: > 25 per 100
• Cervical Cap
• Fertility-Based Methods
• Spermicide
• Sponge
MOST EFFECTIVE
Implanon / Nexplanon
•  Surgically implanted under
skin between bicep & tricep
•  Made of flexible plastic
•  Good for 3 years
•  Contains progestin only
•  Main side effect:
irregular periods
•  99.95% effective
Mirena IUD: Hormonal
•  Progestin-only
•  Fine for women who
haven’t had kids
•  Doesn’t affect fertility
after removal
•  Good for 5-7 years
•  Main side effect:
no periods
•  99.9% effective
Mirena IUD: Hormonal
Paragard IUD: Copper T
•  Different theories about exactly
how it works: Copper zaps sperm?
Makes the uterus a hostile place for
sperm?
•  Fine for women who haven’t had
kids
•  Doesn’t affect fertility after removal
•  Good up to 12 years
•  Main side effects: heavier periods
for some women
•  99.4% effective
♀ Sterilization: Tubal Ligation
•  “Getting tubes tied”
•  Block fallopian tubes by
cutting, burning, or
scarring
•  Can be hard to find a
doctor who will do it for a
person without children
•  Reversal difficult
•  99.5% effective
♂ Sterilization: Vasectomy
•  Cutting vas deferens
•  Can be hard to find a
doctor who will do it
for a person without
children
•  Reversal difficult
•  99.85-99.9% effective
VERY EFFECTIVE
Depo-Provera (“the shot”)
•  Progestin-only
•  1 injection every 3-ish
months
•  Discreet
•  Major side effects:
weight gain,
irregular periods,
slow return to fertility
•  97-99.7% effective
Birth Control Pills
•  Combined oral
contraceptives (COC):
estrogen & progestin
•  Progestin-only pills
(POP or mini-pill)
•  Most common
reversible BC method
in US
•  92-99.7% effective
Ortho-Evra Patch
•  Estrogen & progestin
•  Wear patch for 1 week,
then replace with new
patch
•  Leave patch off for 1 week
and have period (or don’t)
•  Similar side effects as in
BC pills
•  92-99.7% effective
NuvaRing
•  Estrogen & progestin
•  Insert ring in vagina
and leave in place for
3+ weeks
•  Remove during 4th
week and have period
•  Can take out for sex,
must be put back in
within 3 hours
•  92-99.7% effective
Hormonal Birth Control
•  Highly effective (over 99% with perfect use)
•  May have side effects (good or bad)
•  Require Rx or visit to health care provider
•  Most have to be taken or
replaced regularly
•  No STI protection
•  Reversible
•  May be expensive
•  Some people dislike idea
of taking hormones
Hormonal Side Effects
Worsened acne
Decreased libido
Weight gain
Spotting
Mood changes
Nausea
Breast tenderness
Decreased facial hair
Bloating
Headaches
… or Improved acne
… or Increased libido
… or Weight loss
… or Less painful periods/no periods
Everyone reacts differently to every method!
Combined vs Progestin-Only Methods
•  Combined: most Pills, the Patch, the Ring
•  Estrogen doesn’t go well with high blood pressure,
migraines, or history of blood clots
•  Estrogen tends to contribute most side effects
•  If someone hates a combined method, they may
feel fine on a progestin-only method
•  Progestin-only: mini-pills, Depo,
Mirena, Implanon
Skipping “Periods” on Birth Control
•  Pills: skip placebo pills
•  Ring: can leave in place
up to 35 days
•  Patch: can leave each
patch in place up to 9 days
“Periods” on Hormonal Birth Control
•  No such thing!
•  Withdrawal bleed:
–  Uterine lining always thin
due to progestin
–  Destabilize uterine lining  bleeding
•  Cessation of estrogen-containing method
•  High amounts of progesterone vs. estrogen
•  Not medically necessary
•  Periods are not necessarily a reliable “pregnancy test”
MODERATELY EFFECTIVE
Barrier Methods: Condoms
•  Latex, polyurethane, polyisoprene, or membrane
•  85-98% effective against pregnancy
Barrier Methods: Condoms
•  Advantages:
–  STI protection!!!
–  Do not need prescription
or visit to clinic
•  Disadvantages:
–  Need partner cooperation
–  Less effective against pregnancy
–  Easy to use incorrectly, easy to not have available
–  May need to interrupt sex or plan ahead to use
Barrier Methods: Female Condom
•  “Reality”; “FC2”
•  FC: polyurethane
•  FC2: nitrile
•  Vaginal or anal
•  Awkward?
•  STI protection!
•  79-95% effective
against pregnancy
Withdrawal
•  “Coitus Interruptus” or “pulling out”
•  Requires male partner to know his body and
use control—can be difficult for some men,
can be difficult in the moment, can be
difficult if you’re under the influence
•  Free! No side effects!
•  May reduce HIV transmission better
than no method at all
•  Peeing before sex can improve
effectiveness
•  83-97% effective
Combined Chemical & Physical Methods
•  Cervical cap, diaphragm,
FemCap, Lea’s Shield
•  Require fitting at clinic and
Rx to pick up right size at
pharmacy
•  Latex rubber or silicone cups,
fill with spermicide and
insert into vagina before sex
•  Must be left in place for a few
hours after sex
EFFECTIVE
Fertility Awareness Methods
Natural Family Planning (NFP)
–  Cycle Beads
–  Cervical mucus
–  Basal Body Temperature
•  75-99% effective
Spermicides
•  Vaginal Contraceptive Film
(VCF); gel, jelly, foam
•  Available over the counter
•  Can be combined with
other methods
•  May increase risk of HIV or
herpes transmission
•  Tastes terrible and numbs
your mouth
•  71-82% effective
Today Sponge
•  Good for 24 hours
•  Must be left in place at
least 6 hours after sex
•  60-91% effective – less
effective for women
who have given birth
AND ALL THE REST
Not Having Intercourse
•  May mean complete
abstinence from all
sexual activities
•  May mean having
different kinds of sex:
oral sex, mutual
masturbation,
same-sex partners
•  0-100% effective
Emergency Contraception
“Morning After Pill”, “Plan B”
•  High dose of progestin
•  Effective up to 5 days after
sex—sooner is better
•  Prevents ovulation
•  Doesn’t harm an existing pregnancy
•  Next period may be early or heavy
•  Not best first line of defense
•  Plan B is over the counter for ages 17
and over
Future Methods
•  Vaccines
•  Topical microbicides
•  Nasal Sprays
•  New Shots
•  BC for men
–  RISUG: Reversible Inhibition of Sperm Under
Guidance
THINGS TO THINK ABOUT
Choosing Birth Control
•  Hormones or not?
•  How effective does it need to be?
•  How much does it cost?
•  Can anyone find out about it?
•  How often do I have to take or use it?
–  Daily? Every time I have sex? Set it and forget it?
•  How do I get it?
–  Doctor, over the counter, DIY
Birth Control Resources
•  bedsider.org
–  Geared toward younger women, but great information
and easy to use.
•  womenshealth.gov
–  Birth control, and lots of other resources, too.
•  Contraceptive Technology
–  If you’re a huge nerd.
Questions and Comments?