Contraceptives: What Are They For? How Are They Used? What To Expect?

WHAT ARE CONTRACEPTIVES TAKEN FOR?

Hormonal contraceptives such as the pill, patch, and vaginal ring release a steady dose of estrogen and/or progestin. These hormones prevent the ovaries from releasing an egg (i.e. ovulation) and thickens the cervical mucus so sperm cannot enter uterus to fertilize the egg, thereby preventing pregnancy.1,2

If you do not want to get pregnant there are many options for birth control. Your health and many other factors play a role in determining which method is most ideal. Talk to your healthcare provider to discuss which birth control method may be best for you.3,4,5,6 

Method

Use

Pros

Cons

Find out more!

HORMONAL METHODS

Combination estrogen/progestin pill

Active hormone pill taken for 21 days then inactive (placebo) pill or no pill taken for 7 days at which point menstruation occurs.

Can decrease pre-menstrual/menstrual cramping and cyclic mood swings

 

Controls your menstrual cycle and may lighten menstrual flow

 

Improves acne

 

Fertility returns to normal upon discontinuing use

Must remember to take at the same time everyday

 

Increased risk of blood clot formation.

 

Not recommended for women 35 years or older and/or those who smoke as this further increases the risk of blood clot formation

Mayo Clinic

AHRP

Progestin-only pill (mini pill)

Active pill taken everyday (no inactive pills).

Because it lacks estrogen, the mini pill can be used in women who cannot tolerate estrogen (i.e. have a history of blood clots, are smokers, suffer bad headaches from estrogen).

Less effective at preventing pregnancy and has poor cycle control causing a higher degree of breakthrough bleeding. This is because it only contains the progestin component.

 

Consistency is key. If taken 3 or more hours late a back-up barrier method (such as a condom) is required for the next 2 days.

Mayo Clinic

WebMD

 

Patch containing estrogen and progestin

Place a new patch and remove old patch once a week for 3 weeks (21 total days). No patch is worn on the 4th week and menstrual period starts on this patch-free week.

Weekly patch application rather than daily dosing of oral medication

 

Possibility of lighter and less painful periods

Increase the risk of blood clots and stroke due to higher levels of estrogen exposure

 

Less effective for women over 198 pounds

Mayo Clinic

Vaginal ring

Small ring inserted into vagina for 3 weeks that releases estrogen/progestin. Ring removed on the 4th week which is when menstruation occurs.

Regular, lighter and shorter periods

Increased risk of blood clot formation

 

The ring can slip out. If this happens, rinse ring with lukewarm or cool water and reinsert it. If the ring was out of the body for over 3 hours, replace the ring and use a backup barrier method for at least 7 days.

AHRP

Progestin injection

Shot of progestin into the muscle or under the skin given every 3 months by a healthcare provider

Long-term protection against pregnancy

 

Because it lacks estrogen, the progestin shot can be used in women who cannot tolerate estrogen (i.e. have a history of blood clots, are smokers, suffer bad headaches from estrogen).

Risk loss of bone density if receive shot for over 2 years

 

Possible delay in fertility after last injection

WebMD

IMPLANTED DEVICES

Intrauterine Device (IUD)

Releases copper or progestine into the uterine lining and upon being inserted by a healthcare provider can remain in place for years

Convenient

Copper IUD serves as a hormone-free option

Possibly inappropriate for women who experience heavy menstrual bleeding, have a history of pelvic infections, multiple sexual partners, or plan on getting pregnant soon.

Must be inserted by health care professional

WebMD

ARHP

Implantable rod

Inserted under the skin where it releases progestin and can remain in place for up to 3 years.

Convenient

Option for women who cannot use estrogen

Must be inserted by health care professional

WomensHealth

ARHP

BARRIER METHODS

Male condom

 

Female condom

 

Diaphragm    

 

Cervical cap  

 

Contraceptive sponge

Barrier methods block sperm from reaching the egg. Spermacide kills sperm and works best when used with a barrier method.

Spermacide can be purchased over the counter

Barrier methods must be in place prior to sex

 

Spermacide shoud be placed into the vagina no more than 1 hour before having sex

WomensHealth

How effective are oral contraceptives at preventing pregnancy?7,8

When used typically by the average person oral contraceptives have a failure rate of nearly 10%. The best way to avoid unwanted pregnancy if sexually active is to use effective birth control consistently and correctly.

  • Use AHRP.org’s Method Match to help select your preferred birth control method.

 

HOW SHOULD ORAL CONTRACEPTIVES BE USED?

How should I take my oral contraceptive?

  • Oral contraceptives should be taken at the same time every day.

What should I do if I miss a dose?9

  • Missing a dose of your oral contraceptive can increase the chance of unwanted pregnancy. Each type of oral contraceptive has specific instructions on how to address a missed dose which can be found in the package insert. Ask your healthcare provider if you have any questions on what to do in the event of a missed dose.

 

WHAT SHOULD I EXPECT WHEN TAKING ORAL CONTRACEPTIVES?

Do oral contraceptives prevent against sexually transmitted infections?10,11

  • No, oral contraceptives do NOT protect against sexually transmitted infections (STIs). Barrier methods such as a condom should be used to protect against STIs.
  • Condoms reduce the risk of STIs and human immunodeficiency virus (HIV) transmission.

What are common side effects of oral contraceptives?12,13,14

  • Side effects with oral contraceptives are possible, but not everyone gets them.
  • Common side effects include nausea, weight gain, mood changes, breast tenderness, and bleeding between periods. These side effects can often be managed by switching to a different oral contraceptive or a different birth control method.
  • There is a chance of developing a clot while taking combination birth control pills. The estrogen is what increases the risk of clot formation (i.e. embolism) and the risk is the highest during the first year of use. Risk factors include age > 35 years old, smokers, and those who have high blood pressure, high cholesterol, and/or diabetes
  • Report stomach pain, chest pain, headaches, blurred vision, or swelling or pain in the legs to your healthcare provider as these may be signs of a blood clot.
  • Smoking increases the risk of clot formation which can lead to blood clots in the deep veins, heart attack, and stroke when taking combination birth control pills. When deciding on a birth control method discuss your risk factors for heart disease with your healthcare provider. Call the California Smokers’ Helpline at 1.800.NO.BUTTS to help you quit smoking.

Can oral contraceptives cause cancer?15

  • Oral contraceptives lower the risk of ovarian and endometrial cancer, but the risk of breast, cervical, and liver cancer appear to be increased. Risk factors such as duration of oral contraceptive use play a role in the development of cancer.

Can other medications decrease the effect of my birth control?16

  • Some antibiotics and herbal medications, among others, can decrease the effect of your birth control and increase the risk of unwanted pregnancy. Bottom line: Tell your healthcare provider ALL medications you are taking to avoid drug-drug interactions.

Medications that can decrease the effect of your birth control include:

  • Heartburn medications such as antacids (i.e. Tums®), histamine-receptor antagonists (i.e. Pepcid®), and proton pump inhibitors (i.e. Prilosec). Avoid using these medications because they can reduce absorption of oral birth control.
  • Anti-seizure medications (i.e. carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone)
  • Antibiotics. Rifampicin and rifabutin reduce birth control levels and an alternative form of birth control will be needed while taking these medications. If having diarrhea and/or vomiting from taking any antibiotic or your illness itself, a back-up form of birth control may also be required.
  • HIV medications (i.e. ritonavir). Additional and/or alternative method of birth control advised with ritonavir-containing regimens.
  • Herbal supplements (i.e. St. Johns wort) can reduce birth control levels.
  • If taking a medication that interacts with your birth control method, your healthcare provider may suggest changing to a method that is unaffected, altering your current birth control regimen, and/or using a barrier form of birth control (i.e. condoms)
  • If advised to use additional contraception your usual method may be ineffective and contraceptive protection is provided only by the condom.
  • You can use emergency contraception if additional contraception fails or is not used.

 

EMERGENCY CONTRACEPTION17,18,19

How does emergency contraception work?

  • Emergency contraception changes the endometrium (delays ovulation and thickens the cervical mucus) so that it cannot secrete certain chemicals to nourish the embryo and facilitate pregnancy.

How soon can I take the emergency contraceptive pill?

  • Emergency contraception is effective if taken soon after unprotected intercourse.  The emergency contraceptive pill can be taken up to 120 hours (5 days) after unprotected intercourse, but the sooner it is taken after the event, the more effective it will be.
  • You do not have to wait till the morning after to use emergency contraceptives after having unprotected sex.

How can I get emergency contraception?

  • Go to your pharmacy or healthcare clinic. Some methods can be dispensed at the pharmacy without a prescription. Talk to your healthcare provider to see which method is right for you.

Can I use my oral contraceptives as a form of emergency contraception?

  • Yes, but it is less effective than Plan B. The Yuzpe regimen requires that a very specific dose of combination oral contraceptive be taken to effectively prevent pregnancy. Contact your healthcare provider to provide the most effective dose that must be taken to reduce the risk of pregnancy if this method is to be used.

What are the side effects of emergency contraceptive pill?

  • Possible side effects include nausea or vomiting, dizziness, fatigue, headache, breast tenderness, and irregular menstrual bleeding. These symptoms may last a few days after taking the emergency contraceptive pill.
  • Take with food to avoid nausea and vomiting.

When to contact your healthcare provider:

  • If you get severe pain in legs, stomach or chest, vision or breathing changes, yellowing of skin, headaches, numbness, or trouble speaking.
  • If you vomit the emergency contraceptive pill.
  • If your menstrual period does not start.

 

References

  1. http://www.hhs.gov/opa/reproductive-health/contraception/birth-control-pills/
  2. http://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html
  3. http://www.fda.gov/ForConsumers/ByAudience/ForWomen/FreePublications/ucm313215.htm
  4. http://www.arhp.org/publications-and-resources/patient-resources/fact-sheets
  5. http://studenthealth.ucsd.edu/birthcontrol.shtml
  6. http://www.acog.org/~/media/For%20Patients/faq021.pdf
  7. http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm#
  8. http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/PDF/Family-Planning-Methods-2014.pdf
  9. http://www.arhp.org/Publications-and-Resources/Patient-Resources/fact-sheets/Successful-Contraception
  10. http://www.nichd.nih.gov/health/topics/contraception/conditioninfo/pages/std-prevention.aspx
  11. http://www.fda.gov/forpatients/illness/hivaids/prevention/ucm126372.htm
  12. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601050.html
  13. http://www.nobutts.org/About%20Us.shtml
  14. http://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html
  15. http://www.cancer.gov/cancertopics/factsheet/Risk/oral-contraceptives
  16. http://www.medicinenet.com/oral_contraceptives/page3.htm
  17. http://ec.princeton.edu/
  18. http://www.mayoclinic.org/tests-procedures/morning-after-pill/basics/definition/prc-20012891
  19. http://www.arhp.org/Publications-and-Resources/Patient-Resources/Fact-Sheets/EC

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