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Preventing Pregnancy

- Contraceptive Choices - Birth Control Methods and Options

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Updated November 25, 2003

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 smokeand are over 35 or who have a significant family history ofcardiovascular 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.
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