Contraception Today:

What’s new?

Carol E. Peterson, MS, RNWyoming Health Council

Contraception Today: Lots of Options!

Contraception Today: Lots of Choices!

Pills (combined and progesterone only)

Injections

Contraceptive Devices (patch, ring)

IUD / IUS

Barrier Methods (condoms, diaphragm)

Spermicides

Implants

Sterilization

Oral Contraception - ReviewCombined Hormonal (various doses) – estrogen and progesterone (1960s)Progesterone only / mini pills (1973) must be taken within 1 -2 hour window every dayRx only; Must take daily; Still the most popular methodNo protection against STDsCombined failure rate: perfect use 0.3% / typical use 8% (Progesterone only has higher failure rate)

InjectionsDepo Provera IM (1992)(Depo Sub Q – (2005) may allow for self-injection at some point)Repeat injections every 3 months; must be given on timeIrregular bleeding at first – mostly amenorrhea after a few monthsConcerns about bone de-mineralization with teens and long term usersRx only; No protection against STDsFailure Rate: perfect use 0.3% perfect use / typical use 3%

Transdermal Patch (2001)Patch applied to skin

Useful for those who have difficulty remembering to take a daily pill

Apply new patch ever week for three weeks

Hormone is in the adhesive – so must stick – must replace if comes off

No protection against STDs

Failure Rate: perfect use 0.6% / typical use 8%

Emergency Contraception– Plan BAKA – “morning after pill” / prevents release of / fertilization of egg (not to be confused with RU 486 – the “abortion pill”)

Actually two progesterone only pills ( equal to 20 mini pills)

Most effective the sooner it is taken / up to 5 days after unprotected intercourse

75 - 89% effective

Advanced provision increases effectiveness ~ 1.7 million unintended pregnancies per year could be averted

Vaginal Ring (2001)Estrogen and progesterone imbedded in soft, flexible ring; slow continuous releaseAdded benefit - improves vaginal floraInserted into vagina – stays in place for 3 weeks & removed for oneWoman doesn’t feel it – most male partners don’t eitherNo protection against STDsRX only; one size fits allFailure Rate: perfect use 0.3% / typical 8%

IUD / IUS

Paraguard (copper) IUD– RX / good for 10 years; In-office procedure– May make periods heavier– Failure rate (0.8%)

Mirena (progestin) IUS (2001)– RX / good for 5 years; In office procedure– Makes periods very light / 80% amenorrhea– Failure rate 0.1% (nearly perfect)

No protection against STDs with either

Barrier MethodsOffer some protection against STDs

– Male condom• Research is clear -YES they are effective for

birth control and STD prevention if used consistently and correctly

• Failure Rate: Perfect use 2% / typical use 15%

– Female condom• Used more by MSM• Failure Rate: Perfect Use 5% / typical use

21%

OthersDiaphragm– Insert up to two hours prior to intercourse –

leave in for 6 hrs after – Use with spermicide (and a condom to

increase effectiveness and protection) – Rx only – must be fitted– Failure Rate: 20%

Spermicides – contraceptive foam, jelly, suppositories, film – OTC– Use with a condom as their failure rate can be

as high as 50% when used alone

Sterilization

Tubal Ligation - female

Vasectomy - male

Essure – (2003) Device inserted into fallopian tubes – causes overgrowth of tissue and scaring in tubes; takes special training – not widely available here

So What’s New? Continuous Contraception – Continuous delivery of hormonal contraception to prevent ovulation

All human beings miss some pills from time to time; extended use keeps the ovaries “asleep”

Continuous use of pills and ring already being promoted by some practitioners (off-label)

Do not use the patch for this purpose

Continuous UseAdded benefit of Menstrual Suppression; allows women some control over when or if they menstruateStudies show many women interested in this! No known long term consequences – studies continue.Seasonale / Seasonique – approved pills; periods only 4 times a yearLybrel – Pills formulated for one year continuous use; currently under review of FDA

Menstrual Suppression

Mirena IUS and Depo - provide suppression for most womenImplanon – Implant with progesterone only; just received FRD approval Nuvaring – Combined hormonal method under FDA review for this purpose (ring has enough hormone to last for 35 days);Ortho Evra Patch – Combined method NOT Recommended for this purpose; rate for hormone deliver too high

Implanon

Single rod implant – 40mm x 2mm

Easy to insert and remove

Lasts for three years

Progesterone only

Causes amenorrhea

Delivers a steady level of hormone

FDA approved July 2006

Used in Australia for over four years now

Failure rate 0%

What Else is New?

Today Sponge – back by popular demand nonoxynol - 9 spermicide – available OTCNew Spermicide / Microbicide Gels in clinical trials; offer some protection against STDs, including HIV (non n-9 products)– Ushercell– BufferGel & Buffer Gel Duet (gel with a

diaphragm-like device).

Finally … Male ContraceptionMales have not had a lot of options for sharing the responsibility for contraceptionMale contraceptive pill/injection has been elusiveIn Clinical Trials: – Reversible Inhibition of Sperm Under

Guidance (RISUG) – Injectable gel coats wall of vas and kills sperm– Azoospermia in 12 men 5 days after injection– Intra Vas Device (IVD) – also reversible– Soft hollow silicone plugs implanted in the vas;

complete blockage in 27 / 30 men with very low counts in the other 3

Family Planning ClinicsWide variety of FDA approved contraceptives available on a sliding fee scaleSTD and HIV testingConfidential Services; Title X required adolescent servicesLocal experts – presentations, resources about sex education, contraceptives and STDsHealth maintenance / prevention / referralTo find a Family Planning Clinic near you go to www.wyhc.org

Questions?

Carol Peterson, MS, RN

Wyoming Health Council

2120 O’Neil Ave.

Cheyenne, WY

307-632-3640

carol@wyhc.org