Use

Before having the implant put in, it’s important to be sure you’re not pregnant. To avoid getting pregnant in the first two weeks after insertion, it is a good idea to use another method of birth control such as male or female condoms. When the implant is inserted, the clinic will give you a card with the insertion and removal dates. The removal date is important because you cannot count on your implant to prevent pregnancy after that date. Pregnancies are very rare with the implants but if you do get pregnant while you have one, you have a higher chance of tubal or ectopic pregnancy than other women. This is a very dangerous type of pregnancy where the fertilized egg grows outside the uterus. If you have an implant and think you might be pregnant or if you have severe abdominal pain, get medical help right away.

Insertion and Removal

Insertion of a contraceptive implant is simple and quick. Removal is a little more difficult.

Insertion: The implant is inserted in a clinic or doctor’s office. If you are right-handed it is usually put in your upper, inner left arm. If you are left-handed, it is usually put in the upper, inner right arm. You will lie down on an exam table with your arm resting over your head. They will clean your arm with antiseptic and numb the area of insertion with lidocaine. This is the same numbing medication used by dentists.

The implant will be put into a special inserter, which punctures your skin. Then the implant is slipped in just under the skin. You can’t see it, but you can feel it if you press gently. A pressure bandage prevents bleeding for the first 24 hours. There will probably be some bruising or soreness in your arm for a few days.

Removal: The implant is removed through a small incision. Usually it is just under the skin and the incision is very small, less than a half inch. As when the implant was inserted, your upper, inner arm is numbed. After the incision is made, a sterile gauze or forceps are used to rub off any scar tissue around the implant. Then it is gently slipped out with forceps. The incision is usually held closed by small adhesive bandages and a pressure bandage stays on for 24 hours. Soreness and bruising are common. You can get pregnant immediately after it is removed.

Rarely, when the implant was inserted too deeply or if it has moved since the insertion, it may not come out easily. You might have to have it located by ultrasound or MRI and you might have to have a deeper incision done in an operating room. This is very unlikely.

Reinsertion: You need to have the implant removed when it expires. You can however, have a new one inserted at the same time the old one is taken out.

Changes in Menstruation

Most women using implants have changes in their menstrual periods. Many women have unpredictable light spotting. Other women stop bleeding altogether. Some women have heavier bleeding. If bleeding is a problem for you, your healthcare provider may be able to help control it by prescribing birth control pills or other medications.

Your Health

You should not use the contraceptive implant if you are or think you might be pregnant or if you have any of the following health conditions:

• History of serious blood clots such as blood clots in your legs (deep venous thrombosis) in your lungs (pulmonary embolism) in your eyes (retinal thrombosis)
• History of heart attack or stroke
• Unexplained vaginal bleeding
• Liver disease
• Any breast cancer now or in the past
• Allergy to anything in the implant

Women who have diabetes, high blood pressure, high cholesterol or high triglycerides, headaches, epilepsy, depression, gallbladder disease, kidney disease, or are breastfeeding may not be able to use the implant. Certain medications or herbal products can stop it from working.

Risks

It is possible to get an infection where the implant was inserted or removed. If you notice any redness, heat or irritation of the skin after an insertion or removal, you should contact your healthcare provider. Most women have a tiny scar from insertion and removal but rarely there can be large amounts of scar tissue formed. It is possible that the implant could be very difficult or even impossible to remove. This could happen if it moves, breaks or is inserted too deeply. It is possible that the implant could be expelled, although you would most probably notice this. If you notice it coming out, you should contact your healthcare provider.

It is not known if contraceptive implants increase a woman’s risk for serious internal blood clots called thrombosis. We do know that birth control pills and pregnancy increase this risk and contraceptive implants contain one of the hormones that are in birth control pills.

Side Effects

Some women with implants may have weight gain, headache, mood swings, acne and depression. Other possible side effects are vaginal inflammation or dryness, breast pain, stomach or back pain, nausea, dizziness and pain where the implant was inserted. Side effects that are very rare include extra hair on the body or face, trouble with contact lenses, and spotty darkening of the skin, especially on the face.

Drug Interactions

The effectiveness of the implant is lowered when taken with certain medications, including antibiotics, anti-seizure, tuberculosis, and migraine medications. Some drugs used to treat HIV or AIDS may also interfere with the implant. If you are taking any medications, tell your clinician. When taking medications that may interfere with hormonal birth control, consider adding a backup method, like male condom, female condom or spermicide. As with all drugs, it is useful to inform all you medical providers if you are using the implant.

Danger Signs

Women who experience any of the following symptoms while using the contraceptive implant should call the clinic immediately:

• Abdominal pains (severe)
• Chest pain or shortness of breath
• Headaches (severe)
• Eye problems, such as blurred vision
• Severe leg or arm pain or numbness

Advantages

• Easy to use
• Can be worn for three years
• Does not interrupt sex play

Disadvantages

• Does not protect against sexually transmitted infections, including HIV/AIDS
• Raised risk of heart attack and stroke
• Requires a prescription

More Info

• Implanon (bfand name) www.implanon-usa.com
• Nexplanon (brand name) www.nexplanon-usa.com

Some people have criticized withdrawal as a non-method, yet it is 73-96% effective for pregnancy prevention, depending on the male partner’s self-knowledge and self-control. When no birth control is practiced, 85% of heterosexually active partners are likely to become pregnant in a year, only 19% of partners who use withdrawal are. Withdrawal does not protect against sexually transmitted infections (STIs), including HIV/AIDS.

How it works

During sex, the penis releases two kinds of fluids. The first is pre-ejaculate or pre-cum, a lubricant made in a gland in the penis. This fluid usually contains no sperm, but can transmit infections. The second, released with ejaculation, is semen, which is made in the testicles and carries thousands of sperm in addition to any sexually transmittable infections that may be present.

Because previous ejaculations can leave some sperm behind in the folds of the penis, it is important for the man to urinate and wipe the tip of his penis to flush out leftover sperm from the urethra, the tube from which both urine and semen exit the penis.

Use

Before intercourse, the male partner should urinate and wipe the tip of the penis, to ensure no sperm enter the vagina. During sex, partners can have penis-in-vagina sex until the male partner nears ejaculation.

When the male partner feels close to ejaculation, he must withdraw his penis from his partner’s vagina and crotch. Be careful because even sperm (semen) outside the vagina, but on the vulva or on the legs near the vulva, can travel inside and cause pregnancy.

Some partners may decide to have intercourse in the early stages of their sex play, then withdraw and use other forms of stimulation to reach mutual orgasm. This use of withdrawal can reduce anxiety about the timing of a partner’s ejaculation and reduce the risk of an unintended pregnancy.

Awareness

The effectiveness of withdrawal depends on communication between partners before and during sex, as well as the male partner’s knowledge and experience with his own body. Withdrawal may not be effective if the male partner is unable to withdraw before his orgasm.

Partners who are less experienced with withdrawal may have a higher risk of pregnancy during their first attempts with this method. Teens are the age group for which this method is the least effective. To increase effectiveness, new partners may also want to use spermicide or fertility awareness (learning when a female’s menstrual cycle, pregnancy is more likely or less likely). If sperm come near or inside the vagina, taking Emergency Contraception can still be an option for preventing pregnancy.

Your Health

Withdrawal is not an effective method for preventing the spread of Reproductive Tract Infections, Sexually Transmitted Infections (STI), including HIV/AIDS.

Side Effects

There are no side effects to using withdrawal. Some partners may experience nervousness that may, in turn, decrease pleasure. Using additional methods of birth control can help reduce anxiety.

Advantages

• Free and always available
• No side effects.
• Does not alter the menstrual cycle.
• Does not affect future fertility.
• Can help partners be more aware of and learn about their sexual responsiveness.
• More effective with better partner communication.
• Useful for people with religious concerns about using other methods.
• More effective than using no birth control.

Disadvantages

• Does not protect against HIV/AIDS.
• Requires male’s ability to predict ejaculation and use self-control.
• Less effective with less sexual experience.
• Less effective than other methods of birth control.
• Less effective if under the influence of alcohol or drugs.
• Nervousness and sexual interruption may lessen pleasure.

Participation in Pregnancy Prevention

Like condoms, withdrawal is one of the few methods of birth control that male partners can control. Female partners play an important role in withdrawal through communication and attention to sexual responses.

For More Info

• Sexuality.org
• Sexually transmitted diseases (STD) symptoms and treatment
• Coalition for Positive Sexuality
• Better than nothing or savvy risk-reduction practice? The importance of withdrawal by Guttmacher Institute, 2009
• “Does Withdrawal Deserve Another Look?” by Guttmacher Institute, 2009
• Newsweek online magazine covers the Good News About Birth Control
• “Pulling Out Method Gets New Respect“

Fertility Awareness increases a woman’s understanding of her body and her menstrual cycle. To be effective as birth control, it requires her to abstain from intercourse or use a barrier method or withdrawal for birth control during her fertile time, approximately one-third of the month.

If you are want to use Fertility Awareness, please seek additional information from the resources listed at the end.

Fertility Awareness is a form of Natural Family Planning. However, the term ‘Natural Family Planning’ does not always mean the comprehensive valid approach known as Fertility Awareness Method.

Fertility Awareness Method relies upon the following assumptions:

• An egg (ovum) can live inside a woman’s body for 12-24 hours. However, in calculating the fertile time we use 48 hours in case more than one egg is released.
• Sperm can live in a woman’s body up to 5 days after intercourse, though more often 2 days. Pregnancy is most likely if intercourse occurs anywhere from 3 days before ovulation until 2-3 days after ovulation.
• Since the exact time of ovulation cannot be predicted, we add 2 to 3 days to the beginning and end.
• Day 1 in the Menstrual Cycle is the first day of bleeding.

A woman’s fertile time (“unsafe days” if she wants to prevent pregnancy) is thus about one-third of her cycle.

How Fertility Awareness Works

Pregnancy is prevented by not having sexual intercourse during the unsafe fertile time, or by using a barrier method such as male or female condom, cervical cap, diaphragm or withdrawal during the fertile time. Alternatively, if a woman wants to get pregnant, she can know when is the best time to have intercourse that is most likely to result in a pregnancy.

The more regular a woman’s cycle is, the more reliable Fertility Awareness is. As a woman becomes more familiar with the signs of ovulation and the pattern of her menstrual cycle, Fertility Awareness Method becomes more effective for her.

Below we describe the ‘practices’ that help a woman determine when her fertile phase or fertile time is.

Monitor Cervical Mucus

To chart your cervical mucus, observe and record your cervical secretions every day on a calendar or chart. Day 1 is the first day of your menstrual period.

Using a plastic speculum for vaginal and cervical self examination, a woman can learn to see the changes in the os (opening to the cervix) and watch it open as ovulation approaches. Within the os, fertile cervical mucus appears clear and shiny. You may touch and feel this mucus from the speculum after you take it out.

Alternatively, to collect the mucus, wipe yourself front to back with your fingers collecting the secretions from your vaginal opening. Look for a sensation of wetness. Note the color (yellow, white, clear or cloudy) and consistency (thick, sticky, stretchy) as well as how it feels (dry, wet, sticky, slippery, stretchy).

When monitoring your mucus, do not douche as it washes away the secretions. Do not use spermicidal gel, foam, cream or suppositories as they can mask or affect your mucus, making it difficult to identify the changes. Some practitioners warn that during menstruation and the first dry days after menstruation, you should only have intercourse every other day to ensure you do not miss the first signs of increased secretions. You can use male or female condoms to keep semen out of the vagina and to protect yourself from sexually transmitted infections and HIV.

To chart your cervical mucus, observe and record your cervical secretions every day on a calendar or chart. Day 1 is the first day of your menstrual period.

Using a plastic speculum for vaginal and cervical self examination, a woman can learn to see the changes in the os (opening to the cervix) and watch it open as ovulation approaches. Within the os, fertile cervical mucus appears clear and shiny. You may touch and feel this mucus from the speculum after you take it out.

Alternatively, to collect the mucus, wipe yourself front to back with your fingers collecting the secretions from your vaginal opening. Look for a sensation of wetness. Note the color (yellow, white, clear or cloudy) and consistency (thick, sticky, stretchy) as well as how it feels (dry, wet, sticky, slippery, stretchy).

When monitoring your mucus, do not douche as it washes away the secretions. Do not use spermicidal gel, foam, cream or suppositories as they can mask or affect your mucus, making it difficult to identify the changes. Some practitioners warn that during menstruation and the first dry days after menstruation, you should only have intercourse every other day to ensure you do not miss the first signs of increased secretions. You can use male or female condoms to keep semen out of the vagina and to protect yourself from sexually transmitted infections and HIV.

Calendar Method

In Calendar Charting a woman charts her menstrual periods and uses the length of her past menstrual cycles to estimate the fertile time. When she knows the shortest and longest cycles over several months, she can use a formula to estimate the fertile time.

Start by keeping a written record of your menstrual cycle for 8-12 consecutive months. Make a chart showing each month and how many days from one menstrual cycle to the next. Count the first day of menstruation (the first of bleeding) as “Day 1″ of your cycle.

Example: Count the number of days between Day 1 of one period and Day 1 of the next period.

Now, pick your longest and shortest cycles. Subtract 18 from the length of your shortest cycle and note this as the first fertile day. Subtract 11 from the length of your longest cycle and this is the last fertile day.

In this example, the shortest cycle is 26 days and the longest is 31 days. Subtract 18 from 26 to get the first unsafe day, that is Day 8. Subtract 11 from 31 to get Day 20 as the last unsafe day. Therefore, Days 8-20 are the fertile time.

Once you have a record of your cycles, the following table will help you determine your fertile unsafe days.

Here’s another example: if a woman’s menstrual record shows her shortest cycle was 25 days and her longest was 30 days, her unsafe fertile days are Day 7 up to and including Day 19, counting from Day 1 as the first day of her period.

Keeping Your Chart Up to Date: Each month add the number of days between periods to the chart and re-calculate your predictions of fertile times. As your chart grows, cross off the oldest cycles and only consider the past 12 months.

Basal Body Temperature (BBT)

When a woman monitors her Basal Body Temperature (BBT) she can see when ovulation happened after it has occurred. BBT helps identify post-ovulatory infertile (safe) days.

Using an easy-to-read thermometer, take your temperature every morning immediately upon waking and before any activity. Use graph paper so you can see the rise and fall of temperature (see below).

Immediately before ovulation, the temperature drops briefly. Within 12 hours of ovulation the BBT rises several tenths of a degree and remains up until the next menstrual period. When your temperature stays high for 3 days in a row, the fertile period is over and the safe infertile time begins.

The main drawback of using the BBT method by itself, is that several factors can influence your BBT, including illness, lack of sleep, alcohol or drug use.

Record your temperatures on a chart similar to the one above, along with your cervical fluid and the next technique, cervical observation. Keep a chart of your BBT over a period of 8-12 consecutive months to learn the approximate time in your cycle when you usually ovulate.

Cervical Observation

The position of a woman’s cervix changes over the course of her menstrual cycle. Typically, during and in the first few days after menstruation, the cervix is fairly low and firm like the tip of your nose. When the wet cervical fluid begins to show, the cervix begins to move up, become more soft, wet, and open. During ovulation, the cervix is at its highest and most open. After ovulation, the cervix returns to the firm, low, and closed position.

To observe the changes in cervical position, wash your hands, insert your middle finger, and feel your cervix for softness, height, opening, and wetness. A plastic speculum can be helpful in the beginning while you are getting used to finding and feeling your cervix. Check your cervix about the same time of day and in the same position (squatting, sitting on the toilet, or with one leg raised).

Add to your chart a record of the appearance, softness/firmness, and wetness of the cervix.

More Signs

In addition to the changes described above, other physical changes may occur mid-cycle, around the time of ovulation (lasting only a day or less), including:

• Slight one-sided pain or cramp in the area of an ovary in the lower abdomen
• Spotting
• Breast tenderness

Effectiveness

To prevent pregnancy, a woman should abstain from intercourse, or use a barrier method of birth control during her fertile days: 5 days before ovulation through 3 days after ovulation, about one-third of her cycle.

The effectiveness of FAM for birth control varies, depending on the dedication and motivation of the woman and her partner, the length of time she has been using it and the regularity of her menstrual cycle. Combining multiple techniques, as discussed here, increase the effectiveness. Of 100 women who have no vaginal intercourse during their fertile time, between 2 to 20 will become pregnant during the first year. By comparison 60 to 80 women out of 100 who use no birth control will become pregnant.

It is helpful to learn these techniques directly from a qualified instructor if you can find one. Books and websites also have good information.

New technologies such as calculators, computer programs, saliva tests and urine tests can also help determine fertile time. These high tech methods may be especially valuable to women who have had trouble getting pregnant.

Advantages

• No health risks or side effects to the woman.
• Can be used to plan or prevent pregnancy.
• Effective if used correctly and consistently, especially for women who have regular menstrual periods.
• Acceptable for couples with religious concerns about contraception.
• Can increase a woman’s awareness and understanding of her body.
• Couples may develop greater communication, cooperation and responsibility.
• For couples who choose not to abstain during the fertile time, barrier methods at that time offer considerable protection against pregnancy.

Disadvantages

• Learning to use the method takes time and effort.
• Requires considerable commitment, calculation and self-control, both by the woman and her partner.

Learn More

• Toni WeschlerMPH, the Seattle woman who teaches Fertility Awareness, says “it should be seen as a fundamental life skill that all women should learn, just as they are now taught basic feminine hygiene.” Read her book Cycle Savvy – the smart teens guide to the mysteries of her body – everything you want to know about your monthly cycle (includes downloadable charts for you to use).
• GardenofFertility.com posts several articles about Fertility Awareness and photos showing the changes the cervix goes through during a natural menstrual cycle. It offers fertility charts that can be downloaded at no charge. Find in-depth info in the book published in 2004 entitled The Garden of Fertility: A Guide to Charting your Fertility Signals to Prevent or Achieve Pregnancy — Naturally — and to Gauge your Reproductive Health by Katie Singer. The book describes the changes a woman experiences throughout the menstrual cycle; how to chart your fertility signals (the waking temperature and cervical fluid); how to determine, by fertility charts, when you are fertile and not fertile; how to practice natural birth control that is virtually as effective as the Pill; and when to time intercourse if you want to conceive. It explains how to identify, by your fertility charts, whether you’re ovulating, indicating a propensity for thyroid problems, poly-cystic ovarian syndrome, or miscarriage. It tells how to establish and identify unambiguous infertility while breastfeeding, and how to identify when ovulatory cycles are resuming.
• Color-coded Cycle Beads can be a fun way to keep track of where you are in your own cycle. Cycle Beads website has further information on fertility awareness. Includes online and smartphone apps.
• Period tracker is another online and Smartphone application.
• Fertility Awareness Center
• Society for Menstrual Cycle Research – a nonprofit organization and multidisciplinary group of women pioneers in understanding the centrality of menstrual cycle research to women’s health.
• Menstrual Calendar – charting and saving your monthly cycle on your computer.

Use

Male condoms are only effective when placed just before intercourse or oral sex. At first, condoms can be awkward to use; take your time and become familiar with them. Either partner can put a condom on the penis as part of sexual play. Learning how to put on a condom before sex play can help reduce anxiety with a partner. During sex, water-based lubricants can increase pleasure and comfort.

Do not use two condoms at once: Placing two male condoms on a penis can raise the chance of tearing. Male condoms and female condoms should not be used at the same time.

After sex, throw away the condom; Do not reuse it. Do not use the same condom for vaginal and anal intercourse.

Intercourse

The male condom is placed on a man’s erect penis. Before putting on the condom, uncircumcised men may find it useful to pull back the foreskin. With one hand, squeeze a half-inch of the condom’s tip to remove air and leave room for semen. With your other hand, unroll the condom to the base of the penis. The band of latex at the open end of the condom helps to keep it from slipping during intercourse.

After ejaculating, withdraw the penis before losing the erection. Hold the condom on the penis during withdrawal to keep sperm from leaking out. Either partner can hold onto the rim.

Throw away the condom and use a new one if sex continues. Maintain distance between you and your partner’s genitals to prevent infection or pregnancy; Sperm may still be on the penis after the condom is taken off.

Oral Sex

Most people prefer male condoms without spermicide for oral sex. You can also buy flavored male condoms.

For oral sex on a woman, male condoms can be used as a barrier to protect against the spread of infections. Cut off the closed tip of the condom. Make another cut along the side of the condom. This will give you a rectangular sheet. Place the sheet over the genitals or over a partner’s mouth. Be careful to keep any areas of contact fully covered by the condom during oral sex. After oral sex, throw away the condom.

For oral sex on a man, the condom is placed on the penis as it would be for intercourse. After oral sex, throw away the condom.

Sex Toys

If you and your partner choose to share a toy (such as a dildo) using a male condom on the toy can help prevent the spread of infection. Do not use the same condom for more than one person.

Add Lubrication

The most common causes of condom failure are breakage and slipping. To prevent breakage, make sure there is enough lubrication from natural secretions or a water-based lubricant. Dryness creates more friction and can tear a condom. Adding lubrication can also increase pleasure for both partners and encourage continued use of condoms.

To use lubricant with a male condom, add one or two drops into the tip of the condom before putting it on. Add more around the vaginal opening, the inner lips and the clitoris. If the vagina or the condom becomes less lubricated during sex, you can add a few more drops of lubricant or a little bit of water.

Latex or polyurethane barriers (male condoms, female condoms, dental dams or gloves) can be more effective and comfortable for both partners when used with a lubricant from a bottle or tube. Use only lubricants marked for sexual use or as latex-safe such as Astroglide or KY Liquid. Do not use Vaseline, creams, edible oils or vaginal medications because they can cause latex condoms to break.

To keep a condom from slipping off, make sure the rim stays near the base of the penis during intercourse. This is especially important as the penis is withdrawn after sex play.

Care

Oil-based lubricants, like Vaseline or vegetable/olive oils, weaken male condoms and make them less effective.

Store condoms in a cool, dry place. Exposure to heat such as a hot glove compartment in a car, or friction such as a back-pocket wallet can create microscopic holes. Check the condom’s expiration date before using it.

Your Health

There is a chance that male condoms could break or slip during sex. If this occurs, a woman may consider taking emergency contraception (the Morning After Pill or Plan B) to prevent pregnancy.

Side Effects

If you or your partner experience genital burning or itching, it may be a sign of an allergy to either the condom or spermicide used. If you used a latex condom, try using condoms without latex. You can also try a spermicide with different chemicals than the one you used. If your spermicide contains nonoxynol-9, try one without it.

Advantages

• Prevents the spread of sexually transmitted infections (STI), including HIV and AIDS.
• Birth control for men.
• Available without a prescription.
• No hormonal side effects.
• Use can be part of sex play.
• Easy to use.
• Does not affect future fertility.
• May decrease women’s risk for developing pre-cancerous cells on the cervix.

Disadvantages

• Must be readily available.
• Can interrupt sex play.
• Can break or leak.
• Possible allergic reaction.
• Decreased sensation for some people.

Emergency Contraception

If a condom breaks, comes off or doesn’t get used correctly, a woman can take Emergency Contraception pills AFTER SEX to prevent pregnancy.

More Info

• Male Health Center
• Using Condoms, about various condom types and sizes
• Condoms for safer sex to prevent the spread of infections
• Coalition for Positive Sexuality

Use

Female condoms can be inserted up to 8 hours before intercourse and are only effective when placed prior to intercourse. At first, female condoms can be awkward to use, but they are easy with practice. Take your time and try inserting the condom before sexual play. You can stand with one foot up on a chair, sit with your knees apart, or lie down. Lubrication can help keep the condom in place and lessen noise during intercourse. Adding spermicide before or after insertion can reduce the risk of pregnancy.

A female condom and a male condom should not be used at the same time.

Intercourse: To insert the condom, squeeze the ring at the closed end of the tube. Use one hand to spread the outer lips, and insert the squeezed condom into the vaginal canal. The inner ring should be pushed just past the pubic bone and over the cervix.

After insertion, make sure the condom is not twisted. About one inch of the open end will stay outside the body. The outer ring of the female condom will need to be held in place during intercourse, but may increase female stimulation. After intercourse, squeeze and twist the outer ring to keep all fluids, including sperm, inside the condom. Gently pull it out and throw it away.

Oral Sex: Female condoms can be used as dental dams to prevent the spread of sexually transmitted infections during oral sex. Cut off the closed end of the condom and down the side. This will give you a rectangular sheet. Place the sheet over the genitals or over a partner’s mouth. Be careful to keep any areas of contact fully covered by the condom during oral sex. After oral sex, throw away the condom.

Cautions

There are no physical side effects associated with the use of female condoms. However, there is a chance that a female condom could break or slip during sex. If this occurs, women may consider taking Emergency Contraception or the “Morning After” Pill.

Availability

The United Nation’s HIV/AIDS prevention program recognizes the importance and effectiveness of the female condom and is working to make it available globally.

Advantages

• Prevents the spread of sexually transmitted infections, including HIV and AIDS.
• Protects the vagina and vulva.
• Does not reduce a male partner’s stimulation.
• Available without a prescription.
• No hormonal side effects.
• Can be used by people with latex sensitivities.
• Prelubricated and can be used with oil and water-based lubricants.
• Can be inserted before sex play begins.
• Insertion can be part of sex play.
• Erection not necessary to keep condom in place.
• Does not affect future fertility.

Disadvantages

• Noticeable during sex.
• Sometimes difficult to insert or use.
• Does not contain spermicide.
• Can break or leak.
• About three times more expensive than male condoms.

Emergency Contraception

If a condom breaks, comes off or doesn’t get used correctly, a woman can take Emergency Contraception pills AFTER SEX to prevent pregnancy.

More Info

• http://www.fc2.us.com/
• http://www.fc2training.com/
• http://www.avert.org/female-condom.htm
• http://www.acog.org/~/media/For%20Patients/faq022.pdf?dmc=1&ts=20120522T1004397744 – Barrier Methods of Birth Control from American College of Obstetricians and Gynecologists (ACOG)

Use

Spermicide can be used alone or with other birth control methods to reduce the risk of pregnancy. The lubrication it provides can increase pleasure. Insert your spermicide within a half hour before intercourse. Add more spermicide for repeated intercourse. Then after the last act of intercourse, leave your spermicide in your vagina for eight hours and don’t douche until after this time. Douching weakens spermicide.

Foam

Foam comes in a can and is the consistency of shaving cream. To use it, shake the can well. Place the applicator on the top of the can and press down or to the side, depending on the package directions. The plunger will rise as the applicator fills. Insert the applicator about two or three inches into your vagina and press the plunger to deposit the foam over your cervix. As you withdraw the applicator, be sure not to pull back on the plunger. This will suck some foam back into the applicator. It is effective immediately.

Cream or Gel

Creams are opaque and gels are clear. They can be inserted into the vagina with an applicator and/or rubbed over the penis. Cream or gel is typically used with a diaphragm or cervical cap. It can also be used with condoms and is effective immediately.

Vaginal Contraceptive Film (VCF)

VCF comes in thin squares that dissolve over the cervix. To use it, fold the film in half and then place it on the tip of your finger. Insert your finger into your vagina and put the VCF over your cervix. A dry finger and quick insertion will help the VCF stay in place and not stick to your finger. It may take about 15 minutes for the VCF to melt and become effective.

Suppository

Suppositories are capsules that dissolve in the vagina. They’re inserted into the vagina like a tampon and pushed up to the cervix. It takes about twenty minutes for a suppository to become effective.

Sponge

The sponge is a both a spermicide and a barrier method of birth control. As a barrier, it blocks sperm from entering the cervix and uterus, preventing fertilization. Most sponges are made out of polyurethane foam and are soft to the touch. To use, wet with a small amount of water and insert into the vagina with the dimple side facing up. Push the sponge up to the cervix, making certain that the cervix is completely covered. The sponge can be worn for up to 24 hours but must remain in place for six hours after intercourse to be effective as birth control.

Advantages

• Available without a prescription.
• Lubrication may increase pleasure.
• Use can be part of sex play.
• Does not affect future fertility.

Disadvantages

• Does not protect against HIV/AIDS.
• Must be readily available and used prior to penetration.
• Can be messy.
• Can have a bad taste during oral sex.
• Possible genital irritation.
• When used frequently, irritation of the vagina may make a woman more susceptible to HIV/STI carried by a man.

Your Health

The vagina absorbs little spermicide. If you become pregnant while using spermicide, the pregnancy will not be affected.

WARNING

Research indicates that spermicide increases the risk of HIV when used frequently. If you usually have intercourse more than once a day, spermicide is not recommended because Nonoxynol9 can weaken cell membranes allowing transmission of HIV and sexually transmitted infections from male to female.

Side Effects

You or your partner may be allergic to materials in spermicide. This can cause genital irritation, rash, or itchiness. If this happens and your spermicide has nonoxynol-9, try a spermicide without this chemical.

Your Cervix

The cervix is the opening to the uterus where menstrual blood, babies, and sperm pass. It is also the opening through which abortions are performed. Spermicide and barrier methods of birth control, including the female condom, diaphragm, and cervical cap, work by covering the cervix and preventing sperm from entering the uterus. Hormonal methods of birth control, including oral contraceptive pills, Depo Provera shot, Implanon, Patch, and Ring affect the mucus around the cervix and make the opening more resistant to sperm.

Women’s bodies naturally produce hormones that change the cervix during a menstrual cycle. You can learn more about your cervix using a speculum to perform a self-exam. For instructions and a speculum, ask your clinician or visit www.FWHC.org.

Plan B, Plan B One-Step, and Next Choice work by giving the body a short, high, burst of synthetic progestin hormones. This disrupts hormone patterns needed for pregnancy. Plan B affects the ovaries and the development of the uterine lining, making pregnancy less likely. Depending on where the woman is in her menstrual cycle, the hormones prevent pregnancy in different ways. They prevent ovulation (the egg leaving the ovary and moving into the fallopian tube). They block the hormones needed for the egg to be able to be fertilized. They may affect the lining of the uterus and thus alters sperm transport, which prevents sperm from reaching the egg to fertilize it.

Progestin hormone-containing pills may be effective up to 120 hours (5 days) after intercourse, but are most effective within the first 24 hours. People 17 and older can get these brands over-the-counter and do not need a prescription.

Ella is different type of post-sex contraception. It is a pill that contains 30 mg of ulipristal acetate, a progesterone receptor modulator. It is effective for up to 5 days after unprotected sex and requires a prescription.

Having a copper Intrauterine Device (IUD) inserted within one week of unprotected intercourse is another alternative to prevent pregnancy after sex. Getting an IUD requires a clinic visit and the cost, if not covered by insurance, is higher than the cost of pills. It is a useful option for a woman who does not want to get pregnant for a long time. Call your health provider for more information.

Emergency Contraception does not protect against reproductive tract infections, including HIV/AIDS.

Use

Take the medication as directed on the package. Take it as soon as possible after unprotected intercourse. The sooner you take it the more effective it will be at preventing pregnancy.

If you vomit within a half hour, it might not work and you should take another dose. You may want to take it with some food and anti-nausea medication.

Regular prescription birth control pill also work for Emergency Contraception. See this chart to find out how many pills to take. If you, or a friend, have birth control pills on hand, then take them as soon as possible if they are listed. These pills are less effective and cause more nausea and vomiting than the brand names made for this purpose. It is important to take the exact number of pills recommended. Take the first dose as soon as you get the pills. Take the second dose 12 hours later. If possible, take with food.

How Well Does It Work?

Emergency contraception pills are less effective than methods of birth control you use before sex such as condoms or birth control pills.  But if a woman has had sex without protection, emergency contraception significantly lowers her chances of getting pregnant.

After taking Emergency Contraception pills, your next menstrual period should begin within 2 to 3 weeks. If you don’t have a full, normal period within 3 to 4 weeks you might be pregnant and should have a pregnancy test.

Starting birth control after Emergency Contraception pills
You can start using birth control the same day you take EC.  If you are using the pill, patch or vaginal ring, their hormones can give you bleeding much like a normal period, even if you are pregnant. It’s a good idea to get a pregnancy test 2 to 4 weeks after using Plan B.

Warning
Emergency Contraception pills cannot prevent an ectopic pregnancy, which is when a fertilized egg attaches and grows outside the uterus. This can be very dangerous and requires immediate medical attention. Signs of ectopic pregnancy are: pain especially in the lower abdomen or shoulder, dizziness and nausea.

Side Effects

With Plan B and Next Choice, side effects are rare but can happen. They include nausea, vomiting, headaches, breast tenderness, dizziness, fluid retention, abdominal pain and irregular bleeding. If these symptoms don’t go away after 1 to 2 days, you should seek medical care.

Your Health

Emergency Contraception pills do not harm an established pregnancy. They act on the uterus and cannot prevent an ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg attaches and grows outside the uterus. This can be very dangerous and requires immediate medical attention. To protect your health, watch out for the danger signs listed below.

Danger Signs

Women who experience any of the following symptoms while taking EC should call the clinic immediately:

Abdominal pains (severe)
Chest pain or shortness of breath
Headaches (severe)
Eye problems, such as blurred vision
Severe leg or arm pain or numbness

Future Fertility

Emergency Contraception pills do not prevent future pregnancies and are less effective than other methods of birth control. If you want to prevent future pregnancies, male condoms and spermicide are easily available options. You can buy them over-the-counter and you don’t have to wait for the start of your next period.

Pregnancy and Breastfeeding

Studies have not been done on the effect of Emergency Contraception pills on pregnancy and breastfeeding. Birth control pills with the same chemical have been used for many years and have not caused problems. However, the amount of the hormone in some EC is more than the amount in a birth control pill. No problems have shown up in women who have gotten pregnant or breastfed while taking EC. EC will not end an existing pregnancy.

Advantages

• Can be used after intercourse.
• Easily available if you are 17 or older.
• Can get ahead of time.
• Easy to use.

Disadvantages

Plan Ahead

Keep Emergency Contraception Pills on hand just in case! Buy them in advance so you won’t have to make a trip to the pharmacy

More Info

• Plan B One-Step (manufacturer’s website)
• Next Choice (manufacturer’s website)
• ella (manufacturer’s website)
• not-2-late.com website devoted to answering your questions about emergency contraception
• How Plan B Works – published in the Journal of the American Medical Association
• ACOG (American College of Obstreticians and Gynecologists) study indicates EC effective up until 120 hours after sex.
• Brands of Pills and dosages for pills found outside the USA
• International Consortium for Emergency Contraception
• Reproductive Health Technologies Project
• World Health Organization Emergency Contraception Factsheet

There are many different brands of Birth Control Pills. They come in packs of 21 or 28 pills. One pill is taken orally (swallowed or chewed) every day. They contain synthetic hormones that work to prevent pregnancy by stopping ovulation (the process of the ovaries releasing eggs), as well as thickening cervical mucus to make it more difficult for sperm to enter the uterus. The first 21 pills (in a 28-pill pack) contain synthetic estrogen and progesterone hormones that work to prevent fertilization. The last 7 pills of a 28-day pack are hormone-free pills called spacers. Birth Control Pills ares 91 to 99.7% effective as birth control, but do not protect against sexually transmitted infections (STI) including HIV/AIDS.

Use

Starting The Pill: There are several ways to begin taking The Pill. One common way is to start on the first day of your period or the first day after an abortion. Some women prefer to start on the first Sunday after either of these events. If you start the pill in this way (within six days after an abortion or the start of a period), it is effective immediately. If the Pill is started at other times, it will be effective after 7 days of daily use. Condoms can also be used to lower the risk of pregnancy and sexually transmitted infections.

Continuing: Take one pill every day until you finish an entire pack. Try to link taking The Pill with a regular activity that you do at the same time every day, like eating a meal or brushing your teeth. If you have a 28-day pack, start a new pack immediately after you finish the old one. If you have a 21-day pack, take one pill every day for 21 days, no pills for seven days, then start the new pack immediately.

Continuous Use of Birth Control Pills:  Some women prefer to use the pill to have fewer periods or no periods at all. This can be helpful at reducing the symptoms of PMS, menstrual migraines, endometriosis, and anemia. Athletes and women planning their wedding, vacation or special performance have been using this method to “skip their periods” for many years. A lot of women like the idea of not having the bother with the inconvenience of a period, but the most compelling reason to choose continuous hormonal use is to decrease the risk of unwanted pregnancy. Continuous hormonal birth control pills work the same way as regular birth control pills – by stopping ovulation and preventing ovaries from releasing eggs.

If you choose to continuous use of birth control pills, simply take one hormone pill every day. If your pills come in a pack of 28, do not take the spacer pills. If your pills come in a package of 21, just start your new pack as soon as you finish the old one. By only taking the hormone pills and not taking the one week break there will be no withdrawal bleeding. Only monophasic pills can be used for this purpose; monophasic pills contain the same amount of hormones in each pill.

To have a quarterly (every 3 month) period: Take the birth control pill that contain hormones for three full months. Then take the spacer pills (sugar pills, placebo pills) for one week before returning to the hormone pills. Work with your health care provider on a type of pill and regime that works for you. It is recommended that you give yourself four breaks or “periods” each year. Some birth control pills are specially pre-packaged for quarterly periods or 4 periods per year.

To decide when to (or not to) have your period: You are likely to have withdrawal bleeding during the week of spacer non-hormonal pills. You get to decide when to take the full week of spacers. For example if you have a big special event or trip scheduled, then take the hormone pills continuously through the event or trip. Then after the big event or trip, take 7 days of the spacer pills and have your period.

Is it safe to go so long with no period? With regular birth control pills, you take hormonal pills for three continuous weeks then a one week break during which you would have a “withdrawal bleed.” A withdrawal bleed is different from a natural period. When a woman is not on hormonal birth control, the lining of the uterus thickens in preparation for a possible pregnancy. After ovulation, if no pregnancy implanted, the uterus sheds the thick menstrual lining.

With continuous hormonal use the lining of the uterus does not thicken and thus there is nothing or very little for the uterus to empty. Research shows it is safe and effective to use certain birth control pills continuously without stopping for a “period.”

Break through bleeding, or bleeding mid-cycle is very common in the first six months of continual hormonal use. Over time your body will get used to the constant level of hormones and this side effect will usually disappear within 4-6 months of continuous hormonal use.

Non-steroidal anti-inflammatory medications (naproxen or ibuprofen) can decrease bleeding and make you more comfortable during this adjustment time. If your bleeding continues after one week on an anti-inflammatory, consult your health provider.

Missed Pills

Late Start:

The most common way women get pregnant while using The Pill is starting the next package late.

1 day late starting the next package: Take two pills as soon as you remember and one pill each day after. Use a backup form of birth control for two weeks.

2 days late starting the next package: Take two pills per day for two days, then continue as usual. Use a backup form of birth control for two weeks.

3 or more days late starting the next package: Call the clinic for instructions.

During the Cycle:

1 pill missed: Take it as soon as you remember and take your next pill at your usual time. This may mean taking two pills in one day.

2 pills missed in a row in the first two weeks: Take two pills on the day you remember and two pills the next day. Finish the rest of the pack as usual. Use a backup form of birth control for one week.

2 pills missed in a row in the third week: Keep taking one pill every day until Sunday. On Sunday, set aside the rest of the pack and start taking a new pack of pills. Use a backup form of birth control for one week.

3 or more pills missed in a row anytime: Keep taking one pill every day until Sunday. On Sunday, set aside the rest of the pack and start taking a new pack of pills. Use a backup form of birth control for two weeks.

Missing any of the last seven pills of a 28-day package will not raise your risk of pregnancy. Skip the pills you missed, but be sure you start your next pack on time.

Your Health

The effectiveness of The Pill is lowered when taken with certain medications, including antibiotics, anti-seizure, tuberculosis, and migraine medications. If you are taking any medications, tell your clinician. When taking medications that may interfere with The Pill, consider adding a backup method of birth control, like condoms and spermicide. As with all drugs, it is useful to inform all your medical providers if you are using hormonal birth control.

Some women may not be able to take The Pill because of the risk of serious health problems. Women who are over 35 and smoke or who have any of the following conditions should not take The Pill:

• History of heart attack or stroke
• Blood clots
• Unexplained vaginal bleeding
• Known or suspected cancer
• Known or suspected pregnancy
• Liver disease

Women who have the following conditions may or may not be able to take The Pill, and must first consult with their clinician or doctor:

• Migraines
• Gallbladder disease
• Hypertension
• Diabetes
• Epilepsy
• Sickle cell disease
• Have had elective surgery
• Have a history of blood clots, liver or heart disease

Women who use The Pill have a slightly higher risk of heart attack and stroke. The effects of The Pill on breast cancer are still unknown. The Pill lowers a woman’s chance of developing ovarian cancer, endometrial cancer, and pelvic inflammatory disease.

If you are unable to take The Pill for the medical reasons listed above, it may still be safe for you to take the Mini-Pill. The Mini-Pill contains a synthetic progesterone only and does not contain estrogen. This makes it safe for women who are over 35 and smoke, have high blood pressure or certain types of migraines.

Side Effects

As the body adjusts to hormonal changes created by The Pill, women often experience some minor side effects, including:

• Irregular bleeding or spotting
• Nausea
• Breast tenderness
• Weight gain and/or water retention
• Spotty darkening of the skin
• Mood changes

Side effects usually disappear after two to three cycles. If your side effects are bothersome after this time or if heavy bleeding occurs, continue taking your pills and call the clinic for an appointment to talk about your prescription and what other options might be available to you.

Danger Signs

Women who experience any of the following ‘ACHES’ symptoms while taking The Pill should call the clinic immediately

Abdominal pains (severe)
Chest pain or shortness of breath
Headaches (severe)
Eye problems, such as blurred vision
Severe leg or arm pain or numbness

Missed Periods

Missing a period does not always mean that you are pregnant. Pregnancy is more likely

• in the first few months of Pill use,
• if you missed taking any Pills,
• if you are taking another medication (especially antibiotics), or
• if you have been sick (vomiting and/or diarrhea).

If you forgot one or more pills and do not have a period that month, we recommend that you have a sensitive pregnancy test done at a clinic. (Beware of anti-abortion pregnancy centers offering free pregnancy tests – they give out biased information. Seek out a legitimate place to get a pregnancy test, or buy one over the counter.)

If you miss two periods in a row, it could either be normal or a sign of pregnancy. Pregnancy tests are recommended right away. If you become pregnant while on The Pill, there is probably no risk of birth defects.

Future Fertility

Women who want to become pregnant may stop using The Pill at any time. Fertility may return immediately or after a few months.

Advantages

• Can regulate periods or lighten them
• Easy to use
• Does not harm future fertility
• Does not interrupt sex play
• May protect against uterine and ovarian cancers
• May reduce acne
• Can be used for Emergency Contraception

Disadvantages

• Does not protect against sexually transmitted infections, including HIV/AIDS
• Must be taken every day
• Less effective when taken with some medications
• Raises risk of heart attack and stroke
• Requires a prescription

What are Mini Pills?

Mini-Pills are progesterone-only birth control pills. Mini-Pills come in packs of 28 pills and you take one every day. They contain a synthetic form of the progesterone hormone and no estrogen. The Mini-Pill affects the mucus around the cervix and makes it harder for sperm to enter the uterus. It also affects the transport of the egg through the fallopian tubes. In these ways, the Mini-Pill prevents fertilization. Mini-Pills do not protect against reproductive tract infections, including HIV/AIDS. They are called “mini” because they contain less hormones than regular pills.

Use of Mini-Pills

There are hormones in each Mini-Pill; there are no spacer pills. It is important to take a pill every day, at the same time each day. Forgetting a Mini-Pill or taking it late increases the chance of pregnancy more than missing a regular birth control pill.

You can improve the effectiveness of Mini-Pills by adding a backup method, like condoms or spermicide. This is most important during the first three months and days 8-18 of your menstrual cycle after the first three months.

Starting Mini-Pills: Take the first pill on the first day of your period. Take one pill daily, at the same time of day, even during your period.

After the First Pack: As soon as you finish one pack, begin the next one. Start your next pack even if you are still bleeding or have not started your period. Continue taking one pill every day.

If you have problems with the Mini-Pill, call the clinic. DO NOT stop taking the Mini-Pills unless you want to get pregnant or can use another method of birth control.

Your Health: Every woman is different and Mini-Pills are not recommended for all women. Due to the risk of serious health problems, women with the following conditions should not use Mini-Pills:

• Unexplained vaginal bleeding
• Known or suspected pregnancy
• Breast Cancer

Mini-Pills may not be recommended for women who are concerned with weight gain, have liver disease, gallbladder disease, heart disease, diabetes, or a history of depression.

Health Risks: Mini-Pills increase the risk of having functional ovarian cysts. They also very slightly increase the risk of ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg attaches and grows outside the uterus. This can be very dangerous and requires emergency medical attention. To protect your health, watch out for the Mini-Pill’s danger signs.

Health Benefits: Women on Mini-Pills have a decreased risk of endometrial cancer and pelvic inflammatory disease. You may have less menstrual cramping and pain, fewer periods, and less chance of anemia.

Side Effects

The most common side effect for women using Mini-Pills is irregular bleeding. While many women on Mini-Pills have normal periods, others may have irregular periods, spotting between periods or no periods at all. If you do not bleed for 60 days, call the clinic to arrange for a pregnancy test but continue taking your pills.

Other possible side effects of the Mini-Pill are mood changes, headaches, and lowered sex drive.

Some of the typical side effects of regular birth control pills, such as nausea, and breast tenderness, usually do not occur with Mini-Pills.

Drug Interactions

The effectiveness of Mini-Pills is lowered when taken with certain medications. These drugs include rifampin and anti-seizure medications. If you are taking any medications, tell your clinician. When taking medications that may interfere with Mini-Pills, consider adding a backup method of birth control, like condoms and spermicide. As with all drugs, it is useful to inform all your medical providers if you are using hormonal birth control.

Missed Mini-Pills

3 or more hours late: Take a mini-pill as soon as your remember. Use a backup method for 48 hours.

1 mini-pill missed: Take a mini-pill as soon as you remember and take the next one at the usual time. This may mean taking two pills in one day. If you only miss one mini-pill and make it up, you probably will not get pregnant. Use a backup method for 2 weeks.

2 mini-pills missed: Take 2 mini-pill each day for the next 2 days. Use a backup method for 2 weeks. You may have some spotting or bleeding. If the bleeding is like a period, call the clinic.

3 or more mini-pills missed: Use a backup method and call the clinic for instructions.

NEVER TAKE MORE THAN 2 MINI-PILLS IN 1 DAY.

Mini-Pill Advantages

• Avoids typical side effects of regular birth control pills.
• Has no estrogen.
• Easy to use.
• Does not harm future fertility.
• Does not interrupt sex play.

Mini-Pill Disadvantages

• Does not protect against sexually transmitted infections, including HIV/AIDS.
• Must be taken every day at the same time.
• Less effective when taken with some drugs.
• Increased risk of functional ovarian cysts.
• Increased risk of ectopic pregnancy.
• May cause irregular bleeding.
• Requires a prescription.

More Info

• NoPeriod.com – information about using birth control pills to not ever have a period.
• National Women’s Health Network on About Menstrual Suppression

Use

You can start using the Contraceptive Patch immediately or you can wait until the Sunday after the start of your period. The day of the week you pick to apply the Patch will be the same day you change the Patch a week later. If you’re breastfeeding, consult your health care provider.

After filling your prescription from a clinic, apply the Contraceptive Patch yourself. Choose a part of your skin that is clean and dry. The Patch should be placed on a slightly different spot every time to avoid skin irritation, but should never be placed on the breasts. Try to place it where it will not be rubbed by tight clothing.

When you apply the Patch, peel away the packaging without touching the sticky surface. Press the sticky medicated part against your skin for ten seconds. Run your finger along the edge to make sure the Patch is sticking.

Use one Patch per week for three weeks in a row. On the fourth week, no Patch should be worn. Your menstrual period should start sometime while the Patch is off. Then, a new Patch is applied seven days after you removed the old one, on the same day you normally change your Patch.  The Patch should not be worn continuously; it’s important to have a break from the Patch hormones.

When removing the used Patch, fold it in half with the sticky hormonal side in and dispose of it in the garbage. Don’t flush it down the toilet, as this releases the remaining hormones into the environment. If there is a leftover adhesive or a sticky spot on your skin, you can remove this with mineral oil.

Awareness

Check the placement of your Contraceptive Patch daily. It may become loose or fall off. If it has been off the skin for less than a day, reapply it or put on a new Patch as soon as possible. Your Patch change schedule will not be affected, nor will the effectiveness of the method.

If your Patch has been off the skin for over 24 hours or if you’re not sure how long it has been, you can start your four-week Patch cycle over. Use a new Patch as soon as possible and record the day of the week. This will be your new Patch change day. For the first seven days of this new cycle, you may not be protected from pregnancy. Use back-up methods of birth control for seven days.

Approximately two percent of the time, the Patch will fall off and need to be replaced. Do not attempt to reapply Patches with tape or other measures. Do not reapply Patches that have any materials stuck to them. Use a new one to ensure the method remains effective.

Missed Patch Changes

If you forget to change your Patch at the beginning of a monthly cycle, you can apply one as soon as you remember. Record this day of the week as your new Patch change day and use a back-up method of birth control for the next seven days.

If you forget to change your Patch for one or two days in the middle of a monthly cycle, change your Patch as soon as you remember. Keep the same Patch change day. A back-up method is not required.

If you forget to change your Patch for more than two days in the middle of a cycle, put on a new Patch as soon as possible. You will be beginning a new four-week Patch cycle with this Patch. Record the day of the week and use a back-up method of birth control for the next seven days.

If you forget to remove the third Patch in the cycle, remove it as soon as you remember. You will not need to change your regular Patch change day or use back-up contraception.

Missed Periods

Missing a period does not necessarily mean you are pregnant. However, if you miss a period, you may want to consider the likelihood of pregnancy and take a pregnancy test. Pregnancy is more likely if a Patch fell off for longer than 24 hours or if you missed a Patch change during the cycle. If you are pregnant, discontinue use of the Contraceptive Patch.

Your Health

Some women may not be able to use Contraceptive Patches because of the risk of serious health problems. Women over 35 who smoke or have any of the following conditions should not use the Patch:

• History of heart attack or stroke
• Chest pain
• Blood clots
• Unexplained vaginal bleeding
• Severe high blood pressure
• Diabetes with kidney, eye, nerve or blood vessel complications
• Known or suspected cancer
• Known or suspected pregnancy
• Liver tumors or liver disease
• Headaches with neurological symptoms
• Hepatitis or jaundice
• Disease of the heart valves with complications
• Post-surgical conditions requiring long bed rest
• Allergic reaction to the Patch

Women who have a family history of breast cancer, diabetes, high blood pressure, high cholesterol, headaches or epilepsy, depression, gallbladder disease, kidney disease, heart disease, irregular periods, or are breastfeeding may not be able to use the Patch. Women over 198 pounds may not receive a large enough hormone dose for the Patch to be effective.

A woman gets more estrogen in her body from the Patch than she would get from low-dose birth control pills or the Ring.  More research needs to be done to learn if this increases her risk for blood clots, heart attack and stroke.

Using the Patch lowers a woman’s risk of ovarian cancer, endometrial cancer, and pelvic inflammatory disease.

Side Effects

As the body adjusts to hormonal changes, women may experience some minor side effects, including:

• Skin irritation or rashes at site of Patch
• Irregular bleeding
• Problems wearing contact lenses
• Fluid retention or raised blood pressure
• Nausea
• Headache
• Breast tenderness
• Mood changes
• Menstrual cramps
• Abdominal pain

Drug Interactions

The effectiveness of the Contraceptive Patch is lowered when taken with certain medications, including certain antibiotics, anti-seizure, tuberculosis, and migraine medications. Some drugs used to treat HIV or AIDS may also interfere with the Patch. If you are taking any medications, tell your clinician. When taking medications that may interfere with hormonal birth control, consider adding a backup method, like male condom, female condom or spermicide. As with all drugs, it is useful to inform all your medical providers if you are using the Contraceptive Patch.

Danger Signs

Women who experience any of the following “ACHES” symptoms while using the Contraceptive Patch should call the a doctor immediately:

• Abdominal pains (severe)
• Chest pain or shortness of breath
• Headaches (severe)
• Eye problems, such as blurred vision
• Severe leg or arm pain or numbness

Advantages

• Easy to use.
• Can be worn for three weeks.
• Effects fertility one month at a time.
• Does not interrupt sex play.
• May regulate or lighten periods.

Disadvantages

• Does not protect against sexually transmitted infections, including HIV/AIDS.
• Raises woman’s risk of heart attack and stroke.
• Requires a prescription.

More Info

• OrthoEvra (the manufacturer’s website)
• www.cbsnews.com/stories/2005/11/11/earlyshow/health/health_news/main1037611.shtml
• www.webmd.com/content/Article/115/111590.htm
• Ortho Evra Birth Control Patch Users Twice as Likely To Develop Blood Clots as Women Taking Oral Pills, Manufacturer-Funded Study Says from Our Bodies Ourselves Health
• Coalition for Positive Sexuality
• Scarleteen sex ed for the real world

Use

Insert the Vaginal Ring immediately or within the first 5 days of your monthly period. The Vaginal Ring is effective after 7 days of continuous use. To reduce the chance of pregnancy and reproductive tract infections, especially during the first week of use, male condoms or spermicide can be used with a Vaginal Ring. (If breastfeeding, consult your health care provider.)

Insertion: Insertion may be awkward at first. However, since the vaginal ring is not a barrier method, the Ring will be effective as long as it is inside your vagina – there is no “correct” position it has to be in. You may choose to sit with knees apart, stand with one leg raised, or lie on your back with your knees spread. Squeeze the outer sides of the ring into a tight oval and gently push it into your vagina. Push the ring far enough in so it feels comfortable or so you can’t feel it at all.

Removal: A Vaginal Ring remains in the vagina for three weeks. To remove the Ring, hook it with a finger and pull it out. To dispose, wrap it in the original foil wrapper and dispose in the trash to protect the hormones from being released into the environment. Within the next few days, your menstrual period bleeding from should begin. For another month of birth control, insert a new Vaginal Ring seven days after removal of the last one, even if your period has not ended.

Storage: Vaginal rings for future use should be stored at room temperature, no more than 77 degrees Fahrenheit, and away from direct sunlight.

Continuous Use: Naturally, a woman has a period when the lining of the uterus thickens in preparation for a possible pregnancy. After ovulation, if a pregnancy has not occurred, the uterus sheds that thick menstrual lining. With continuous hormonal use, the lining of the uterus does not thicken and thus there is nothing or very little for the uterus to empty. It is okay to wear the Vaginal Ring constantly and not have a monthly period. Wear the Ring for 4 weeks, take it out and insert a new one. Continue replacing the Ring every 4 weeks with no interruption. By adding hormones to the body by using a new vaginal ring every 4 weeks continuously with no breaks, a woman can stop the monthly bleeding. Break through bleeding, or bleeding mid cycle is very common in the first six months of continual hormonal use. Over time your body will get used to the constant level of hormones and this side effect will usually disappear within 4-6 months of continuous hormonal use.

Awareness

A Vaginal Ring can slip out of the vagina. If this happens, you can wash the ring with cold to lukewarm water (not hot) and reinsert it. If you lose the original ring, insert a new one as soon as possible. If more than three hours pass without the ring in your vagina, there is a chance of becoming pregnant. The Vaginal Ring must be worn continuously for 7 days to regain effectiveness. During this week, you may wish to use a back up method of birth control such as like male condom, female condom or spermicide; a diaphragm is not recommended as a back up method for the Ring.

Missed Periods

Missing a period does not necessarily mean you are pregnant. However, if you miss a period, you may want to consider the likelihood of pregnancy and get a pregnancy test. Pregnancy is more likely if the last ring used was outside the vagina for more than three hours, two periods are missed consecutively, or if a ring was worn for longer than four weeks. If you are pregnant, discontinue use of the Vaginal Ring.

Your Health

Some women may not be able to use the Vaginal Ring because of the risk of serious health problems. Women over 35 who smoke or have any of the following conditions should not use the Vaginal Ring:

• History of heart attack or stroke
• Chest pain
• Blood clots
• Unexplained vaginal bleeding
• Severe high blood pressure
• Diabetes with kidney, eye, or nerve complications
• Known or suspected cancer
• Known or suspected pregnancy
• Liver tumors or liver disease
• Headaches with neurological symptoms
• Jaundice
• Disease of the heart valves with complications
• Require long bed rest following surgery
• Allergic reaction to the vaginal ring

Women with a family history of breast cancer, diabetes, high blood pressure, high cholesterol, headaches or epilepsy, depression, gallbladder or kidney disease, recent major surgery, easily irritated vagina, dropped uterus, dropped bladder, rectal prolapse, severe constipation, or are breastfeeding may not be able to use a Vaginal Ring. Your clinician or doctor can decide with you.

Side Effects

As the body adjusts to hormonal changes from the vaginal ring, women may experience some minor side effects, including:

• Vaginal discharge
• Vaginal irritation
• Headache
• Weight gain
• Nausea
• Irregular bleeding
• Breast tenderness
• Mood changes

Drug Interactions

The effectiveness of a Vaginal Ring is lowered when taken with certain medications, including antibiotics, St. John’s Wort, anti-seizure, tuberculosis, and migraine medications. If you are taking any medications, tell your clinician. When taking medications that may interfere with the Vaginal Ring, consider adding a backup method of birth control, like male condom, female condom or spermicide. As with all drugs, it is useful to inform all your medical providers if you are using hormonal birth control.

Danger Signs

Women who experience any of the following symptoms while wearing a Vaginal Ring should call the clinic immediately:

• Abdominal pains (severe)
• Chest pain or shortness of breath
• Headaches (severe)
• Eye problems, such as blurred vision
• Severe leg or arm pain or numbness

Advantages

• Easy to use.
• Can be worn for three weeks.
• Effects fertility one month at a time.
• Does not interrupt sex play.

Disadvantages

• Does not protect against sexually transmitted infections, including HIV/AIDS.
• Raised risk of heart attack and stroke.
• Requires a prescription.

More Info

• NuvaRing (the manufacturer’s website)