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Contraception

Choosing the right method of contraception involves the consideration of many factors, including such factors as lifestyle, frequency of intercourse, and number of partners. Finding the right method or methods of birth control to use on a long-term basis might mean experimenting with several methods first. There are some side effects from all methods of contraception -- for more detailed information about these options, speak to a nurse or physician or consult pamphlets available at health services. Remember that only condoms protect against STIs!

  • Contraception
    Click to download a pdf version. Women's Health Matters: The Patch

    The Patch

    What is the birth control patch?

    In Canada, as many as 5.5 million women use some form of birth control on a regular basis, 1.5 million of whom use the birth control pill. Since a large number of women forget to take their birth control pill every day, the effectiveness of this form of birth control is decreased.

    Since its introduction in 2001, the contraceptive patch has become an alternative to the pill. The patch is a hormonal method of contraception that can be obtained by prescription. The birth control patch is a 1 3/4-inch square, thin, beige-coloured patch that looks like a square band-aid. It is applied directly to the skin of the buttocks, abdomen, upper torso or upper outer arm.

    The patch is replaced weekly on the same day of the week for three consecutive weeks. During the fourth week, no patch is applied to allow your menstrual period to occur.

    The patch can be safely worn when showering, bathing, exercising or swimming. However, you cannot change its location once it is applied to your skin, as doing so may cause the patch to become loose.

    Rarely, the birth control patch may loosen or fall off. This usually occurs because the patch was applied incorrectly. If the patch is reapplied to the same area of the body within 24 hours, its contraceptive effects remain intact. However, if more than 24 hours have elapsed, use an additional form of birth control until the patch has been in place for 7 days.

    How does the patch work?

    The contraceptive patch works like the pill by slowly releasing a combination of estrogen and progestin hormones through the skin. These hormones prevent the release of eggs from the ovary (ovulation) and thicken the cervical mucus, making it more difficult for sperm to enter the uterus. Finally, the birth control patch changes the lining of the uterus in order to prevent eggs from being implanted. When used correctly, it is about 99% effective as birth control except for women weighing 198 pounds or more when it is only about 92% effective. The Patch does not protect against STIs or HIV/AIDS.

    What kinds of side effects are associated with its use?

    Side effects are uncommon in healthy non-smokers. Birth control patches have side effects that are similar to those experienced by users of oral contraceptives, including a slight risk of blood clots in the legs or the lungs and hypertension.

    Other minor side effects may include:

    • Minor skin irritation at the application site
    • Headaches
    • Breast tenderness
    • Irregular vaginal bleeding
    • Moderate weight gain
    • Nausea and vomiting
    • Bloating

    Additional side effects may include: yeast infections, contact lens problems, and depression.

    What are the pros and cons of using the patch?

    Advantages

    • Highly effective when used correctly
    • Doesn't inhibit sexual spontaneity
    • Minimal side effects
    • Disappearance of contraceptive effects shortly after use is discontinued
    • You do not have to remember to take a pill each day or go to the doctor's office for a shot

    Disadvantages

    • Requires weekly application
    • Requires a prescription
    • No protection against STDs
    • Must use a secondary form of birth control for the initial 7 days of use
    • Possible long-term health risks unknown
    • Less effective in women 198 pounds or more
    The cost of the patch is comparable to the pill.

    Those who should not take oral contraceptives probably should not use a birth control patch either. The birth control patch should not be used by women who:

    • Smoke and are over 35
    • Have high blood pressure
    • Have breast or uterine cancer
    • Have a history of blood clots
    • Have a history of heart attack or stroke
    • Are allergic to hormones
    • Have diabetes
    • Have liver disease
    • Have unexplained vaginal bleeding.

    Contact your healthcare provider immediately if you experience any of the following:

    Chest pains; redness, swelling, or pain in your legs; abnormal or irregular vaginal bleeding; jaundice (your skin looks yellow) or if you think you might be pregnant.

    Click to download a pdf version. Women's Health Matters: Depo-Provera

    Depo-Provera®

    Depo-Provera® is a combined contraception given by injection which is effective for 12 weeks. It contains a hormone much like the progesterone a woman produces during the last 2 weeks of each monthly cycle. It stops a woman from releasing a mature egg from her ovaries. When there is no egg to be fertilized, pregnancy cannot occur.

    The injection is usually given in the upper arm, thigh or buttocks, whichever you prefer. For some women, a small lump may occur where the injection was given which usually disappears within a few days.

    Depo-Provera® is 99.7% effective, making it one of the most reliable methods of birth control. If you receive your injection within the first five days from the beginning of your menstrual period, Depo-Provera® is immediately effective.

    **Depo-Provera® will NOT protect you against HIV infection (AIDS) or other STIs. Only using a latex condom will provide this protection.

    How often do I have to get the injection?

    The injection must be given once every 10-13 weeks, or roughly 4 times a year. By calling 1-888-671-DEPO(3376) or visiting www.birthcontrol.pnu.ca, you can enroll in a FREE reminder program. You will then be notified in writing, by phone or email when you should schedule your next appointment. The cost of Depo-Provera® is approximately 40$ per injection so check with your insurance provider to see if you are covered.

    The amount of Depo-Provera® in the bloodstream is at the highest level just after injection. Over time, the level drops and after three months the level may no longer offer enough protection. Therefore it is important to be on time for your next injection. If it has been over 13 weeks since you last injection, you should get a pregnancy test and then use back-up methods for 3-4 weeks following the next injection.

    Can any women take Depo-Provera®?

    You should NOT receive Depo-Provera® if you are or suspect you are pregnant.

    Depo-Provera® may not be suitable for women who have two or more conditions that may lead to a weakening of the bones including slim build, lack of exercise and smoking.

    Medications which are thought to interfere with Depo-Provera® are aminoglutethimide (Cytadren®) and rifampin/rifampicin (Rifadin®, Rimactane®, Rofact®). Tell your doctor or nurse if you are taking, or begin taking, any other medications, even over-the-counter medications.


    Advantages of Depo-Provera®
    Nothing must to be taken daily or used at the time of sexual intercourse.

    Depo-Provera® is extremely effective. At 99.7%, it is one of the most reliable birth control methods.

    Women often lose less blood using Depo-Provera® and have less menstrual cramping. Often after 3 injections women stop having periods. This is safe.

    Privacy is a major advantage. No one has to know you are using this method.

    It's OK to start a new contraceptive if fewer than 13 weeks have passed since the last shot.

    Depo-Provera® may improve PMS, depression, and symptoms from endometriosis.

    When Depo-Provera® is discontinued, normal periods and fertility return. Most women will be able to conceive within nine months of their last injection.


    Disadvantages of Depo-Provera®
    Depo-Provera® injections can lead to very irregular periods.

    Some women gain weight. To avoid weight gain, eat a healthy diet and get lots of exercise.

    Depo-Provera® does not protect you from AIDS or other infections. Use condoms if you are at risk.

    You have to return to the clinic every 3 months for your injection.

    Depression and premenstrual symptoms may become worse.

    It may take a couple of months before your periods return to normal after your last shot.

    Depo-Provera® may lower your estrogen level and cause bone loss, although this is not certain. Get regular exercise and consider taking extra calcium to protect your bones from osteoporosis.

    A few women are allergic to Depo-Provera®. Fortunately, allergic reactions are rare.

    You should see a doctor immediately if you experience:

    -Heavy, continuous bleeding.
    -Severe pain in the calf of your leg.
    -Numbness or weakness in you arm or leg.
    -Severe headache or slurred speech.
    -Vision loss, double vision, or other vision changes.
    -Shortness of breath, chest pain or coughing up blood.
    -Severe pain in your lower stomach.
    -Yellowing of your skin or eyes.
    -Severe pain, bleeding or pus where you received you injection.


    You can get a prescription for Depo-Provera at Health Services by appointment with a doctor. The injection can also be given by a nurse or doctor at Health Services again by appointment at 398-6017.

    Click to download a pdf version. Women's Health Matters: Diaphragm

    Diaphragm

    The diaphragm is a round soft rubber dome worn inside the vagina during vaginal intercourse. It fits snuggly into the vagina and prevents pregnancy by blocking the cervix (opening of the uterus) and by holding spermicidal foam or jelly in place.

    The effectiveness of the diaphragm is about 85-97%, but this depends mainly on how well it is used. It must be used correctly every time a woman has vaginal intercourse and it must fit properly. It doesn't work if it's in your drawer!

    Getting a Diaphragm

    Make an appointment with a doctor; he or she will give you a physical examination and discuss the diaphragm with you. You must get a doctor's prescription for a diaphragm, which can be filled at any pharmacy.

    The doctor will decide with you the best type and size of diaphragm for your body and show you how to insert and remove it.

    It is really important that you become comfortable and confident doing this before you begin to use your diaphragm.

    How long will my diaphragm last?

    With proper care, your diaphragm should last at least a couple of years. However, it is important to make sure that the size of the diaphragm remains correct; a regular check up every year with your PAP smear, is recommended. If you have a baby, lose or gain more than 10 pounds, have an abortion or have vaginal surgery, you should be refitted for a new diaphragm.

    Using Your Diaphragm

    Your diaphragm should be inserted no more than two hours before you have intercourse.

    Hold the diaphragm up to the light to be sure that there are no holes or cracks. If there are, don't use it!

    p>Your diaphragm should be used with spermicidal cream or jelly. Never use Vaseline or petroleum-based products, as they weaken the rubber.

    Squeezing the diaphragm in one hand, hold you vaginal lips open with your other hand, and slide the diaphragm into the vagina. Use a finger to check that the cervix is covered.

    If you aren't sure what your cervix feels like (like the tip of your nose) ask your doctor to show you. You may also teach your partner to insert the diaphragm for you and to verify that it is in place correctly.

    To remove your diaphragm, slide a finger into your vagina, hook it under the rim of the diaphragm and pull it forward and down.

    Wash your diaphragm with mild soap and warm water and carefully pat dry. Don't use talcum power on it as it destroys the rubber. Don't ever boil your diaphragm.

    Should I use a condom as well?

    The best reason to use a condom is to prevent sexually transmitted infections (STIs) including HIV. The diaphragm offers some protection against STIs, but a latex condom is the best protections and also offers additional contraceptive protection.

    Advantages of Using a Diaphragm

    The diaphragm is fairly effective (~95%) and gives woman some control over contraception.

    The diaphragm can be put in several hours before initiation of sexual activity.

    Your partner can put it in as part of love-making.

    The diaphragm is safe and contains no hormones. Thus, there are no hormonal side effects.

    The penis can remain inside the vagina after ejaculation.

    Intercourse during a woman's period is less messy with a diaphragm because the diaphragm holds back menstrual blood.

    Disadvantages of Using a Diaphragm

    You must be fitted for a diaphragm by a doctor

    You should wash your hands with soap and water before putting in your diaphragm and you MUST use spermicide with the diaphragm.

    Insertion of the diaphragm may interrupt sex.

    Some women find the diaphragm unattractive and it is difficult for some women to insert a diaphragm correctly.

    The diaphragm may slip out of place during sex. If you change positions, you may want to check to see that the diaphragm is still covering the cervix.

    The diaphragm must be left in place 6 hours after the last act of intercourse.

    Vulvar itching, burning or rash may occur if you are allergic to the cream or jelly, or even the diaphragm itself. Try switching brands of cream or jelly or consult your doctor, under the rim of the diaphragm and pull it forward and down.

    Recurrent cystitis (bladder infections) may be due to the upward pressure of the rim of the diaphragm against the urethra.

    If your diaphragm is too large or improperly positioned, you may experience pain or discomfort while it is in, especially during intercourse. If this is a problem, go see your doctor.

    There is a slight risk of toxic shock syndrome associated with the use of the diaphragm during menstruation. It can cause flu-like symptoms including fever, nausea, vomiting and rash. If you experience any of these symptoms, remove your diaphragm immediately and see your doctor right away.

    You must leave your diaphragm in for at least 6 hours after intercourse. If you have sex more than once, don't remove the diaphragm, just put in an applicator of spermicide. Your diaphragm should never be left in for more than a total of 24 hours.

    Click to download a pdf version. Women's Health Matters: IUD

    Intrauterine Device (IUD)

    An IUD is a safe and effective method of birth control which doctors have been testing for nearly one hundred years. However, it gives NO protection against sexually transmitted diseases. An IUD is a small, plastic or plastic and copper device attached to a pair of thin plastic threads which is inserted into the uterus. Its exact mechanism of action is not known, but it is believed to involve a change in the lining of the uterus which prevents implantation of a fertilized egg which is then expelled during the menstrual period.

    Where do I get it?

    In Canada, an IUD is usually inserted by your doctor and can remain in the uterus from one to five years. The IUD is inserted through a small tube and once in the uterus opens to its proper shape. The attached strings descend through the cervix into the upper vagina and provide a means of checking that the IUD is properly in place.

    An IUD must be inserted while you are having your period. It can be removed at any time although it may be more comfortable if you have it removed during your period. You may experience cramps for the first few days after the IUD is inserted, and spotting is normal during the first 2-3 months. While the IUD is in place your periods may be longer and heavier with more cramping. If your pain is severe, or if you have heavy blood loss, consult your doctor. If you ever develop fever, pelvic pain, abdominal pain during intercourse or unusual bleeding or discharge, see a doctor.

    How effective is it?

    The IUD is about 97-99% effective, but even with it in place it is possible to become pregnant. If your period is two weeks late you should have a pregnancy test done. If you do conceive, the IUD will have to be removed regardless of whether you plan to continue the pregnancy or not.

    Although an IUD is effective immediately it is more likely to be expelled by the uterus in the first few months after insertion. Therefore, during this time you should check for the string at least once a month, especially after you period. After the first few months, it is a good idea to check for a dropped-out IUD when changing underwear, napkins or tampons.

    Remember you should continue to have yearly gynecological exams, including a pap smear. If you change partners and choose not to use condoms, you should come in for regular checkups and STD testing.

    If you have any questions or concerns, or would like further information, please do not hesitate to contact a nurse or doctor at Health Services at 398-6017.

    Click to download a pdf version. Women's Health Matters: Morning After Pill

    Morning After Pill

    The morning after pill is a combination of high does female hormones (estrogen and progestin). It is an emergency back-up measure for a woman who has had unprotected intercourse or who was using a contraceptive method that failed (i.e. a broken condom). It should not be used as a regular birth control method because the dosage of the hormones is quite high and can disrupt the menstrual cycle.

    The morning after pill does not provide any protection against STIs. It should also be noted that the morning after pill is a special combination of female hormones, it is NOT equivalent to 2 or 3 regular birth control pills.

    The morning after pill must be taken within 72 hours of having unprotected intercourse and is most effective within the first 12-24 hours. Overall, its effectiveness is ~75-90 %. It is believed that the pill prevents pregnancy by slowing down the rate at which the egg travels through the fallopian tube and altering the uterine lining so that the egg, if fertilized, cannot implant and begin to develop.

    Women who need emergency contraception are given 2 Ovral pills to be taken immediately and 2 Ovral pills to be taken exactly 12 hours later. Nausea and vomiting are common side effects. If vomiting occurs within 2 hours of taking the pills, 2 additional pills should be taken. In addition, Gravol can be taken before each set of pills to try and avoid this problem. Gravol is an anti-nausea drug that can be purchased in any pharmacy without a prescription, but it can make you drowsy. Often Gravol is given out with the Ovral pills.

    Once the Ovral pills have been taken, menstruation should resume anytime within the following 3 weeks. If menstruation does not resume in that time frame, then a pregnancy test should be taken. It generally takes 14-21 days after intercourse for a pregnancy test to show a positive result in the event of pregnancy.

    If you have any questions or concerns, or would like further information, please do not hesitate to contact a nurse or doctor at Health Services at 398-6017.

    Click to download a pdf version. Women's Health Matters: The Pill

    The Pill

    There are actually two different kinds of oral contraceptive pills. The most common kind is called the “combined pill”, because it
    contains two different kinds of hormones, progestin and estrogen. These are similar to the hormones produced in your ovaries, and they mimic the effects of these ovarian hormones in your body. The
    second kind of pill is called the “minipill”, because it only contains progestin.

    How does the Pill work?

    In order for pregnancy to occur, an egg must be released from your ovaries and become fertilized by a sperm. This fertilized egg must then implant itself in the lining of your uterus, where it then grows into a fetus. Birth control pills work in three ways to prevent pregnancy. The combined pill works by preventing the release of eggs, so fertilization can’t take place. Both the combined pill and the minipill also cause the mucus of the cervix to thicken, making it more difficult for the sperm to get through your cervix and into your uterus. This means the sperm cannot reach the egg to fertilize it. Both pills also prevent the lining of the uterus from thickening, which means that a fertilized egg is unable to implant itself in the lining and grow.

    If properly used, the birth control pill is over 99% effective.

    How do I go on the Pill?

    The Pill is only available through a prescription, so you need to make an appointment with a family doctor. She or he can discuss the Pill with you, and give you a physical examination, which will probably involve a Pap smear. Your prescription for the Pill can be filled at any pharmacy.

    You need to take the Pill every day in order for it to be effective. When you take a pill, the full amount of the hormone is released into your body. Over the next 24 hours, the amount slowly decreases. If you take your pill at the same time each day, your body can adjust more easily to this cycle, rather than trying to maintain a hormonal balance with random increases in hormone levels, and the pill is more effective. It is also much easier to remember to take the pill if you take it at the same time each day.

    You may have some spotting or bleeding between periods with the first few packs of pills. This is called breakthrough bleeding, and it usually goes away after the first few months.

    If you are prescribed any other medication, such as antibiotics, be sure to tell your doctor you are on the Pill. Ask whether the medication will reduce the effectiveness of the Pill and whether the Pill will decrease the effectiveness of the medication.

    What if I miss a pill?

    Each pill is slightly different, and what you should do depends on when you miss a pill, and how many you miss.

    Read the instruction pamphlet in the box your pills came in. It should include a section on what to do if you have missed a pill.

    If you are still unsure, call a nurse at the Health Service. With the proper information, they will be able to tell you how to handle the situation.

    What if I skip a period?

    If you are sexually active with a male partner and miss a period, or if your period is abnormal in any way, you should have a pregnancy test. Speak with a health care professional if you have any concerns.

    When should I use back-up contraception?

    Back-up contraception could include condoms, spermicidal foam or jelly, a diaphragm, and/or a contraceptive sponge.

    Use it:
    Until you have completed your first package of pills.
    If you miss one or more pills.
    If you experience stomach flu causing vomiting (within several hours of taking the pill) and diarrhea. In these cases, the Pill may not be completely absorbed, making it less effective.
    If you are taking medication that interferes with the Pill’s effectiveness, which can include some antibiotics and antidepressants. Always tell your doctor that you are taking oral contraceptives so that s/he may advise you accordingly.
    If you want to protect yourself against sexually transmitted infections, including HIV, the virus that leads to AIDS.

    It is essential to remember that the Pill offers NO protection against STIs including HIV. You must use a latex condom to protect against STIs.

    What side effects does the Pill have?

    There are effects you may experience while on the pill, including:

    Nausea (This can be helped by taking your pill at night.)
    Bloating
    Breast swelling or tenderness
    Breakthrough bleeding
    Mood swings

    These side effects occur less frequently with low dose pills and generally they disappear after a few months. If they persist and are bothersome to you, don’t hesitate to discuss them with your doctor.

    Often a simple change of Pill brand will be better for you.

    If you are planning surgery, you should stop taking the birth control pill one month prior to the surgery to avoid the possibility of vein inflammations or blood clots.

    What possible dangerous side effects should I watch for?

    There can be serious complications and risks association with the Pill. Danger signals or symptoms of these could be:

    Headaches
    Blurred vision, loss of vision, or vision change
    Sever leg pain or swelling, red streaks or rash on legs
    Tingling, numbness or loss of function in hands, feet, arms or legs
    Chest pain or unexplained shortness of breath, coughing up blood
    Unexplained dizziness or fainting
    Abdominal pains

    If you experience any of these, see a doctor right away and stop
    taking the Pill.

    If is essential to carefully read the product information sheet that comes with your oral contraceptive pills to learn how to take them correctly and to understand what the risks are. If you have any questions, do not hesitate to contact a doctor or nurse.