Birth Control Options

Depo-Provera (Depo) is an injectable form of birth control that is 99.7% effective in preventing pregnancy. Depo works to prevent pregnancy by preventing ovulation in some women. The drug also thickens mucus in the genital tract, obstructing the forward movement of sperm, and reduces the ability of the uterine lining to be receptive to pregnancy.

The first dose of Depo must be injected during the first five days of the menstrual cycle. Subsequent doses of Depo will be administered every 12 weeks or 84 days. Doses of Depo can be given earlier than 12 weeks, but no later than 13 weeks or 91 days without a lapse in birth control.

If a subsequent Depo dose is not obtained by 91 days, then it will not be administered unless you are on your menses, have abstained from intercourse for two weeks and have a negative pregnancy test. If you are late for your injection, then your new injection will not be effective birth control for up to two weeks.

Remember: Emergency birth control is available over-the-counter at your pharmacy and is safe and effective.

Recommended injection site is the buttocks. Although the site will be sore, you should resist massaging it, as this will disperse the medication too quickly..

Common side effects of Depo include: irregular bleeding, breast tenderness, bloating, weight gain (5 pounds the first year, 0 – 3 pounds every year after), acne, headache or worsening depressive symptoms.

If irregular bleeding bothers you, you may obtain a Depo injection sooner than 12 weeks. Ask your doctor about this option.

After the fourth injection, most women do not menstruate anymore. This is not permanent, but regular menstruation may not resume for 3 – 12 months after discontinuing Dep.

Depo effectively prevents pregnancy two weeks after the first injection. Birth control is continuous provided you obtain subsequent injections of Depo when you are due.

Depo does not protect you from sexually transmitted infections.

Because Depo decreases your estrogen levels, the drug can also reduce your bone strength. We recommend that you take a daily vitamin and calcium supplement. Your calcium goal is 1,200 mg. daily.

If you are over 40 years old, Depo may lead to irreversible bone loss. Ask your health care provider about other options for birth control that have no impact on your bone health.

Emergency contraception is birth control you can use to prevent pregnancy up to five days (120 hours) after unprotected sex. The morning-after pill is safe and effective and available at health centers and drugstores. Costs vary from $10 to $70.

 
WHAT IS THE MORNING-AFTER PILL (EMERGENCY CONTRACEPTION)?

The morning-after pill goes by the brand names of Ella, Next Choice and Plan B One-Step.  It can be used up to five days (120 hours) after unprotected intercourse.

 
HOW DOES THE MORNING-AFTER PILL WORK?

Two brands of the morning-after pill — Plan B One-Step and Next Choice — are made of one of the hormones found in birth control pills called progestin. The other brand of the morning-after pill — Ella — is made of a medication called ulipristal acetate.

All brands of the morning-after pill work by keeping a woman’s ovaries from releasing eggs — ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormone in the morning-after pill also prevents pregnancy by thickening a woman’s cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. The morning-after pill can also thin the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching and implanting into the uterine lining.

You might have also heard that the morning-after pill causes an abortion, but that’s not true. The morning-after pill is not the abortion pill. Emergency contraception is birth control, not abortion.

 
HOW EFFECTIVE IS THE MORNING-AFTER PILL?

Emergency contraception can be started up to 120 hours — five days — after unprotected intercourse. The sooner it is started, the better it works. It can reduce the risk of pregnancy by 89 percent when started within 72 hours after unprotected intercourse. It continues to reduce the risk of pregnancy up to 120 hours after unprotected intercourse, but it is less effective as time passes.

You need to use the morning-after pill to prevent pregnancy after each time you have unprotected intercourse. The morning-after pill will not prevent pregnancy for any unprotected intercourse you may have after taking the pill. If you do not have your period within three weeks after taking emergency contraception, you may want to consider taking a pregnancy test.

The morning-after pill offers no protection against sexually transmitted diseases or infections. You may want to consider STD testing if there is a possibility that unprotected sex put you at risk.

 
HOW SAFE IS THE MORNING-AFTER PILL?

Emergency contraception is safe and millions of women have used it. Various forms of emergency contraception have been used for more than 30 years. There have been no reports of serious complications.

Even though Plan B One-Step and Next Choice are made of one of the same hormones used in the birth control pill, the morning-after pill does not have the same risks as taking the pill or other hormonal birth control methods continuously. That’s because the hormone in the morning-after pill is not in your body as long as it is with ongoing birth control.

 
WHAT ARE THE DISADVANTAGES OF THE MORNING-AFTER PILL?

Although most women use the morning-after pill with few problems, you may experience some undesirable side effects while using this medication. Nausea and vomiting are the most common side effects. Less than 1 out of 4 women feel sick when they take the morning-after pill. You can use anti-nausea medicine one hour before taking emergency contraception if you are concerned about being nauseated. Many women also find it helpful to take the emergency contraception pill with a full stomach.

Other side effects of the morning-after pill may include:

  1. Breast tenderness
  2. Irregular bleeding
  3. Dizziness
  4. Headaches

 

If you use the morning-after pill frequently, it may cause your period to be irregular. It may be earlier or later than usual. It may be heavier, lighter, more spotty, or the same as usual. Remember, if you do not have your period within three weeks after taking emergency contraception or if you have any symptoms of pregnancy, take a pregnancy test or schedule an appointment with your health care provider.

Emergency contraception should not be used as a form of ongoing birth control because there are other forms of birth control that are much more effective.

 
HOW DO I GET THE MORNING-AFTER PILL?

Plan B One-Step and Next Choice are available from drugstores and health centers without a prescription for women and men 17 and older. If you are interested in getting emergency contraception and are 17 or older, you can try your local drugstore. If you are younger than 17, you’ll need to go to a health care center or private health care provider for a prescription.

We all like to be prepared. That is why it’s a great idea to keep some emergency contraception in your medicine cabinet or bedside table in case of an accident. Having the morning-after pill on hand will let you take it as soon as possible after unprotected intercourse, when it is most effective.

STARTING THE PILL

You may start the pill on the first day of your period or wait until the first Sunday after your period has started. Use back-up birth control for 2 weeks.

New pill users can be nauseated on their first pack. In this case, you may try to take the pill with food or at night before you go to bed.

 
TAKING THE PILL

Because the pill contains such a low dose of hormones, you must take it every day at about the same time for it to be effective in preventing pregnancy and irregular bleeding. Irregular bleeding is common in the first 3 packs and will resolve with continued daily use.

You may take the pill with other medicines such as cold remedies, vitamins or calcium. The use of antibiotics reduces the effectiveness of your pill in preventing pregnancy. Use condoms while on antibiotics.

 
MISSING A PILL

If you miss one pill, take one as soon as you remember and then take one pill at the regular time. If you miss two pills, then take two when you remember and one pill at the regular time. You must use back-up birth control (condoms) for one week to prevent pregnancy.

If you miss the first pill of the pack, you must start the pack as soon as possible and then use back-up birth control for 2 weeks! Neglecting to do so is a common cause of unplanned pregnancy. Always keep a pack of your pills on hand and monitor your refill number at the pharmacy. You must return to the office yearly to get a refill.

 
CALL IF YOU EXPERIENCE
  • Irregular bleeding after 3 months
  • Worsening acne or headaches
  • Chest, leg or calf pain
  • Unusual abdominal pain
 
MORE INFORMATION

The pill will not work if you do not take it daily. The drug is out of your system 24 hours after your last dose. The pill is safe and beneficial for long term use. You do not have to take a “break” from the pill.

 
HEALTH BENEFITS

The birth control pill often reduces the amount of pain and cramping that you experience with a period. You may bleed less and sometimes not bleed at all during your period. The pill will not cause birth defects or cancer. The pill will not protect you against sexually transmitted diseases. Women also experience fewer problems with their ovaries and enjoy being able to predict their periods weeks in advance.

Birth control pills should not cause weight gain and can improve mild to moderate acne. The pill can prevent pregnancy now, but it will not interfere with your ability to become pregnant in the future.

Smoking increases the risk of heart attack and stroke in pill users. You should stop smoking to protect your health or use another method of birth control.

HOW DOES IT WORK?

There are many drugs which can be delivered through the skin for an equal or better benefit to the body. The birth control patch is one of these products. The patch, which contains the active ingredients in a birth control pill (estrogen and progestin) delivers continuous levels of hormones to your system through your skin. It works exactly like a birth control pill to prevent pregnancy by thickening mucus in the genital tract, preventing the formation of eggs and preventing ovulation. For some women who find taking the birth control pill daily difficult, the patch can offer more effective pregnancy prevention and menstrual control. The patch can be 97-99% effective in preventing pregnancy.

 
WHERE DO I PUT IT?

You have 4 choices: the lower abdomen, buttocks, upper, outer arm or back of the shoulder. The patch should never be applied to the chest or breasts. To ensure the effectiveness of ORTHO EVRA®, do not place the patch on areas of your skin where make-up, lotions, creams, powders or other products are or will be applied. In addition, do not place ORTHO EVRA® on skin that is red, irritated or cut.

You should change the location of the patch weekly to avoid skin irritation and enable you to remove the adhesive from the old site. When removing your used patch, simply lift one corner and quickly peel it back. If a small ring of adhesive is left on your skin, remove it by rubbing a small amount of baby oil on the area.

The patch adheres well to the skin, allowing you to perform your daily activities such as bathing, showering, swimming and exercising without interruption. If the sticky surface of the patch becomes wet, discard it and apply a new patch. Once you have prepared the skin and applied the patch, you will not be able to remove it and place it in a new location. The adhesive is unlikely to adhere adequately. You will have to use another patch.

Patches cannot be altered or cut. Modifying the patch will decrease the effectiveness of preventing pregnancy and controlling your periods.

 
WHEN DO I START THE PATCH?

Apply your first patch on the first day of your period. The patch will be effective in two weeks. Apply a patch every 7 days for 3 weeks. Remove the patch for one week while you have your period and then refill your prescription and re-apply the patch for the next cycle.

 
HELPFUL REMINDERS

You will need to change the patch every 7 days to maintain effective period control and pregnancy prevention. Although using the patch means that you will not have to take a daily birth control pill, you must still remember to change the patch weekly. Try these ideas to remind you:

  • Set the alarm on your cell phone for a weekly reminder.
  • Make it a part of your routine to change your patch before your first class on Monday morning.
  • Add a weekly reminder to the calendar on your work and/or personal e-mail.
  • Keep a weekly “to do” list, and add a patch reminder to that agenda.
  • Put a yellow sticky note on the bathroom mirror: “TUESDAY!” Only you will understand the meaning.
  • Keep a calendar on your refrigerator and circle all “Patch Change Days” for the year.

In clinical trials, less than 2% of birth control patches had to be replaced because of complete detachment and less than 3% had to be replaced because of partial detachment. Proper preparation of the skin will ensure that your patch will stick for a week thru exercise, swimming and bathing. Still, you should ask your provider for an extra prescription that allows you to obtain just one patch at the pharmacy in case you need to replace one.

See this web site for further information: www.orthoevra.com

At some point in life you may decide that you would not like to become pregnant again. Some women will choose permanent sterilization to prevent pregnancy for the remainder of their reproductive years.

There are several options for sterilization or permanent birth control. Sterilization, otherwise known as tubal ligation (tying your tubes) can be done through a small incision in your belly button or through the uterus without any incisions. The tubal ligation with the incision is performed as an outpatient procedure. It is done under general anesthesia and requires 2-7 days off of work for recovery.

The incisionless tubal ligation (Essure or Adiana) is performed in our office under sedation using a camera in the uterus to place plugs in the fallopian tubes. Most women recover from this procedure rapidly and return to work in 1-2 days.

Before making a decision to permanently remove the possibility of future pregnancy, your physician will want to discuss your decision to choose permanent birth control. Your doctor wants to be certain that you have examined all of your choices and considered all other reversible methods of birth control. You should understand that tubal ligation or Essure/Adiana procedures are non-reversible and meant to be permanent.

Modern sterilization procedures for women, although not 100% effective, are generally much more effective than typical birth control pill, Depo-Provera or condom use. Modern IUDs are as effective as tubal ligation and may be an alternative method for you, offering 5-10 years of birth control without undergoing a surgical procedure.

We offer both of these procedures in our office. Click on the links to learn more about Adiana www.adiana.com or Essure www.essure.com.

Progesterone-only birth control pills (POPs), also called the “mini pill,” contain progesterone instead of progesterone and estrogen which are the ingredients found in a regular birth control pill.

Estrogen-containing pills can increase the risk of clotting in women with high blood pressure, diabetes, migraine, clotting disorders and smokers. These women are encouraged to use products without estrogen. Estrogen can also decrease the production of milk in breastfeeding women. Women who want to continue to breastfeed should avoid products containing estrogen.

A regular birth control pill is 93-99% effective in the first year of use and 97-99% effective in subsequent years of use. A progesterone-only birth control pill is 97-99% effective.

With all birth control pills, effective pregnancy prevention relies upon the regular, daily use of the product.

Many generics are available.

The most common complaint of women using progesterone-only birth control pills is irregular periods  with unpredictable bleeding. Most women experience lighter periods over months of use and do develop some type of pattern to their periods. Some women will experience no period after many months of taking progesterone-only birth control pills. This is not harmful. Periods will return when the pill is discontinued.