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How it works:
Combined hormonal contraception works by stopping ovulation, or the release of an egg from the ovary.
Who can use it:
Women who want a reliable, reversible, method of contraception that does not interrupt intercourse may consider this method.
A woman should not use this method if she:
Common side effects:
Irregular bleeding, breast tenderness, nausea, weight gain, and mood changes. These are often experienced during the first three menstrual cycles.
Transdermal contraceptive patch
This method is now approved for use in Canada. The way it works and the side effects are similar to combined OCs. Control of the menstrual cycle is also similar to the OC pills.
How it works:
Depo-medroxyprogesterone acetate (DMPA) works primarily by stopping the secretion of pituitary gland hormones, stopping ovulation.
Who can use it:
This method could be considered by women who are breastfeeding, are over the age of 35 who smoke, have migraine headaches, have endometriosis, take medication to prevent convulsions, or have sickle cell disease.
A woman should not use this method if she:
Common side effects:
Progestin-only pill
How it works:
It changes the mucus of the cervix. This increases the viscosity (thickness and texture) of the mucus. This results in little or no sperm getting through the mucus into the vagina and finding an egg. As well, sperm motility (ability to move) is impaired, and ovulation is halted. See the injectable progestin section for information on who can use this method and the common side effects. Special considerations for women who use these methods of hormonal contraception:
How it works:
An Intraunterine Device (IUD) stops the egg from being fertilized, or prevents a fertilized egg from burrowing (implanting) into the wall of the uterus.
Who can use it:
The IUD is suited for women who want long term birth control. It does not require a woman to remember to take a pill.
A woman should not use this method if she:
Common side effects:
Bleeding, pain, problems with cysts in the ovaries, the IUD perforating the uterus, and infection. An IUD can come out or can fail to prevent a pregnancy.
These methods include condoms, female condom, diaphragm, cervical cap and contraceptive sponge and spermicides (foam). They work by preventing sperm from entering the uterus and fertilizing an egg. Barrier methods are not as effective as the previously mentioned contraceptives. With a natural decline in fertility, barrier methods may be more reliable for mature women than they are for younger women. As a bonus, the condom provides protection against sexually transmitted diseases.
Calendar calculations, charting basal body temperature and assessing cervical mucus (Billings method) are considered forms of natural family planning. As fertility declines with age, this may be a suitable form of contraception. On the other hand, menstrual cycles tend to become irregular with age as ovulation becomes less frequent. Since these forms of natural family planning rely on identification of ovulation, the method becomes less reliable in for women between the age of 40 and menopause.
Coitus interruptus (withdrawal by the male prior to ejaculation) and abstinence are other natural family planning methods.
Sterilization is the permanent way to avoid pregnancy once child-bearing has been completed. This surgical procedure involves cauterizing, clipping or cutting the woman’s fallopian tubes (tubal ligation) under general anesthetic. This is usually done through a laparoscope with two small incisions. Healing is rapid. Men are sterilized with a vasectomy. The man’s vas deferens (sperm ducts) are closed off so sperm can’t get through.
Before deciding on the best contraceptive method for you, schedule a counselling session with your doctor. Discuss the methods, their risks and side effects, and how suitable they are for your needs. You should also discuss your family planning strategies and need for periodic health checkups. Contraception for special needs may need to be discussed, such as contraception during the time around menopause.
Emergency contraception (EC) is any method of contraception used after intercourse and before an egg might implant in the uterus. Two methods have been developed but only one is available in Canada.
These pills decrease the risks of cancer of the ovaries and the lining of the uterus. There is either no increase or a very slight increase in the risk of breast cancer in women who currently use combined OCs.
Once OC pills are stopped, fertility is restored within one to three months.
The patch is just as effective as OC pills. There does not appear to be an association between the patch and weight gain.
DMPA is an effective method of birth control during breastfeeding. It has shown to have no or little effect on breastfeeding or on infant development.
DMPA is a reversible method, though there may be a nine month delay before fertility returns.
Not all men know how to use condoms to prevent breaking or spilling of the contents. A spill just outside or in the vagina can result in a pregnancy, so it is important to learn how to use condoms correctly.
Any skin-to-skin contact from genital ulcers or sores can cause STDs. These sores may be outside the area covered by a condom, and may not be visible.
Condoms and the female condom can protect against HIV. Protection from HIV is limited with a diaphragm, cervical cap, contraceptive sponge and spermicides since the wall of the vagina is exposed. The sponge and spermicides containing nonoxynol-9 may also cause irritation to the lining of the vagina. This can increase the risk of infection by HIV.
Is using a diaphragm alone (without spermicide) just as effective as using a diaphragm with spermicide?
Using a diaphragm with a spermicide improves the diaphragm’s prevention of pregnancy.
Cervical caps are not associated with increased risk of cancer of the cervix. They are available in Canada through some family planning clinics.
Contraceptive sponges may possibly damage the lining of the vagina. This may enhance STD transmission and make a woman more vulnerable to sexually transmitted infections, including HIV.
Emergency contraceptive pills act before a fertilized egg implants in the wall of the uterus. There is no effect on an established pregnancy.
The brief, one-time use of the emergency contraceptive pill is safe. Almost any women can use it.
| ALWAYS VERY EFFECTIVE METHODS | PREGNANCIES per 100 women in first 12 months of use |
| Vasectomy - male sterilization | 0.1 |
| DMPA (depot-medroxprogesterone acetate) | 0.3 |
| Tubal ligation - female sterilization | 0.5 |
| Cu-380 IUD (no longer available in Canada) | 0.6 |
| Progestin-only oral contraceptives (during breastfeeding) | 0.5 |
| EFFECTIVE AS COMMONLY USED | |
| Lactational (breastfeeding) amenorrhea method | 0.5 |
| Combined oral contraceptive (OC) | 0.1 |
| Progestin-only oral contraceptives (not during breastfeeding) | 0.5 |
| ONLY SOMEWHAT EFFECTIVE AS COMMONLY USED | |
| Male condoms | 3 |
| Coitus interruptus | 4 |
| Diaphragm with spermicide | 6 |
| Fertility-awareness based methods | 1.9 |
| Female condoms | 5 |
| Spermicides | 6 |
| Cervical cap - women who have not given birth | 9 |
| Cervical cap - women who have given birth | 26 |
| No method | 85 |
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