Birth Control

The Center for Women’s Health is pleased to offer you some information on birth control. With many different types of birth control available it can be overwhelming. The doctors and nurses at the Center for Women’s Health can assist you in selecting the right method of birth control. Please contact the staff at the Center for Women’s Health if you wish to discuss any of these topics in more detail. Click here to contact the office.
Some women should not take the Pill, including women who have blood clots, certain cancers, a history of heart attack or stroke, as well as those who could be pregnant.
The Pill does not protect against HIV infection or other sexually transmitted diseases (STDs).

Essure Tubal Sterilization

The Essure procedure is the first and only FDA approved female sterilization procedure to have zero pregnancies in the clinical trials. The Essure procedure is permanent and is NOT reversible. Therefore, you should be sure you do not want children in the future.

The Essure procedure is different than the traditional method of a surgical tubal ligation. With Essure there is no cutting into the body. Instead, an Essure trained doctor inserts spring-like coils, called micro-inserts, through the body’s natural pathways (vagina, cervix, and uterus) and into your fallopian tubes.

The procedure can be performed in your doctor’s office without general anesthesia.

During the first 3 months following the procedure, your body and the micro-inserts work together to form a tissue barrier that prevents sperm from reaching the egg. During this period, you will need to use another form of birth control.

After 3 months, your doctor will perform an Essure Confirmation Test, a special type of x-ray to confirm that your tubes are completely blocked and you can rely on the Essure micro-inserts for birth control.

Unlike birth control pills, patches, rings, and some forms of IUDs, Essure does not contain hormones to interfere with your natural menstrual cycle. Your periods should more or less continue in their natural state.

Fact Sheet On Emergency Contraception

What is Emergency Contraception (EC)? Emergency contraception (EC) is an effective back-up birth control method that can prevent pregnancy after unprotected intercourse or contraceptive failure (a broken condom). The most common form of EC is emergency contraceptive pills, which contain high dosages of the same hormones found in daily birth control pills. A woman takes EC within 72 hours of unprotected sex, followed by a second dose 12 hours later.

Is Emergency Contraception the Same Thing as the “Morning-After Pill”? Because EC can help reduce the risk of pregnancy after sex, some people like to call it the “morning-after pill.” Actually, a woman can take EC up to 72 hours after unprotected intercourse or birth control failure. And the process of using EC involves taking two doses of the pills, twelve hours apart. Emergency contraception should not be confused with Mifeprex (RU-486). EC helps to prevent pregnancy, while Mifeprex terminates an early pregnancy.

How Do Emergency Contraceptive Pills Work? EC prevents pregnancy the same way that the daily pill does: by delaying or inhibiting ovulation, inhibiting fertilization, or preventing implantation of a fertilized egg in the uterus. All of these events occur before the beginning of pregnancy, which science defines as the implantation of a fertilized egg in the lining of a woman’s uterus; implantation typically begins five to seven days after fertilization. EC does not interrupt a pregnancy. It will not work if a woman is already pregnant.

How Effective is Emergency Contraception? Emergency contraceptive pills containing only progestin reduce the risk of pregnancy after unprotected intercourse by 85 percent; combined estrogen-progestin pills reduce the risk by 75 percent. Recent data also shows that the sooner a woman takes EC, the more effective it is. However, an 85 percent reduction in the risk of pregnancy does not mean that 15 percent of women using EC will become pregnant. Rather, if 100 women take EC after having unprotected sex in the second or third week of their menstrual cycles, only one will become pregnant. Without EC, an average of eight of the 100 women would become pregnant.

Are There Any Side Effects Associated With Emergency Contraceptive Pills? Some women using EC may experience temporary side effects, which include nausea, vomiting, and breast tenderness. These symptoms are more common with combined estrogen-progestin pills than with the regimen using progestin-only pills. There are no known serious side effects of emergency contraceptive pills. If a woman who is already pregnant takes ECP’s, there are no known risks to the developing fetus.

Why Would a Woman Need Emergency Contraceptive Pills? There are about 3 million unintended pregnancies each year in the United States. Half of these happen to women who are using a regular method of contraception. Despite the highly effective birth control options women have to choose from, none is 100% perfect. And sometimes, mistakes happen – a condom breaks, a woman forgets to take her pill. Or she has sex when she didn’t plan to – or want to. Researchers estimate that roughly half of the unintended pregnancies in the U.S. could be prevented by widespread awareness and use of EC. One of the reasons a woman might need emergency contraception is in the case of rape. Each year, thousands of American women are the victims of this violent crime. By offering a woman the option of taking emergency contraception, health care providers can help to eliminate at least one trauma associated with rape – the fear of an unwanted pregnancy.

Where Can Women Get Emergency Contraception? Emergency contraceptive pills are available in the U.S. only by prescription. A woman can get EC – or a prescription for the pills – from any physician and many other health care providers. Most clinics require a woman to come in for an office visit before prescribing emergency contraception. However, some women’s health specialists are exploring ways to provide EC to women who cannot get to their provider within the 72-hour window they have for using this back-up birth control method. In a some states, women are able to obtain EC directly from a pharmacist without having to visit a health care provider first.

Where Can Women Get More Information? There is an automated, 24-hour-a-day, toll-free hotline (1-888-NOT-2-LATE) or the Spanish mnemonic (1-866-en-tres-dias) and an Emergency Contraception Website http://www.not-2-late.com. Both also provide guidance about where to get EC in a given area. Or contact the Center for Women’s Health for assistance.

Implanon

IMPLANON™ is a small, thin, implantable hormonal contraceptive that is effective for up to three years. It has recently been approved by the U.S. Food and Drug Administration.

What is IMPLANON™?

Implanon is a type of birth control for women. It is a flexible plastic rod the size of a matchstick that is put under the skin of your arm. Implanon contains a hormone called etonogestrel. You can use a single IMPLANON™ rod for up to three years. Because Implanon does not contain estrogen, your healthcare provider may recommend Implanon even if you cannot use estrogen.

What if I need birth control for more than three years?

You must have Implanon removed after three years. If you want to continue using Implanon, your healthcare provider can put a new Implanon under your skin after taking out the old one.

What if I change my mind about birth control?

Your healthcare provider can remove Implanon at any time. If you want to become pregnant after Implanon removal, your ability to get pregnant may return quickly. If you don’t want to get pregnant, you should start another birth control method right away.

How does Implanon work?

Implanon prevents pregnancy in several ways. The most important way is by stopping release of an egg from your ovary. Implanon also changes the mucus in your cervix and this change may keep sperm from reaching the egg. Also, Implanon changes the lining of your uterus.

How well does Implanon work?

If Implanon is inserted correctly, your chance of getting pregnant is very low (less than one pregnancy per 100 women who use Implanon for one year). It is not known if Implanon is as effective in very overweight women because studies did not include many overweight women.

What You Should Know About Current Birth Control Methods

There are some new choices available for birth control. We will discuss some of the methods recently arriving to the U.S. and currently available in Europe and South America.

There are two reasons for the delay: First, the Food and Drug Administration (FDA) has a more lengthy approval process than in Europe. Second, since more American women are already satisfied with birth control pills, start-up costs for a new method could easily exceed 150 million dollars. This may give American women a hidden advantage women in other countries test these methods before they become available here, and potential adverse effects are discovered. The new methods
make highly effective contraceptive options available to women who:

• Are over 35, and still smoke cigarettes

• Have tried other methods without success

• Want to change their method of birth control

• Are not yet ready for permanent sterilization

EXTENDED DOSE ORAL CONTRACEPTIVES

No longer must a woman have a “monthly” cycle. New birth control pills are available for four periods, or no periods per year.

PROGESTERONE-ONLY Birth Control Pill (“MINI-PILL”)

Many women who have not had good results with regular birth control pills have done well with the “Mini-Pill,” because it contains no estrogen. Many women who quit pills did so because of the side effects of estrogen, NOT the progesterone. The “Mini-Pill” is about 97% effective, may be used by breast-feeding mothers, and is a safer option for smokers over 35.

DEPO PROVERA®

Women complain about the amount of effort required with most birth control methods. Pills should be taken the same time each day, a diaphragm must be inserted before intercourse, and lovemaking can be interrupted for use of condoms and spermicides. Many have been pleased with Depo-Provera—a long-acting injection given every three months. It provides +/- 98% protection against pregnancy. Among side effects of Depo-Provera is unpredictable return to fertility and interrupted menstrual patterns, usually resolving after the second injection. It contains only progesterone, and can be used by nursing mothers and smokers over age 35. Eventually, most women report very scant periods.

THE IUD

The IUD is a small “T”-shaped plastic device inserted into the uterus. Its presence acts to disrupt the balance/environment within the uterus in such a manner as to prevent pregnancy about 99% of the time. The Mirena® IUD can be kept in place for five years, and provides an immediate return to fertility on removal. While in place, it requires no attention. This IUD decreases or eliminates menstrual flow because it contains the synthetic rogesterone levonorgestrel. There may be cramps after insertion. The ParaGard® IUD contains copper, but no hormones. It is highly effective for up to ten years. The user may have more cramps and slightly longer periods compared to Mirena.

THE CONTRACEPTIVE “RING”

The contraceptive “ring” NuvaRing® is a soft silicon ring about 2 inches in diameter that a woman inserts in her vagina, and then removes and discards it after 4 weeks. The device contains both a synthetic estrogen and a progestin, just like the Pill. After four weeks, there is a week without the ring, just like the week of “sugar pills” in a pack of birth control pills. The effectiveness is equal to the Pill, and there are fewer side effects. Because the hormones in the ring are absorbed directly into the bloodstream, there is much less nausea. The ring can be removed for very short periods of time if the patient or her partner desires.

THE SINGLE ROD IMPLANT

Implanon® is a single-rod contraceptive implant that is inserted under the skin of the upper arm and provides highly reliable protection against pregnancy for up to 3 years. Implanon does not contain estrogen, making it suitable for women who do not tolerate or should not take estrogens. The implant can be removed at any time, after which fertility is rapidly restored. It is a very reliable contraceptive method, as was shown in the clinical trials, in which no pregnancies occurred during use over 73,000 monthly cycles. It is important for women to know that no form of contraception is 100 percent effective. Like other progestogen-only contraceptives, the use of Implanon is associated with irregular menstrual bleeding and sometimes absence of bleeding, and counseling is required to ensure women make informed choices.

“MORNING-AFTER-PILL” (EMERGENCY CONTRACEPTION)

The “morning after pill” is really not one pill, but several birth control pills taken under our supervision to prevent a pregnancy following unprotected intercourse or condom failure. It is not meant to be used for routine birth control. If properly taken, the “morning after pills” are almost 95% effective in preventing pregnancy. The critical time for success is less than 72 hours after intercourse. To use this “emergency” method, the woman should contact our office as soon as possible following unprotected intercourse.

PERMANENT STERILIZATION

Our office provides two methods of permanent sterilization: Laparoscopic tubal sterilization and the ESSURE® method. Laparoscopy uses an incision in the umbilicus and a tiny incision in the lower abdomen. This procedure is done under general anesthesia, and there is a 2-4 day recovery period.

ESSUREuses 2 “micro-inserts” threaded through a hysteroscope inserted through the cervix and into the uterus, permanently blocking the tubes as they enter the uterine cavity. There is no incision with ESSURE, it can be performed in our office using i.v. sedation, and there is no post-op recovery period.

WHEN YOU NEED OUR HELP:

Drs. Hodes and Nauser, and Colleen O’Donnell, RN-C are known for their dedication in helping women find suitable contraceptive methods. Because of their research association with major pharmaceutical companies, the office has access to new developments that are not yet widely available. They have been involved with the research protocols necessary for approval in the U.S. of some of the methods mentioned above. To discover whether these new methods–or traditional ones–are appropriate for you, call our office for an appointment. We are eager to provide care for you, and your friends or family.