ORAL CONTRACEPTIVE PILL (A.K.A.

THE PILL)
WHAT IS IT?

The oral contraceptive pill (OC) is one of the most researched (and often most
misunderstood) drugs in the world. It is also one of the world's most prescribed
medications - about 100 million women across the globe rely on it. The Pill is a
contraceptive suitable for most healthy women, regardless of age, and can be used
long-term. Some women only want to take the Pill when they are in a stable
relationship and stop taking it when the relationship ends. However, doing so can
put people at risk of unintended pregnancy while adjusting back to a new
contraceptive method. With proper use, the Pill is 99.9% effective, making it the most reliable
contraception available. However, there is a 3% user failure rate.

BENEFITS ARE NUMEROUS

In addition to being the most effective form of contraception, the Pill regulates the menstrual cycle,
reduces menstrual flow, can reduce the number of periods per year, reduces acne, protects against
certain cancers, and is completely reversible (once a woman is off the Pill, the body resumes its normal
cycle).

DISADVANTAGES

The Pill doesn't protect against STIs, and it may cause side-effects such as irregular bleeding, breast
tenderness, weight gain, headaches and nausea. These side-effects generally disappear after a few
months. In rare cases where these side-effects don't go away, you should see your doctor.

HOW IT WORKS

Just take the Pill on a daily basis, and try to take it at the same time each day so that it becomes a habit.
Some women find it helpful to set an alarm clock, pager or beeper as a reminder.

MYTHS

A common myth is that women who stop taking the Pill may not be able to get pregnant. Rest assured
that taking the Pill will not cause you to be infertile. Most women who use a method of contraception,
including the Pill, can later get pregnant if they wish. Another common myth is that the Pill causes cancer.
Again, false.in fact, the Pill actually reduces the risk of getting certain cancers such as endometrial and
ovarian. Note: The Pill should be used with condoms to prevent both pregnancy and STIs.

WHERE TO FIND IT

You can get a prescription by visiting your doctor or a clinic. The cost of the Pill varies from place to place;
various health plans cover the cost. The Pill can be obtained at most public health clinics and Planned
Parenthood Affiliates for free or at low cost.

TROUBLESHOOTING

If you miss one pill, you should take it as soon as you remember (this may mean taking two pills in one
day). If you miss two pills in a row during week 1 or 2 of the pack, take two pills on the day you remember
and two pills the next day. Remember to use a back-up method of birth control such as a condom if this
happens. If you miss two pills in a row during week 3 of the pack, throw out the remainder of the pack and
start a new pack on the day you remember. Use a back-up method of birth control. You may not have a
period this month or your period may come early. If you ever miss 3 pills in a row, throw out the pack and
start a new one the day you remember. Use a back-up method of birth control. You may not get your
period this month or it may come early.

CONTRACEPTIVE PATCH
The contraceptive patch (Evra®) is a new method of birth control that has been available in Canada since
January 2004. It is a 4 x 4 cm beige patch that sticks to a woman's skin and continuously releases
estrogen and a progestin (two female hormones) into the bloodstream.

HOW IT WORKS

The patch prevents pregnancy primarily by stopping the ovaries from releasing an egg, but it may also
thicken the cervical mucus (making it harder for sperm to get into the uterus) and make the uterine lining
thin. Its method of action is very similar to the Pill.

HOW TO USE IT

Unlike the Pill, which has to be taken every day, each patch is worn on the skin for seven days. One
patch is worn each week for 3 weeks. The patch should be changed on the same day each week (called
the "Patch Change Day"). The fourth week is patch-free, allowing a period to occur. The patch should
never be off for more than seven days. Following the seven patch-free days, a new cycle is started when
you apply a new patch on your Patch Change Day.

WHERE TO WEAR THE PATCH

The The The The

Stomach Upper Arms Buttocks Back

The patch can be worn on the buttocks, stomach, back or upper arms, but not on the breasts. It
may help to change the location a bit each week. The patch should be applied to clean, dry skin. You
should not use any creams or lotions near a patch you're already wearing, or where you'll be applying a
new one. The patch is very "sticky". You can exercise, shower, swim or go in a sauna or hot tub and it still
sticks 98% of the time! (Read below for what to do if it comes off.)

HOW TO START

You'll need to visit your doctor or health clinic to see if this is a good choice for you, and to get a
prescription. Ideally, you should apply the first patch on the first day of your period. If you apply the patch
more than 24 hours after the start of your period, you will not be protected from pregnancy for the first
week. Women switching from a birth control pill should also start the patch on their first day of bleeding
(not when you would have started the next pack of pills).
EFFECTIVENESS

Like the Pill, the patch is also more than 99% effective at preventing pregnancy when used perfectly, with
about a 3% failure rate for typical users. For women who have trouble remembering to take a pill every
day, the patch may work better than the Pill. It may be a bit less effective in women who weigh more than
90 kg (198 pounds).

OTHER BENEFITS

Other benefits to being on the patch include a regular, lighter period, often with less PMS and cramping. It
is believed to reduce the risk of endometrial and ovarian cancers and help prevent benign ovarian cysts
like the birth control pill because it works in a similar way. It is completely reversible. Once you stop the
patch, your body resumes its natural cycle.

DISADVANTAGES

The patch does not protect against sexually transmitted infections.

When starting the patch, you may notice side effects such as breakthrough bleeding (between periods),
breast tenderness, headaches, or nausea as your body gets used to the hormones. These symptoms
usually go away in the first three months. You may also notice some skin irritation.

Women who cannot take estrogen due to a medical condition cannot use the patch or the Pill. See your
doctor to decide if the patch is a good choice for you.

It may not be covered by all drug plans.

TROUBLESHOOTING

Check each day to make sure the patch is still well applied. If the edges come loose try to smooth it
back on by pressing with your hand for 10 seconds. If it does not stick back on, or comes off completely,
apply a new patch. You would still change it on your same Patch Change Day and you are still protected
against pregnancy.

If the patch falls off for more than 24 hours put a new patch right away, and start a new four-week
cycle. You will need to use a back up method of birth control for the next week and you will have a new
Patch Change Day.

If you forget to change your patch for 1 or 2 days, remove the patch when you remember and apply a
new patch. You will still change it on your next Patch Change Day - you are still protected against
pregnancy. If you are more than 2 days late changing the patch, you start a new four-week cycle with
the new patch. You will need to use a back up method of birth control (like condoms) for the next week.

If you forget to take off your patch at the start of the Patch-free week, take it off when you remember
and start the next cycle at the usual time. Your period may be shorter, or you may still be bleeding when
you put on the next patch.

If you forget to put on your patch after your patch-free week (so you have had more than 7 days with
no patch) put it on as soon as you remember. You need to use back up birth control for the first week of
the new cycle, and your Patch Change Day will be different.

If you are not sure, talk to your doctor or pharmacist.

INJECTION (DEPO-PROVERA®)
Depo-Provera® is a hormonal birth control method that contains a progestin. It does not
contain estrogen. It is administered by a needle in the muscle of the arm or buttocks
every 12-13 weeks. It is 99.7% effective in preventing pregnancy, but causes loss of
bone density. Because of this, Depo-Provera® is usually only recommended for people
who are unable to take other contraceptive methods. The injection should be used with
condoms to prevent sexually transmitted infections (STIs).

HOW IT WORKS

It stops your ovaries from releasing an egg every month (ovulation). It also thins the
lining of the uterus.

BENEFITS

With this method of birth control, you only have to think about it 4 times a year! You do not have to
remember to take it every day. It is reversible.

Fifty percent of women will stop having periods all together (amenorrhea) within the first year of starting
Depo-Provera®. This is not unhealthy and, for women who have heavy or painful periods, this may be a
positive side effect.

Depo-Provera® can be used by breastfeeding mothers. It has no effect on breast milk production. It also
decreases the risk of endometrial cancer.

DISADVANTAGES

Depo-Provera® is associated with a decrease in bone mineral density. For this reason, it is
recommended when other birth control methods are not a good option.

Depo-Provera® does not protect against sexually transmitted infections (STIs) or HIV. Condoms should
still be used to protect against STIs or HIV. Women must return to their health care provider every 12-13
weeks to receive their next injection.

SIDE-EFFECTS

The most common side effects are irregular bleeding and weight gain, although they do not happen to
every user. Some hormonal side effects have been reported but only occur in a small number of users.

Irregular bleeding
Irregular bleeding is common in the first few months of use. Some women have no bleeding, some
women have spotting, and some women experience heavier bleeding. The bleeding usually decreases
with time. By one year, 50% of women will stop having periods altogether.

Weight gain
The average weight gain in the first year of use is approximately 5 pounds. This may be due to increased
appetite and an increased food intake.

Decreased bone density

There is a decrease in bone density in women who use the injection, similar to that seen in women who
have breastfed for 6 months. Bone density improves when the injections are stopped. This bone density
loss is of particular concern for young women in their teens, whose bones are still hardening. The impact
of this decrease in bone density is unknown for perimenopausal or postmenopausal women. Women
using Depo-Provera® should make sure that they get enough Calcium and Vitamin D, either in their diet
or in vitamin supplements, in order to help protect their bones.

Return to fertility
A woman's return to fertility with this method can be longer than with the oral contraceptive pill. It takes an
average of 9 months after your last injection to return to your regular menstrual cycle pattern.

HOW TO TAKE IT

The first injection should be given during the first 5 days of the menstrual cycle. It becomes fully effective
24 hours after the injection. Your next injection is given within 12-13 weeks of your last injection.

Your health care provider or nurse will administer the injection to you. A prescription is required. The cost
is about $40.00 for each injection that lasts about 3 months.

TROUBLESHOOTING: WHAT IF YOU ARE LATE FOR YOUR NEXT INJECTION?

It is important to get your next injection within 12 weeks of your last injection. Late for your next
appointment? If you wait longer than 14 weeks, a pregnancy test should be done before you receive your
next injection. A non-hormonal method of birth control (eg. condoms, diaphragm, cervical cap) should be
used until you receive your injection and for two weeks after your injection.

VAGINAL RING (NUVARING)

WHAT IS IT?

The vaginal ring (NuvaRingTM) is a new birth control method that is now available in Canada. This soft,
flexible, clear plastic ring measures 54mm in diameter and is inserted into a woman's vagina where it
slowly releases two female hormones (estrogen and a progestin) for three weeks.

HOW DOES IT WORK?

These hormones enter into the woman's bloodstream and prevent pregnancy mainly by stopping the
ovaries from releasing an egg. It may also thicken the cervical mucous and make the uterine lining thin.
The ring's method of action is very similar to the combined oral contraceptive pill. The ring does not
provide a physical barrier to sperm and it does not prevent sexually transmitted infections.

The ring comes in only one size, and does not need to be in a particular position in the vagina to be
effective. It is held in place by the walls of the vagina and a woman usually cannot feel the ring once it is
in. The woman inserts and removes the ring herself and most women find this easy to do. Remember, the
vagina is a closed space and there is no way for the ring to get "lost" or go anywhere else.
The ring is worn inside the vagina for three weeks, followed by a one-week (seven day) ring-free interval.
When the ring is removed, a woman usually has a period within a few days. At the end of the ring-free
week, the woman inserts another ring to begin a new cycle.

The ring should be left in place during sex. Most men and women do not notice it during intercourse, and
even for those who do, it is not usually bothersome.

EFFECTIVENESS

The ring is at least as effective as the birth control pill, and it may be more effective if a woman has
trouble remembering to take her pill every day.

BENEFITS

In addition to preventing pregnancy, the ring has the added benefit of making a woman's periods more
regular, lighter, and may reduce cramping. It is also believed to have similar benefits as the birth control
pill in treating PMS, endometriosis and acne, and preventing ovarian and endometrial cancers, but this
has not yet been proven. It is completely reversible. When a woman stops using the ring, her body
resumes its normal cycle and fertility returns quickly.

SIDE EFFECTS

Uncommonly reported side-effects include headaches, vaginal irritation, discomfort or discharge, nausea,
and breast tenderness.. Breakthrough bleeding (bleeding between periods) occurred in about five percent
of women, especially during the first few months. The ring does NOT cause weight gain, nor does it
increase vaginal infections.

WHO SHOULDN'T USE IT

Women who cannot take the birth control pill for medical reasons cannot use the ring either. This includes
women who have had a blood clot, heart attack, stroke or breast cancer, as well as women with active
liver disease or women over 35 years old who smoke. See your doctor to decide if the ring is right for you.
 HOW TO GET IT

You will need a prescription from your doctor and you pick it up at a pharmacy.

TROUBLESHOOTING

1. What to do if the ring falls out?

If the ring falls out, it should be rinsed off and replaced as soon as possible. If it has been out for less than
three hours, you should still be protected against pregnancy. If it has been out for more than 3 hours, a
back-up method of birth control is needed for the next seven days. The ring must stay in for at least 7
more days after being out for longer than 3 hours; this may mean that you wear it for more than 21 days
in total that month. Following this, a one-week ring-free interval can occur and the next ring inserted.

2. What to do if you forget to take the ring out?

If it has been in for less than 28 days (that is, up to one week too long) remove it, have a seven-day ring-
free interval, then insert the next ring. You are still protected against pregnancy. If the ring has been in for
more than 28 days, immediately remove it, insert a new ring and use a back-up method of birth control for
the next 7 days. You may have irregular bleeding, or no period that month.

3. What to do if you forget to insert the ring after the week off?
Insert the ring as soon as you remember and use a back-up birth control method for 7 days. If you have
unprotected sex after the ring has been out for more than one week, consider using emergency
contraception. You should not have more than 7 days without wearing a ring or you risk getting pregnant.
Talk to your doctor or pharmacist if in doubt.

INTRA-UTERINE SYSTEM (MIRENA)

The intra-uterine system (IUS) provides reliable, reversible contraception for
up to five years. This method of hormonal contraception is more than 99%
effective in preventing pregnancy.

HOW DOES IT WORK?

The IUS is made up of a small T-shaped frame with a small cylinder

containing the hormone levonorgestrel. It does not contain estrogen. This
cylinder slowly releases the hormone that acts on the lining of the uterus.
The lining of the uterus becomes thinner and the cervical mucus becomes
thicker which makes it harder for sperm to enter the uterus.

BENEFITS

The IUS does not contain estrogen so it can be used in women who cannot take or have a sensitivity to
estrogen. The IUS is effective for up to five years. Unlike the copper intra-uterine device (IUD), the IUS
decreases the amount of menstrual bleeding and may decrease menstrual cramping.

DISADVANTAGES

The hormonal IUS does not protect against sexually transmitted infections (STIs) or HIV. Condoms
should be used to protect against STIs or HIV.
 Complications associated with the IUS are rare but may occur. Possible complications of inserting an IUS
include irregular bleeding or spotting, perforating the uterus (making a small hole in the uterus), infection,
or expulsion (the IUS falls out).

SIDE-EFFECTS

 Irregular bleeding or spotting

This is most common within the first 3 months following insertion. It usually improves with time.
 No periods (amenorrhea)
Most women that use the IUS notice that their periods are less heavy. Of women that are using the IUS,
20-30% of women will stop having periods (amenorrhea). Not having a period does not necessarily mean
that you are pregnant but it may just be a side-effect of the IUS.
MYTHS AND FACTS

1. MYTH: The IUS cannot be used by someone who hasn't had a baby before.
FACT: The IUS can be used by women who have not had a baby.

2. MYTH: The IUS increases the risk of infertility.

FACT: IUSs do not increase the risk of infertility. Women who have their IUS taken out because they
want to get pregnant will get pregnant at the same rate as women who have never used an IUS.

3. MYTH: IUSs increase the long-term risk of infection (pelvic inflammatory disease).
FACT: After the first month of use, the risk of infection is not significantly higher than in women without
IUSs.

4. MYTH: The IUS increases the risk of having an ectopic pregnancy (a pregnancy in the fallopian tubes)
FACT: The IUS does not increase the risk of ectopic pregnancy.

HOW TO USE THE IUS

You will need a prescription to get the IUS from the pharmacy. A health
care provider must insert the IUS, usually in the office. Your health care
provider will insert the IUS into the uterus through the cervix (opening of
the uterus). The IUS can be inserted at any time during the menstrual
cycle as long as pregnancy can be ruled out. If you have already an IUS
inserted, it can be removed and a new one inserted on the same day. It
takes only a few minutes to insert an IUS. You may feel some cramping
pain when the IUS is being inserted. You may be given a local anesthetic
or pain medicine to help control discomfort during insertion.

You should check for the IUS strings from time to time to make sure that the IUS is still in the uterus. You
can do this by putting a finger inside the vagina and feeling for the strings near the cervix.

You should contact your health care provider if any of the following occur:

 You cannot feel the IUS threads

 You or your partner can feel the lower end of the IUS
 You think that you are pregnant
 You experience persistent abdominal pain, fever, or unusual vaginal discharge
 You or your partner feel pain or discomfort during intercourse
 You experience a sudden change in her menstrual periods
 You wish to have the device removed or you want to get pregnant.

INTRAUTERINE CONTRACEPTIVE DEVICE (THE COPPER IUD)

The IUD is a small, T-shaped device with a copper wire. Inserted into the
uterus, the copper wire changes the chemistry in the uterus and destroys
sperm.

BENEFITS

The copper IUD provides up to 5 years of contraception, and has no

negative impact on future fertility, once removed. It fails in only 1 of 100
users per year. The IUD should not alter the timing of your periods. Women
who use an IUD have a lower rate of ectopic pregnancy than women who do
not use any birth control. However, if pregnancy should occur, it is important
to see your health care provider immediately, because there is a significant
chance the pregnancy is in the fallopian tube.

The copper IUD may be a good choice for you if:

 You are at low risk for contracting a sexually transmitted infection (STI)
 You are looking for a long-term, reliable method of contraception
 You have had failure with other methods in the past (can not remember to take the pill)
 You are breastfeeding (it has no effect on breast milk)
 You have completed your family but do not want a tubal ligation
 You have problems with hormonal methods of contraception
DISADVANTAGES

The copper IUD does not protect against sexually transmitted infections (STIs) or HIV. Condoms should
be used to protect against STIs or HIV.

Women who use the copper IUD, may find that their periods get heavier or more crampy. Complications
associated with the IUD are rare but may occur. Possible complications of inserting an IUD include
irregular bleeding or spotting, perforating the uterus (making a small hole in the uterus), infection, or
expulsion (the IUD falls out).

WHERE TO FIND IT

You will need a prescription to get a copper IUD. A health care provider must insert the IUD, usually in the
office or family planning clinic. During your first visit, you will have a physical exam, take a sexually
transmitted infection test and discuss your medical history. You may need to book a second visit to have
the IUD inserted. Your health care provider will insert the IUD into the uterus through the cervix (opening
of the uterus). The copper IUD costs from $60-$100.

TROUBLESHOOTING

You should contact your health care provider if any of the following occur:
 You cannot feel the IUD threads
 You or your partner can feel the lower end of the IUD
 You think that you are pregnant
 You experience persistent abdominal pain, fever, or unusual vaginal discharge
 You or your partner feel pain or discomfort during intercourse
 You experience a sudden change in your menstrual periods
 You wish to have the device removed or you want to get pregnant.

MALE CONDOM
The male condom is a latex sheath that is rolled over a male's penis to prevent
secretions (including semen) from entering the vagina.

BENEFITS

condoms are 97% effective when used properly and consistently, and they
protect against most STIs.

DISADVANTAGES

Some males complain about lack of sensitivity. The condom may slip off during
sex. Rough handling may cause the condom to break. Some males and females
may be allergic to latex.

WHERE TO FIND THEM

Your teen can pick up a pack of condoms at the drugstore for about 50 cents per condom, or buy one in a
washroom, supermarket, convenience store, or free at a family planning centre.

CONDOMS IN DEPTH

Condoms protect you and your partner from unwanted pregnancy. They're also your best defence against
sexually transmitted infections (STIs) - the only type of birth-control method to offer such protection. They
act as a physical barrier to prevent the bacteria and viruses that may be present in your partner's genital
fluid from infecting your own genitals, anal area, or mouth. On a more global scale, condoms prevent the
spread of disease within communities.

Condoms are inexpensive, easy to use and effective. When used as directed, they offer better protection
against AIDS and other STIs than any other birth control method.

For added protection, team up a condom with a spermicidal jelly, foam, cream, suppository or film. These
products can stop sperm from moving up the female reproductive tract in case the condom breaks. But
remember, spermicides used on their own can facilitate the transmission of HIV.

The only situation in which it's generally safe not to use a condom is in a long-term, monogamous
relationship with a partner who has tested negative for STIs and who has proven worthy of your trust.
Testing is important. Just because you've been with a person for a long time doesn't necessarily mean
they are free of STIs. Keep in mind that some STIs show little or no symptoms, and others such as HIV
can take up to 15 years for symptoms to appear.
 CONDOMS, HPV AND HEPATITIS B

Bear in mind that condoms may not protect you from two common STIs: human papillomavirus (HPV) and
Hepatitis B.

HPV can be transmitted through sex or through close skin-to-skin contact with the genitals. Some forms
of HPV can lead to genital warts, and others can cause cervical cancer. A medical test called a PAP
smear can reveal whether your cervix contains abnormal cells, which can be removed before they lead to
cancer. If you're a sexually active female, be sure to have your doctor perform this simple test on a
regular basis.

The Hepatitis B virus can be transmitted from contact with semen or blood, Interactive Demo
and more rarely from saliva or vaginal secretions. The virus must enter the
bloodstream in order to cause disease. Detectable through a blood test,
Hepatitis B often heals spontaneously but may cause serious liver damage in
some people. A vaccine now exists to protect against Hepatitis B. If you're
sexually active, discuss the Hepatitis B vaccine with your doctor.

PUTTING ON A CONDOM

Male condoms usually come rolled up in a sealed packet, and most are pre-
lubricated on the outside (the preferred choice). If the condom is brittle, stiff
or sticky, discard it and use another. Begin the procedure when your penis is
hard. Try our interactive
Demo:
 Put a drop or two of lubricant or saliva inside the tip of the condom (optional) How to put on a
condom
 If you're not circumcised, pull back your foreskin
 Place the rolled-up condom over the tip of your penis, leaving a half-inch
space for semen collection
 Pinch the air out of the tip of the condom
 Unroll the condom all the way to the base of the penis
 If you're not using a pre-lubricated condom, lubricate the outside of the condom with a water-based
lubricant
When you've finished having sex (vaginal, anal or oral), hold the condom against the base of your penis
while you pull out.

FEMALE CONDOM
The female condom is a polyurethane sheath in the shape of a round,
upside-down baggie inserted into the vagina before sex. This condom holds
in the sperm, preventing it from entering the vagina.

BENEFITS

It's the only contraceptive controlled by females that protects them from both
pregnancy and sexually transmitted infections (STIs). Used perfectly, the
female condom has a failure rate of 5%.
DISADVANTAGES

Some women may have trouble inserting it correctly, and they can be expensive - around $3 each.

WHERE TO FIND IT

You can pick one up at a drugstore or at a family planning clinic.

TROUBLESHOOTING

If you are uncomfortable with it or have too much trouble inserting it, try something more suitable for you
or ask for expert advice at a birth control clinic.

PUTTING ON A FEMALE CONDOM

Female condoms can be inserted up to 8 hours before intercourse. You can insert it either standing with a
foot on a chair, or sitting or lying with your legs apart.

One end of the

condom will have an Squeeze the flexible
Carefully remove the
opening for the penis inner ring at the
condom from its
to enter. This end will closed end of the
package.
remain outside the condom.
vagina.

Some women find it or you may find it more

While squeezing the
comfortable to insert comfortable to insert
ring, insert the closed
the condom while the female condom
end of the condom
standing with one leg while squatting or lying
into your vagina.
raised, down.
 Placing your index The outer ring of the Make sure his penis
finger inside of the condom should remain enters inside the
condom, gently push outside of the vagina. female condom, not to
the inner ring into your Placing lubrication one side. The female
vagina as far as it will inside of the condom condom should not be
go. Be careful not to may help keep it in used with a male
twist the condom. place during sex. condom.

When removing the Throw the used female

condom after sex, condom into the
twist the outer ring so garbage. Do not flush
that no semen leaks it down the toilet. Do
out during removal. not reuse the condom.

CONTRACEPTIVE SPONGE
This disposable sponge containing spermicide is placed at the cervix and kills sperm before they can
enter. When used in combination with the male condom, the failure rate is only 2%.

BENEFITS

It's a barrier method and spermicide in one. Provides 12-hour protection, and you won't have to change
the sponge if sex is repeated during this time. They enhance the effectiveness of other forms of
contraception such as condoms.

DISADVANTAGES

On it's own, the contraceptive sponge is not a very effective contraceptive method, and should not be
used without another form of contraception. They do, however, provide good secondary protection when
used with condoms. Some women find it difficult to remove the sponge, or forget to take it out all together.
Some may also be allergic to the spermicide. By itself, the sponge will not protect against sexually
transmitted infections (STIs).

WHERE TO FIND IT

You can pick up a package of 4 sponges in a drugstore (for about $10) or at a birth control centre.

TROUBLESHOOTING

Some women who use the sponge report recurrent yeast infections. If this is the case, talk to your doctor
about finding a different method of contraception that works best for you.

DIAPHRAGM
The diaphragm is a latex cap that covers the cervix and prevents sperm from
getting inside. The diaphragm should always be used in combination with a
foam spermicide, placed inside the diaphragm, to offer protection from
pregnancy.

BENEFITS

It offers women privacy and control, because they can insert it before sex. If
used perfectly, the failure rate is 4-8%. In other words, if 100 women use it
correctly for one year, four to eight of them will become pregnant.

DISADVANTAGES

Some women find diaphragms difficult to insert at first, and others find that it doesn't fit them right. There
is also a chance of developing a urinary tract infection while using it. Does not protect against sexually
transmitted infections(STIs).

WHERE TO FIND IT

You can make an appointment with your doctor to have a diaphragm fitted properly to your body. Average
cost is about $40.

TROUBLESHOOTING

If you are having difficulty inserting the diaphragm correctly, practise before
having sex. If too much spermicide is used (1-2 teaspoons is best), it makes it
difficult to handle when you try to fold the diaphragm during insertion. For
increased protection against pregnancy and STIs, use with a condom.

CERVICAL CAP
A deep silicone cap that fits against the cervix and prevents sperm and bacteria from entering.
BENEFITS

It provides a woman with privacy and control, because she can insert it before sex.

EFFECTIVENESS

There is a difference in effectiveness when used by women who have already given birth and women who
have not. If used perfectly (meaning if it fits you well and you insert the cap correctly every time you have
sex), the failure rate is of 9% in women who have never given birth. This means that if 100 women use
the cap perfectly for a year, nine will likely become pregnant. However, the typical-use failure rate is 20%.

For women who have had children before, the failure rates are much higher: 26% for women who use the
method perfectly every time, and 40% for the typical user.

DISADVANTAGES

It doesn't protect against sexually transmitted infections (STIs), and it must be used with spermicide,
which kills sperm. A poor fit or latex allergy will prevent some women from using the cap.

WHERE TO FIND IT

Your doctor can fit you for a cap, and then you can purchase it online or from certain family planning
clinics for about $40.

TROUBLESHOOTING

If the cap moves out of place during sex, see a doctor as soon as possible for emergency contraception.
For increased protection against pregnancy and protection against STIs, use with a condom.

LEA CONTRACEPTIVE
A soft, silicone device inserted into the vagina in front of the cervix, to prevent sperm from entering. To
increase effectiveness, it should be used with a spermicide - failure rates increase to 12.9% from 8.7%
when used alone.

BENEFITS

The re-usable Lea offers 8-hour protection, and it can be inserted hours before intercourse, providing a
degree of privacy.

DISADVANTAGES

It doesn't protect against Sexually Transmitted Infections (STIs), and the device is not overly effective if
used without a spermicide. Some women may also find it difficult to insert at first.

WHERE TO FIND IT

At a drugstore or family planning clinic for about $50.

TROUBLESHOOTING

If the male partner feels the Lea during sex, it means that it's not inserted properly.

Note: Use with a condom for increased prevention of pregnancy and STIs.
TUBAL LIGATION
In tubal ligation, the two fallopian tubes, which transport the eggs from the
ovaries to the uterus, get disconnected. The egg never meets the sperm,
and pregnancy is impossible. Tubal ligation is considered permanent,
because reversal is costly, difficult, and not guaranteed. A 1-2.5% chance
of failure may occur up to 10 years later, because sometimes the tubes try
to "heal" themselves.

BENEFITS

It's the most effective method of contraception that is controlled by women.

It is ideal for women who don't want to have any more children.

DISADVANTAGES

Pain, bleeding and nausea may follow surgery. Some women eventually regret their choice, and find that
they can't reverse the process. Tubal ligation provides no protection against STIs.

WHERE TO FIND IT

After a full medical exam and after signing a consent form, a gynaecologist will perform the surgery. Two
popular options are as follows: Operating through a very small incision in the bellybutton, this procedure is
called laparoscopy or band-aid surgery. It can be performed under local anaesthesia in some cases.
Operating through a larger incision in the belly, another option is called laparotomy. This can also be
performed under local anaesthesia in some cases. It is less common, but often used when tubal ligation is
requested shortly after delivering a baby.

TROUBLESHOOTING

Ectopic pregnancy (pregnancy outside the uterus) is more likely to occur in women with tubal ligation.
Women showing any signs of pregnancy should contact a physician a.s.a.p.

VASECTOMY
The surgery blocks a male's sperm duct and prevents sperm from entering the
ejaculate. The male can still ejaculate during sex, but the fluid doesn't contain
any sperm. A vasectomy is considered permanent, because reversal is
difficult and costly. The pregnancy rate following vasectomy is 0-2.2%.

BENEFITS

It's the most effective method of contraception controlled by a male. The

procedure is easy, permanent, and relieves both men and women of
contraceptive burdens.

DISADVANTAGES

Swelling may follow the surgery, but the biggest reported problem is regret... and reversal doesn't always
work.
WHERE TO FIND IT

After an examination to see if a male is a candidate for the procedure, a urologist or a general practitioner
performs this out-patient procedure under local anesthetic.

TROUBLESHOOTING

Remember that a male can still have sperm in his ejaculate up to 3 months after the surgery, so another
method of contraception must be used until check-up time. Condoms should be used to prevent against
STIs.

PERMICIDE
A chemical called nonoxynol-9 comes in the form of cream (only for use with
diaphragms), gel, foam, film, or suppository. By inserting spermicide in front of
the cervix, in the vagina, it destroys sperm on contact. Spermicides should be
used along with another method of contraception, such as a condom, because
alone they are not highly effective.

BENEFITS

Along with protecting against pregnancy, spermicide also protects against

bacterial infections and pelvic inflammatory disease. It can also be used as an
emergency method, if inserted immediately after you have an accident with your primary contraception.

DISADVANTAGES

Spermicide can be messy. You have to insert spermicide right before sex, because it's usually only
effective for one hour. It may irritate the entrance of the vagina or the tip of the penis. Using a spermicide
alone can increase your risk of HIV transmission, so only use it with a steady partner. The failure rate of
spermicides used alone is between 6% (perfect use) and 21% (typical use).

The popular spermicide called nonoxynol-9 does not protect people from sexually transmitted infections
as previously thought. Contraceptive products that contain this spermicide, such as condoms, vaginal
gels, inserts, and contraceptive film, are now required by the Food and Drug Administration (FDA) in the
United States to carry a label indicating nonoxynol-9 does not protect against STIs. It may actually
increase the risk of getting HIV from an infected person, because of the irritation it can cause to the lining
of the vagina or rectum. The SOGC recommends that spermicide only be used by women who are at low
risk for STIs and HIV, for example, women in monogamous relationships where STIs have been ruled out.
It’s best to use uncoated condoms instead of nonoxynol-9 coated condoms.

WHERE TO FIND IT

You can buy spermicide at any drugstore.

TROUBLESHOOTING

Some spermicides have a bad odour or taste. When buying spermicide, make sure that it's nonoxynol-9.
There are lots of other hygiene-type products that look very similar, and are pretty easy to confuse with
spermicide.
 NATURAL BIRTH CONTROL METHODS
Natural birth control methods teach women to determine the fertile phase (typically 7 to 10 days long) of
their menstrual cycle. To avoid pregnancy, women avoid intercourse on fertile days.

There are many variations of natural birth control. The most effective methods teach women to chart the
signs of fertility that ebb and flow with the natural hormonal changes of each menstrual cycle. There are
two main approaches 1) the sympto-thermal approach where waking temperature and cervical mucus
are charted, and 2) the mucus approach where only cervical mucus is charted.

It is helpful for women and their partners to know about the two most common methods:

1. Fertility Awareness Method (FAM) refers to a natural birth control method outside of a religious
framework that supports the use of barrier methods (condom, diaphragm, and spermicide), emergency
contraception, and abortion. Justisse is a Canadian developed variant of FAM that teaches both the
mucus only and the sympto-thermal approaches.

2. Natural Family Planning (NFP) typically refers to natural birth control that is taught and practised
within a religious framework, most commonly Catholic centred organizations. It does not support the use
of barrier methods, emergency contraception, or abortion. Billings Ovulation Method teaches
onlymucus observations. Serena and Couple to Couple League methods aresympto-
thermal NFP variants. The Creighton Model will teach both mucus only and sympto-thermal approaches.

HOW NATURAL BIRTH CONTROL WORKS

The FAM/NFP sympto-thermal method is explained below. It is considered the most effective of all the
natural birth control methods.

Sympto-thermal teaches a woman how to observe, chart and interpret her waking temperature (basal
body temperature or BBT) and cervical mucus to understand what days she is fertile and what days she is
not fertile. She then knows when she is likely and when she is less likely to become pregnant from
intercourse.

A woman who has a regular menstrual cycle will usually experience the following sequence of events:

 3 to 7 days of menstruation
 several days where she does not feel or see mucus in her vagina or on her vulva
 several days of a ‘wet’ or ‘slippery’ sensation at her vulva or in the vagina where she sees and/or feels
mucus, which becomes progressively more slippery, stretchy, and clear as ovulation approaches
 after ovulation her waking temperature rises, mucus disappears from the vulva, and the vulva and vagina
feel “drier
Fertile days begin with the first sensation of mucus at the vulva and continue until both the mucus has
dried up and the waking temperature has been high for 3 days in a row. With days of higher fertility and
lower fertility determined, a woman can time intercourse to avoid or achieve pregnancy.

If a woman’s cycle does not follow a typical pattern, using natural birth control will be more difficult.
However, she can still use natural birth control but she is advised to seek consultation with a trained
FAM/NFP instructor in order to use the method most effectively. In general, FAM/NFP are not
recommended for women with the following difficulties: irregular cycles, inability to interpret the fertility
signs correctly, or persistent infections that affect the signs of fertility.
 Cervical changes are a third fertility sign that a woman may find useful in determining her fertility. She
checks for variations in the position, firmness and openness of the cervix that relate to fertile and infertile
days.

EFFECTIVENESS

In order to effectively use FAM/NFP a woman needs to accept responsibility for charting and interpreting
her fertility on a day-to-day basis. The possibility of an unplanned pregnancy should not represent a
devastating occurrence in order to use this method of family planning. As with all forms of birth
control,motivation, intention, and cooperation between partners are the key to effective, successful
use.

Successful use of FAM/NFP methods depends on the accuracy of the method in identifying the woman’s
actual fertile window, a woman’s/couple’s ability to correctly identify the fertile time, and the couple’s
ability to follow the instructions of the method they are using. The effectiveness of FAM/NFP(Strauss
and Barbieri 2004, Hatcher 2004.) varies depending on the method:

1. 95-98% effective with perfect use (user strictly follows rules to avoid pregnancy)
2. 75-88% for typical use (user may not always follow rules)
BENEFITS OF FAM/NFP

1. Effective method of birth control

2. Has no negative health side effects
3. An alternative for women who cannot or do not want to use hormonal methods
4. Promotes positive body awareness
5. Consistent with many religious beliefs and lifestyles
6. Alerts women to reproductive health and fertility concerns
7. Fosters communication between partners
8. Encourages partners to enjoy a variety of romantic or sexual activities as alternatives to vaginal
intercourse during fertile periods
9. Encourages male involvement
DISADVANTAGES OF FAM/NFP

1. Provides no protection from sexually transmitted infections

2. Often difficult to find trained FAM/NFP instructors
3. Requires time to learn (usually 3 to 6 cycles)
4. Requires discipline and commitment to chart fertility signs and follow the rules to avoid pregnancy
5. Times of abstinence from intercourse may be a challenge for some couples
OTHER NATURAL BIRTH CONTROL METHODS

Lactational Amenorrhea Method (LAM) is used by a woman who has just given birth and is exclusively
breastfeeding. This method is highly effective for the first six months after childbirth, provided the woman
breastfeeds the baby at least every four hours during the day and every six hours through the night, and
that her menstrual period has not yet returned. After six months fertility may return at any time.
 In the Temperature Method a woman takes her waking temperature to identify a rise in temperature
indicating ovulation has passed. Elevated waking temperature for three days in a row is considered
confirmation of the post-ovulatory less fertile phase.

Rhythm (Calendar) Method is a much less effective natural birth control method. It predicts a woman’s
fertile days using calculations based on the length of past cycles and not daily observations of fertility
signs as used by FAM/NFP. The Standard Days Method/Cycle Bead Systemis a variation of the
Rhythm Method. These are the least effective natural birth control methods and are not generally
recommended.

EMERGENCY CONTRACEPTION AFTER SEX

If you've had unprotected intercourse and don't want to get pregnant, you still have a method of birth control at your disposal: emergency contraception
(EC). Unlike other forms of contraception, EC can be used after intercourse to prevent pregnancy.

You have two types of EC methods to choose from:

 Hormonal EC methods (‘’the morning after pill’’)

 a special formulation called Plan B® (progestin-only method)
 a special formulation called NorLevo® (progestin-only method)
 a series of four contraceptive pills called the Yuzpe method (combined estrogen and progestin)

 A copper intrauterine device (copper IUD) inserted by a health-care professional and available by prescription only
After an unprotected sexual encounter, you have a window of 5 days in which to use EC pills or 7 days for the copper IUD, although the sooner you
use it, the better it works.

The methods come with clear and simple instructions, and up to 99 per cent of women who use them are able to avoid an unwanted pregnancy.

Emergency contraceptives work by delaying or inhibiting the release of an egg (ovulation), altering the luteal phase length, and also possibly inhibiting
the implantation of a fertilized egg. In the unlikely event that implantation does occur, EC does not interrupt the pregnancy or put the fetus at risk.

It can prevent an unplanned pregnancy in the following situations:

 No contraception was used

 Missed birth control pills, patch, or ring
 The condom slipped, broke, or leaked
 The diaphragm or cervical cap is dislodged during sexual intercourse or was removed too early
 Error in the calculation of the fertility period
 Non-consensual sexual intercourse (sexual assaul)
EC is very safe, but it can cause side-effects such as nausea or vomiting. These effects are much less common with progestin-only methods (Plan B®
or NorLevo®) than with the Yuzpe method. If you vomit within an hour of taking EC, you'll need to retake the dose.

HOW TO GET IT
EC is easy to find because it is now available directly in the pharmacy without a prescription. You can also contact the nearest health centre in your
area, your own doctor, a walk-in clinic, or the nearest birth control/sexual health clinic. The cost varies depending on which EC you use and where you
get it. You can obtain the product in advance and store it for use in case of an emergency. Emergency contraception is intended for occasional use
only. You should not rely on EC as your primary method of birth control, as it's less effective than regular contraceptive methods and offers no
protection against sexually transmitted infections.

 Call the Canadian Federation for Sexual Health’s bilingual hotline (formerly Planned Parenthood Federation of Canada), 1-888-270-7444, for guidance
about getting ECs in your area.

 Or use our clinic locator.

When mistakes happen, EC is your last chance to take control of your reproductive destiny, so make sure you know how to get it - just in case.

WHAT'S THE BEST CHOICE FOR ME?

The best choice is what feels right for you and your partner, and what will be most effective in preventing an unwanted pregnancy and sexually
transmitted infections.
 Different contraception methods suit different people. Someone in a long-term monogamous relationship might prefer different methods than someone
in a new relationships or someone who has multiple sexual partners. Your age and where you are in your sexual life can also be a big factor in your
decision. Talk to your physician about your choices, and discuss contraception with your partner before making a decision.

 The most effective methods:

Hormonal methods are the most effective, and if you are a healthy woman, the Pill, the Patch or the Vaginal Ring are great choices, since they can be
used long-term.

 If you are interested in having fewer periods each year:

Certain hormonal contraceptives can result in fewer and lighter periods each year. Contraceptives containing the Progestin hormone given by injection
(Depo-Provera), or in a Intrauterine device (Mirena) usually results in fewer periods. Also, a woman taking an extended cycle Pill (Seasonale) would
expect to have a period only four times a year.

 Preventing sexually transmitted infections:

The risk of contracting sexually transmitted infections is greatly reduced by using dual protection - using a condom with your choice of birth control. Use
a condom if you are in a new relationship, until you can both get tested for STIs, or if you are not sure your partner is faithful.

 If you have just given birth:

If you have just given birth, intrauterine contraceptive devices (IUCDs), progestin-only contraceptives (POP) and condoms are good choices because
they do not affect the quality or quantity of your breast milk. If you choose to use a diaphragm or cervical cap, these must be re-fitted several months
following the birth of your baby, so before this point you should choose an alternative contraceptive method. Remember, there is no grace period after
a pregnancy - it is possible to become pregnant again almost immediately after giving birth!

 If contraception fails:
If your contraception method has failed, consult your health care provider without delay and begin taking emergency contraception. Consider getting a
prescription in advance, so that you will have it just in case you ever need it.

 If you have had an abortion:

If you have had an abortion, you may wish to choose a more effective means of birth control. If you wish to have a child at some point in the future,
hormonal methods like birth control pills, the contraceptive patch or the new vaginal ring are all good choices. If you prefer a non-hormonal method,
intrauterine contraceptive devices (IUCDs) also provide long-term pregnancy protection. If you are certain that you will never want to have children in
the future, something more permanent like tubal ligation or vasectomy may be the right choice for you or your partner.

 If you smoke:
If you are over 35 and smoke, you may need to discontinue using birth control pills, except for the progestin-only pill (POP). You may wish to consider
using an intrauterine contraceptive device (IUCD). Speak to your doctor or pharmacist if you would like help to quit smoking.

 If you are approaching menopause:

If you are approaching menopause, low-dose oral contraceptives may help you deal with menopausal symptoms like hot flashes and vaginal
dryness. It will also provide contraception in the event that ovulation is still occurring sporadically.

 If you want to wait before having another child:

If you wish to space out your family, natural methods like withdrawal or fertility awareness, in combination with a secondary contraceptive method such
as condoms or a contraceptive sponge may be quite effective. You can also use more effective hormonal methods such as the Pill or the Patch and be
guaranteed a quick return to fertility once you decide to have a child.