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BostonObstetrics&Gynecology,OneBrooklinePlace,Ste.

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PatientServices CONTRACEPTION
Gynecology Therearemanyformsofcontraceptiontohelpavoidbecomingpregnant.Noformof
HavingaBaby contraceptionis100%effectiveandtheyallhavedifferentrisksandbenefits.Everywomanmust
PatientResources decidewhichformofcontraceptionisbest.Nomatterwhichformofcontraceptionyouuse,
makesureyouknowhowtouseitproperly,whatsideeffectscanoccurandwhetheritprevents
sexuallytransmitteddiseases.
Search
Whatistheeffectivenessofdifferentformsof
contraception?
Search Mosteffective99%:Intrauterinecontraception(IUD),contraceptiveimplants,and
sterilizationareassociatedwithalowpregnancyrateinallusers.
MoreEffective98%:Injectablecontraceptives,thebirthcontrolpill,thevaginalringand
birthcontrolpatcharealsoassociatedwithaverylowpregnancyrateiftheyaretaken
consistentlyandcorrectly,butactualpregnancyratesaresubstantiallyhigherbecauseof
inconsistent/incorrectuse.
Lesseffective9495%:Condoms95%,diaphragmandspermacide94%,spermicide
alone91%.
Leasteffective85%:withdrawal,andrhythmortimedcoitusareassociatedwithhigher
ratesofpregnancy

IntrauterineDevice(IUD)
AnIUDisasmall,Tshapeddevicethatisinsertedandleftinsideyouruterustoprevent
pregnancy.AnIUDmustbeinserted(andremoved)byyourdoctorinheroffice.

INTRAUTERINEDEVICESDONOTPROTECTAGAINSTSEXUALLYTRANSMITTED
INFECTIONS

Effectiveness1womanoutof100willbecomepregnantwithinthefirstyearofusinganIUD,
withtypicaluse.

RisksMostcommon:bleeding,Lesscomon:infectioninsidetheuterusandfallopiantubes,an
IUDcancomeoutoftheuterusandmoveintothevagina,orpokeintotheuterinewallorpoke
throughtheuterusrequiringremovalorsurgery.Althoughrare,ifpregnancyoccurs,youare
morelikelytohaveapregnancyinthefallopiantubes(ectopicpregnancy).

Benefitshighlyeffective,private,longacting,reversibleformofcontraception.AnIUDdoesnt
interruptthespontaneityofsexandyoudonthavetotakeadailypillorinsertamonthlyring.
YourbaselinefertilityreturnsimmediatelyafteryourIUDisremoved,soyoucantrytoget
pregnantrightaway.Itissafeformostwomen,includingteens,womenwhohavenothad
childrenandbreastfeedingmothers.AprogesteroneIUDmaydecreasetheriskofendometrial
cancer.

Thereare3typesofIUDsavailableintheUnitedStates:

ParaGardnohormones,copperIUDthatiseffectiveforupto10years.Womenretain
regularityofperiods,canbeinsertedasemergencycontraceptionafterunprotectedsex.
Mensesmaybeheavier,longer,ormoreuncomfortable,particularlyinthefirstseveralperiods
afterinsertion.

MirenaProgesteroneonly,effectiveforupto5years.Womenoftenhavelighterperiodsor
noperiods,decreasesmenstrualcramping,maydecreasepainfromendometriosis,may
decreasethechanceofgettingauterinecancer.Commontohavespottingdailyafterinitial
insertion,missedperiods,irregularspottingorbleeding.Hormonalsideeffectslikeheadaches,
nausea,breasttenderness,moodchanges,acne,hairloss,ormoodchangesareless
commonlyseen.
Skylaprogesteroneonly(lessthanmirena)effectiveforupto3years,womenoftenhave
lighterperiods,lastsupto3years.Sideeffectsincludeirregularspottingorbleeding,
headaches,nausea,breasttenderness,moodchanges,acneorhairloss.

ProperUseanIUDmustbeinsertedandremovedbyyourdoctorinheroffice.Youshould
checktofeelyourIUDstringsaboutonceamonth.

Implants(Nexplanon)
Nexplanonisasinglerod,progesteronecontainingimplant(aboutthesizeofamatchstick)thatis
injectedundertheskinoftheupper,innerarmandremainsinplaceforuptothreeyears.
Nexplanonmustbeinsertedandremovedbyyourdoctorinheroffice.

CONTRACEPTIVEIMPLANTSDONOTPROTECTAGAINSTSEXUALLYTRANSMITTED
INFECTIONS

EffectivenessWithtypicaluse,lessthan1womanoutof100willbecomepregnantwithinthe
firstyearofusingtheimplant.

RisksAlthoughrare,ifpregnancyoccurs,youaremorelikelytohaveapregnancyinthe
fallopiantubes(ectopicpregnancy).

Benefitshighlyeffective,private,longacting,reversibleformofcontraception.Nexplanon
doesntinterruptthespontaneityofsexandyoudonthavetotakeadailypillorinsertamonthly
ring.Yourbaselinefertilityreturnsimmediatelyafterthecontraceptiveimplantisremoved,soyou
cantrytogetpregnantrightaway.Itissafeformostwomen,includingteens,womenwhohave
nothadchildrenandbreastfeedingmothers.

SideEffectsCommonlycausesirregularspottingorbleeding,prolongedbleeding,heavier
periods.Othersideeffectsmayincludeheadache,weightgain,acne,breasttenderness,mood
changesordepression.

ProperUseacontraceptiveimplantmustbeinsertedandremovedbyyourdoctorinheroffice.

FormoreinformationaboutNexplanon,clickhere(forinformationfromthemanufacturerclick
here)

PermanentSterilization
Thereareseveralmethodsofsafeandpermanentsterilization,includingLaparoscopictubal
ligation,Essure,andformenvasectomy.Talktoyourdoctorifyouareinterestedinthese
methods.

TheBirthControlPill
Thebirthcontrolpillmustbetakeneverydayandmostcontainacombinationofestrogenand
progestronethatpreventspregnancy.Therearemanytypesofbirthcontrolpills.Youandyour
doctorcanchooseonethatisrightforyou.

BIRTHCONTROLPILLSDONOTPROTECTAGAINSTSEXUALLYTRANSMITTED
INFECTIONS

Effectiveness9womenoutof100willbecomepregnantduringthefirstyearofusingbirth
controlpillswithtypicaluse.

Risksthereisaverysmallriskofdevelopinghighbloodpressure,havingastrokeorgettinga
bloodclotinyourlegsorlungs.Peoplewithhighbloodpressure,smokersovertheageof35,
andmigraineswithaurahaveahigherriskofbloodclotorstroke.Talktoyourdoctoraboutwhat
yourrisksmightbe.Thepillisnotassociatedwithanoverallincreasedriskofcancer.

BenefitsMajorbenefitsincludearegular,shorter,lighter,lesspainfulperiod,aswellasfewer
premenstrualsymptoms.Otherbenefitsincludedecreaseinacne,decreaseinunsightlyhair
growthandpreventionofmenstrualmigrainesandovariancysts.Womenwhousethepillare
lesslikelytogetcolon,uterineorovariancancer.Theriskofdevelopingbreastcancerisnot
increasedifyouusethebirthcontrolpill.

SideEffectsSpottingorbleedingbetweenperiods,missedperiods,bloating,nausea,breast
tenderness,headaches,moodchanges,decreasedinterestinsex.Thesesideeffectsareoften
bothersomeenoughtostopthepill,buttheyusuallygoawayafteraboutthreemonthsoftaking
thepill.Thebirthcontrolpilldoesnotcauseweightgainasasideeffect.Ifyouarehavingside
effectsfromthepill,callyourdoctorandshecanhelpyoufindanotherbirthcontrolpillorother
formofcontraception.

ProperUseBirthcontrolpillsneedtobetakeneverydayaboutthesametimeofday.Skipping
pillsortakingthepilllatecanincreasethechanceofgettingpregnant.Birthcontrolpillpackets
usuallyinclude4to7daysofhormonefreepillsattheendofthepackeachmonth.Itisduring
thesehormonefreedaysthatwomengettheirperiod.Ifyoumissapilltakeitassoonasyou
remember.Ifyoumiss2pillscalltheofficeforadviceonhowtoproceed.Womenwhoprefernot
togetaperiodcanskipthehormonefreepillsandtakeahormonepilleverydayinstead.After
thehormonepillsinthepackareconsumed,thenewpillpackmustbestartedimmediately.The
progesteroneonlypillpackdoesnothaveanyhormonefreepillsallpillsshouldbetaken.

NuvaRing
Thenuvaringisaflexible,plasticringthatyouinsertintothevaginaonamonthlybasis.It
releasesestrogenandprogesteronewhichisabsorbedthroughthevagina.Youinserttheringon
yourownanditisleftinsidethevaginafor34weeks,onceremoved,yougetaperiod.

NUVARINGSDONOTPROTECTAGAINSTSEXUALLYTRANSMITTEDINFECTIONS

EffectivenessWithtypicaluse,9womenoutof100willbecomepregnantduringthefirstyear
ofusingthenuvaringorbirthcontrolpatch.

Riskssimilartothebirthcontrolpill,thereisaverysmallriskofdevelopinghighblood
pressure,havingastrokeorgettingabloodclotinyourlegsorlungs.Talktoyourdoctorabout
whethertheserisksaretoohighforyou.Thepillisnotassociatedwithanoverallincreasedrisk
ofcancer.

BenefitsOncepermonthdosing,noneedtotakeapilldaily,majorbenefitsincludearegular,
shorter,lighter,lesspainfulperiod,aswellasfewerpremenstrualsymptoms.Otherlikelybenefits
includedecreaseinacne,decreaseexcesshairgrowthandpreventionofmenstrualmigraines
andovariancysts.

SideEffectsAnincreaseinvaginaldischarge,spottingorbleedingbetweenperiods,missed
periods,bloating,nausea,breasttenderness,headaches,moodchanges,decreasedinterestin
sex.Thesesideeffectsareoftenbothersomeenoughtostopthering,buttheyusuallygoaway
afteraboutthreemonthsoftakingthepill.Thebirthcontrolringdoesnotcauseweightgainasa
sideeffect.

ProperUseTheringiswornfor2128days,removedfor47days,andthenanewringis
inserted.Duringtheweekitisout,bleedingoccurs.Theringalsocanbeusedasacontinuous
doseformofbirthcontrol.Touseitthisway,removetheoldringafter28daysandinsertanew
ringimmediatelywithnoringfreeweekinbetween.

ThePatch
Thebirthcontrolpatch,OrthoEvra,isasmall,adhesivepatch,likealargebandaid,that
releasesestrogenandprogesteronewhichisabsorbedthroughtheskintopreventpregnancy.
Eachpatchlastsoneweek,thenmustberemovedandreplacedforthreeweeksinarow.

DOESNOTPROTECTAGAINSTSEXUALLYTRANSMITTEDINFECTIONS

EffectivenessWithtypicaluse,9womenoutof100willbecomepregnantduringthefirstyear
ofusingthebirthcontrolpatch

RisksSimilartothebirthcontrolpill,thereisaverysmallriskofgettinghighbloodpressure,
havingastrokeorgettingabloodclotinyourlegsorlungs.Theriskofbloodclotorstrokeis
slightlyhigherthanthatofmostbirthcontrolpills.Talktoyourdoctoraboutwhethertheserisks
aretoohighforyou.Thepillisnotassociatedwithanoverallincreasedriskofcancer.

BenefitsOnceperweekdosingcomparedtodaily(birthcontrolpill).Majorbenefitsincludea
regular,shorter,lighter,lesspainfulperiod,aswellasfewerpremenstrualsymptoms.Otherlikely
benefitsincludedecreaseinacne,decreaseexcesshairgrowthandpreventionofmenstrual
migrainesandovariancysts.

SideEffectsSkinrashorirritationatpatchsite,bandaidstickinessatthepatchsite,spotting
orbleedingbetweenperiods,missedperiods,bloating,nausea,breasttenderness,headaches,
moodchanges,decreasedinterestinsex.Thesesideeffectsareoftenbothersomeenoughto
stopthering,buttheyusuallygoawayafteraboutthreemonthsoftakingthepill.Thebirth
controlringdoesnotcauseweightgainasasideeffect.
ProperUseThepatchreplacedweeklyfor34weeksandthenremovedfor7days.During
theweekwithoutthepatch,bleedingusuallyoccurs.Thepatchalsocanbeusedasa
continuousdoseformofbirthcontrol.Touseitthisway,replacewithanewpatcheveryweek.

Injection(Depotmedroxyprogesteroneacetate,commonly
calledDepoProvera)
DepoProveraisaprogesteroneinjectionthatpreventspregnancyfor3months.

DEPOPROVERADOESNOTPROTECTAGAINSTSEXUALLYTRANSMITTEDINFECTIONS

EffectivenessWithtypicaluse,6womenoutof100willbecomepregnantwithinthefirstyear
ofusingtheinjection.

RisksDepoProveramaycauseadecreaseinbonedensity.Thisbonelossusuallyresolves
oncetheinjectionsarestopped.Somewomenmaybeatincreasedriskofheartdisease,
particularlythosethatsmoke,arediabetic,havehighbloodpressureorahistoryofstrokeor
vasculardisease.

BenefitsReversibleformofcontraceptionthatdoesnotcontainestrogen.TheDepoprovera
injectiondoesntinterruptthespontaneityofsexandyoudonthavetotakeadailypillorinserta
monthlyring.

SideEffectsManywomenhaveirregularbleedingduringthefirst69monthsofuse,which
maybeheaver,lighter,orunpredictable.Manywomenstophavingperiodswhileusingthebirth
controlinjection.Othersideeffectsincludeweightgain(4poundsperyear),headaches,mood
changes,nervousness,dizziness,weakness,fatigue.

ProperUseyoumustreturntoseeyourdoctoreverythreemonthstoreceivethebirthcontrol
injection.

Barriermethods

Condoms
Condomscanbemakeoflatex,polyurethaneornaturallambskin.Spermicidalcondomsareno
moreeffectivethanotherlubricatedcondoms.

CONDOMSDOHELPPROTECTAGAINSTSEXUALLYTRANSMITTEDINFECTIONS

Effectivess18outof100womenwillbecomepregnantwithtypicaluseduringthefirstyear

Risksnone

Benefitsprotectsagainstsexuallytransmittedinfections,inexpensive,noprescriptionneeded,
canbeusedwithbreastfeedingandishormonefree

SideEffectsallergicreactions

ProperUseBeforeanypenetration,placetherolledupcondomoverthetipoftheerectpenis.
Holdtheendofthecondomtoallowalittleextraspaceatthetip.Thenunrollthecondomover
thepenis.Rightafterejaculation,graspthecondomaroundthebaseofthepenisasitis
withdrawn.Throwthecondomaway.Donotreuseacondom.

SPERMACIDE

Spermacideisafoam,cream,jelly,suppositoryorfilmthatisinsertedintothevaginatotrytokill
sperm.Itcanbeusedwithallotherbarriermethodsexceptthesponge,whichalreadycontainsa
spermicide.

Ifusedwithoutacondom,SPERMICIDESDONOTPROTECTAGAINSTSEXUALLY
TRANSMITTEDINFECTIONS

Effectiveness28outof100womenwillbecomepregnantwithtypicaluseduringthefirstyear.

Risksnone

Benefitsinexpensive,noprescriptionneeded,canbeusedwithbreastfeeding,hormonefree

SideEffectsallergicreactions,vaginalitchingorburning
ProperUseWhenusedalone,aspermicideshouldbeinsertedintothevaginaclosetothe
cervixnomorethan30minutesbeforeintercourseandshouldremaininplacefor68hours
aftersex.Aspermicideshouldbereappliedwitheachactofsex.

Diaphragm
Adiaphragmisasmalldomeshapeddevicemadeoflatexorsiliconethatfitsinsidethevagina
andcoversthecervix.Itmustbeusedwithspermicide.Theyrequireaprescriptionandyour
mustbefittedyourdoctor

ADIAPHRAGMDOESNOTPROTECTAGAINSTSEXUALLYTRANSMITTEDINFECTIONS

Effectiveness1213outof100womenwillbecomepregnantwithtypicaluseduringthefirst
year

Risksnone

BenefitsInexpensive

SideEffectsAllergicreaction

ProperUseBeforeintercourse,applyspermicidearoundtherimandinsidethedomeofthe
diaphragm.Squeezetherimbetweenyourfingersandinsertitintoyourvagina.Thefrontpartof
therimshouldbefeltbehindthepubicbone.Checktoseeifyourcervixiscompletelycoveredby
thediaphragm.Insertadditionalspermacideifsexuallyactivewithin6hours.Adiaphragmmust
remaininplacefor6hoursaftersexbutnomorethan24hours.

Toremovethediaphragm,pullgentlyonthefrontrim.Towashthediaphragm,usemildsoap
andwater.Rinsethesoapoffwell(soapcandamagetherubber),dryit,andputitbackinits
case.

Femalecondom
AFEMALECONDOMDOESHELPPROTECTAGAINSTSEXUALLYTRANSMITTED
INFECTIONS

Effectiveness21outof100womenwillbecomepregnantwithtypicaluseduringthefirstyear

Risksnone

Benefitsinexpensive,noprescriptionneeded,canbeusedwithbreastfeeding,hormonefree,
canbeinsertedupto8hourspriortointercourse

SideEffectsvaginaldiscomfort,allergicreaction

ProperUseSqueezetheinnerringbetweenyourfingersandinsertitintothevaginaasfaras
possible.Pushtheinnerringupuntilitisjustbehindthepubicbone.Aboutaninchoftheopen
endshouldbeoutsideyourbody.Rightafterejaculation,twisttheouterringclosed,andpullthe
pouchoutgently.Throwthecondomaway.Donotreuseit.Donotuseamaleandfemale
condomtogether.

ContraceptiveSponge(TodaySponge)
ATodaySpongeisadoughnutshapedspongemadeofsoftfoamcoatedwithspermicidethatis
insertedintothevagina.

ACONTRACEPTIVESPONGEDOESNOTPROTECTAGAINSTSEXUALLYTRANSMITTED
INFECTIONS

Effectiveness12outof100womenwhohaveneverbeenpregnantwillbecomepregnantwith
typicaluseduringthefirstyear.Thespongeislesseffectiveinwomenwhohavegivenbirth:24
womenoutof100whohavegivenbirthwillbecomepregnantwithinthefirstyearoftypicaluse.

RisksToxicshocksyndrome

Benefitsinexpensive,noprescriptionneeded,canbeusedwithbreastfeeding,hormonefree,
canbeinsertedupto24hourspriortointercourse

SideEffectsvaginalirritationandallergicreactionstopolyurethane,spermicides,orsulfites(all
ofwhicharefoundinthesponge).
ProperUseWetthespongecompletelyandsqueezeitgently.Squeezethesidesofthe
spongeupwardandawayfromtheloopandinsertthespongeasfarbackintoyourvaginaas
youcan.Checkitspositionwithyourfinger.Youshouldbeabletofeeltheloop.Itcanbeworn
forupto30hourstotalandcanbeinsertedupto24hoursbeforesexandshouldbeleftinplace
foratleast624hoursaftersex.Toremovethesponge,grasptheloopandslowlypullthe
spongeout.

Formoreinformationonallformsofcontraception,clickhere

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