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WORLD CONTRACEPTION DAY
world contraception da 2009
YOUR CONTRACEPTION GUIDE
YOUR CONTRACEPTION GUIDE
FOREWORD BY THE LOCAL PARTNERS
HORMONAL METHODS
The Combined Pill The ‘Your Contraception Guide' has been developed as part of - The Everyday Pill the World Contraception Day initiative. The campaign aims to - The Pill with Natural Estradiol The Progestogen-only Pill improve awareness and education regarding contraception and Emergency Contraceptive Pill reproductive well-being. To help both women and men of all ages Contraceptive Patch to make an informed choice about the contraceptive method that works best for them, this booklet provides an overview of the range of contraception available and details of what to consider when choosing a method. INTRAUTERINE METHODS
Whether you are using contraception for the first time, are unsure Intrauterine System (IUS) Intrauterine Device about the best contraceptive method to suit your needs and circumstances, or want to change your contraceptive method, you will find the content of this guide useful to help you make a decision. For further information, visit www.mycontraception.ie. BARRIER METHODS
For a detailed consultation on contraception please speak with your local doctor. Diaphragm plus Spermicide Cervical Cap plus Spermicide Please note that many of the options described to you in this booklet will not offer protection against sexually transmitted infections (STIs). Remember that condoms are essential in reducing the risk of contracting STIs.
Female Sterilisation Male Sterilisation Niall Behan, CEO, IFPA Alison Begas, CEO, Dublin Well Woman Centre Irish Family Planning Association FERTILITY AWARENESS METHODS
Natural Fertility Awareness World Contraception Day is a multi-national initiative driven by a coalition of non-governmental organisations committed to promoting reproductive health, including: the European Society of Contraception, the Irish Family Planning Association and the Dublin Well Woman Centre. It is supported by Bayer Schering Pharma which has a long history in women's health and is committed to improving education on sexual and reproductive health.

YOUR CONTRACEPTION GUIDE
YOUR CONTRACEPTION GUIDE
When choosing the best contraceptive for you and your partner, there are a few things you should consider. Different methods suit different people in different stages of life, so before making a decision, it is a good idea to look at the different options and to find out about their advantages and disadvantages. You will also need to take into account your personal circumstances: How important is it for you to avoid pregnancy? Your age and health are important factors, as there are medical conditions and circumstances in which the use of certain methods of contraception is not allowed or advisable. Your doctor should have access to your medical history. Your relationship status needs to be taken into consideration. For example, are you in a committed relationship, or is your relationship open? How often do you have intercourse? Is your family completed, or do you still want to have children? Do you want a contraceptive method that is independent of your sexual activity or could you integrate a barrier or behavioural method within your sexual activity? Contraceptive methods also vary in their effectiveness to prevent
an unintended pregnancy. The table on page 34 compares the
reliability of each contraceptive method. These comparisons take
into consideration perfect use (where the contraceptive is used
with 100% accuracy as you would see in a clinical trial) and typical
use (where the contraceptive is used in real life and where
occasionally it is not used properly).
There are a number of methods available for you to choose from,
and one of them will be right for you and your stage of life. The
following information will help you review the options available to
you and highlight important information for you to consider.
Hormonal methods are one of the most reliable forms of protection against unintended pregnancy. There are a range of different hormonal contraceptives available.
Hormonal methods are a reversible form of contraception; The Combined Pill a woman can get pregnant again once she stops using - The Everyday Pill - The Pill with Natural Estradiol There are a number of options available to suit different needs, for example different mixes and doses of hormones, Contraceptive Patch different modes of delivery (pills, patch, ring, hormonal coil, implant, injection). Hormonal methods are easy to use. The Progestogen-only Pill There are a number of added health benefits, Emergency Contraceptive Pill e.g. improvements in skin and hair condition, lighter and shorter or no periods. (Refer to each method to find out more.) Hormonal methods do not protect against sexually transmitted infections (STIs), so you may have to use a condom as well. Some women experience side effects – it is worth exploring the reasons behind the symptoms as there may be another method of hormonal contraception that is better suited to you.
THE COMBINED PILL
THE EVERYDAY PILL
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Very high reliability.1 Very high reliability4 WHAT IS IT?
WHAT IS IT?
The combined pill contains estrogen and progestogen. The woman is given one pack The everyday pil contains estrogen and progestogen. The woman takes 24 active pink for each 28-day cycle, and should take one pill each day for 21 days followed by a 7 pills followed by 4 inactive white (placebo) pills. The woman will menstruate during the 4 white inactive tablets, but bleeding may also run into the next pack.
WOULD THIS METHOD SUIT ME?
WOULD THIS METHOD SUIT ME?
There are a number of different types of combined pills available, so if one particular The combined everyday pill has additional benefits which include shorter, lighter and more type doesn't suit you, you do have more choices. regular periods. The new 24 + 4 dosing regimen is designed to help reduce premenstrual related symptoms such as breast tenderness, headaches, period pains and pelvic cramps5. This Additional benefi ts may include regular periods, fewer or no pelvic cramps, lighter and method wil increase compliance: as it is easier to remember to take it every day. The shorter periods, improved premenstrual syndrome symptoms, and a positive effect everyday pill also has positive effects on skin and hair. Further health benefits include a on skin and hair. Further health benefi ts include a reduced risk of ovarian cancer and reduced risk of ovarian cancer and cancer of the womb and less frequent occurrence of cancer of the womb and less frequent occurrence of benign breast tumors.2 There is a benign breast tumours.2 There is slightly increased risk of breast cancer, but this risk is very slightly increased risk of breast cancer, but this risk is very low.2,3 Fertility will quickly return to normal when the pill is no longer taken.
Fertility will quickly return to normal when the pill is no longer taken.
Some women may experience mood swings, changes in sex drive, headaches, cyclical bloating, or bleeding problems when taking the combined pill. These vary from woman Some women may have minor side effects when they start taking the pill, but usually these to woman and according to the type of pill that is taken.
subside during the first month of use. Side ef ects can include bleeding between periods, headaches and breast tenderness. These symptoms should not persist for longer than 3 months. If you are worried about side effects of if they persist for longer than 3 months, you should talk to your doctor about them.
THE PILL WITH NATURAL ESTRADIOL
VAGINAL RING
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Very high reliability.1 Very high reliability6 WHAT IS IT?
WHAT IS IT?
The vaginal ring contains an estrogen and a progestogen combination, and is inserted It is a combined oral contraceptive pill containing estradiol valerate and dienogest. Estradiol into the vagina and is kept in place for three weeks; it should then be removed for a valerate is the same estrogen which is produced naturally by a woman's body. Dienogest one-week break. Fol owing the week break, a new vaginal ring is inserted.
is a progestogen which has pronounced endometrial properties which mean the woman may have fewer, lighter spotting days6. This pill is taken over a period of 28 days with no WOULD THIS METHOD SUIT ME?
break. The pil contains 26 days of active ingredient and 2 days of placebo. There are four The vaginal ring provides an alternative form of contraception which has to be changed active phases allowing an estrogen step down, progestogen step up process mimicking only once every four weeks.
the woman's natural cycle.
It may also make your periods more regular, lighter and may reduce cramping.
It can cause similar hormonal type side ef ects as you would experience with the WOULD THIS METHOD SUIT ME?
combined pil but in addition you may experience vaginal irritation, discomfort or This may suit the hormonally conscious woman due to the use of natural estradiol. Like discharge. Some women and/or their partners may be able to feel it during intercourse.
al pil some women may experience headaches, bloating, mood swings or bleeding problems6. Due to the strong effect of Dienogest on the endometrium some woman may experience amenorrhea (no bleed during your cycle). Additional benefits include lighter shorter bleeds, fewer or no pelvic cramps.
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Very high reliability.1 Very high reliability.1 WHAT IS IT?
WHAT IS IT?
The thin patch contains an estrogen and a progestogen and is affi xed to the The injection contains progestogen. It is given by a doctor or nurse once every abdomen, thigh, buttocks or upper arm. It is not transparent, so this method is twelve weeks.
visible. The hormones are released continuously, entering the bloodstream viathe skin. You need to change the patch weekly for three weeks, fol owed by a WOULD THIS METHOD SUIT ME?
week's break.
The injection is a long-acting hormonal method providing effective contraception without the need for a daily dose of treatment. Progestogen-only injections are also WOULD THIS METHOD SUIT ME?
suitable for women who are breast-feeding, and those who do not tolerate estrogen. The patch provides an alternative form of combined hormonal contraception to Injections may also reduce heavy painful periods and help with premenstrual syndrome the combined pil , as the patch is only changed once a week.
symptoms. Periods and fertility may take up to a year to return after stopping It can cause similar hormonal type side ef ects as you would experience with the combined pil but in addition you may experience skin irritation.
Some women experience headaches, dizziness, pimples and greasy skin, bloating, weight gain, breast tenderness, abdominal discomfort, and changes in mood and sex drive. As the hormones cannot be removed from the body once the injection has been administered, side effects may continue from the time of the injection and for some time afterwards. With the progestogen-only injection women may have a risk of losing bone mineral density which may increase the risk of osteoporosis. THE PROGESTOGEN-ONLY PILL
(also known as the mini-pil ) EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Very high reliability.1 Very high reliability.1 WHAT IS IT?
A smal soft plastic rod containing a progestogen reservoir is inserted in the upper
WHAT IS IT?
arm with minor surgery carried out by a trained doctor. The progestogen is released This pil only contains progestogen. The woman takes one pil every day, which means in tiny doses and the implant is effective for three years. It can be removed at any taking pil s during the period, and no break between packs.
time by minor surgery.
WOULD THIS METHOD SUIT ME?
WOULD THIS METHOD SUIT ME?
The progestogen-only pil is suitable for women who cannot tolerate estrogen. It can The implant is particularly suitable for women who want long-term contraception and also be used while breastfeeding as it does not affect the breast milk. wish to avoid daily intake of a contraceptive. It is also suitable for women who are breast-feeding, and those who do not tolerate estrogen. Most progestogen-only pil s should be taken each day at the same time or they do not work – any delay must not exceed more than three hours. Fertility wil return to normal when the implant is removed. It can cause irregular bleeding, but this can settle with time. On the other hand, some The implant can cause similar hormonal type side ef ects as you would experience women experience no bleeding at al . It may also initial y induce temporary side-effects with the combined pil but in addition you may experience irregular bleeding for the such as pimples and greasy skin, breast tenderness, bloating and headaches.
fi rst few months.
(often known as the "morning after pil ") EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Reasonable reliability.1
WHAT IS IT?
Women should take the emergency contraceptive pil as soon as possible after
unprotected intercourse – ideal y within 12 hours, but you can take it up to 72 hours
after unprotected intercourse. The sooner a woman takes it the more effective it
wil be. The emergency contraceptive pil contains progestogen only and works by
inhibiting ovulation.
WOULD THIS METHOD SUIT ME?
This emergency method of contraception can be used if unprotected sex has taken
place or when another method of contraception has failed (e.g. torn condom or
forgotten pil ). It should not be used regularly, and is only intended as a back-up
method. After using emergency contraception you should use another form of
contraception for the rest of your cycle to protect yourself if you do not want to
become pregnant.
Women looking for a contraceptive method that they can use and forget about for longer periods of time, may want to consider an intrauterine method. Intrauterine methods can be broadly divided into two types - INTRAUTERINE SYSTEM (IUS)
hormone releasing intrauterine systems (IUS) and copper bearing intrauterine devices (IUD). The IUS or IUD is inserted into the (also known as hormonal coil) woman's womb through her vagina.
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Very high reliability.1
WHAT IS IT?
A smal soft plastic device with a reservoir containing a progestogen is inserted into the
Intrauterine methods are the longest acting reversible cavity of the womb by a trained doctor. The tiny dose of progestogen is released slowly methods, which can provide contraceptive protection for up from the system. The IUS prevents pregnancy by thickening cervical mucus at the entrance of the womb, making it diffi cult for sperm to get through.
It also thins the lining of the womb to prevent an egg from being implanted, and Once inserted, there is no need to do anything right before, in some women, ovulation is inhibited.
during, or after sex, which provides flexibility. The IUS can improve heavy and painful periods, protect WOULD THIS METHOD SUIT ME?
against pelvic infections and cancer of the uterine lining. The IUS is suitable for women who want reliable long-term contraception and who prefer not to think about birth control on a daily basis. The IUS can stay in place for The IUD can be used as an emergency contraceptive. up to fi ve years, and can be removed at any time. As fertility returns immediately after The ability to get pregnant will return soon after the IUS or removal of the IUS, it can also be used by young women. IUD is removed.
The IUS is suitable for women who cannot tolerate estrogen. It can also be used while breast-feeding, as it does not affect the breast milk. Additional benefi ts may include improvement of heavy and painful periods and protection against cancer of the uterine lining. Some women may have reduced bleeding and a few may have no bleeding, which reduces the chances of becoming anaemic. The copper IUD may increase cramps and bleeding during the cycle.
There may be irregular bleeding for the fi rst three months, but this should soon settle down. Initial occurrences of headaches, breast tenderness or nausea are possible.
INTRAUTERINE DEVICE
(IUD, also known as the coil) EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Very high reliability.1
WHAT IS IT?
A smal soft device with a copper thread or copper cylinders that is inserted into the
cavity of the womb by a trained doctor. It can be left in the uterus for 5-10 years
(depending on the type).
The IUD affects the way that the sperm or the egg moves. It releases a substance that immobilises the sperm and makes it diffi cult for the egg to travel along the fal opian tubes. If the egg become fertilised, the IUD af ects the movement of the egg so that it travels too fast to be implanted in the womb.
WOULD THIS METHOD SUIT ME?
The IUD provides a long-term contraceptive option. It can also be used as an
emergency contraceptive for up to 5 days after unprotected intercourse (Note: The
IUS cannot be used as an emergency contraceptive). It is not usual y the method
of choice for women with anaemia. The IUD neither protects nor increases the risk
of pelvic infections. The IUD can also cause increased cramping, dizziness, and
heavier and prolonged periods.
Barrier methods are designed to stop sperm from entering the womb. There are different options available and before looking at the individual methods it is worth looking at the overall advan-tages and disadvantages of using a barrier method.
MALE CONDOM
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Barrier methods provide an option for women who cannot or do not want to use hormonal contraception. Reasonable reliability.1 The condom is the only form of contraception that offers WHAT IS IT?
protection against most STIs if used properly. A latex or polyurethane sheath that fi ts over the penis when it is erect. It is closed at Barrier methods offer protection against unintended one end with a ‘teat' at the top to hold the sperm when a man ejaculates. The condom pregnancy without acting on the menstrual cycle, so there is rol ed down over the erect penis before sex takes place to prevent sperm from are no hormone-related side effects.
entering the vagina. The condom should be held in place on the penis as soonas ejaculation has occured, to ensure that it does not slip off and to prevent anysperm from escaping as the penis is withdrawn.
WOULD THIS METHOD SUIT ME?
The male condom provides protection against most STIs if used properly. It is recommended when you have sex with a new partner, have multiple sexual partners Barrier methods are less reliable at preventing unintended or are unsure of your partner's sexual history.
pregnancy than hormonal methods. Condoms can be used at short notice, however some people fi nd they interfere with They require practice to be used effectively. spontaneity and sensation.
They can interfere with spontaneity, sensation and pleasure.
Condoms can fail by tearing or coming off during sex. Oil-based lubricants should not be used with condoms as they can weaken the latex and cause it to break.
FEMALE CONDOM
DIAPHRAGM PLUS
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Reasonable reliability.1
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Low reliability.1
WHAT IS IT?
The female condom is a polyurethane sheath which fi ts inside the woman's vagina.
WHAT IS IT?
There is a fl exible ring at each end to hold the female condom in place. The closed A diaphragm is a dome-shaped circle made of rubber or silicone that is inserted into end of the female condom covers the cervix and the open end is positioned at the the vagina to form a barrier between the sperm and the entrance of a woman's womb. entrance of the vagina.
It requires initial fi tting by a doctor or nurse. It must be inserted before intercourse and should be used with a spermicide. It must be left in for at least six hours after WOULD THIS METHOD SUIT ME?
intercourse (and no more than 24 hours).
The female condom provides protection against STIs. It is recommended when you have sex with a new partner, have multiple sexual partners or are unsure of your WOULD THIS METHOD SUIT ME?
partner's sexual history.
It does not interfere with sex, and the man is not aware of it; however, it can interfere It requires practice to use correctly.
with spontaneity. Effectiveness increases when the diaphragm is used in combination with spermicides.
It requires a little practice to use this method correctly. It can cause vaginal irritation, and occasional y infection of the bladder.
CERVICAL CAP PLUS
SPERMICIDE
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Low reliability.1
WHAT IS IT?
A cap made of rubber or silicone, smal er compared to the diaphragm, and it covers
only the cervix. It requires initial fi tting by a doctor or nurse. It must be inserted before
intercourse, and must not be left in the vagina for more than 48 hours.
WOULD THIS METHOD SUIT ME?
It is not recommended for al women because it may not fi t the cervix properly. It is less
reliable than other contraceptive methods, particularly in women who have given birth
because of the potential distortion of the woman's cervix. Effectiveness increases when
the cervical cap is used in combination with spermicides.
Some people require practice in using this method, and it can interfere with sexual spontaneity.
Any man or woman can be sterilised. It is a permanent method of contraception, suitable for people who are sure they never want children or do not want more children. Remember there are other forms of long-acting contraception, which are as effective, but reversible.
Sterilisation does not interrupt sex. After sterilisation there is no need to do anything about contraception ever again.
Sterilisation cannot be easily reversed, except by using complex and potentially dangerous surgery which is not successful in all cases. Sterilisation involves an operation. Sterilisation does not protect against STIs. There is a small chance, although this is very rare, that the tubes may rejoin and you will be fertile again. The overall failure rate in women is about one in 200 and one in 2,000 for men. It takes at least two months for a vasectomy to be effective, and other forms of contraception should continue to be used until then. EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Very high reliability.1 Very high reliability.1 WHAT IS IT?
WHAT IS IT?
Surgical procedure to cut or block the fal opian tubes (which carry the egg from the Vasectomy is a surgical procedure to cut the ducts that carry sperm so that, while a man ovary to the womb) so that the sperm cannot meet the egg. The operation af ects a can stil ejaculate, there is no sperm present. The operation, which can be carried out woman's fertility potential and has no effect on the libido or the ability to have sexual under local anaesthetic, affects a man's fertility potential and has no effect on the libido or the ability to have sexual intercourse.
WOULD THIS METHOD SUIT ME?
WOULD THIS METHOD SUIT ME?
Sterilisation is only for people who have decided they defi nitely do not want to have This method of contraception is permanent and only suitable for those who do not want children, either now or in the future. Although there is a chance of reversal, the to have children. Although there is a chance to reverse it, the procedure is complicated procedure is complicated and rarely successful. Very occasional y, there can be a and rarely successful. technical failure during the procedure where the fal opian tubes re-open, or closure is Sperm is stil present in the male genital organs immediately after the operation, with two or more semen analyses required to check when the sperm has cleared. This usual y takes place approximately 16-18 weeks after the operation so other contraceptive methods should be used during this time.
FERTILITY AWARENESS
basal body temperature (also known as fertility awareness) EFFECTIVENESS OF BIRTH CONTROL WHEN USED PROPERLY
Low reliability.1
WHAT IS IT?
There are several fertility awareness methods, al of them based on the fact that
there are only a few days during each menstrual cycle – the days before and during
ovulation – when a woman can get pregnant. The menstrual cycle begins the day a
woman starts her period (bleed) and ends the day before her next period starts. These
methods require a woman to observe various fertility signs such as changes in body
temperatures and cervical mucus.
WOULD THIS METHOD SUIT ME?
If you are using the fertility awareness method you are advised to use a barrier method
(e.g. diaphragm, cervical cap or condom) or not have sexual intercourse on the days
you are fertile if you do not want to get pregnant. If you want to get pregnant, fertility
awareness can help you to know which days you should have sex.
Alternatives to hormonal methods, intrauterine methods, barrier The disadvantage of fertility awareness is that it does not take into account fl uctuations methods and sterilisation include fertility awareness methods. It in cycle. Many circumstances in everyday life can infl uence the rhythm of the menstrual is important to note that there is no protection against STIs with cycle, making reliable calculation of the fertile and infertile days diffi cult.
these options, so you may have to use a condom as well if you think you may be at risk.
The fol owing table compares the reliability of each contraceptive method. These comparisons take into consideration perfect use (where the contraceptive is used with 100% accuracy as you would see in a clinical trial) and typical use (where the contraceptive is used in real life and where occasional y it is not used properly).
% of women getting pregnant within the fi rst year of useTypical use* This information education leafl et is supported by Bayer Schering Pharma, which has a long history in women's health and are committed to improving education on sexual and reproductive health.
The aim of the contraception guide is to provide an overview of available contraceptive methods, their reliability and advantages/disadvantages to help people to make informed choices. Considerable care and effort has been taken Combined pil and progestin-only pil regarding the contents of the presented information, however, no responsibility can be taken for its accuracy and availability, and changes may have occurred since this booklet was last updated. Al presented information has been careful y referenced. Specifi c product labels may include different fi gures and information based on alternative data. Speak to your doctor if you wish to have information tailored to Intrauterine Methods your specifi c needs.
No liability shal be taken by the contributors for the contents of this document, or the contents of the referenced documents or for any damages caused as a result of the use of the information provided.
Female sterilisation Male sterilisation If you're interested in reading more about your contraceptive choices, there are many good sources of information available to you. These include: Guil ebaud J. Contraception: Your Questions Answered. Fourth edition. Churchil Livingstone, 2004.
www.ifpa.ie www.wel womancentre.ie Revised edition, 2008
References
1. Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Stewart F, Nelson A, Cates
* Trussel J. Contraceptive effi cacy. In: Hatcher RA, Trussel J, Stewart F, Nelson A, Cates W, Guest F, Kowal D. W, Guest F, Kowal D. Contraceptive Technology: Nineteenth Revised Edition. New York, NY: Contraceptive Technology: Nineteenth Revised Edition. New York, NY: Ardent Media, 2007.
Ardent Media, 2007. 2. Guillebaud, J. Contraception: Your Questions Answered. Fourth edition.
# Information on the cervical cap is taken from Hatcher RA, Trussel J, Stewart F, Nelson A, Cates W, Guest F, Churchill Livingstone, 2004. 3. Cancer Research UK. Breast Cancer risk factors 2008. Available
Kowal D. Contraceptive Technology: Seventeenth Revised Edition. New York, NY: Ardent Media, 1998.
at: http://info.cancerresearchuk.org/cancerstats/types/breast/riskfactors/ (Accessed 12 March
2008.) 4. Bachmann G et al: Contraception 2004; 70(3):191-8 5. Sulak PJ et al: Obstet Gynecol
2000; 5(4):256-64 6. Parke et al: Obstet Gynecol 2008, No: 578073
Bayer Schering, The Atrium, Blackthorn Road, Sandyford, Dublin 18 01 - 2999 313 urtext no: 06.09.00023.ie

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