CASE STUDY 112

Princess Levie Ceniza BSN 2A GROUP 1

SCENARIO

You are working in a busy OB/GYN office, and the last patient of the day is P.B., a
36 year old who is planning to get married soon. She wants to use birth control but is
not sure what to choose. Her fiance is in law school, and they do not have health
insurance, so she is anxious not to get pregnant right away. She asks you to review the
various methods and help her explore what is best for her.

1. What past medical information will you need to ask P.B. about ?

- The past medical information that I will ask P.B about her is first, her childhood
illnesses and immunizations, accidents or traumatic injuries, hospitalizations,
surgeries, psychiatric or mental illnesses, allergies, and chronic illnesses. For women,
include history of menstrual cycle, how many pregnancies and how many births.

2. Are there any other conditions that would influence the choice of a
contraceptive method ?

- A patients choice of contraceptive method involves factors such as efficacy, safety,

non contraceptive benefits, cost, and personal considerations.

3. Is P.B. currently at risk for sexually transmitted infections ( STI s ) ?

- P.B is not currently at risk for sexually transmitted infections. Both of them don’t
have multiple partners and any history of STI.

4. What lifestyle information will help you assist P.B. in choosing an appropriate
method for her ?

- I will tell her the effectiveness of the different contraception methods. I will ask her
if she can make the contraception part of her daily routine, would she prefer the
contraception that she didn’t need to remember everyday, would she be comfortable
inserting contraceptives in her vagina, does she mind if her periods change.
I will also ask her if she smoke, smoker can use most type of contraception. But if you
are a smoker and over 35 years old, some contraceptives might not be suitable. I will
ask her if she is overweight, weight won’t affect most of types of contraception, and
most contraception won’t make you put on weight. However, the contraceptive
injection has been linked to a small amount of weight gain if used for two years or
more.
I will also ask her if she wants to get pregnant in the future, all methods of
contraception can be stopped if you want to have a baby, a woman’s fertility usually
returns to normal within the first month after stopping the combined pill, vaginal ring
or contraceptive patch. Your fertility may take longer to return to normal after
stopping the contraceptive injection.
5. P.B. asks you about the effectiveness rating of available birth control methods.
Categorize your response according to the following efficacy ratings: most
effective ( more than 99% ), highly effective ( 97% to 99% ), and moderately
effective ( less than 90% ).

Most effective contraceptive method

( more than 99% )
Tubal ligation
Vasectonomy
Copper IUD
Contraceptive implant
Mirena IUD
Highly effective contraceptive method (
97% to 99% )
Emergency contraception pill ( ECP )
Nuva ring
Depo provera injection
Progestogen - only pills, aka The Minipill
Combined oral contraceptive pill, aka
The Pill
Patch
Moderately effective contraceptive
method ( less than 90% )
Diaphragm
Male condoms
Sponge
Cervical cap
Female condom
Withdrawal
Spermicide
Fertility awareness based methods

6. P.B. asks you to explain the main advantages and disadvantages of the most
effective methods ?

Tubal Ligation - also known as having your tubs tied or tubal sterilization, is a type
of permanent birth control. During tubal ligation, the fallopian tubes are cut, tied or
blocked to permanently prevent pregnancy. Tubal ligation prevents an egg from
travelling from the ovaries through the fallopian tubes and blocks sperm from
travelling up the fallopian tubes to the egg. The procedure doesn’t affect your
menstrual cycle.
ADVANTAGES DISADVANTAGES
The main advantage of tubal ligation is Reversing tubal ligation is complex and
that it is incredibly effective. The not always effective. It depends on the
techniques has a rate up to a 99% occlusion technique used and the time
reliability and this figure actually that has passed since the surgery was
increases after the first year. performed. That is, it is not always

Another, and no less significant
advantage is that it is a relatively simple
intervention. Patients can return home
after just a few hours in hospital.
The procedure does not affect ovarian of
uterine function. As such, the menstrual
cycle persists and patients continue to
have periods. Furthermore, it does not
alter when the woman will go through the
menopause.
If everything goes as expected, no It does not protect against sexually
posterior medical check ups and transmitted diseases.
appointments are needed.
possible. Furthermore, even when it is
performed, the chances of conceiving
once again naturally are very low.
Therefore, if a woman wishes to have
children once again, in vitro
fertilisation is advised. By doing so, the
role of the Fallopian tubes in fertilizing
the ova can be bypassed and the entire
procedure can be performed in a
laboratory. Patients need to undergo
ovarian stimulation in order to retrieve
ova and male partners must provide a
semen sample. The prognosis is generally
favourable in these cases.
As with all other existing means of birth
control, it is not 100% effective. It is a
reliable method but it isn’t fail-safe. Most
recent studies have recorded a failure rate
under 1%.Whilst it is incredibly unusual,
the ends of the Fallopian tubes can join
together once again and lead to an
unwanted pregnancy. There is also an
increased risk of an ectopic
pregnancy (pregnancy outside the uterus).
The most common side effects are linked
to the surgical technique itself and the
general anaesthetic.

Vasectonomy - is a form of male birth control that cuts the supply of sperm to your
semen. It's done by cutting and sealing the tubes that carry sperm. Vasectomy has a
low risk of problems and can usually be performed in an outpatient setting under local
anesthesia.
Before getting a vasectomy you need to be certain you don't want to father a child in
the future. Although vasectomy reversals are possible, vasectomy should be
considered a permanent form of male birth control.
ADVANTAGES DISADVANTAGES
a vasectomy is more than 99% effective vasectomy doesn't protect against STIs,
at preventing pregnancy so you may need to use condoms as well

long-term effects on your health are rare a vasectomy can't be easily reversed, and
reversals are rarely funded by the NHS
it doesn't affect your hormone levels, sex you need to keep using contraception
 drive or interfere with sex
it may be chosen as a simpler and safer possible
alternative to female sterilization
after the operation until tests show your
semen is free of sperm
complications include a
collection of blood inside the scrotum
(haematoma), hard lumps called sperm
granulomas (caused by sperm leaking
from the tubes), an infection, or long-
term testicle pain (you may need further
surgery)
the vas deferens tubes can reconnect, but
this is very rare

Copper IUD - ParaGard is an intrauterine device (IUD) that can provide long-term
birth control (contraception). It's sometimes referred to as a
nonhormonal IUD option.The ParaGard device is a T-shaped plastic frame that's
inserted into the uterus. Copper wire coiled around the device produces an
inflammatory reaction that is toxic to sperm and eggs (ova), preventing pregnancy. It
can prevent pregnancy for up to 10 years after insertion.

ADVANTAGES
. IUDs are very effective forms of.
contraception that have a high success
rate of 99%.
DISADVANTAGES
Once inserted, 1% of women have
a risk of infection, and 1% of them have
a risk of perforation or damage of the
womb.

. Their effects are long-lasting.. Copper IUDs may make

Once inserted, a IUD prevents your periods more painful and heavier
pregnancy for 5 years or even more. So, than before.
you are saved from popping a pill every
night, or wearing a condom every time
you have sex with your long-term
partner. Just get an IUD inserted in your
uterus, and forget about contraception
for several years.

. Unlike permanent sterilization,. Some women may also develop

the effectiveness of an IUD is an allergic reaction to a foreign material
completely reversible. You stay infertile inserted inside their body.
for as long as you do not want to get
pregnant, and you become fertile again
once you get it removed. So, if you get
an IUD inserted for 5 years, and you
change your mind to have a baby before
that, you can simply get your IUD
removed, and become completely fertile
again.
. An IUD does not have any affect.
on your breastfeeding. So, if you have
recently delivered a baby and you are
still breastfeeding, you can still get an
IUD inserted and continue feeding your
child.
In some women, hormonal
IUD may cause headaches, acne, nausea,
breast tenderness, weight gain, loss of
libido, mood changes etc.

. Unlike pills and condoms, you. In 5% of cases, IUDs come out on

don’t need to keep anything by your bed
side, and no one would be able to know
that you are using this contraceptive.
Even if you are traveling, you don’t need
to carry anything in your bag.
their own. That is why, it is
recommended to check its strings after
each period.

. Copper IUDs are free from

hormones, which means that they keep
you infertile without causing any
hormonal changes in your body.

Contraceptive implant - The contraceptive implant (Nexplanon) is a small flexible

plastic rod that's placed under the skin in your upper arm by a doctor or nurse.It
releases the hormone progestogen into your bloodstream to prevent pregnancy and
lasts for 3 years. The implant steadily releases the hormone progestogen into your
bloodstream, which prevents the release of an egg each month (ovulation).It also
thickens the cervical mucus, which makes it more difficult for sperm to move through
the cervix, and thins the lining of the womb so a fertilised egg is less likely to implant
itself.

ADVANTAGES DISADVANTAGES
it works for 3 years you may experience temporary side
effects during the first few months,
like headaches, nausea, breast
tenderness and mood swings

it doesn't interrupt sex your periods may be irregular or stop

altogether

it's an option if you can't use you may get acne or your acne might
oestrogen-based contraception, such get worse
as the combined contraceptive pill,
contraceptive patch or vaginal ring
it's safe to use while you're you'll need a small procedure to have
breastfeeding it fitted and removed
your fertility will return to normal as it doesn't protect you against sexually
 soon as the implant is taken out transmitted infections (STIs), so you
may need to use additional
contraception (such as condoms) as
well
it may reduce heavy periods or period
pain

Mirena IUD - Mirena is a hormonal intrauterine device (IUD) that can provide long-
term birth control (contraception).
The device is a T-shaped plastic frame that's inserted into the uterus, where it releases
a type of the hormone progestin. To prevent pregnancy, Mirena:

 Thickens mucus in the cervix to stop sperm from reaching or fertilizing an egg
 Thins the lining of the uterus and partially suppresses ovulation
ADVANTAGES DISADVANTAGES
 It is the most effective reversible  Do NOT start this method of birth
method ever developed! control unless you will find it acceptable
to have your periods change.  They WILL
change a lot.
 It prevents ectopic pregnancies   There may be more bleeding days
(15 times lower than non-contraceptors). than normal for the first few months and
less than normal after 6 to 8 months. If
your bleeding pattern is bothersome,
contact your clinician. There are
medications which can help you have a
better pattern of bleeding.
  It decreases menstrual cramping  The IUD does not
and dramatically decreases menstrual provide protection against sexually
blood loss (a 97% reduction in menstrual transmitted infections. Use condoms if
blood loss in one study). but probably there is any risk.
about a 90% reduction in blood loss on
average). Some women experience an
absence of menstrual bleeding after one
year (about 20%). This IUD may be left
in place for at least 5 years (probably
effective for 7 or even more years).
 Mirena decreases menstrual  There may be a high initial cost of
cramps and pain. Mirena improves insertion.
endometriosis
 Mirena prevents endometrial  There is a very slightly increased
hyperplasia and reduces a woman’s risk risk of pelvic infection in the first 20 days
for endometrial cancer. after Mirena insertion.
 Mirena is safe, inexpensive over  The risk of uterine perforation at
time, and provides extremely effective the time of Mirena insertion is also low –
long-term contraception from a single between 1 in 1,000 and 1 in 2,000.
decision.
 One of the costs of any  Mirena gives off very low
contraceptive is the cost to you should amounts of a progestin into the blood
your contraceptive fail. Given the stream and can lead to some systemic
extremely low failure rate of Mirena, a effects such as weight gain and acne, but
person using this method is far less likely these are uncommon
to have the emotional and financial
expenses associated with an unintended
pregnancy. IUDs are the most cost
effective contraceptives over time.
 Mirena my possible reduce a
woman’s risk for developing pelvic
inflammatory disease by producing a
very thick cervical mucus preventing the
ascent of microorganisms that cause PID
 All you have to do is check for the
strings each month (many clinicians no
longer recommend this after several
months).
 May be used by postmenopausal
women on estrogen therapy to protect the
endometrium against endometrial cancer.
 Once Mirena is removed, fertility
returns immediately. Approximately 8
out of every 10 women who want to
become pregnant will become pregnant in
the first year after Mirena is removed.

7. What are the main advantages and disadvantages of the contraceptive

methods in the highly effective category ?

Emergency contraception pill ( ECP ) - The emergency contraceptive pill (ECP) is

a pill that is taken after unprotected sex to prevent pregnancy.

The ECP: 

 Stops or delays the release of an egg from your ovaries until the sperm aren’t
active in your body any more.
 Prevents the sperm from fertilising an egg by changing the way the sperm
moves in your body.
 Doesn’t work once the egg has been fertilised.
 Doesn’t harm you or a developing embryo.
ADVANTAGES DISADVANTAGES
This is a very safe method of Birth control pills can’t give you a
contraception: the majority of birth 100 % guarantee that you won’t get
control pills give you a 99 % pregnant: even the best OC can fail
guarantee that you won’t get
pregnant.
Girls and women of practically any
age can take them even though for
each age group there are certain birth
control pills.
They get the hormonal background
back to normal and decrease the risk
of such diseases occurrence as
ovarian cancer, endometriosis and
cystic ovary.
They make menstrual period regular
in case your periods were often late
earlier or you had them several times
a month.
They decrease the risk of
premenstrual syndrome.
When you’re taking OC your
menstruations become less abundant
and last for not so long.
If you take birth control pills, you’ll
have an opportunity to delay
unwanted menstruation (for example,
if you’re going on holidays).
They have a treating effect in case of
mastopathy.
you.
It’s necessary to take birth control
pills everyday: Even if you miss
taking only 1 pill, it decreases the
pills’ effect and may lead to
pregnancy.
In case you are taking some other
drugs (for example, antibiotics) the
efficiency of the pills may get
decreased.
For some time after you started taking
OC you may have smear-like bloody
discharges in the middle of the
menstrual cycle.
Birth control pills may contribute to
an increased appetite. They also may
make water stay in the organism: if
you don’t want to gain weight on the
background of taking OC, you need
to keep an eye on the way you eat and
lead an active way of life.
Birth control pills may be the cause
for hair loss.
Once a woman stops taking birth
control pills, her menstrual cycle may
become not regular (however, it’s
very rare and can be called an
exception from the way the things
usually are).
 If you decide to plan pregnancy, then
you’ll have more chances to get
pregnant after you stop taking OC.

All effects of birth control pills go

away right after you stop taking them.

Vaginal ring - The vaginal ring (NuvaRing) is a small soft, plastic ring that you
place inside your vagina. It releases a continuous dose of the hormones oestrogen and
progestogen into the bloodstream to prevent pregnancy.

The ring steadily releases the hormones oestrogen and progestogen into your
bloodstream, which prevents the release of an egg each month. It also thickens the
cervical mucus, which makes it more difficult for sperm to move through the cervix,
and thins the lining of the womb so a fertilized egg is less likely to implant itself.

ADVANTAGES
it doesn't interrupt sex
it's easy to put in and take out
you don't have to think about it every
day or each time you have sex
the ring isn't affected if you're sick
(vomit) or have diarrhoea
it may help with premenstrual
symptoms
period-type bleeding usually becomes
lighter, more regular and less painful
DISADVANTAGES
you may not feel comfortable
inserting or removing it from your
vagina
you can have spotting and bleeding in
the first few months
it may cause temporary side effects,
such as increased vaginal discharge,
headaches, nausea, breast tenderness
and mood changes
the ring doesn't protect against STIs
you need to remember to change it
and put in a new one – if
remembering to do this is difficult, a
longer-acting method such as
the contraceptive
implant or intrauterine device
(IUD) may be more suitable
some medicines can make the ring
less effective – see a GP, nurse or
pharmacist for advice
it may take a while for you to return
to normal fertility – in some women
this may take up to a few months
Depo provera injection - Depo Provera is a contraceptive injection containing
progestogen. Some people call it “the injection”, "the jab" or "DP".Progestogen is
similar to one of the hormones produced naturally in the ovaries. The injection is
given every 13 weeks.Depo Provera prevents pregnancy by stopping the ovaries
releasing an egg each month. There are also changes to the lining of the uterus
(endometrium).

ADVANTAGES DISADVANTAGES
Almost 100% effective. Once you have had an injection of Depo
Provera, it lasts at least 13 weeks which
can be a nuisance if you experience a side
effect.

Convenient. It can cause irregular or longer than usual

bleeding. This is more common when
first starting to use Depo Provera and
often improves with time.

Lasts for 13 weeks.

No daily pill taking.

Doesn’t interfere with sexual

intercourse.
No one else needs to know you are
using it.
Reduces the risk of endometrial cancer
(cancer of the lining of the uterus) by
80%.
Helps if you have heavy or painful
periods.

Progestogen - only pills, aka The Minipill - The traditional progestogen-only pill
(POP) prevents pregnancy by thickening the mucus in the cervix to stop sperm
reaching an egg.The desogestrel progestogen-only pill can also stop ovulation.The
progestogen-only pill needs to be taken every day to work.

ADVANTAGES DISADVANTAGES
it does not interrupt sex you may not have regular periods
while taking it – your periods may be
lighter, more frequent, or may stop
altogether, and you may get spotting
between periods
 you can use it when breastfeeding
it's useful if you cannot take the
hormone oestrogen, which is in
the combined pill, contraceptive
patch and vaginal ring
it does not protect you against STIs
you need to remember to take it at or
around the same time every day

you can use it at any age some medicines, including some

(uncommon) antibiotics, can make it
less effective

Combined oral contraceptive pill, aka The Pill - The combined oral contraceptive
pill is often just called "the pill". It contains artificial versions of female hormones
oestrogen and progesterone, which are produced naturally in the ovaries. If sperm
reaches an egg (ovum), pregnancy can happen. Contraception tries to stop this
happening usually by keeping the egg and sperm apart or by stopping the release of an
egg (ovulation).

ADVANTAGES
it does not interrupt sex
it usually makes your bleeds regular,
lighter and less painful
it reduces your risk of cancer of the
ovaries, womb and colon
it can reduce symptoms of PMS
(premenstrual syndrome)
it can sometimes reduce acne
DISADVANTAGES
it can cause temporary side effects at
first, such as headaches, nausea,
breast tenderness and mood swings
– if these do not go after a few
months, it may help to change to a
different pill
it can increase your blood pressure
it does not protect you
against sexually transmitted
infections
breakthrough bleeding and spotting is
common in the first few months of
using the pill
it has been linked to an increased risk
of some serious health conditions,
such as blood clots and breast cancer

it may protect against pelvic

inflammatory disease
it may reduce the risk of fibroids,
ovarian cysts and non-cancerous
breast disease
Patch - The contraceptive patch is a small sticky patch that releases hormones into
your body through your skin to prevent pregnancy.
The patch releases a daily dose of hormones through the skin into the bloodstream to
prevent pregnancy.It contains the same hormones as the combined pill – oestrogen
and progestogen – and works in the same way by preventing the release of an egg
each month (ovulation).It also thickens cervical mucus, which makes it more difficult
for sperm to move through the cervix, and thins the womb lining so a fertilised egg is
less likely to be able to implant itself.

ADVANTAGES DISADVANTAGES
it's very easy to use and doesn't it may be visible
interrupt sex
unlike the combined oral it can cause skin irritation, itching and
contraceptive pill, you don't have to soreness
think about it every day – you only
have to remember to change it once a
week
the hormones from the patch aren't it doesn't protect you against STIs, so
absorbed by the stomach, so it still you may need to use condoms as well
works if you're sick (vomit) or have
diarrhoea
it can make your periods more some women get mild temporary side
regular, lighter and less painful effects when they first start using the
patch, such as headaches, sickness
(nausea), breast tenderness and mood
changes – this usually settles down
after a few months
it can help with premenstrual bleeding between periods
symptoms (breakthrough bleeding) and spotting
(very light, irregular bleeding) is
common in the first few cycles of
using the patch – this is nothing to
worry about if you're using it properly
and you'll still be protected against
pregnancy
it may reduce the risk of ovarian, some medicines can make the patch
womb and bowel cancer less effective – see a GP, nurse or
pharmacist for advice

8. What about the moderately effective birth control methods ? What are the main
advantages and disadvantages ?

Diaphragm - A contraceptive diaphragm or cap is a circular dome made of thin, soft

silicone that's inserted into the vagina before sex.It covers the cervix so sperm cannot
get into the womb (uterus) to fertilise an egg. A diaphragm or cap is a barrier method
of contraception. It fits inside your vagina and prevents sperm passing through the
cervix (the entrance of your womb). You need to use it with a gel that kills sperm
(spermicide).

ADVANTAGES
you only need to use a diaphragm or
cap when you want to have sex
DISADVANTAGES
it's not as effective as other types of
contraception, and it depends on you
remembering to use it and using it
correctly

you can put it in at a convenient time it does not provide reliable protection
before having sex (use extra against STIs
spermicide if you have it in for more
than 3 hours)
there are usually no serious associated it can take time to learn how to use it
health risks or side effects
you're in control of your putting it in can interrupt sex
contraception
cystitis (bladder infection) can be a
problem for some women who use a
diaphragm or cap
latex and spermicide can cause
irritation in some women and their
sexual partners

Male condoms - Condoms can protect you against sexually transmitted infections

(STIs) and they can be used to prevent pregnancy. A male condom is placed over a
man's erect penis before sex. Condoms are also called "rubbers," "sheaths," or "skins."
Condoms are made of latex (rubber), polyurethane, or sheep intestine. While latex and
polyurethane condoms help prevent the spread of sexually transmitted
infections (STIs) such as HIV, sheep intestine condoms do not.
ADVANTAGES DISADVANTAGES
They are the most effective protection Some people are embarrassed to use
available against STIs. condoms or feel they may interrupt
foreplay or intercourse.
They do not affect future fertility for Both partners must be comfortable with
either a woman or a man. using a condom and be prepared to use
one every time they have sex.
They are used only at the time of sexual Condoms may decrease sexual sensation.
intercourse.
They are safe to use while a woman is Some people are allergic to latex
breastfeeding. (rubber). These couples should use
condoms made of polyurethane (plastic).
They are less expensive than hormonal Condoms may break or leak.
methods of birth control.
They are widely available without a
prescription.
They may help prevent a man from
having an orgasm too quickly (premature
ejaculation).

Sponge - The contraceptive sponge, or birth control sponge, is a soft, round piece of
plastic foam with a loop for removal. It’s available over the counter in many
drugstores. The sponge is filled with a spermicide known as nonoxynol-9. You insert
the sponge deep into your vagina before sexual intercourse to prevent pregnancy.The
sponge works in three ways:

1. It blocks sperm from fertilizing an egg by covering the cervix.

2. It continually releases spermicide to kill sperm that approach the cervix.
3. It can absorb and trap sperm.
ADVANTAGES
It’s available without a prescription.
You can buy it from most drugstores.
You can insert it up to a day before
having sex.
You can use it as-needed, rather than
daily or monthly.
It doesn’t affect your hormone levels.
DISADVANTAGES
It’s less effective if you’ve given
birth.
It’s unsafe to use during your period.
It doesn’t protect against sexually
transmitted infections (STIs) — only
condoms can do that.
The sponge or spermicide may irritate
your vagina, which can increase your
risk of STIs.
Insertion and removal can be messy
or difficult.

Cervical cap - The cervical cap is a reusable dome-shaped cap made from
nonallergenic silicone rubber that is inserted into the vagina.The cervical cap is
similar to the diaphragm. The only difference is it’s slightly smaller and fits more
tightly over the cervix.The cervical cap keeps sperm from entering the uterus and
fallopian tubes. If sperm cannot enter the fallopian tubes to fertilize the egg,
pregnancy can’t occur.The cervical cap must be used with spermicide for maximum
effectiveness. It stops the sperm from moving, and is a second line of defense against
pregnancy.
 ADVANTAGES
can be inserted in advance without
interrupting intimacy
can be used multiple times
low cost
no side effects from hormones
DISADVANTAGES
not the most effective form of birth
control
doesn’t protect against sexually
transmitted infections (STIs)
easy to use incorrectly
can slide, or be pushed out of place,
during intercourse
can be uncomfortable for the woman
or her sexual partner

can’t be used during menstruation

requires the use of spermicide, which

may cause irritation to either partner

Female condom - Female condoms are made from soft, thin synthetic latex or latex.
They're worn inside the vagina to prevent semen getting to the womb.Female
condoms are a barrier method of contraception worn inside the vagina. They prevent
pregnancy by stopping sperm meeting an egg.A female condom can be put into the
vagina before sex, but make sure the penis does not come into contact with the vagina
before the condom has been put in.Semen can still come out of the penis even before
a man has had an orgasm (fully ejaculated).

ADVANTAGES
Female condoms help to protect both
partners from STIs, including HIV.
When used correctly, they're a
reliable method of preventing
pregnancy.
It's a form of contraception you only
need to use when you have sex.
There are no serious side effects.
DISADVANTAGES
Some couples find that putting in a
condom interrupts sex. To get around
this, insert it in advance or try to
make doing so a part of foreplay.
Female condoms are very strong, but
they may split or tear if not used
properly.
They're not as widely available as
male condoms and can be more
expensive.
Withdrawal - Sometimes called the "pull out method" or coitus interruptus, the
withdrawal method is a technique that is sometimes used during intercourse to
decrease the chances of a pregnancy.Exhibiting great self-control and being aware of
timing are required for correct use of the pull out method. Men must be able to know
exactly when they are reaching the point where ejaculation can no longer be stopped
or delayed.
ADVANTAGES DISADVANTAGES
Pulling out is safe, simple to do, and Risk of unwanted pregnancy
convenient for both members of the
couple.
When no other form of contraceptive Risk of being exposed to or
method is available, the withdrawal transmitting STIs
method can always be used.
There are no reported medical or High likelihood of using the
hormonal side effects to using the withdrawal method incorrectly
withdrawal method as a (especially among teens and sexually
contraceptive. inexperienced men)
The method doesn't require a Requires great self-control, practice,
prescription. and experience (and is still not
guaranteed effective)
Very cost-effective as it is free. Not to be used by men who
experience premature ejaculation
Can make other forms of birth
control more effective when used in
conjunction with other contraceptive
options.

Spermicide - A spermicide is a substance that kills sperm. Spermicides are available

as jelly, foam, cream, suppositories, and film. The active ingredient of most
spermicides is a chemical called nonoxynol-9.
Most spermicides come with an applicator. The applicator is filled with spermicide
and inserted into the vagina right before intercourse.
 When using a jelly, foam, or cream, you can then have sex right away.
 A spermicide film or suppository is inserted deep into the vagina using a
finger and is placed close to the cervix. Film or suppositories must be inserted at
least 15 minutes before having sex to allow the spermicide to spread in the
vagina.
One application of spermicide is necessary for each act of sexual intercourse.
ADVANTAGES DISADVANTAGES
They do not affect future fertility for Spermicides cause an extra discharge
either the woman or the man. from the vagina. Women who use
spermicides should not douche for at
least 8 hours after intercourse so that the
spermicide continues to work to prevent
pregnancy. (Douching is not
recommended for women in general.)
They are used only at the time of sexual Some people are allergic to nonoxynol-9,
intercourse.
They are safe to use while breastfeeding
(birth control that contains estrogen
affects milk supply).
They are less expensive than hormonal
methods of birth control.
They are safe for women who have other
health problems (birth control that
contains estrogen makes some health
conditions worse).
the active ingredient in most
spermicides. They can develop itching or
sores in the vagina or on the penis, which
make it more likely that HIV can be
passed from an infected person during
sex.
The nonoxynol-9 in spermicides may
also increase the risk of getting
HIV/AIDS from an infected partner.
Some people are embarrassed to use
spermicide and a barrier method or
worry that it may interrupt foreplay or
intercourse. This can create a problem
with using it every time they have sex.

Fertility awareness based methods - The fertility awareness method (FAM) is a

natural family planning strategy that women can use to help prevent pregnancy. It
involves tracking your natural cycle of fertility and your menstrual cycle, developing
a better awareness of your body, and using a variety of non-pharmaceutical methods
to detect ovulation.In the rhythm method and in FAM, you abstain from sex (periodic
abstinence) during your most fertile days. Alternately, you can use backup
contraception on your fertile days.FAM is one of the least reliable forms of pregnancy
prevention. But it can be an appropriate choice of birth control for some diligent and
self-aware adult women.

ADVANTAGES DISADVANTAGES
costs very little You need to consistently track your
menstrual cycles for at least six
months before the method can be
considered reliable.

is safe to use You need to abstain from sex or use

backup contraception during your
fertile days.

requires no medication Both members of the couple must be

involved in the process.

produces no side effects FAM has a higher failure rate

compared to many other forms of
birth control, such as condoms,
diaphragms, and birth control pills,
patches, or injections. But if used
 correctly, it can be just as effective.

can be stopped easily and

immediately if you decide you want
to get pregnant

9. She wants to know about cost with each method because she will be on a tight
budget, with limited insurance coverage ?

Most effective contraceptive method COST

( more than 99% )
Tubal ligation Php 3,000 to hp 25,000
Vasectonomy Php 25,000 to Php 50,000 or more
Copper IUD Php192.75 per piece
Contraceptive implant  Php 3,000 per case
Mirena IUD P15,000-P20,000 (not including insertion
fee)
Highly effective contraceptive method (
97% to 99% )
Emergency contraception pill ( ECP )  ₱3,800.00
Vaginal ring  $200
Depo provera injection  P500-P1000
Progestogen - only pills, aka The Minipill Php189 per pack
Combined oral contraceptive pill, aka  Php1948
The Pill
Patch Php500 per pack
Moderately effective contraceptive
method ( less than 90% )
Diaphragm  $15 and $100
Male condoms ₱ 270.50
Sponge $170,72
Cervical cap $275
Female condom 15.14 PHP per piece
Withdrawal none
Spermicide  $5 to $20 a tube
Fertility awareness based methods none

10. She asks you which method you would pick. What do you tell her ?
- if I were to choose I will chose the female condoms because it help to protect both
partners from STIs, including HIV.

CASE STUDY PROGRESS

P. B. comes back in a week and tells you that she can get a low cost oral
contraceptive through a local store. You convey this information to the nurse
practitioner, who examines P.B. and writes a prescription for a biphasic pill
containing ethinyl estradiol and norethindrone. You are asked to discuss the use of the
pill with P.B.

11. What key factors should you address with P.B. ?

- I will tell the uses, how to use, side effects, and precautions if she would take this
prescription.

USES
- This combination hormone medication is used to prevent pregnancy. It contains 2
hormones: a progestin and an estrogen. It works mainly by preventing the release of an
egg (ovulation) during your menstrual cycle. It also makes vaginal fluid thicker to help
prevent sperm from reaching an egg (fertilization) and changes the lining of the uterus
(womb) to prevent attachment of a fertilized egg. If a fertilized egg does not attach to the
uterus, it passes out of the body.Besides preventing pregnancy, birth control pills may
make your periods more regular, decrease blood loss and painful periods, decrease your
risk of ovarian cysts, and also treat acne.Using this medication does not protect you or
your partner against sexually transmitted diseases (such as HIV, gonorrhea, chlamydia).

HOW TO USE Norethin-Eth Estrad Biphasic Tablet

- Take this medication by mouth as directed by your doctor, usually once daily. Pick a

time of day that is easy for you to remember, and take your pill at the same time each
day.

- If you are taking the chewable tablet, you may either swallow it whole or chew it
thoroughly and swallow. Carefully follow the manufacturer's directions for your brand.

- It is very important to continue taking this medication exactly as prescribed by your

doctor. With certain brands of birth control pills, the amount
of estrogen and progestin in each active tablet will vary at different times in the cycle.
Therefore, it is very important that you follow the package instructions to find the first
tablet, start with the first tablet in the pack, and take them in the correct order. Do not
skip any doses. Pregnancy is more likely if you miss pills, start a new pack late, or take
your pill at a different time of the day than usual.

- Vomiting or diarrhea can prevent your birth control pills from working well. If you

have vomiting or diarrhea, you may need to use a back-up birth control method (such
as condoms, spermicide). Follow the directions in the Patient Information Leaflet and
check with your doctor or pharmacist for more details.

- Taking this medication after your evening meal or at bedtime may help if you
have stomach upset or nausea with the medication. You may choose to take this
medication at another time of day that is easier for you to remember. No matter what
dosing schedule you use, it is very important that you take this medication at the same
time each day, 24 hours apart. Ask your doctor or pharmacist if you have any questions.

- Your pill pack contains 21 pills with active medication. It may also contain 7 reminder
pills with no medication. Take one active pill (with hormones) once daily for 21 days in
a row. If you are using a product with 28 tablets, take an inactive pill once daily for 7
days in a row after you have taken the last active pill unless otherwise directed by your
doctor. If you are using a product with 21 tablets, do not take any tablets for 7 days
unless otherwise directed by your doctor. You should have your period during the fourth
week of the cycle. After you have taken the last inactive tablet in the pack or gone 7 days
without taking an active tablet, start a new pack the next day whether or not you have
your period. If you do not get your period, consult your doctor.

SIDE EFFECTS
- Nausea, vomiting, headache, bloating, breast tenderness, swelling of the ankles/feet
(fluid retention), or weight change may occur. Vaginal bleeding between periods
(spotting) or missed/irregular periods may occur, especially during the first few months
of use. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
If you miss 2 periods in a row (or 1 period if the pill has not been used properly), contact
your doctor for a pregnancy test.

PRECAUTIONS

- Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or
if you have any other allergies. This product may contain inactive ingredients, which can
cause allergic reactions or other problems. Talk to your pharmacist for more details.

- Before using this medication, tell your doctor or pharmacist your medical history,
especially of: vaginal bleeding of unknown cause, certain cancers (such as breast
cancer, cancer of the uterus/ovaries), blood clots, stroke, heart disease (such as heart
attack), liver disease, kidney disease, family medical history
(especially breast lumps, cancer, blood clots), family or personal history of a certain
swelling disorder (angioedema), blood clotting disorders (such as protein C or protein S
deficiency), high blood pressure, diabetes, high cholesterol/triglyceride
levels, obesity, lupus, underactive thyroid (hypothyroidism), mineral imbalance (low or
high level of calcium in the blood), a certain hormone problem (hypoparathyroidism),
uterus problems (such
as fibroids, endometriosis), gallbladder disease, asthma, seizures, migraine headaches, a
certain blood disorder (porphyria), mental/mood disorders (such
as dementia, depression).

- Do not smoke or use tobacco. Estrogens combined with smoking further increases

your risk of stroke, blood clots, high blood pressure, and heart attack, especially in
women older than 35.

- Tell your doctor if you just had or will be having surgery, or if you will be confined to
a chair or bed for a long time (such as a long plane flight). These conditions increase
your risk of getting blood clots, especially if you are taking an estrogen product. You
may need to stop this medication for a time or take special precautions.

- This medication may cause blotchy, dark areas on your face and skin (melasma).
Sunlight may worsen this effect. Limit your time in the sun. Avoid tanning booths and
sunlamps. Use sunscreen and wear protective clothing when outdoors.