Contraception Choices

Adolescent Clinic NNMC

 Objective
 Discussthe different options
 Important counseling points
 Review by playing a game
 Method Typical Use Perfect Use
Implant 0.09 0.09

Options
Injection-combo 0.1 0.1
Injection- 0.3 0.3
progestin
 Abstinence IUD 0.1-2.0 0.1-1.5
OCP-combo 2.5-6.0 0.1
 Timing schemes OCP-progestin 3.0-10.0 0.5
 Barrier methods Patch - 0.1
Vaginal ring - 0.65
 Hormonal preparations Male condom 12.0 3.0
Diaphragm/Cerv 16.0-18.0 6.0
cap
Withdrawal 19.0 4.0
Periodic - 2.0-9.0
abstinence
Female condom 21.0-26.0 5.0
Spermicides 40.0 6.0
No method 85.0 85.0
 Abstinence/Timing
 While some groups encourage “The rhythm
method” as a form of birth control we do not
recommend it
 Temperature, cervical mucus and record
keeping are needed to do it right.
 Barrier
 2nd most popular
 STD protection
 Inexpensive
 Failure rate: 3-18%
 Proper wear important
 Hormonal
 Combination OCPs
– Monophasic
– Biphasic
– Triphasic
– Failure rate 0.1% (2-6%)
 Progestin only
– Failure rate 0.5% (3-10%)
 Depo-Provera, DMPA
 Depo medroxyprogesterone acetate
– Prevents egg release
– Failure rate: 0.3%
– Shot every 3 months
 The Patch
 Ortho Evra

 Combination preparation
 20% bleeding in first cycle
 Change patch once per week
 May not be as effective if >90kg
 Vaginal Ring
 NuvaRing

 Combination preparation
 Worn for 3 weeks at a time
 Low breakthrough bleeding rate
 Vaginal Ring
 NuvaRing
– Low failure rate
– Can wear during menses
– Can wear during intercourse
– Can remove for intercourse
– Does not have to be fitted
– Vaginal position does not matter
– No increased risk of infection
 Choosing a Method
What myths have you heard?

What side effects have you

heard about?
 Common Myths
 2/3 women believe OCPs unsafe
 Causes cancer
 Causes heart disease
 Leads to infertility
 Body needs break from OCPs

 ALL FALSE
 Advantages
 Less dysmenorrhea
 Shorter, lighter menses
 Less Mittelschmerz
 Acne & hirsutism improved
 Prevents ovarian & endometrial cancer
 Reduction in PID
 Possible side effects
ESTROGEN PROGESTERONE
 Nausea/vomiting  Androgenic

 Edema/leg cramps – Oily skin

– Hirsutism
 Bloating – Acne
 Vascular headaches – Increased appetite
 Clear vaginal d/c  Mastalgia
 Cystic breast changes Inreased breast size
 Bloating
 Chloasma
 Depression
 Do not use if:
 You have had a  You have high blood
blood clot pressure

 You have had cancer  You are on seizure

medicine
 You have liver
disease  You have bad
migraines
 If you miss a pill
 Missed pills
 2 per day until caught up
 Condoms if miss >2 pills per

month
 Headaches
 Contactus if you get frequent
headaches or headaches
during the reminder pills
Some things that can Interact
 Seizure medicine
 St. John’s Wort
 Rifampin, griseofulvin
 Vitamin C
– Irregular bleeding
Time to Play……
 $100 1,000,000
1,000,000
500,000
500,000
Which is not sexual 250,000
250,000

activity 100,000
100,000
50,000
50,000
25,000
25,000
A. Oral Sex C. Adultery 10,000
10,000
B. Intercourse D. Coveting 5,000
5,000
1,000
1,000
500
500
100
 $100 1,000,000
1,000,000
500,000
500,000
Which is not sexual 250,000
250,000

activity 100,000
100,000
50,000
50,000
25,000
25,000
A. Oral Sex C. Adultery 10,000
10,000
B. Intercourse D. Coveting 5,000
5,000
1,000
1,000
500
500
100
 $500 1,000,000
1,000,000
500,000
500,000
What is the best way 250,000
250,000

to prevent pregnancy 100,000

100,000
50,000
50,000
25,000
25,000
A. Monogamy C. Withdrawal 10,000
10,000
B. Abstinence D. Rhythm Method 5,000
5,000
1,000
1,000
500
500
100
 $500 1,000,000
1,000,000
500,000
500,000
What is the best way 250,000
250,000

to prevent pregnancy 100,000

100,000
50,000
50,000
25,000
25,000
A. Monogamy C. Withdrawal 10,000
10,000
B. Abstinence D. Rhythm Method 5,000
5,000
1,000
1,000
500
500
100
 $1,000 1,000,000
1,000,000
500,000
500,000
Most OCP side effects 250,000
250,000

resolve by 100,000
100,000
50,000
50,000
25,000
25,000
A. 1 month C. 1 year 10,000
10,000
5,000
5,000
1,000
B. 3 months D. Never 1,000
500
500
100
 $1,000 1,000,000
1,000,000
500,000
500,000
Most OCP side effect 250,000
250,000

resolve by 100,000
100,000
50,000
50,000
25,000
25,000
A. 1 month C. 1 year 10,000
10,000
5,000
5,000
1,000
B. 3 months D. Never 1,000
500
500
100
 $5000 1,000,000
1,000,000
500,000
500,000
Depo causes this side 250,000
250,000

effect, and thus a 2 year 100,000

100,000

use recommendation 50,000

50,000
25,000
25,000
A. Weight gain C. Thin bones 10,000
10,000
B. No period D. Acne 5,000
5,000
1,000
1,000
500
500
100
 $5000 1,000,000
1,000,000
500,000
500,000
Depo causes this side 250,000
250,000

effect, and thus a 2 year 100,000

100,000

use recommendation 50,000

50,000
25,000
25,000
A. Weight gain C. Thin bones 10,000
10,000
B. No period D. Acne 5,000
5,000
1,000
1,000
500
500
100
 $10,000 1,000,000
1,000,000
500,000
500,000
The easiest method of 250,000
250,000

birth control to keep 100,000

100,000

private 50,000
50,000
25,000
25,000
A. The Pill C. The Shot 10,000
10,000
B. The Patch D. The Ring 5,000
5,000
1,000
1,000
500
500
100
 $10,000 1,000,000
1,000,000
500,000
500,000
The easiest method of 250,000
250,000

birth control to keep 100,000

100,000

private 50,000
50,000
25,000
25,000
A. The Pill C. The Shot 10,000
10,000
B. The Patch D. The Ring 5,000
5,000
1,000
1,000
500
500
100
 $25,000 1,000,000
1,000,000
500,000
500,000
How often does a 250,000
250,000

patient need Depo 100,000

100,000

Provera 50,000
50,000
25,000
25,000
A. Monthly C. 3 months 10,000
10,000
B. 6 months D. Annually 5,000
5,000
1,000
1,000
500
500
100
 $25,000 1,000,000
1,000,000
500,000
500,000
How often does a 250,000
250,000

patient need Depo 100,000

100,000

Provera 50,000
50,000
25,000
25,000
A. Monthly C. 3 months 10,000
10,000
B. 6 months D. Annually 5,000
5,000
1,000
1,000
500
500
100
 $50,000 1,000,000
1,000,000
500,000
500,000
What side effect of the 250,000
250,000
Patch is in the news 100,000
100,000
50,000
50,000
25,000
25,000
A. Rashes C. Pregnancies
10,000
10,000
B. Falling off D. Clots
5,000
5,000
1,000
1,000
500
500
100
 $50,000 1,000,000
1,000,000
500,000
500,000
What side effect of the 250,000
250,000
Patch is in the news 100,000
100,000
50,000
50,000
25,000
25,000
A. Rashes C. Pregnancies
10,000
10,000
B. Falling off D. Clots
5,000
5,000
1,000
1,000
500
500
100
 $100,000 1,000,000
1,000,000
500,000
500,000
What percent of teens 250,000
250,000

15-19 get pregnant 100,000

100,000

each year 50,000

50,000
25,000
25,000
A. 1% C. 5% 10,000
10,000
B. 10% D. 25% 5,000
5,000
1,000
1,000
500
500
100
 $100,000 1,000,000
1,000,000
500,000
500,000
What percent of teens 250,000
250,000

15-19 get pregnant 100,000

100,000

each year 50,000

50,000
25,000
25,000
A. 1% C. 5% 10,000
10,000
B. 10% D. 25% 5,000
5,000
1,000
1,000
500
500
100
 $250,000 1,000,000
1,000,000
500,000
500,000
250,000
250,000

Which item does not 100,000

100,000
50,000
decrease STIs? 50,000
25,000
25,000

A. Condom C. Dental dam 10,000

10,000
Female condom 5,000
B. Diaphragm D. 5,000
1,000
1,000
500
500
100
 $250,000 1,000,000
1,000,000
500,000
500,000
250,000
250,000

Which item does not 100,000

100,000
50,000
decrease STIs? 50,000
25,000
25,000

A. Condom C. Dental dam 10,000

10,000
Female condom 5,000
B. Diaphragm D. 5,000
1,000
1,000
500
500
100
 $500,000 1,000,000
1,000,000
500,000
500,000
What percent of teens not 250,000
250,000
using birth control become 100,000
100,000
pregnant in a year 50,000
50,000
25,000
25,000
A. 15% C. 50% 10,000
10,000
B. 85% D. 99%
5,000
5,000
1,000
1,000
500
500
100
 $500,000 1,000,000
1,000,000
500,000
500,000
What percent of teens not 250,000
250,000
using birth control become 100,000
100,000
pregnant in a year 50,000
50,000
25,000
25,000
A. 15% C. 50% 10,000
10,000
B. 85% D. 99%
5,000
5,000
1,000
1,000
500
500
100
 $1,000,000 1,000,000
1,000,000
500,000
500,000
What percentage of 250,000
250,000

10th grade girls have 100,000

100,000

had sex 50,000

50,000
25,000
25,000
A. 20 C. 35 10,000
10,000
B. 50 D. 67 5,000
5,000
1,000
1,000
500
500
100
 $1,000,000 1,000,000
1,000,000
500,000
500,000
What percentage of 250,000
250,000

10th grade girls have 100,000

100,000

had sex 50,000

50,000
25,000
25,000
A. 20 C. 35 10,000
10,000
B. 50 D. 67 5,000
5,000
1,000
1,000
500
500
100
 Conclusion
 We are here to help you in any way
we can
 Please feel free to contact us with
any questions or concerns you have
Questions?