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Contraception
Birth Control Pills
Pros:
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Very effective against pregnancy if used correctly
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Make menstrual periods more regular and lighter
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Decrease menstrual cramps and acne
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Makes you less likely to get ovarian and uterine cancer, pelvic inflammatory disease, ovarian cysts, and anemia
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Doesn't interrupt lovemaking
Cons:
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Doesn't protect against STDs
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Cost between $15-$50 per month if not covered by insurance
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Need to remember to take every day at the same time
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Can't be used by women with certain medical problems or by women taking certain medications
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Can cause side effects such as nausea, increased appetite, headaches, irregular bleeding, high blood pressure in those predisposed, and, very rarely, blood clots, heart attacks, and strokes
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Need a prescription
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Need to use a barrier method if a pill is missed or using certain medications
Vaginal Hormonal Ring (NuvaRing)
Pros:
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Benefits similar to the oral contraceptives
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Some patients may have less side effects because of the lower blood levels of hormones
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Lessens some symptoms of menstruation, such as cramping and heavy flow
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Less likely to forget to use; once a month dosing
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Doesn’t interrupt sexual activity
Cons:
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May cause side effects, such as nausea, breast tenderness, bloating, depression, or increased vaginal discharge
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May pose the risk of rare but serious complications, such as blood clots, heart attacks, and strokes
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Offer no protection against STDs, including HIV
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May be felt during sex, but can be removed for short period of time without changing efficacy
Patch (OrthoEvra)
Pros:
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As effective as the “Pill”
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Benefits similar to the pill and vaginal ring
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Convenience of weekly application of the transdermal or “thru the skin” patch
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Discrete and easy to use weekly; don’t have to worry about “missing pills”
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Doesn’t interrupt sexual activity
Cons:
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Side effects similar to the pill and vaginal ring
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Increased exposure to estrogen by 60% compared to the birth control pill (35 mcg) which increases the risk of blood clots, heart attacks, and strokes in those susceptible
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No protection against STDs
Depo-Provera Injection
Pros:
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Each injection provides 3 months of protection against pregnancy
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Very effective against pregnancy
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Many women stop getting their menstrual period while getting injections. (This is not a medical problem and menstrual periods usually return 6-18 months after you stop taking injections)
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Helps protect against uterine cancer
Cons:
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Doesn't protect against STDs
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Need to see your health care provider every 3 months for an injection
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Costs $30-$75 every 3 months for 1 injection
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May have side effects such as weight gain, tiredness, delay in return of fertility in some, and possibly a decrease in bone density
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Menstrual irregularities, such as spotting and bleeding between periods, are common.
Intra-Uterine Device (IUD)
Pros:
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Very effective against pregnancy; patient satisfaction with IUD’s is among the highest of any reversible method.
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Long –term reversible birth control: Copper IUD (ParaGard) lasts 10 years. Low dose hormonal IUD (Mirena) lasts 5 years. They can be removed at any time.
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Provide protection against pregnancy as long as in place in your uterus- protects as soon as inserted (so don't need to remember to use contraception if you have sexual intercourse)
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Convenient- doesn't need daily attention; just need to check to make sure in place at least once a month at time of menstrual period
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Comfortable- you and your partner cannot feel the IUD; sometimes your partner may feel the string
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The levonorgestrel IUD (Mirena) lessens menstrual flow and can be used to treat heavy periods
Cons:
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Doesn't protect against STDs
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Needs to be inserted by a health care provider
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Should not be used by women who might get a sexually transmitted disease. It is best for women who have already had children and are in a steady relationship with one partner.
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Can fall out or can rarely puncture the uterus
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The copper IUD can have side effects such as menstrual cramping, longer and/or heavier menstrual periods, and spotting between menstrual periods
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Slightly higher risk for infection in the few weeks after insertion
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Expensive for some people because the cost of the device and insertion is often “up-front” rather than paid monthly like oral contraceptive pills, but is comparable or less costly over time used
Cervical Cap
Pros:
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Can insert several hours before sexual intercourse
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Can leave in place 24-48 hours, will give protected sex for up to 48 hours
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Use less spermicide with the cap than with the diaphragm- no need to apply more spermicide with each act of intercourse
Cons:
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Doesn’t protect against sexually transmitted diseases
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Cost $25-$50, plus the cost of spermicidal gel
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Need to be fitted by a health care provider and need a prescription
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Limited sizes available
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Can’t take out until 6-8 hours after intercourse
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Can be difficult to insert and may get moved out of place
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Some women may be allergic to material of cap or to spermicide
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Need to get a new one every so often if becomes cracked, tears, or following a delivery
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Can’t be used by women with a history of abnormal Pap tests
Diaphragm
Pros:
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Can be put in place right before intercourse or 2-3 hours before intercourse
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Don't need to take out between acts of sexual intercourse (protects against pregnancy for about 6 hours, but need to reapply spermicide
Cons:
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Doesn't protect against sexually transmitted diseases
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Need to get fitted by a health care provider and need a prescription
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Can't take out until 6 hours after intercourse
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Cost $25-$45, plus the cost of spermicidal gel
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May get moved out of place during sexual intercourse
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Some women may be allergic to the diaphragm or to the spermicide
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Need to get a new one every so often (replace every 2 years or if torn or cracked, often need to be refitted with 10 pound weight gain or loss and after pregnancy)
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Can be messy
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Need to reapply spermicide with each act of sexual intercourse
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Can cause an increase in urinary tract infections
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Rarely associated with Toxic shock syndrome
Sponge
Pros:
Cons:
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Doesn't protect against sexually transmitted diseases and may increase the risk of HIV infection with multiple daily acts of sexual intercourse
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Can't take out until 6 hours after sexual intercourse
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Cannot be used by women that are allergic to nonoxynol-9 (in the spermicides)
Male Condom
Pros:
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Lowers risk of STDs
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Effective against pregnancy
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Contraception that provides the most protection against sexually transmitted diseases (latex condoms are best)
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Don't cost much (50 cent s each), can buy at almost any drug store (don't need a prescription)
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"Last longer" when using a condom
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Allow men to have an active part in preventing pregnancy
Cons:
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Have to use a new one every time you have sexual intercourse (can only be used once)
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May disrupt/interrupt lovemaking
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Can break during use
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Women may be allergic to latex
Female Condom
Pros:
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Provide protection against STDs (new product, so not clear how much protection given) and pregnancy
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Can be inserted well before intercourse
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Male does not need to withdraw right after ejaculation, as he does with a male condom
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Cheap- each costs about $2.50
Cons:
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May move, be noisy, or uncomfortable
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Can only use for one act of sexual intercourse
Spermicide
Pros:
Cons:
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Doesn't protect against sexually transmitted diseases (STDs) and may increase the risk of HIV infection in women who have sex multiple times daily because of irritation from the spermicide
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Effectiveness usually lasts only one hour (need to reapply each time have sexual intercourse)
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Some women and men may be allergic to spermicides
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May interrupt lovemaking (some forms need to be inserted at 10-20 minutes before intercourse)
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Has a lower effectiveness against pregnancy than many other types of contraception- should use with another form of contraception to increase effectiveness
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May change bacteria living in vagina and increase urinary tract infections
Non-reversible Contraception
Tubal Ligation
Pros:
Cons:
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Need to have minor surgery (done usually laparoscopically or hysteroscopically); please see “Procedures” section of website
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Permanent (although it is possible to undo sterilization with major surgery, it is not always successful)
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Only should be used by women who are absolutely sure that they do not want any or any more children
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Expensive- ranges from $1000-$2500- but cost for contraception spread over rest of life
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No protection against STDs
Vasectomy
Pros:
Cons:
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Although permanent, it can be reversible, but is less so over time
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Only should be used in those who do not desire any more children
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No protection against STDs
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