Plan B

Hey everyone - now that we have covered the common forms of birth control I want to discuss our last and most important topic. What to do if we screw up! Are we doomed if we make a human mistake and forget to use our method or use it incorrectly? Thank goodness the answer NO. Our back-up plan to a bad situation is called Emergency Contraception or better known as Plan B. Plan B is used when one has unprotected sex and fears that they could get pregnant. Plan B comes in a pill form and can prevent pregnancy if taken within 72 hours after the unprotected sex. Let’s explore more about this pill.

Kim Walters-Cross, LPN at Family Planning Health Services, says “Plan B used to be 2 pills but now can be purchased as one pill & is taken by mouth within 72 hours or even up to 120 hours after having unprotected sex.” When a situation happens; like a condom breaks, you forget to take your birth control pills for more than two days, your Nuva Ring falls out, or your Depo shot is overdue, Plan B works as a backup plan. Walters-Cross explains “once digested it prevents a pregnancy by altering the tubal transport of sperm and/or ova, by forming a mucous lining on the cervix, thus preventing fertilization.” Meaning: it prevents the sperm from finding the egg and making a baby.

There are side effects to Plan B. Walters-Cross says “the most common side effects are nausea (23.1%), vomiting (5.6%), and breast tenderness (10.8%). You may also experience some bleeding after taking it but don’t worry, everything is ok.”



The big controversy around Plan B is some people feel it is a form of abortion. However as Walter-Cross explained “it prevents a pregnancy from happening, just like the birth control pill prevents a pregnancy.” She continued to explain that Plan B is not effective once the process of implantation has begun. If a woman is already pregnant, no matter how many pills she takes, she will remain pregnant. “Plan B will not affect an established pregnancy or harm the developing fetus” Walter-Cross added, “Therefore, it is not fair to compare Plan B to the abortion pill RU486 because they work completely in two different ways.”

With any form of birth control the important thing to remember is that nothing is 100% effective except abstinence. But, if and when we do make a mistake it is good to know that there is help available – Plan B. Walter-Cross concluded that “keep in mind that the effectiveness of the pill can go down every time Plan B is used. So use wisely and remember that this is a way to prevent pregnancy, not a regular birth control method.”

Ortho Evra Patch

We are finally getting down to the last method of birth control that I will be discussing. We have covered everything from the pills to the IUD, and now it is time to talk about the Ortho Evra Patch, “the once-a-week birth control.” I will once again cover how the patch works, the complications, and the cons. Lastly I will be informing you of the pros.

So let’s take a look at how the patch works. Tracy Krueger, RN says, “It is used weekly on a 28 day cycle. Each box contains 3 patches. One patch is worn for 7 days then removed and replaced with a new patch on the same day of the week that is to be worn for the next 7 days. After 3 weeks of wearing a patch, no patch is worn the 4th week and this is when a woman gets her menstrual period. After the patch “free” week or end of the 28 day cycle, a woman begins a new 4 week cycle on the same day the patch was removed.” Therefore you need to keep track of the weeks that the patch is on or off. Patches can be worn in four different places: the buttocks, upper torso (front and back, excluding breasts), abdomen, and the upper outer arm.

Next we need to look at the complications… if there are any. Krueger says there are major side effects. “Some side effects include Benign liver tumors, blood clots, Gall bladder disease, heart attack, and stroke. Young healthy woman have a very small chance of developing these”. There are minor side effects, which are bleeding between periods, headaches, nausea, breast tenderness and an application site reaction like a rash or irritation that I mentioned earlier. Krueger informed us that, “All side effects except for the site reaction are the same for oral contraceptives as well.” Meaning that these complications can come with any birth control method.



There are downfalls to the patch Ortho Evra Patch. It may cause a skin irritation or rash at the application site. Also, if the patch is not applied correctly (on dry, clean skin) there may be problems with the patch coming loose or falling off.
As stated earlier there are cons to using the Ortho Evra Patch. Even though you have to keep track of the weeks that the patch is on or off, it is better than having to take a birth control pill daily. Krueger added, “Unlike the use of pills there is a less chance for human error while on the patch. A discreet patch can be worn under clothing making it hard for people to notice it.”

If you are interested in using the Ortho Evra Patch I would suggest asking your doctor if it is right for you.

IUD's

The fifth birth control method that we will look today is the IUD (Intrauterine Device) or IUC (Intrauterine Contraception). It is quit different from other methods that we have talked about because the IUD is placed inside the uterus. Before we get started I want to make clear that there are two different types of devices. According to Choosing a Birth Control Method, published in 2009, the two methods available are

1.The Copper T 380A (brand name ParaGard®) which contains no hormones and is effective for 10 years.

2.The Levonorgestrel intrauterine system (brand name Mirena®) which contain progestin and is effective for 5 years.

Jan Ray, a RN Board Certified Women's Health Nurse Practitioner and Advanced Practice Nurse Prescriber talks about how the IUD works once it is inserted. “Once the IUD is inserted it makes the cervical mucus very thick which does not allow the sperm to penetrate, changes the uterine lining, and changes tubal motility, and inhibits ovulation.”

So you are probably wondering how does it get inserted and is it uncomfortable. As with the Implanon, the medical provider must be trained. Ray says, “Speculum is put in the vagina, the cervix is cleansed with a antimicrobial soap, tenaculum (hooklike pointed instrument with a slender shank for grasping) is put on the cervix to keep it from moving, uterus is sounded (sized) to determine how big it is, the inserter is then passed and the IUD is put in place in the uterine cavity, inserter is removed, speculum is removed and we are done”. This seems like a complicated process but however with the proper training it is not.



As with all birth control methods there are the positive and the negatives. Rays says that a potential complication of placing the IUD is perforation of the uterus. Another problems but not a complications may be that the uterine cavity is too small or the cervical os (opening) is too small to allow the inserter to be passed. She also said that there are usually no problems with taking it out, unless the strings that hang from the IUD are not visible.

So enough negative, let’s look at the positive. Ray says, “IUD is a long acting reversible method. Don’t have to do anything after it is inserted except to check the strings once a month. How easy it that. Also, it is also very effective!”
When choosing a method or making any medical decision education is important. Ray says, “Paragard may cause heavier periods and more cramps. Mirena periods usually disappear which for some women this is grand for others they may be uncomfortable without a period so good counseling is extremely important.” Furthermore, some providers may not put IUD’s in women who have not been pregnant even though current recommendations are that it can be inserted in women who have not been pregnant.

So when deciding on a birth control method, be sure you have done your research. Know all about it and make sure your doctor answers all the questions you have.

Depo Shot

So we have looked the pill, the Nuva Ring and the Implanon that are all forms of birth control, yet in many ways they are very different from each other. So now I’m going to take a look into another method. If any of the methods we talked about didn’t feel right for you, this one may. Lets take a look at the Depo shot. First we will review the assumptions of weight gain, then go over the dangers and the precautions and lastly the pros of the injection.

According to On Women by Deborah Kotz, when women use the Depo shot they gain an average of 11 pounds over three years. This is three percent increase in body fat. Cynthia Olson a Reproductive Health Clinician says that weight gain has been seen among Depo users but it is not consistent for all women. “Research has been done in regards to Depo and weight gain. Some studies show no weight gain among users and other studies have shown that if an individual gains weight the first three months of Depo use, they will continue to gain weight throughout their use.” Olson explains why weight gain is common and what can keep the weight off. “Weight gain is caused by the hormone progestin and its reaction to the body therefore a woman who gains weight using Depo cant “diet” to keep it off. Eating healthy and exercise is helpful but most women will not lose the weight until they stop using depo.”


Now that we tackled the weight gain, lets look at the dangers and precautions of the Depo shot. Luckily there aren’t very many. Olson says there aren’t few precautions compared to the other methods because the shot doesn’t use both progestin and estrogen. “Caution is used but does not restrict usage if a woman suffers from depression because it can escalate her problems.” If you are considering getting the Depo shot you need to be aware of your allergies. Olson says, “Although it is rare, some allergic reactions have occurred. If there are concerns the client must wait 20 minutes after the injection before they can leave the clinic”.

Finally, lets discuss the advantages of using Depo. A pro according to Olson is the Depo is ranked in the top tier of contraceptive effectiveness. “Therefore nursing mothers are able to this form without concerns to breast milk, no estrogen therefore it can be used by smokers over the age of 35 or woman who have high blood pressure and no pills to remember to take daily.”

NuvaRing

H1N1 has invaded schools, and is highly contagious. Unfortunately H1N1 can be damaging to pregnant women. Cynthia Olson, RN/Reproductive Health Clinician says, “If you become pregnant at this time, you will have a lot of decisions to make regarding all vaccinations. H1N1 has been shown to affect pregnant women differently because of the complications that can arise.” As we all know, birth control can prevent pregnancy and so this week I wanted to talk about a different method of birth control, the NuvaRing.

The NuvaRing, aka “the once a month birth control”, is insert into the vagina and protects against pregnancy for 21 days. Olson says, “NuvaRing is composed of etonogestrel, a progestin, and ethinyl estradiol, an estrogen, which is released when the NuvaRing contacts the vagina. The vaginal walls then absorbs the hormones and distributes them directly into the bloodstream.”
Olson explained that most of her clients prefer the ring because once it is inserted there is nothing else to do. It lasts for three weeks. Also the clients don’t have to worry about taking a pill every day or panic if they miss a pill. Just like the pill, women who are one the NuvaRing can have control over their monthly cycles or choice to continuous cycle. Olson clarified that continuous cycling can be obtained by placing the ring in for 28 days, remove it and place a new ring in the same day and then continue with this cycle for three times.





As with any birth control method there are misconceptions. The most heard rumor is that it can easily fall out. Olson says, “The NuvaRing can slip out but that does not happen often. The muscles in the vagina do keep the NuvaRing in place and if the ring does slip out, just wash it off with room temperature water and reinsert it. The ring can be out up to 3 hours before protection is decreased.” Another common misconception of the ring is that your partner can feel it or that it is uncomfortable for the women. However, research shows that most partners can’t feel it and women don’t feel the NuvaRing either because the nerve endings in the upper vaginal wall are not very sensitive compared to the nerve endings of the outer vagina.

So the NuvaRing is still another way, a once a month way, to prevent pregnancy.

Implanon

Last week I discussed birth control pills and now that you understand the pills, lets take a look at another type of birth control method…the Implanon! The Implanon is unlike the birth control pill because of its structure, however; it works in the same way. Today we will learn what it is, look at the main differences, the complications of removing it (if any), the pros and the cons.

The Implanon is a tiny bar that is inserted into your arm and lasts for three years. Jan Ray, a RN Board Certified Women's Health Nurse Practitioner and Advanced Practice Nurse Prescriber says “The Implanon works because it has a hormone in it that stops the ovaries from making an egg each month, changes the cervical mucus making it hostile to sperm, and it also changes how the uterine lining develops each month.”

So this bar works in a similar way that the pill does, but the advantage is that you don’t have to take a pill every day. Ray stated “ The Implanon is inserted in the inner aspect of the upper arm after a small amount of local anesthetic is used to numb the area.”

So after three years of this rod being in an arm, I was concerned that there may be complications to taking out the Implanon. Ray was soon to put my worries at rest. She says there is no complications to taking the Implanon out and once out women return to their menstrual cycle and can get pregnant immediately.

Girls I know how it can be stressful trying remember to take a pill every day. That is why the reason females use the Implanon compared to other methods is because there is no work involved once it is in. Ray knows first hand because girls come to her clinic and complain about forgotten pills. She explains that it is very effective in preventing a pregnancy because there is nothing to do after it is inserted. Another advantage is the Implanon decreases the amount of bleeding, menses, the women has. For some women their period disappears all together and for those who bleeding is heavy this prevents anemia.





Along with the pros, there must be cons. Rays says, “There may be some irregular bleeding for the first 3 to 6 months. It is usually light in nature but may be longer that the woman wants to put up with it.” When choosing this type of method for birth control, women must understand that they probably will not have monthly periods with Implanon. For some women this concept will be hard for them and therefore, they should not choose this method and for some this concept will be greatly welcomed.

So if you want less to deal with when it comes down to birth control and want to be protected for a long period of time the Implanon may be right for you.

Birth Control Pills

Ok, so everyone knows about the pill. It’s simple right? Just take a tiny pill every day and you won't get pregnant. Well there is more to it than that. You have to question yourself: are you at high risk; are you forgetful and what are the positives? Here are some important things you need to know that could make or break you decision to take the pill.

Alright let’s look at how the pill is packaged. The pill comes prepackaged, 28 pills in a veridated compact. To pop a pill out of the container you simply but your thumb on top of the pill and push down through the opening at the bottom of the container. After swallowing the pill, how does that pill work? I asked Bonnie Obois, a RN/RHC at Family Planning Health Services-Adams WI. She says "The pill works in a couple of ways. Mainly by preventing an ovary from releasing an egg. With no egg present for sperm to fertilize, a woman can't get pregnant".

Secondly, when talking about high risk, I'm talking about ways the pill can affect you negatively. Examples of high risk woman are: smokers who are over the age of 35, or people who have factor 5 blood disorder. This means is you should be taking a different kind of pill. You should be taking the pill without estrogen. The pill that contains estrogen can lead to development of blood clots and that could then lead to a stroke or heart attack. Just remember always ask your doctor!!!

Another negative about the pill is that you might forget to take one. It’s so important to take one every day at the same time. If you do forget to take the pill Bonnie says, "as soon as you remember to take your pill take it. If it's already the next day, you can take two pills at the same time".

Enough about the bad, let’s talk about the pros of taking the pill. The pill is tiny and but its very effective. Also you don't have to insert a ring, get a shot, or have a bar in your arm as you do with the other types of birth control! Obois sees patients every day and says why patients like to take birth control over the other methods. "Taking a birth control pill every day puts you in direct charge of your reproductive health care. If for some reason, whether it be a side effect, or a decision to get pregnant you can easily stop taking the pill. Also, pills are less expensive than the ring, gives better cycle control than with the DMPA(shot), usually there is no weight gain associated with it and it may just be preferable to some people".



So if you trying to decide if the pill is your choice for contraception just ask yourself: Am I at high risk? Do I want to take a pill every day? Is the pill right for me? There are many different options for birth control and I will be talking about those later on.