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Birth control

Birth control pill

What is the birth control pill?

The birth control pill (BCP) is the most common type of birth control. It is a pill taken by mouth every single day to prevent pregnancy. The BCP contains two types of female hormones - estrogen and progestin. The BCP is up to 99.9 per cent effective if used the right way.

How does the birth control pill work?

The BCP prevents the ovaries from releasing an egg each month (ovulation). If there is no egg to meet the sperm, pregnancy will not occur. The BCP also changes the lining of the uterus making it difficult for and egg to attach itself. Finally, the BCP changes the mucus in the cervix making it harder for sperm to enter the uterus.

Who can use the birth control pill?

The BCP is for all women seeking a reliable and reversible method of birth control.

How do I use the birth control pill?

Begin taking the BCP on the first day of your period or on the Sunday following the first day of your period. You must take your BCP around the same time each day to avoid unintended pregnancy. Try to take your BCP with a scheduled daily activity such as a shower or breakfast.

28-day packs: take one pill every day for 28 days (21 days of active pills and seven days of “sugar” pills). Your period should begin during the last seven days of that pill pack (“sugar” pills). Start a new pill pack after completing the previous pack.

21-day packs: take one pill every day for 21 days, then stop taking the pill for seven days. Your period should begin during the last seven days (pill-free week). Start a new pill package after your seven-day break, even if you still have your period.

Backup?

For the first seven days you begin the BCP, use a backup method of birth control such as condoms or do not have sex during this time.

If you miss a pill, follow these directions:

  • If you miss a pill, take it as soon as you remember. This may mean taking two pills in one day.
  • If you miss two pills in a row during the first two weeks of the pack, take two pills on the day you remember and two the next day. Use a backup method of birth control if you have sex in the next seven days. If you had unprotected sex after missing a pill, use emergency contraception.
  • If you miss two pills in a row in the third week of the pack, throw out the rest of the pack and start a new pack on the day you remember. You may not have a period this month. If you had unprotected sex after missing a pill, use emergency contraception.
  • If you miss three pills in a row, throw out the rest of the pack and start a new pack on the day you remember. You may not have a period this month. Use a backup method of birth control if you have sex in the first seven days of the new pack. If you had unprotected sex after missing a pill, use emergency contraception.

What are the advantages, possible side effects or complications of the BCP?

Advantages

  • Decreased cramping and menstrual bleeding
  • Improved cycle control
  • Reduced risk of ovarian and endometrial cancer
  • Can reduce acne

Possible side effects

Minor possibility of: (will likely resolve within the first three months)

  • Irregular bleeding (breakthrough bleeding)
  • Nausea
  • Headaches
  • Sore breasts
  • Mood changes
  • Water retention

Possible complications

Women who have any of these symptoms while on the BCP should go to the hospital:

  • Abdominal pain (severe pain or lump in the abdomen)
  • Chest pain or shortness of breath
  • Headache (severe) with dizziness, weakness or numbness
  • Eye problems (vision loss or blurred vision) or speech problems
  • Severe leg pain or numbness (calf or thigh)

Remember

  • The pill does not protect you against sexually transmitted infections (STIs) or HIV; use condoms to lower your risk.
  • If you have any vomiting or diarrhea, continue to take the BCP, but use a backup method of birth control (condoms) for the rest of the cycle.
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have questions or need help.
  • For more information on the birth control pill, please consult www.sexualityandu.ca

Lactational amenorrhea method

What is Lactational Amenorrhea Method?

Lactational Amenorrhea Method is a method of contraception. Lactational means breastfeeding and amenorrhea means having no monthly period.

How does it work?

Lactational Amenorrhea Method takes advantage of the normal processes that occur in a woman's body after childbirth and when she breastfeeds her baby. The baby's suckling prevents the release of certain hormones needed for ovulation. The breastfeeding woman, then, does not ovulate and cannot become pregnant.

Who can use it?

Breastfeeding can be used as a method of contraception only if the mother meets all the following requirements:

  • her baby is under six months old;
  • her monthly periods have not returned;
  • her baby is fully or nearly fully breastfed,* and;
  • her baby is breastfeeding at least every four hours during the day and at least every six hours at night.
  • fully breastfed means the baby gets all food from the breast. * Nearly fully breastfed means, in addition to breastfeeding, vitamins, minerals, juice, water or other foods are given to the baby infrequently (no more than one or two mouthfuls a day.)

Note: To be fully breastfed or nearly fully breastfed, the baby should go no more than 4 hours between breastfeedings during the day. At night, the baby should go no more than six hours between breastfeedings.

If you answer "NO"

If you answer "NO" to any of the above statements, begin using another method of contraception. Birth control pills can decrease your milk supply. It is recommended that you wait until your baby is six weeks old before starting them. You can discuss other birth control options with your doctor or public health nurse. Keep breastfeeding as long as you can for Health and your baby's health. Adapted and reprinted with the permission of the Toronto Public Health.

Remember

Because a woman can only rely on this method for up to six months, it is important to plan ahead and to have an alternate method available for use when Lactional Amenorrhea Method is no longer reliable (i.e. when her periods return, when the baby begins taking solid foods and /or supplements, or when the baby reaches six months of age.).

Depo-Provera

What is the injectable contraceptive?

The injectable contraceptive, also known as Depo-Provera®, is given once every 12 weeks (four times a year) as an injection (shot) to prevent pregnancy. Depo-Provera® contains only one female hormone, a progestin. Depo-Provera® is a highly effective form of birth control, 97 to 99.7 per cent effective if used the right way.

How does Depo-Provera work?

Depo-Provera® prevents the ovaries from releasing an egg each month (ovulation). Depo-Provera® also changes the lining of the uterus making it difficult for an egg to attach itself. Finally, Depo-Provera® changes the mucus in the cervix making it harder for sperm to enter the uterus.

Who can use Depo-Provera®?

All women seeking a reliable and reversible method of birth control that requires little attention can use Depo-Provera®. Also, it may be a good option for women who are unable to take estrogen.

How do I use Depo-Provera®?

Depo-Provera® must be injected into the upper arm (deltoid muscle) or the hip (gluteus muscle) by a health care provider (HCP):

  • During the first five days of your period
  • During the first five days of stopping the birth control pill, the Evrapatch® or the NuvaRing®
  • During the first five days after an abortion
  • During the first five days after having a baby if not breastfeeding. If breastfeeding, wait four to six weeks until breast milk is established
  • Any time during the menstrual cycle if pregnancy or the possibility of pregnancy can be ruled out

Backup?

If given within the first five days of your period, Depo-Provera® is effective within the first 24 hours. If given after the first five days of the menstrual cycle, a backup method of birth control should be used for the next 2 weeks.

Late injection

If it has been 13 or more weeks since your last injection (shot), use a backup method of birth control such as condoms until the next Depo-Provera® injection can be given and for two weeks after the injection was given.

What are the advantages, possible side effects or complications of Depo-Provera®?

Advantages

  • Convenient (one every three months)
  • Some women stop having their periods
  • Decreased cramping and menstrual bleeding
  • Reduced risk of endometrial cancer
  • Reduction of symptoms linked with endometriosis, premenstrual syndrome, and chronic pelvic pain
  • Decreased incidence of seizures
  • Possible reduced risk of pelvic inflammatory disease

Possible side effects

  • Reduction in bone mineral density (bone mass)
  • Menstrual cycle changes (irregular bleeding)
  • Hormonal side effects
  • Headache
  • Acne
  • Decreased libido
  • Nausea
  • Breast tenderness
  • Weight gain due to appetite stimulation
  • Mood effects

Remember

Depo-Provera® and Bone Mineral Density

A side effect of Depo-Provera® is a decrease in bone mineral density (BMD). Most of this BMD loss occurs within the first two years of use, and it has been noted that BMD returns almost to previous levels about two years after usage stops. It is not known if BMD loss due to Depo-Provera® use is connected to osteoporosis or bone fracture post-menopause. While on Depo-Provera®, bone health should be considered (daily physical activity, coupled with sufficient calcium and Vitamin D intake).

  • Depo-Provera® does not protect you against sexually transmitted infections (STIs) or HIV; use condoms to lower your risk
  • If you experience any side effects after the injection was given, it cannot be reversed until the hormones wear off
  • Depo-Provera® does not affect your fertility, but there may be a delay in the return of ovulation
  • Depo-Provera® may result in a decrease of bone mineral density (weak bones), therefore eat calcium rich foods, exercise regularly, and limit your nicotine and alcohol intake
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have questions or need help
  • For more information on Depo-Provera®, please consult this Web site: www.sexualityandu.ca

Female condom

What is the female condom?

The female condom, Reality Female Condom®, is a soft, thin, loose-fitting polyurethane sheath with two flexible rings at each end that is inserted in the vagina. The inner ring at the closed end of the condom is used to insert the condom and to keep it in place. The outer ring at the open-end of the condom stays outside the vagina and partially covers and protects the lips of the vagina. The female condom is 79 to 95 per cent effective if used the right way.

How does the female condom work?

The female condom prevents semen (sperm) from entering the vagina and it prevents the exchange or bodily fluids between both partners. The female condom protects against unintended pregnancy and sexually transmitted infections and HIV.

Who can use the female condom?

Women can use the female condom for vaginal sex and anal sex. It can also be used by men for anal sex.

How do I use the female condom?

  • Find a comfortable position. Stand with one foot up on a chair, or sit with knees apart, or lie down
  • Be sure the inner ring is at the bottom, closed-end of the pouch
  • If you wish, add a drop of extra lubricant to the closed-end outside ring for extra comfort when you insert the condom
  • Hold the condom with the open end hanging down. While holding the outside of the pouch, squeeze the inner ring with your thumb and middle finger
  • Place your index finger between the thumb and middle finger and keep squeezing the inner ring. With the other hand, spread the labia (lips) of your vagina and insert it into the vagina
  • Push the inner ring and the condom all the way up into the vagina with your index finger. Check to be sure the inner ring is up just past the pubic bone
  • Before intercourse, make sure the condom is not twisted and that the outside ring lies against the vulva
  • During intercourse, side to side movement of the ring is normal, but if you feel the ring slip into the vagina or the penis starts to enter underneath the condom, stop
  • After intercourse, the condom should be removed before you stand up. Squeeze and twist the outer ring to keep the sperm inside the condom. Pull out gently. Throw away in a trashcan
  • Use a new condom every time you have sex

What are the advantages, possible side effects/problems of the female condom?

Advantages

  • A woman can place it herself and has full control of the effectiveness (the woman controls the show)
  • Protects against unintended pregnancy and STIs/HIV
  • It adjusts well to the vagina
  • Non-latex
  • Compatible with oil-based products

Possible side effects/problems

  • Allergy to polyurethane and irritation
  • Slippage
  • Insertion difficulties
  • The inner ring may cause discomfort during sex

Remember

  • The female condom can be inserted up to eight hours before sex
  • The female condom and the male condom should not be used together; use one or the other, not both
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have questions or need help
  • For more information on the female condom, please consult this Web site: www.sexualityandu.ca

Intra-uterine device

What is an intra-uterine device (IUD)?
How does an IUD work?

Who can use an IUD?

How do I use the IUD?

What are the advantages, possible side effects and complications of the IUD?

Remember

What is an intra-uterine device (IUD)?

The IUD is a method of birth control inside the uterus (intra-uterine). The IUD is a small T-shaped plastic device with a copper wire around it. The IUD must be inserted by a health care professional (HCP). It can stay in place for five years before needing to be changed. The IUD is 99.4 per cent effective in preventing pregnancy.

How does an IUD work?

The IUD primarily prevents sperm from fertilizing an egg. It impairs sperm function.

Who can use an IUD?

All women who are seeking a reliable and reversible method of birth control that requires little attention can use an IUD. Also, the IUD may be a good option for women who are unable to take estrogen or women who are breastfeeding.

How do I use the IUD?

An IUD must be inserted by a HCP
  • A first visit and pelvic (internal) exam is needed before the IUD can be inserted to make sure there is no infection in the vagina and the cervix. The doctor will then give you a prescription for your IUD, which you can get at a pharmacy
  • The IUD can be inserted at any time during your cycle provided pregnancy is ruled out
  • Check the IUD strings before sex and after each period. If you feel the plastic part of the IUD or if the strings are absent, use another method of birth control until you can see your HCP
  • A follow-up visit should be arranged four to six weeks and yearly after the IUD has been inserted to assess infection and bleeding. Seek care sooner if you have these symptoms: late period or no period, abdominal pain, fever, chills, increased or foul smelling discharge, spotting, heavy bleeding or clots with your period
  • Never attempt to remove an IUD yourself

What are the advantages, possible side effects and complications of the IUD?

Advantages

  • Long-lasting method of birth control
  • Other method of birth control for women who cannot or do not want to take hormonal methods of birth control
  • Does not affect breastfeeding
  • Reduces the risk of endometrial cancer

Side effects and complications

  • Pain and bleeding after insertion
  • Irregular bleeding
  • Heavier menstrual bleeding
  • Painful periods, maybe longer periods

Possible complications for IUD

  • If a pelvic infection is present, its progression can be more severe and can lead to infertility
  • Uterine perforation (tear in the uterus)
  • Risk of expulsion (IUD can come out)

Remember

  • The IUD does not protect you against sexually transmitted infections (STIs) or HIV; use condoms to lower your risk
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have questions or need help
  • For more information on IUDs, please consult this Web site: www.sexualityandu.ca

Intra-uterine system

What is an intra-uterine system (IUS)?

The IUS Mirena is a method of birth control inside the uterus (intra-uterine). The IUS Mirena is a small T-shaped plastic device. The IUS Mirena is similar to an intra-uterine device (IUD), but contains one female hormone, a progestin. The IUS Mirena must be inserted by a health care provider (HCP). It can stay in place for five years before needing to be changed. The IUS Mirena is 99.9 per cent effective in preventing pregnancy.

How does an IUS Mirena work?

  • The IUS Mirena primarily changes the mucus in the cervix making it harder for sperm to enter the uterus
  • The IUS Mirena also changes the lining of the uterus making it difficult for an egg to attach itself. In some women, the IUS prevents the ovaries from releasing an egg each month (ovulation)

Who can use an IUS Mirena?

All women who are seeking a reliable and reversible method of birth control that requires little attention can use IUS Mirena. Also, this method may be a good option for women who are unable to take estrogen or women who are breastfeeding.

How do I use the IUS Mirena?

An IUS Mirena must be inserted by a HCP

  • A first visit and pelvic (internal) exam is needed before the IUS Mirena can be inserted to make sure there is no infection in the vagina and the cervix. The doctor will then give you a prescription for your IUS Mirena, which you can get at a pharmacy
  • The IUS Mirena can be inserted at any time during your cycle provided pregnancy is ruled out
  • Check the IUS Mirena strings before sex and after each period. If you feel the plastic part of the IUS Mirena or if the strings are absent, use another method of birth control until you can see your HCP
  • A follow-up visit should be arranged four to six weeks and yearly after the IUS Mirena has been inserted to assess infection and bleeding. Seek care sooner if you have these symptoms: abdominal pain, fever, chills, increased cramping, increased or foul smelling discharge, spotting, heavy bleeding or clots with your period. Overtime your menstrual period may disappear. If an abrupt change to your period occurs, see your HCP
  • Never attempt to remove an IUS Mirena yourself

What are the advantages, possible side effects and complications of the IUS Mirena?

Advantages

  • Long-lasting method of birth control
  • Other method of birth control for women who cannot or do not want to take hormonal methods of birth control
  • Does not affect breastfeeding
  • Reduces menstrual flow
  • Less painful periods
  • Reduces the risk of endometrial cancer
  • Shorter and lighter periods

Side effects and complications

  • Pain and bleeding after insertion
  • Irregular bleeding
  • Mild cramping
  • Hormonal side effects
  • Headaches
  • Sore breasts
  • Mood changes
  • Acne

Possible complications for IUS Mirena

  • If a pelvic infection is present, its progression can be more severe and can lead to infertility
  • Uterine perforation (tear in the uterus)
  • Risk of expulsion (IUS can come out)

Remember

  • The IUS Mirena does not protect you against sexually transmitted infections (STIs) or HIV; use condoms to lower your risk
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have questions or need help
  • For more information on the IUS, please consult this Web site: www.mirena.com

Male condom

What is the male condom?

The male condom is a thin sheath that covers the penis. Most condoms are made of latex, although polyurethane, plastic, and lambskin condoms are available. A variety of condoms are available: plain or reservoir-tipped, dry or lubricated form, straight or shaped, smooth or textured, natural or brightly coloured, and a variety of sizes. Free condoms are available at the Sexual Health Centre and other community health centres. The male condom is 85 to 98 per cent effective if used the right way.

Type of condom

Comments

Latex condom

  • Most popular
  • More effective if used with a spermicide like vaginal contraceptive film(VCF)
  • Protects against sexually transmitted infections (STIs)
  • Prevents pregnancy

Polyurethane condom

  • Stronger than the latex condom
  • Transmits more body heat, allowing more sensitivity
  • More resistant
  • Can be used with oil-based lubricants
  • Can be used by those who are sensitive or allergic to latex
  • More expensive than latex condoms
  • Provides protection against STIs and pregnancy similar to latex condoms

Plastic condom

  • Higher risk of breakage than latex condoms
  • Ability to protect against STIs is unknown
  • Prevents pregnancy

Lambskin condom

  • Made from lamb’s intestines
  • Not recommended for protection against STIs
  • Prevents pregnancy
  •  

How does the male condom work?

The male condom acts as a barrier that prevents contact between bodily fluids (semen or vaginal secretions) and the sexual partner. The male condom protects against unintended pregnancy and STIs and HIV.

Who can use the male condom?

The male condom is for men for oral, vaginal, and anal sex.

How do I use the male condom?

  • Check the expiry date
  • Check the package. It should be sealed and not ripped
  • Put a drop of water-based lubricant or saliva on the tip of the condom for better sensation (oil-based lubricant can only be used with polyurethane condoms)
  • Place the rolled condom over the tip of the erect penis
  • Leave a space at the tip of the condom for semen collection if the condom does not already have a reservoir at the tip
  • It not circumcised, pull back the foreskin with one hand
  • Pinch the air out of the tip
  • Unroll the condom over the erect penis. Unroll it all the way down to the base of the penis;
  • Apply lubricant outside of condom
  • Remove the condom immediately after ejaculation (“cumming”). Hold the condom on the base of the penis while pulling out. Pull out before the penis softens
  • Use a new condom every time you have sex

What are the advantages, possible side effects/problems of the male condom?

Advantages

  • Easily accessible and affordable
  • It can be used in combination with other methods of birth control
  • Protects against pregnancy. Latex and polyurethane condoms protect against most STIs and HIV

Possible side effects/problems

  • Allergy to latex and irritation
  • Spermicidal condoms may cause irritation to the genitals
  • Slippage or breakage
  • Decreased sensation or loss of erection

Remember

  • Store condoms away from heat, light, and friction to protect the latex
  • Novelty condoms do not offer protection against STIs and pregnancy
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have questions or need help
  • For more information on the male condom, please consult this Web site: www.sexualityandu.ca

Progestin-only pill

What is the progestin-only pill?

The progestin-only pill (POP), also known as the Micronor®, is not as well known or frequently used as the combined oral contraceptives, but is very safe and effective. It is a pill taken by mouth every single day at the same time to prevent pregnancy. The POP contains one female hormone - a progestin. The POP is 92 to 99.7 per cent effective if used the right way, i.e. the POP must be taken at the same time every day.

How does the POP work?

The POP primarily changes the mucus in the cervix making it harder for sperm to enter the uterus. In some women, the POP prevents the ovaries from releasing an egg each month (ovulation) and changes the lining of the uterus making it difficult for an egg to attach itself.

Who can use the POP?

All women seeking a reliable and reversible method of birth control can use POP. Also, this method may be a good option for women who are unable to take estrogen or women who are breastfeeding. The POP may be a good option for women over age 35 who smoke and women who experience migraine headaches.

How do I use the POP?

Begin taking the POP on the first day of your period. You must take the POP at the same time each day to avoid pregnancy (within a three-hour window). Try to take your POP with a scheduled activity such as a shower or breakfast.

28-day packs POP is only available in 28-day packs. Take one pill every day for 28 days (28 days of active pills). There is no pill-free interval (“sugar” pills). Start a new pack of pills after completing the previous pack.

Backup?

During the first month of taking POP, your body is adjusting to the hormones and you may be at risk of pregnancy. For the first seven days you begin the POP, use a backup method of birth control such as condoms or do not have sex during this time.

What if you miss a pill?

Follow these directions if late by more than three hours

If you miss a pill take it as soon as you remember. The next pill should be taken at the regular time. This may mean taking two pills in one day. Use a backup method of birth control if you have sex in the next 48 hours

If you miss two or more pills in a row take two pills per day for two days. Use a backup method of birth control if you have sex in the next 48 hours

In the event of a missed or late pill, use emergency contraception.

What are the advantages, possible side effects or complications of the POP?

Advantages

  • Decreased menstrual bleeding
  • No more periods
  • Decreased menstrual cramping and premenstrual symptoms

Possible side effects

Minor possibility of (will likely resolve within the first three months)

  • Irregular bleeding
Hormonal side effects
  • Headache
  • Bloating
  • Acne
  • Breast tenderness

Remember

  • The POP does not protect you against sexually transmitted infections (STIs) or HIV; use condoms to lower your risk
  • If you have any vomiting or diarrhea, continue to take the POP, but use a backup method of birth control (condoms) for the remainder of the cycle
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have questions or need help
  • For more information on the POP, please consult this Web site: www.sexualityandu.ca

Spermicides

What are spermicides?

Spermicides are composed of a chemical agent and are inserted into the vagina to prevent pregnancy. Nonoxynol-9 is the most common spermicide in Canada. Spermicides are available in different forms such as film, jelly, suppository, cream, tablet, and foam. Spermicides are 71 to 82 per cent effective when used alone, but should be used in combination with other methods, such as the condom.

How does spermicides work?

Spermicides are composed of a chemical agent that destroys sperm on contact

Who can use spermicides?

All women who are sexually active and who do not have an allergy to spermicides can use this contraceptive method.

How do I use spermicides?

  • Check the expiry date
  • Read and follow the package instructions carefully
  • Insert spermicide high in the vagina
  • Apply the right amount of spermicide
  • Wait the recommended time between insertion and having sex
  • Insert more spermicide with every sexual contact
  • Do not douche for at least 6 hours after sexual contact
Product

Effective how soon after insertion

Effective for how long

Comments

Vaginal contraceptive film (VCF)

15 minutes

1 hour

Apply more spermicide before having sex again

Advantage 24® – bioadhesive jelly

Immediately

24 hours

  • Apply more spermicide before having sex again
  • Use an applicator

Foam

Immediately

1 hour

  • Apply more spermicide before having sex again
  • Use an applicator

Gel or cream

Immediately

1 hour (if used with diaphragm or cap, 6-8 hours)

  • Apply more spermicide before having sex again
  • Good to use with diaphragm and cap
  • Use an applicator

Suppository

10-15 minutes

1 hour

  • Apply more spermicide before having sex again

Contraceptive Sponge (Protectaid® or Today Sponge®)

15 minutes

12 hours

  • Also acts as a barrier method
  • Less effective in women who have given birth
  • No need to change sponge if sex repeated within the 12-hour period
  •  

What are the advantages, possible side effects/problems of spermicides?

Advantages

  • The foams, creams, and jellies may be used as lubricants with condoms

Possible side effects or problems

  • Irritation of the vagina, the penis due to an allergic reaction to spermicides, which may increase the risk of HIV transmission
  • Increase risk of urinary tract infection (UTI)
  • Timing of application
  • Lack of spontaneity
  • Can be messy
  • Unpleasant odour or taste

Remember

  • Spermicides should only be used in monogamous relationship (when you only have one regular sexual partner), as it does not protect you against sexually transmitted infections (STIs). Spermicides may cause vaginal irritation, which increases the risk of HIV transmission
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have any questions or need help
  • For more information on spermicides, please consult this Web site: www.sexualityandu.ca

The contraceptive patch

What is the contraceptive patch?

The contraceptive patch, also known as the Evra® patch, is a birth control patch changed weekly and worn on the skin to prevent pregnancy. The Evra® patch contains two types of female hormones - estrogen and progestin, which are taken in through the skin. The Evra® patch is up to 99.7 per cent effective if used the right way.

How does Evra® patch work?

The Evra® patch prevents the ovaries from releasing an egg each month (ovulation). If there is no egg to meet the sperm, pregnancy will not occur. The Evra® patch also changes the lining of the uterus making it difficult for the egg to attach itself. Finally, the Evra® patch changes the mucus in the cervix making it harder for sperm to enter the uterus.

Who can use Evra® patch?

All women seeking a reliable and reversible method of birth control that does not require daily attention can use the contraceptive patch.

How do I use the Evra® patch?

Apply a new patch on the same day of the week for three weeks in a row. The fourth week is patch-free; your period should begin during the patch-free week.

First day start: Apply your first patch during the first 24 hours of your period. This is Day one, your “patch change day”. If the patch is not applied within the first 24 hours, use a backup method of birth control if you have sex in the next seven days.

Sunday start: Apply your first patch on the first Sunday after your period starts. This is Day one, your “patch change day”. Use a backup method of birth control if you have sex in the next seven days.

Application method

  • Apply to clean, dry, intact healthy skin. To ensure that the patch sticks well on the skin, avoid using make-up, creams, lotions, powders or other skin products on or around the patch area
  • To avoid skin irritation, apply the patch to a new area each time you change it. Ensure the patch is not worn in an area where it can be rubbed by tight clothing
  • The patch is placed on one of four areas: the buttocks, the lower abdomen, the upper outer arm and upper back (shoulder blade). Do not place on the breasts or skin that is red, irritated or cut
  • Check patch daily to ensure well in place
  • The patch can be worn during all daily activities (bathing, swimming, etc.). For your health, avoid spending a lot of time in saunas or hot tubs as you may be exposed to more estrogen
  • Do not cut, write on or change the patch in any way
  • Do not use other tapes or wraps to hold EVRA® in place, even if the edges start to peel away from the skin

Backup

What to do if the Evra® patch partially or fully comes off?

  • Less than one day (24 hours): re-apply it right away or apply a new patch, NO backup method of birth control is needed and your “patch change day” remains the same
  • More than 24 hours: STOP the current cycle. Start a new cycle right away by applying a new patch and this is now Day one of your cycle and your new “patch change day”. Use a back-up method of birth control if you have sex in the next seven days

What to do if you forget to change the your Evra® patch?

Week 1

Week 2 or Week 3

Week 4

More than 1 day late applying your first patch at the start of any cycle

Up to 48 hours late

More than 48 hours late

If you forget to take your patch off during week 4

  • Apply the first patch as soon as you remember
  • You will now have a new Day 1 and a new “patch change day”
  • You must use a backup method of birth control for 7 days
  • Remove the used patch and apply a new patch right away
  • The next patch should be applied on your normal “patch change day”
  • No backup method of birth control is needed
  • Remove the used patch and apply a new patch right away to start a new cycle
  • You will now have a new Day 1 and a new “patch change day”
  • You must use a backup method of birth control for 7 days
  • Take the patch off as soon as you remember
  • Start your next cycle on your normal “patch change day”
  • No backup method of birth control is required

What are the advantages, possible side effects or complications of the Evra® patch?

Advantages

  • Convenient (once a week)
  • Decreased cramping and menstrual bleeding
  • Improved cycle control
  • Reduced the risk of ovarian and endometrial cancer
  • Can reduce acne

Possible side effects

Minor possibility of (will likely resolve within the first three months)

  • Irregular bleeding
  • Nausea
  • Headaches
  • Sore breasts
  • Local skin reaction: redness or itchiness on or around the patch area

Possible complications

Women who have any of these symptoms while on the Evra® patch should go to the hospital

  • Abdominal pain (severe pain or lump in the abdomen)
  • Chest pain or shortness of breath
  • Headache (severe) with dizziness, weakness or numbness
  • Eye problems (vision loss or blurred vision) or speech problems
  • Severe leg pain or numbness (calf or thigh)

Remember

  • The Evra® patch is less effective in a women with a body weight of greater or equal to 90kg than in women with lower body weights
  • The Evra® patch does not protect you against sexually transmitted infections (STIs) or HIV; use condoms to lower your risk
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have questions or need help
  • For more information on the transdermal contraceptive patch, please consult this Web site: www.orthoevra.com

Vaginal contraceptive ring

What is the vaginal contraceptive ring?

The vaginal contraceptive ring, also known as the NuvaRing®, is a bendy, soft, one size fits all see through ring about two inches (5 cm) wide. The NuvaRing® is inserted in the vagina and changed once a month to prevent pregnancy. The NuvaRing® contains two female hormones - estrogen and progestin, which are taken in through the walls of the vagina and then distributed in the blood. The NuvaRing® does not require sizing or fitting and is 99.7 per cent effective if used the right way.

How does the NuvaRing work?

The NuvaRing® prevents the ovaries from releasing an egg each month (ovulation). If there is no egg to meet the sperm, pregnancy will not occur. The NuvaRing® also changes the lining of the uterus making it difficult for and egg to attach itself. Finally, the NuvaRing® changes the mucus in the cervix making it harder for sperm to enter the uterus.

Who can use the NuvaRing?

All women seeking a reliable and reversible method of birth control that does not require daily attention can use this method. The NuvaRing® has to be prescribed by a health care professional.

How do I use the NuvaRing?

The NuvaRing® ring is made to release a steady amount of hormones over a 21-day period with a seven-day ring-free period. Each ring is used for one cycle and then removed.

Insert a NuvaRing® into your vagina between day one and day five of your period and keep it in place for three weeks in a row. Remove the NuvaRing® for a seven-day break after which you will insert a new ring. Your period should begin during the ring-free week. The NuvaRing® should be left in place during sex and is usually not felt by either partner. It can be used with a condom and tampons.

To insert

After washing your hands, squeeze NuvaRing® between the thumb and the index finger and insert it into the vagina as far as it will go. The exact placement is not important for NuvaRing® to work and the muscles of the vagina should keep the ring in place.

To remove

Put a finger into the vagina and pull it out. Dispose the used ring in the foil pouch it came in, but not in the toilet.

Backup?

What if it slips out?

Rarely, does the NuvaRing® slip out. It can occur if the ring is not properly inserted, if you strain for a bowel movement (stool) or during sex.

Out for less than three hours
  • You should still be protected against pregnancy
  • No backup method of birth control is needed
  • The ring should be rinsed with cool-to-lukewarm (not hot) water and re-inserted as soon as possible (within three hours)
  • If NuvaRing® is lost, you should insert a new ring and stay on the same schedule
Out for more than three hours
  • You may not be protected against pregnancy
  • The ring should be rinsed with cool-to-lukewarm (not hot) water and re-inserted as soon as possible
  • The woman must use a backup method of birth control until the new ring has been in place for seven days in a row

What are the advantages, possible side effects or complications of the NuvaRing?

Advantages
  • Convenient (once a month and private)
  • Decreased cramping and menstrual bleeding
  • Improved cycle control
  • Reduced the risk of ovarian and endometrial cancer
  • Can reduce acne

Possible side effects

Minor possibility of (will likely resolve within the first three months)

  • Irregular bleeding
  • Nausea
  • Headaches
  • Sore breasts
  • Vaginal irritation with whitish vaginal discharge

Possible complications

Women who have any of these symptoms while on the NuvaRing® should go to the hospital

  • Abdominal pain (severe pain or lump in the abdomen)
  • Chest pain or shortness of breath
  • Headache (severe) with dizziness, weakness or numbness
  • Eye problems (vision loss or blurred vision) or speech problems
  • Severe leg pain or numbness (calf or thigh)

Remember

  • The NuvaRing® does not protect you against sexually transmitted infections (STIs) or HIV; use condoms to lower your risk
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have questions or need help
  • For more information on the vaginal contraceptive ring, please consult this Web site: www.nuvaring.com

Emergency Contraceptive Pills (ECP)

What is emergency contraception?

Emergency contraception can be used to prevent a pregnancy from occurring.  There are 2 methods of emergency contraception

  • Oral medication (2 options) taken within 5 days of unprotected intercourse
    • Plan B® (levonorgestrel) or
    • Ella® (ulipristal acetate)
  • Copper-IUD inserted within 7 days of unprotected intercourse

Plan B® (levonorgestrel) and Ella® (ulipristal acetate) are not abortion pills and will have no effect if you are already pregnant.

What is Plan B® (levonorgestrel)?

Plan B® contains the hormone progestin and works by:

  • Delaying the release of an egg from the ovaries
  • Thickening the cervical mucus
  • Changing the endometrial lining

You can purchase Plan B® at most pharmacies without a prescription or at the Sexual Health Centre.

Plan B® works best when taken as soon as possible after unprotected sexual contact, preferably within 72 hours and has some effectiveness up to five days (120 hours) after unprotected sexual contact.

Plan B® may not be as effective in women with a BMI>25.

What is Ella® (ulipristal acetate)?

Ella® is a selective progesterone receptor modulator and acts on the body's hormones to delay the release of an egg from the ovary.

Ella® is available at most pharmacies by prescription only.

Ella® can be used by women for emergency contraception up to 5 days after unprotected intercourse.

Ella® may not be as effective in women with a BMI>35.

What is a copper IUD?

A copper IUD can be inserted within 7 days of unprotected intercourse.

Please see the IUD fact sheet for further information or discuss with your health care provider.

How does emergency contraception work?

You can get emergency contraception at most pharmacies without a prescription or at the Sexual Health Centre.

Emergency contraception contains the hormone progestin and works by:

  • Delaying the release of an egg from the ovaries
  • Preventing fertilization of the egg; or
  • Preventing a fertilized egg from implanting in the uterus

Emergency contraception works best when taken as soon as possible after unprotected sexual contact, preferably within 72 hours and has some effectiveness up to five days (120 hours) after unprotected sexual contact.

Plan B® is not an abortion pill and will have no effect if you are already pregnant.

Who can use emergency contraception?

Almost every woman can use emergency contraception. Even women who cannot use birth control pills containing estrogen sensitivity can use Plan B® (levonorgestrel) or Ella® (ulipristal acetate) because there is no estrogen in these medications. If you know or suspect you are pregnant you should not use emergency contraception.

How do I use emergency contraception?

Take two tablets as soon as possible after unprotected sex or as directed by the doctor/nurse.
If you vomit within one hour of taking the dose, you will need to retake the medication.

What are the advantages and possible side effects of emergency contraception?

Advantages

  • Emergency contraception is very safe for almost all women
  • Emergency contraception will prevent three out of four pregnancies
  • Emergency contraception will do no harm to an already existing pregnancy

Possible side effects

Most women experience no side effects at all, but some women may experience: nausea, vomiting, diarrhea, stomach pain, breast tenderness, headache, or menstrual changes related to hormone intake.

Remember

  • Notify your health care provider or take a home pregnancy test if you do not get your menstrual period within 21 days of using oral emergency contraception
  • For those taking birth control, use a back-up method such as condoms for the rest of the cycle.
  • Emergency contraception does not protect against sexually transmitted infections (STIs) or HIV
  • Oral emergency contraception should only be used as a back up method of birth control, discuss future contraceptive needs with your health care provider
  • Call the AIDS & Sexual Health Info Line at 613-563-2437 if you have questions or need help.
  • For more information on the emergency contraception, please consult the following Web site: www.planb.ca and/or http://ellanow.com/