Contraceptives

Some contraceptives can be downright frustrating to use, others can bring on an attack of the giggles -you’ll know what I mean if your diaphragm has ever flipped itself across the room! I have discovered some very clear sets of instructions on ‘How To” use various types of contraceptives so I thought I’d start the year by going back to basics and featuring them on my site. The tips may be useful to ‘first timers’ and may save a lot of fumbling about for those of you who still have trouble.
The link to the instructions is below (they were prepared for handing out to patients by doctors) but here are a few pros and cons on the first type- the diaphragm- to give you a good basis for further discussion with your doctor.

Contraceptive Type- The Diaphragm

Advantages:

• reasonably effective (if used perfectly, approx. 6 out of 100 women get pregnant each year using a diaphragm)
• does not contain hormones so no hormonal side effects
• it can be put in several hours before any sexual activity
• the woman is in charge of birth control
• your partner can put it in as part of your lovemaking
• his penis can stay inside you after ejaculation
• intercourse during your period is less messy as the diaphragm holds the blood

Disadvantages:

• you must be fitted for a diaphragm by your doctor initially
• you must wash your hands with soap and water before inserting your diaphragm
• you MUST also use a spermicide
• if not put in prior to sex, insertion may interrupt sex
• you increase the risk of getting a urinary tract infection
• some women find a diaphragm unattractive and difficult to put in correctly
• a diaphragm must NOT be left in for more than 48 hrs or there is a slight risk of toxic shock
• a diaphragm must be left in place for 6hrs after the last intercourse
• the diaphragm may slip during various sexual positions so you make sure your cervix is still covered
• you may need a fitting for a different size after having a baby, an abortion, miscarrying or gaining more than 15 pounds

Diaphragms are used with spermicides for extra protection - spermicides kill sperm but read the warnings about Nonoxynol 9 before buying this one.
GO HERE for diagrams and instructions on How To Use a Diaphragm- they also explain what a diaphragm is, how to store it and how it works to prevent pregnancy.

Sources: www.contraceptiononline.org

Emory Department of Gynecology & Obstetrics

It is very important to make sure that the contraceptives you buy/use are in good condition and are stored properly. I have obtained the information below from www.cdc.gov/reproductivehealth/Global/Contraceptives.htm where you will find other related sources if you require further information about this topic.
Do Not Use the following contraceptives if they show any of these conditions:

Oral Contraceptives - Store away from direct sunlight in a cool, dry location.
· Pills are visibly damaged (broken, cracked, crumbled, discolored).
· The aluminum packaging for any of the pills is broken.
· The packet is missing any pills.
· There are signs of deterioration (brown spots, pill crushes easily).
Condoms - Store Below 40°C. No long exposure to high humidity, direct sunlight, fluorescent light, or ozone. Don’t store near chemicals.
· Any condom packets in the batch are brittle or otherwise damaged.
· Any ‘yellowed’ condom packets
· The seal of the condom packet is not intact.
Spermicidal Jelly - Store Between 15 and 30°C. where there will be no extreme changes in temperature or humidity.
· The jelly tube is wrinkled or leaking.
· The applicator cannot easily be screwed onto the top of the tube.
Foaming Tablets - Store Below 40°C.
· The package has broken or missing tablets.
· The package is puffy (this indicates a moisture leak).
· The foil laminate has cracks.
· The tablets are discoloured (they should be white).
· The tablets are soft, wet, damp, or crumble easily.
Diaphragms - Store Below 40°C. where there will be no long exposure to high humidity, extreme temperatures, ozone, or direct sunlight. Don’t store near chemicals.
· The package seal is damaged.
· The diaphragm looks dirty (only the service provider needs to check for this).
· The diaphragm shows holes or cracks when held up to a light (only the service provider needs to check for this).

If you have stored your contraceptives for any length of time OR if they show any of the above signs do not use them. If the contraceptives were in poor condition when you purchased them, return them to the seller and report the problem at once.

You may have noticed that I have not addressed the disturbing issues surrounding the hormonal patch as an acceptable contraceptive. I do not wish to alarm -just to to alert you to investigate this contraceptive thoroughly and certainly discuss its suitability with your doctor if you are wishing to use it.  I am not advocating its use, just pointing you in the direction of the latest information and keeping you up to date with the latest warning.

The Boston Collaborative Drug Surveillance Program (at the request of Johnson and Johnson, manufacturers of the Birth Control Patch) conducted a study of women between between the ages of 15 and 44 who use the patch. The results corroborated an earlier study that there was a greater risk of VTE (Venous Thromboembolism) indicated for women in this age bracket.

The FDA (Food and Drug Administration) have issued a strong warning that women who use the ‘patch’ may face increased risk of developing blood clots in their legs or lungs, a condition called Venous Thromboembolism (VTE). The labels inside the packages have been changed to reflect this risk. The patch contains much higher doses of estrogen than the contraceptive pill does.

Be Informed and ask questions- there are reports that some women have been using the patch unaware of the possible complications so, given that in 2005 the FDA revealed that the patch sold in the US exposed women to 60% more estrogen than the oral contraceptive ‘pill’, be cautious. The Canadian ‘patch’ has lower levels of estrogen than the one sold in the US but even so, unless you see a HUGE advantage to using this form of birth control, maybe you should consider other options— just in case?

This site has the full report and also shows you stats on contraceptive buys from pharmacies.

Risks- Yes, there are risks with taking oral contraceptives too but now that the estrogen levels are much lower in today’s pills ( 30-20 mg as opposed to 150mg in the 60’s and 70’s) the side effects have been reduced.

The ’scary’ words associated with the “Patch”, namely, blood clots, stroke and heart attack have been loud enough to warrant warnings from Government health officials in Canada and the USA. The adhesive ‘patch’ works by delivering hormones to a woman’s body through her skin- it is only available through prescriptions. We are being reassured that in healthy women the risk is not high but if you add the risks of smoking and obesity….? Mmm..is it worth the extra risk?

Thank you to Diane Rubino of The Population Council (pubinfo@popcouncil.org) for updating and supplying the additional information for this topic. The previous post with this title has been deleted so as not to cause any confusion with the current status on this issue.
The information has been directly supplied to me by the Office of Public Information at the Population Council.

The future is looking bright for the soon to be available new contraceptive for women- the contraceptive spray. Companies on opposite sides of the globe, Acrux Pharmaceuticals (West Melbourne, Australia) and The Population Council (New York, NY) have combined their products and expertise to develop a revolutionary way of blocking ovulation.

The contraceptive spray is still under development. It has not yet completed the safety and effectiveness testing that is required by the FDA before the agency determines whether or not a product should be put on the market.

Effective, safe and appealing-these are the main elements women want in their range of contraceptives

Igor Gonda PhD and now ex CEO of Acrux Ltd, stated in 2005, “The Population Council and Acrux are developing this new product because we believe that we will provide many women with an attractive choice of contraception that could be convenient, effective, and have no or few side effects”.

Results from the initial phase are positive, with the Population Council’s “Nestorone” (estradiol) being administered via Acrux’s patented spray.

The Council’s Nestorone®, a progestin, is combined with a natural estrogen, estradiol, which are administered via Acrux’s patented spray technology.

The solution containing Nestorone and estradiol is sprayed onto the skin each day in a measured amount, is absorbed into the bloodstream and blocks ovulation.

Nestorone is a derivative of the natural progesterone, and is combined with a natural estrogen, unlike the hormones currently used in oral contraceptives and the patch.

The hormones are ‘carried’ in an alcohol base that also contains a ’skin penetration enhancer’.

Advantages of the spray

Acrux had previously developed a spray delivering the natural estrogen estradiol to be used for postmenopausal hormonal therapy. Now approved by the FDA, the spray may be on the market by next Christmas. It is expected to be on the market by the first quarter of 2008, probably under the name “Evamist” for treatment of postmenopausal symptoms.

The same spray technology is being evaluated to deliver a combination of Nestorone and estradiol for contraceptive purposes.

• The contraceptive is sprayed onto the inside of the forearm, where it dries within a minute. Then the hormones Nestorone and estradiol are slowly released into the bloodstream over a period of time.

• A woman may have more flexibility with WHEN she uses it, since the little pool or ‘reservoir’ that forms in the outer layer of the skin supplies the progesterone derivative and estradiol constantly. This ‘reservoir’ is then topped up with the next dose.

• The fluctuations in blood levels will be milder than with traditional pills.

• The TIMING of application will not be as crucial with the spray as with the oral contraceptive,(which should be taken at approximately the same time each day to be most effective)due to the fact that one dose of Nestorone will be distributed to the body steadily over a 24-hour period.

NATURAL hormones such as Nestorone and estradiol are used in the spray–not synthetic ones (as in the patch and pills, which previously have been linked to rare cases of cardiovascular disease).

Nestorone is so effective in blocking ovulation that only microgram, rather than milligram doses (found in some contraceptive pills), will be needed.

According to Régine L. Sitruk-Ware, MD, executive director of research and development at the Population Council,“The two natural hormones we use should improve the tolerability and will have much less impact on the liver than products on the market.” Furthermore, the formulation may also be suitable for breastfeeding women because the compound Nestorone cannot be orally absorbed and will not harm infants.

Fewer Side Effects

Researchers are optimistic that the contraceptive spray will be far more ‘user friendly’ than the birth control pill or the contraceptive ‘patch’ as it will eliminate some side effects.

Nausea (which makes some women skip doses of the pill) in particular will not occur because nothing is taken down the gastrointestinal tract to the stomach.

We don’t yet know what the conditions of use will be (no swimming after spraying?!!!)but this method of contraception is under development to evaluate the efficacy and safety in women seeking contraception. It is to be hoped that when the final phase of clinical trials is completed, the spray will be very affordable (lower dose = lower price?) This is an important milestone for the contraceptive market–and why wouldn’t it be? Worldwide sales of hormonal contraceptives in 2006 were around $6.7 billion!

Source: The Population Council