Birth control

Dr.Joe's Data Base

Facts of Life Netline ©
Birth Control

Which Birth Control Method Should We Use?

Birth Control Effectiveness: How Well Does It Work?

The Birth Control Pill

The Diaphragm and Jelly or Cream

The Intrauterine Device or IUD

Natural Family Planning: Is There a Safe Time of the Month?

Sterilization for Men: Vasectomy

Sterilization for Women: Tubal Ligation

The Morning After Pill and IUD for Post-Coital Contraception

Norplant

Other Methods of Birth Control and RU486

Which Method Should We Use?
If a couple decides to have sexual intercourse, but doesn't want to start a
pregnancy, then they can use birth control or contraception. What is best for
one couple may not be suitable for another. There is no contraception that is
100% effective. However, some methods can be very effective if they are used
properly.
Making mistakes or "taking chances" by not following instructions carefully
makes any method risky.
Pregnancy can start almost any time. A woman can get pregnant,
the first time she has sex

in any position

during her menstrual period

even if she doesn't have sex very often

even if she doesn't have an orgasm

even if her partner pulls his penis out of her vagina before he ejaculates
or "comes"

even if she doesn't have vaginal intercourse, if her partner ejaculates near
the outside of her vagina.
These are some of the reasons why 85 to 90 of every 100 women who don't use
birth control when they have intercourse get pregnant within one year. That's up
to 90%! So, the question is, "Which method would we use carefully, every time?"
Do you have sex often? Would it be easier to use a method that's only needed
when you have intercourse, like condom and foam, or a diaphragm and jelly? Or
would it be easier for you to remember to take a pill at the same time every
day? (Remember that the pill doesn't prevent sexually transmitted diseases.)
There are many types of birth control. Some can be bought at the drug store
without a prescription, for instance condoms and foam or the sponge. For others,
such as the diaphragm, birth control pill, IUD, cervical cap, Depo-Provera or
Norplant, you must see a doctor or health care worker. Natural Family Planning
requires cooperation and training for both partners. This is not the same as the
old rhythm method, counting days on a calendar. Many people, after they are sure
they don't want children in the future, consider permanent sterilization.
Another method of preventing pregnancy is not including sexual intercourse in
your lovemaking. Many couples find that creative sexual stimulation is as
exciting and satisfying as intercourse. You might want to read the message on
Outercourse, in the Sexuality Menu.
You may have heard of other methods of birth control. Withdrawing the penis just
before ejaculation has a high failure rate. Breast feeding cannot be counted on
to prevent pregnancy. Douching can actually speed the sperm on their way.
So, if you don't want to start a pregnancy, you need to choose an effective
birth control method that suits you and your partner. Think about the following
questions:
What would you do about a pregnancy?

How would your partner feel about it?

How does your partner feel about birth control?

Can you talk about it together?

Could you cooperate to use a method of birth control?

What will it cost? Will you and your partner share the cost?

Are you protecting yourself and your partner against sexually transmitted
diseases at the same time?
The type of birth control you choose now may not be the right method for you in
a year, or even next month. As you and your lifestyle change, your birth control
needs may change too. Some women have side effects with some types of birth
control, and have to change methods. The best method is the one you will use
correctly and safely.
If you want to talk with someone about birth control, you can call a local
Planned Parenthood organization or Public Health Unit -- see
References/Resources.

Birth Contol Effectiveness: How Well Does It Work?
There are several birth control or contraceptive methods available today, each
with advantages and disadvantages. Many of the methods used to prevent pregnancy
may, along with the use of a latex condom, help prevent sexually transmitted
diseases.
Each method has been studied to see how effective it is. Researchers find out
how many women get pregnant when they use a method for one year. If 100 couples
use the same method and 3 women get pregnant, there is a 3% failure rate.
Sometimes, you will hear about effectiveness rate. If 3 out of 100 women get
pregnant, there is a 97% effectiveness rate. That's 3 subtracted from 100.
The effectiveness of any method of birth control depends greatly on how
carefully it is used. If used correctly every time, most methods are very
effective. Because we can forget or make mistakes or take chances, it is very
difficult to say exactly how effective a method is.
Sterilization, which is tubal ligation for women and vasectomy for men, is
almost 100% effective.

Condoms used with contraceptive foam, jelly or cream are more than 99%
effective if used correctly.

Condoms by themselves are about 88 to 90% effective if used with average
carefulness.

Foam, jelly and cream are between 80 and 97% effective. Because they can be
less effective than other methods, we recommend that they be used with a
condom.

The birth control pill is 98 to over 99% effective.

The intrauterine device, or IUD, is about 99% effective.

The diaphragm with jelly is 82 to 98% effective, depending on how well it is
used.

The cervical cap and sponge are each 82 to 94% effective.

The diaphragm, cap and sponge are all much more effective when used with a
condom.

Natural Family Planning or Fertility Awareness, which is NOT the old
"rhythm" or "calendar" method, is 70 to 97% effective. This depends on how
well a couple learns the method and how carefully they follow the
directions.
You will notice that none of these is 100% effective. There is no perfect
contraception. But, any of these methods can be highly effective if used
correctly and regularly.
Some methods are not recommended. One is "withdrawal", when the man pulls his
penis out before he "comes" or ejaculates; however, it is better than nothing.
The old rhythm or calendar method is about 12 to 20% effective. Breastfeeding is
unreliable. Douching may even have a negative effect, by speeding sperm on their
way. Using no method is only 10% effective over one year. That is, 9 out of 10
couples using no method for a year will start a pregnancy.
Any type of birth control has to be used carefully every time, to give the best
chance forsuccess. That is why it is important to choose the method that is best
for you and your partner.
If you would like further information about birth control, you can call a local
Planned Parenthood organization or Public Health Unit -- see
References/Resources.

Condom and Spermicide
One of the best methods of birth control can be used without seeing a doctor.
Condoms and spermicide can be bought at any drug store. Used properly, this
method is over 99% effective in preventing pregnancy, and extremely effective
against the spread of sexually transmitted diseases. It is therefore highly
recommended.
Spermicide comes as foam, cream or jelly. The active ingredient is Nonoxynol-9
which kills sperm and may help stop some sexually transmitted diseases.
Contraceptive foam comes in a small can. The first package you buy should have
an applicator. Then you can buy refills. You might want to have a second can
with you, since it is difficult to tell when it's getting empty.
Use foam twenty minutes or less before intercourse. Remove the cap of the can.
Shake it well. Next, fit the applicator over the top of the can. Insert one
applicator full of foam into the vagina.
If you have sex again, use more foam. When buying foam, make sure that the
package says "contraceptive" or "spermicidal". It may look like other feminine
hygiene products which are not effective as birth control.
Foam is not poisonous. Sometimes it can cause skin irritations or rashes. You
can switch to another brand. Remember to check the expiry date on the package.
Contraceptive jelly and cream are sold in tubes. They are used like foam. Buy an
applicator with the first package, and then just buy refills. Remove the cap,
fill the applicator and insert the jelly or cream into the vagina.
Condoms should be latex. They are available in many forms: smooth or textured,
coloured, even flavoured. Some brands are slightly larger or thinner than
others. Don't test the condom for holes; you may damage it. Be careful that
fingernails don't tear it. Never re-use a condom. If you use a lubricant, make
sure that it is water-based. Vaseline and other oil-based lubricants damage
latex. Don't store condoms where they'll get hot -- in a wallet or glove
compartment -- heat can also damage them. Check the expiry date on the package.
A condom should be used as soon as the man has an erection. There is sperm in
early semen, before ejaculation. Remove the condom from its package. Squeeze the
tip of the condom, to leave a space for the semen. Then roll the condom down to
the base of the penis. After ejaculation, a man should withdraw before he loses
his erection. Keep a fingeron the condom while withdrawing to prevent spilling
the semen.
Condoms are thin and transmit body heat. Using condoms and spermicide can become
part of lovemaking. Even if it reduces the enjoyment of sex slightly for some
couples, it also shows that you respect your partner. Respect yourself and make
sure that you are respected. You can say, "If we can't use a condom then we can
make out some other way besides intercourse". There are other ways to express
love and attraction.
In case the condom breaks, there are two methods available to stop pregnancy.
Read the message on "The Morning After Pill and Post-Coital IUD", in the Birth
Control Index, for more information.
For more information go to a clinic or see a doctor. Or you can call a local
Planned Parenthood organization or Public Health Unit -- see
References/Resources.

The Birth Control Pill
Birth control pills usually contain 2 female hormones called estrogen and
progesterone which stop the ovaries from releasing an egg, or ovum. They also
cause other changes in a woman's body which make pregnancy very unlikely. Used
correctly, it can be more than 99% effective. "The Pill" does not protect
against sexually transmitted diseases.
If a woman wants to go on The Pill, she has to get a prescription. The doctor
will first ask questions about her health, her family's health and whether she
smokes. If she starts, she will need to know exactly how to take it. She will
not be protected from pregnancy for the first month, and should use a back-up
method of birth control such as latex condoms with foam.
She needs to know which day to start taking the pills, and when to start the
next pack. She will always start a new pack on the same day of the week. If she
takes the first pill on a Sunday, she will always take the first pill of every
pack on a Sunday.
There are two kinds of pill packages: 21 day and 28 day. Both kinds have 21
pills with active ingredients. A woman who takes the Pill according to the
instructions is protected from pregnancy every day, even if she is using a
21-day Pill. In a 28-day package, the last 7 pills contain no hormones; they
just help a woman stay in the habit of taking the pills properly every day. With
a 21-day Pill, she doesn't take any pills for 7 days after completing a pack.
She then starts her next pack.
It is normal for menstrual periods to become lighter, or even for a woman to
skip a period while on the Pill.
The Pill is most effective if it is taken properly. Here are some guidelines to
follow:
1. Take the Pill at the same time every day. This keeps a steady supply of
hormones in the body.
2. Pick a time of the day when you will remember to take the Pill, and when
the pills will be handy, then stick to it. It is helpful to connect
pill-taking with another activity, such as brushing your teeth or eating
lunch.
3. If you are late taking a pill or forget to take a pill by four hours or
more, take the pill as soon as you remember, but use a back-up method of
birth control such as condoms and spermicide for the rest of the month. If
you and your partner don't, you could get pregnant.
4. Other types of medicine such as antibiotics or antacids can stop birth
control pills from working. If you are taking antibiotics or any other kind
of medicine, even one that you got without a prescription, check with a
doctor or pharmacist to see if it will affect the Pill. If it will, you and
your partner will need to use a back-up method such as condom and spermicide
while you are taking the other medicine. Also, if you are vomiting or have
diarrhea you may not be protected from pregnancy. So you and your partner
should use an additional method of birth control such as condom and
spermicide for the rest of the month.
Many women notice some changes in their bodies when they go on the Pill. Tell
your doctor or go to a clinic if any of the following changes are upsetting or a
problem: nausea, headaches, breast tenderness, weight gain, spotting or bleeding
during your cycle, irritability, depression or other mood changes. Some of these
changes are no problem, and most of them go away in 2 or 3 months when the body
gets used to the Pill. But some women may need to switch to a different type of
pill, or use another method of birth control.
The Pill can cause very serious problems for some women, especially women who
smoke. There is a slight risk of high blood pressure, blood clots, heart attack
and stroke. Some women who have high blood pressure or diabetes may not be able
to take the Pill.
The warning signs of serious problems when a woman is taking the Pill are severe
abdominal pain or cramps; chest or stomach pain; shortness of breath; coughing
up blood; severe headaches; pain, tingling, swelling or numbness in the leg; and
blurred or temporary loss of vision. If you notice any of these signs, get to a
doctor or clinic right away.
There is no evidence that the Pill causes cervical, uterine or breast cancer.
Research on a connection between the Pill and breast cancer has not reached any
conclusion yet. There is no evidence that taking the Pill will make it harder
for a woman to get pregnant in the future.
Beneficial side effects of the Pill include having clearer skin, having shorter,
lighter periods and less menstrual cramping, and a reduced chance of ovarian and
endometrial cancers. Many women who get Pre-Menstrual Syndrome find the Pill
helpful. There is some protection against breast and ovarian cysts. For many
women, not having to worry about pregnancy makes sexual intercourse more
enjoyable.
The Pill is a good method of birth control for many women. Remember, it will not
protect against sexually transmitted diseases. If you start, be sure to remember
to take it at the same time every day, and watch for the warning signs for
serious problems! For more information, you can call a local Planned Parenthood
organization or Public Health Unit -- see References/Resources.

Diaphragm And Jelly
The diaphragm is a soft rubber cup. It is worn inside a woman's vagina during
intercourse. It must be filled with special jelly or cream which kills sperm.
Then it is inserted at the back of the vagina, to cover the cervix -- the
opening to the uterus or womb. It blocks sperm from getting into the uterus. If
any sperm get around the diaphragm, they are killed by the jelly or cream.
Diaphragms come in different sizes. Each woman is fitted by a doctor or health
worker to get the right size. Make sure you learn how to put it in correctly,
know if it is in place and remove it. When it is in place, the woman and her
partner usually can't feel it. If it is uncomfortable, then it may be the wrong
size or inserted incorrectly.
You need to use spermicidal jelly or cream with your diaphragm. Put an
applicator full of jelly, about 2 to 6 teaspoonsful, or 10 to 30 milliliters, in
the diaphragm and around the edge.
To insert the diaphragm squeeze the rim, folding it in half, and slip it into
the vagina as far as it will go. Feel it with a finger to make sure the cup
covers the cervix. This gets easier with practice.
Jelly becomes less active after about 2 hours, so if you have sex more than once
or if more than 2 hours have passed, insert more jelly. Do not remove the
diaphragm to do this. Insert another applicator of jelly into the vagina. When
you buy jelly or cream, make sure the package says "contraceptive" or
"spermicidal". These are available in drug stores without a prescription. They
aren't poisonous and don't stain clothes. They may also help protect against
sexually transmitted diseases.
Leave the diaphragm in place for 6 to 8 hours after your last intercourse. Don't
take a bath, swim or douche during this time. Showers are okay. Do not leave the
diaphragm in longer than 24 hours. It will not interfere with urination or bowel
movements.
Diaphragms work well, if used properly and taken care of. After removal, wash it
with warm water and dry it well. Check it for holes by holding it up to the
light. Even the tiniest hole will allow sperm to pass through. Buy a new one at
least every 2 years.
If a woman gains or loses more than 10 pounds or 4 kilograms, she may need a
different size diaphragm. She may also need a different size if she gives birth,
has an abortion, or has surgery in her lower abdomen.
For more information about the diaphragm, you can call a doctor or family
planning clinic. Or, call a local Planned Parenthood organization or Public
Health Unit -- see References/Resources.

The IUD
The IUD, or intrauterine device, is a small piece of plastic or copper, shaped
like a T, which is placed inside a woman's uterus or womb by a doctor. The IUD
causes a fertilized egg to leave the uterus during menstruation. It is very
reliable: about 99% effective in preventing pregnancy. Once it's in, the IUD is
good for 1 to 5 years, depending on the type.
An IUD may not be the best kind of birth control for everyone. Some women with
IUDs notice changes in their bodies. These changes can include longer or heavier
periods, more cramps, spotting between periods or heavier discharge from their
vaginas. These often settle down after their bodies get used to the IUD, but
some women decide to have the IUD removed.
For a few women, the IUD can cause serious problems. It is rare, but the IUD can
push through the wall of the uterus. Also, if pregnancy occurs with an IUD in
place, there is a higher chance of having a tubal pregnancy. But the most
serious problem is pelvic infection. You may want to read the message on Pelvic
Inflammatory Disease, in the Sexually Transmitted Infections section.
The IUD has a thread on it which hangs down through the cervix. This lets a
woman check that the IUD is in place, and makes it easy for a doctor to remove
it. The woman should check with her finger every week during the first month
after the IUD is inserted, and monthly after that. The IUD doesn't interrupt
love-making, isn't messy and doesn't have to be remembered at the same time
every day.
The IUD will not prevent sexually transmitted diseases. Sometimes bacteria, such
as those causing gonorrhea or chlamydia, will travel up the thread into the
uterus. So there is a greater risk of getting a sexually transmitted disease
while an IUD is in place. The bacteria can cause a pelvic infection which can
leave a woman infertile, that is, unable to get pregnant. However, this happens
very rarely if a woman has only one sexual partner or practices safer sex. There
is a greater chance of getting a pelvic infection if you have had a pelvic
infection or a tubal pregnancy. Some doctors will not insert an IUD in a woman
who plans to have children in the future.
If you do try an IUD, remember you might feel abdominal pain and cramps at
first. The IUD danger signs include unusual heavy abdominal pain or cramps,
heavy bleeding, fever or chills, or unusual vaginal discharge. If you have any
of these danger signs, or if you just want more information about the IUD, you
can call a local Planned Parenthood organization or a Public Health Unit -- see
References/Resources.

Natural Family Planning: Is There A Safe Time Of The Month?
Many people wonder if there's a safe time of the month when a woman can have
intercourse without getting pregnant. There may be, but you can't know when just
by guessing or counting days on a calendar. Pregnancy is possible the very first
time a woman has intercourse and at any time during a woman's menstrual cycle,
even during her period. Sperm can live inside a woman's body for several days.
Natural Family Planning or Fertility Awareness is not the old "Rhythm Method".
It can be used to prevent pregnancy, and combined with other birth control
methods for greater effectiveness.
Every month, a woman's body gets ready for pregnancy. An ovum or egg leaves one
of her ovaries and travels down her tubes. If the egg meets a sperm, it is
fertilized and a pregnancy starts. The egg leaves the ovary about 2 weeks before
her period starts; however, this time can depend on things like illness, stress,
travel or changes in diet. This means that the egg could leave an ovary a few
days earlier or a few days later than usual. For some women this could happen
during their period. Once the egg leaves the ovary, it can take a day to travel
down the tubes. If it meets a sperm at any time, the woman can get pregnant.
You can see why just guessing or counting days on a calendar can't tell you when
the chance of pregnancy is small. The method called Natural Family Planning
teaches couples how to tell what days of the month are safest. They learn how a
woman's temperature changes during her monthly cycle, how to take it and record
it on a graph. They also learn how her vaginal mucus changes during her cycle.
People need patience, cooperation and special training to use this method
properly. There are courses in some communities for couples to take. You can
also get books and pamphlets in libraries and Public Health Units.
If you are interested in learning more about natural family planning or birth
control, you can call a local Planned Parenthood organization or Public Health
Unit -- see References/Resources.

Sterilization For Men: Vasectomy
Vasectomy is a permanent method of birth control for men. It is a simple 15-30
minute operation which prevents the man's sperm from being released during
sexual intercourse.
During a vasectomy, the vas deferens or tubes which carry the sperm are cut and
tied. This prevents sperm from getting into semen. When a man has sex, he still
releases semen, but the semen doesn't contain sperm. Therefore he can't start a
pregnancy.
The operation is done in a doctor's office or the outpatient department of a
hospital. A local anesthetic is used, numbing or freezing the genital area.
After giving the man an anesthetic, the doctor makes a small cut on each side of
the scrotum, the sac which holds the testicles. The tubes which carry sperm are
cut and tied, and small cut is sewn up.
Most men recover from a vasectomy in a day or two. There is pain and bruising,
and he will need to take it easy at first. Ordinary pain killers are often
helpful.
A vasectomy is not effective right away. There are still sperm in the tubes
above the place where they are tied off. After about 6 weeks, the man needs to
go back to his doctor to make sure that no sperm are getting into his semen.
Until the doctor is sure this isn't happening, the couple should use another
kind of birth control, like condom and foam, to prevent pregnancy.
A man's sex drive is affected by a hormone called testosterone which is produced
in the testicles. This doesn't change because of a vasectomy. The penis and
testicles are not affected. Only two tiny pieces of tubes are removed. Vasectomy
is one of the most effective methods of birth control: over 99.9% effective.
You should not have a vasectomy unless you are sure that you will not want
children in the future. There is no guarantee that a vasectomy can be reversed,
although some men have had this done. The reversal operation is long and
difficult and not always successful. Be sure before you decide to have a
vasectomy.
For more information about vasectomy, you can call a local Planned Parenthood
organization or Public Health Unit -- see References/Resources.

Sterilization For Women: Tubal Ligation
Sterilization for women, or tubal ligation, is a permanent method of birth
control. The fallopian tubes which carry eggs from the ovaries to the uterus are
closed off. This operation is often called "having your tubes tied". Some women
stay overnight in hospital, while others have the operation done in the
hospital's outpatient department.
Tubal ligation is nearly always successful, and very few tubes ever grow back
together again. This makes it the most effective method of birth control: over
99.9%. After one menstrual period following the operation, a women can have
intercourse without risk of pregnancy.
It "usually" does not affect her menstrual periods, or her sex drive. The uterus
or womb is not removed; however, sperm can no longer reach the egg. Some women
enjoy sex more when they do not have to worry about pregnancy.
A woman needs a general anaesthetic for this operation and time to recover after
she wakes up. Therefore, there is a slightly greater risk with tubal ligation
than there is with vasectomy for men. Vasectomies are done under local
anesthetic, freezing the genital area, and do not require cutting into the
abdomen. You may want to listen to the message on Vasectomies, also in the Birth
Control menu.
Some women who have had a tubal ligation try later on to have their tubes
reconnected, but it is a long and difficult operation and hardly ever
successful. A woman should not have a tubal ligation unless she is sure that she
will not want children in the future.
For more information, you can call a local Planned Parenthood organization or
Public Health Unit -- see References/Resources.

The Morning After Pill and Post-Coital IUD
What can you do if the condom breaks? What can you do if you had unprotected
sexual intercourse, and don't want to become pregnant? What can you do if you
have been sexually assaulted? There is something to do if you act quickly.
The Morning After Pill is really four hormone pills. A doctor can prescribe them
to a woman who has had intercourse once within the past 72 hours, or 3 days. It
will not interrupt a pregnancy from a previous act of intercourse. And it does
not protect you from pregnancy for the rest of your cycle. It affects the lining
of your uterus or womb so that a fertilized egg can't implant.
A woman is given 4 pills. She takes 2 as soon as possible, and the other 2 pills
12 hours later. Be careful not to sleep through this time!
The pills might cause nausea and vomiting, especially with the second set.
Taking a tablet such as Gravol and having something to eat half an hour before
she takes the second dose, might help. Then take the second dose with a glass of
milk (not water). Some doctors and clinics give a third set of pills in case the
second set is vomited. If they are not needed, they should be thrown away.
Other possible side effects can be spotting or bleeding from the vagina, cramps
and diarrhea. These are temporary but may last several days. The bleeding is not
a menstrual period. The period will probably come when it is due. If it does
not, then the woman should have a pregnancy test. The Morning After Pill will
not protect you from pregnancy for the rest of your cycle.
The effectiveness rate for the Morning After Pill is very high -- about 98%,
especially if taken early; however, a woman should consider what she would do if
it doesn't work. Then she may choose to have an abortion or continue the
pregnancy.
Many doctors and clinics prescribe the Morning After Pill. You can often get it
at the Emergency Ward of a hospital, which is open 24 hours a day. But call
before you go to make sure.
The Morning After Pill is simpler than the second option in this situation: a
post- coital IUD. Some doctors will insert an IUD in a woman after intercourse
to prevent pregnancy. This can be done up to 7 days after unprotected
intercourse. You may want to listen to the message on the IUD in the Birth
Control Menu.
For more information, you can call a local Planned Parenthood organization or
Public Health Unit -- their numbers are listed in the Referrals section of the
Facts of Life Line.

Norplant
Norplant is available in many countries around the world. Since March 1994,
Norplant has also been available in Canada.
Women who want a long-term method of birth control but may want to have children
in the future might consider Norplant. If you chose Norplant, you would not have
to remember to take the Pill every day, or to use contraceptive jelly or foam
every time you had intercourse. Norplant costs between $450 and $500 in Canada,
which works out to less than $13 a month over five years. Some insurance plans
may cover part of the cost.
Norplant is a set of six small capsules or rods, about the size of matchsticks.
A specially trained doctor makes a small cut in a woman's upper arm and inserts
the rods just under the skin, in a fan shape. This takes 10 to 15 minutes. No
stitches are needed, but a bandage will cover the area for a few days.
Once inserted, the capsules become effective within 24 hours, and prevent
pregnancy for up to five years. They do not prevent sexually transmitted
diseases.
The Norplant capsules release the hormone progestin, also present in many birth
control pills. It stops pregnancy in three ways.
First, it helps prevent ovulation, or release of an egg each month. Second, it
increases the thickness of the woman's cervical mucus. This makes it harder for
sperm to enter the uterus or womb. It also decreases the thickness of the lining
of the uterus, also called the endometrium. A fertilized egg needs to attach
itself to a thicker lining.
Norplant contains no estrogen. It is therefore an option for women who cannot
take birth control pills which have estrogen.
Even though they will work for five years, the capsules can be removed from a
woman's arm at any time, for any reason. Removal is also done by a trained
doctor. A woman can become pregnant shortly after the capusles are removed.
Norplant is as safe and more effective than the birth control pill. Its
effectiveness rate in the first year is more than 99%. This rate gets a little
lower in following years, and is slightly lower for women who weight more than
70 kilgrams or 154 pounds.
In the rare instance when a woman using Norplant does become pregnant, there is
a slightly higher risk of ectopic or tubal pregnancy. There is no evidence that
Norplant causes birth defects.
Many women who use Norplant experience side effects, especially during the first
year. The most common side effect is irregular menstrual bleeding. Usually this
means longer but often lighter periods, or bleeding between periods. Other side
effects can include weight gain, acne, depression, headaches, hair growth and
itching around the capsules. Very rarely, there is numbness in the arm around
the capsules.
It is very important for a woman considering Norplant to talk to a counsellor.
Counsellors can describe Norplant's advantages and disadvantages, possible side
effects and suggestions for dealing with them.
Norplant is not a good choice for some women, including women who have liver
disease, breast cancer or a history of blood clots. Women who are pregnant or
think they might be pregnant should also not use Norplant.
For a woman who is well informed and who protects herself and her partner
against sexually transmitted diseases, Norplant may be a good birth control
method. For more information, you can call a local Planned Parenthood
organization or Public Health Unit -- see References/Resources.

Other Methods of Birth Control and RU486
Some methods of birth control which are available in Canada, might not be that
well known. The cervical cap is similar to the diaphragm. It fits tightly over
the cervix, partly by suction. A woman must be fitted at a doctor's office or
clinic. It should be one third filled with spermicidal jelly or cream six hours
or less before intercourse. Then it is left in place for six to 24 hours after
the last act of intercourse. The cervical cap, made of latex, needs to be
carefully removed, washed and dried after use. Its effectiveness rate is between
82 and 92%, depending on how carefully it is used.
The contraceptive sponge is available at drug stores without a prescription. It
can be inserted in a woman's vagina up to 24 hours before intercourse, so many
women find it convenient. To use the sponge, first wash your hands, then remove
the sponge from its package. Put it under tap water to wet it thoroughly,
squeezing it several times until it becomes foamy. This activates the
spermicide. Insert the sponge carefully into your vagina as far as it will go,
so that it covers the cervix. The sponge provides protection for 24 hours. It
should remain in place for 6 to 8 hours after the last act of intercourse. The
sponge can't be reused -- throw it away after you remove it. The sponge has a 72
to 91% effectiveness rate, depending on how carefully it is used, and on whether
the woman has had a full term pregnancy. Effectiveness is greater for women who
have not given birth.
Depo Provera is used as a contraceptive in many countries around the world. In
Canada it is approved for other medical purposes, but it is beginning to be used
as a method of birth control by some people here as well. It is injected into a
muscle every three months to prevent pregnancy. It will not prevent sexually
transmitted diseases. "Depo" changes a woman's menstrual bleeding, so that after
three or four injections most women will have no bleeding at all.
Great care must be taken to be sure that a woman understands what Depo is, how
it works, its effectiveness (which is over 99%), who can use it, advantages and
disadvantages. Although some women choose Depo themselves, it has been used in
the past to control fertility in other women who did not know what it was or
what it might do to them. Many people are still concerned about improper use of
Depo.
Some of Depo's benefits may include decreased menstrual cramps, and lower rates
of uterine and ovarian cancers. The fact that it is reversible is an advantage.
About 80% of women find that they can become pregnant within one year after they
stop using Depo. Many women find it extremely satisfactory. But, it doesn't
prevent sexually transmitted diseases.
Contraceptive suppositories are available at drug stores. These are inserted
into the woman's vagina 10 minutes or more before intercourse so they have time
to fully dissolve. Their effectiveness rate is 80 to 85%. When you buy
suppositories, make sure that the package says they are for "contraceptive" use.

There is a female condom available in some countries. This gives the woman more
control over her own protection. It is a pre-lubricated sheath of latex similar
to the condom for men, but has a ring at the bottom end. The top end is closed,
and fits over the woman's cervix like a diaphragm. The bottom end is open. It
covers the labia, or lips of the pubic area. Like the condom, it is disposable.
Vaginal Contraceptive Film, or VCF, is a semi-transparent square of film which
is placed high in a woman's vagina, as close as possible to the cervix. It
dissolves into a gel, and remains effective against pregnancy and some sexually
transmitted diseases for two hours. It does not need an applicator. It is not
yet available in Canada.
RU486, or the "French" or "Abortion" Pill is an alternative to a surgical
abortion. It is also being studied as a Morning After Pill. Although it is now
being used in some countries, it is not yet available in Canada. In countries
where it is available, RU486 can be prescribed by a physician if a woman has
decided to abort a pregnancy. The pill is followed by an injection or another
pill two days later, and then a check-up. It is a safe and effective method of
abortion which does not require surgery.
Scientific research continues, but at the moment, not having intercourse is the
only way to be 100% sure a woman will not become pregnant.

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