Ch. 11-contraception & abortion.docx

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Department
Family Relations and Human Development
Course Code
FRHD 2100
Professor
Cindy Clarke

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Chapter #11: Contraception andAbortion Contraception in Canada Contraceptive UseAmong Canadian Women • 14.9% women in theAmanda Black study didn’t use contraception • Table on page 272 • The vast majority of Canadian women rely on male condoms and oral contraceptives for birth control • 54.3% used condoms and 43.7% used oral contraceptives—withdrawal was third most popular method used by 11.6% of women Contraceptive UseAmong Canadian Teens • in 2005-2006, Canadian study called Health Behavior in School Aged children found that about one quarter of students in grade 10 had experienced sexual intercourse • contraceptive methods used most often by these sexually experienced youth at last intercourse were condoms( males 47% females 40%) and birth control pills (males 25% and females 33%)—withdrawal was the third most common method (males 8% and females 14%) • large scale study of teenagers in BC found that condom use during last intercourse increased between 1992 and 2003 (64% to 75% among males and 53% to 64% among females) • as teenagers get older and form long term relationships they go on the pill Methods of Contraception Oral Contraceptives (the Pill) • an oral contraceptive is commonly referred to as a birth control pill or simply the pill • there are many kinds of birth control pills varying in hormone types and dosages —birth control pills fall into two major categories: Combination pills nad minipills • combination pulls contain a combo of synthetic forms of the hormones estrogen and progesterone. Most combo pills provide a steady dose of synthetic estrogen and progesterone—other combination pills called multiphasic pills, vary the dosages of these hormones across the menstrual cycle, reducing the overall dosages and possible side effects women are exposed to • the mini pill only contains synthetic progesterone (progestin) How it Works: • in normal period, low estrogen levels during and just after menstrual phase stimulate the pituitary gland to secrete follicle stimulating hormone, which in turns stimulates maturation of the ovarian follicles • the estrogen in the combination pill inhibits FSH production, so follicles don’t mature Chapter #11: Contraception andAbortion • the progestin inhibits the pituitary’s secretion of luteinizing hormone, which would otherwise lead to ovulation –the women continues her period, but there are no unfertilized ova to be sloughed off in the flow • combination pill is taken for 21 days of the 28 day cycle, then for 7 day woman takes no pill or takes placebo pill • the sudden drop in hormone levels causes the endometrium to disintegrate and menstruation to follow 3 or 4 days after the last pill is taken, cycle is then repeated • progestin in the combination pill aso increases the thickness and acidity of the cervical mucus—the mucus thus becomes a more resistant barrier to sperm and inhibits development of the endometrium, therefore even if an eff were somehow to mature and be released, sperm wouldn’t be likely to survive the pass through the cervix • the mini pill contains progestin, but not estrogen—minipills are taken daily through the menstrual cycle, even during menstruation. They act in two ways: they thicken the cervical mucus, to impede the passage of sperm thru a cervix and they render the inner lining of the uterus less receptive to a fertilized egg Effectiveness: • when used consistently and correctly, the failure fate of BC is very low— 0.5% or less depending on type of pill • under typical use, failure rate increases to 3% • a woman who misses a pill should take one as soon as possible, and then continue taking one each day. If she misses 3 or more combination pills in a row, however, she should use condoms or abstain from sex until she has taken pills for 7 days in a row • with lowest dose pills, women should take extra caution after missing just two pills Reversibility • a woman may temp. experience reduced fertility after discontinuing oral contraceptives but their use is not associated with permanent infertility • within 3 moths one should ovulate regularly Advantages and Disadvantages • it is nearly 100% effective when its used properly • doesn’t interfere with spontaneity or diminish sexual sensation • reduce risk of pelvic inflammatory disease, benign ovarian cysts and fibrocystic breast growths • pill regularizes the period and reduces cramps • can help in treating iron deficiency anemia and facial acne • combination pill reduces the risks of ovarian and endometrial cancer, even for a number of years after the woman stops taking it • does not protect against STIs • may reduce the effectiveness of antibiotics used to treat STIs • there Is concern with link between pill and breast cancer Chapter #11: Contraception andAbortion • caution women who have hypertension, diabetes, migraine headaches, fibrocystic breast tissue, uterine fibroids and elevated cholesterol levels • estrogen in combo pills may reduce side effects such as nausea and vomiting, fluid retention, weight gain, increased vaginal discharge, headaches, tenderness in breasts, dizziness—these are temporary • many women experience hormone withdrawal symptoms the week they don’t take the pill—headaches, pelvic pain, bloating and breast tenderness • many women have avoided pill because of the risk of blood clots –risks for clotting are lower now than in the 60s • research has found that the pill is safe for most women under age 35 who don’t smoke • women who should avoid the pill are: if they have had circulatory problems, blood clots, coronary disease, heart attacks, strokes, breast or uterine cancers, undiagnosed genital bleeding, liver tumors or sickle cell anemia • pill may psychological effects –depression and irritability Emergency Contraception (EC) • morning after pill—taken after unprotected sex or when contraception fails • two forms are available: most popular is 0.75 milligram tablets of levonorgestrel (known as plan b), taken together • other is known as Yuzpe regimen, it is a hormonal method that combines multiple birth control pills • plan b has fewer side effects than Yuzpe • prevents the joining of the sperm and the egg preventing fertilized eff from attaching to uterine wall • should be taken as soon as possible after the sex-most effective when taken within 72 hours • don’t need prescription • nausea is a common side effect The Contraceptive Patch • delivers estrogen and progestin to prevent ovulation and implantation • it is thin and measures about 5 CM • worn in the stomach, butt, upper arm or upper torso but not on boobs • gradually releases hormones into blood stream • patch is worn weekly for 3 weeks, then 4 week is patch free to allow bleeding • patch is more than 99% effective if used right • doesn’t interrupt sex • side effects are similar to pill The Vaginal Ring • relatively new in Canada • delivers hormones thru the skin • contains estrogen and progestin Chapter #11: Contraception andAbortion • ring is inserted into the vagina and worn for 3 weeks followed by a 4 ring free week for cycle • ring is left in during sex • may experience vaginal discomfort • as effective as the pill • don’t know long term side effects Injectable Contraception • Depo-Provera is an injectable hormone solution that’s available by prescription • contains progestin, it prevents ovulation and its 99.7% effective • administered by needle in muscle of arm or butt every 12 weeks, prevents pregnancy for 3 months • similar side effects as pill • prolonged use—two years or more has been associated with bone loss Intrauterine Devices (IUDs) • used by more than 100 mill woman around the world • most live in china • used by less than 5% of sexually active women of reproductive age in Canada • small objects that comes in a variety of shapes and is inserted into the uterus by doctor • two are available in Canada • 99% effective for about 5 years • check strings several times a month • reduces menstrual bleeding and cramping • excessive menstrual cramping, irregular bleeding between periods, pelvic inflammatory disease The Diaphragm • shallow cup or dome made of a thin latex rubber • rim is flexible metal ring covered with rubber • available by prescription and must be fitted to vagina • inserted and removed by women like a tampon, its like a condom as it forms a barrier to the sperm • its unreliable when used alone—should be used with spermicidal cream or jelly • place a tablespoon of spermicidal cream or jelly on the inside of the cup and spreads it inside the rim • woman opens the inner lips of her vag with one hand the squeezes the ring to fold it with the other—she inserts it against the cervix with the in side facing forward • should be left in at lest 6 hours after sex to allow spermicide to kill remaining sperm In vagina • if used right, failure rate is estimated to be 6% during the first year of use • in typical use, failure is 18% Chapter #11: Contraception andAbortion Cervical Cap • dome shaped rubber cup, must be fitted by doctor • size of a thimble • should be used with spermicide or jelly • when inserting it, women fills the cap about a third full of jelly, then squeezing edges together, the woman insert the cap high in her vag so it presses firmly against her cervix • should be left in place for at least 8 hr after sex • 18%-36% failure rate Spermicides • coat the cervical opening, blocking the passage of sperm and killing sperm by chemical action • come in many forms such as jellies, creams, suppositories and aerosol foams • should be left in place in the vagina for several hou
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