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Contraception and Abortion Notes.docx

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Western University
Psychology 2075
William Fisher

Contraception and Abortion 11/15/2012 7:54:00 PM - contraceptive illegal until 1969 by Pierre Trudeau - before 1969 could be jailed for intending to do anything relating to contraception  statute was under “Offences Tending to Corrupt Morals”  was intended to protect public and preserve social values - 1969 abortion was made legal but there were certain requirements ^- circumstances for abortions were then deemed unconstitutional in 1988 Reasons for Contraceptives  Babies and mothers are healthier when spaced 3-5 years apart  Couples want to limit families  Single women want to avoid pregnancy  Overpopulation  Teenage adolescent crisis o Physicians do not need to inform parents that they are giving out contraceptives if teenager can handle the responsibility Hormonal Methods Pill, patch, vaginal ring, implants, injections Combination Pill Combination birth control pills  oral contraceptives: birth control pills that contain a combination of estrogen and progestin (Alesse Yasmin) - traditional 21-7 pattern, but Seasonal (84) and Loestrin (24 on, 4 off) - continuous or extended pill use is as effective as the traditional pill and results in fewer menstrual days - preferred method: quickstart: stats taking the pill the first day she gets the prescription regardless of the day of the menstrual cycle How it works - mainly by preventing ovulation - estrogen levels are made high  inhibits FSH and ovulation message never sent out - progestin inhibits LH preventing ovulation  backup features o cervical mucus thick, changes lining of uterus to that implantation is unlikely Effectiveness Failure rate: the pregnancy rate occurring using a particular contraceptive method: the % of women who will be pregnancy after a year of use of the method - Effectiveness: 100 minus failure rate failure rate for perfect users: studies of the best possible use of the method  taught well and uses it with perfect consistency failure rate for typical users: failure rate when people actually use the method  using it imperfectly - combination pills  most effective method: PUF: 0.3%, TUF: 8% o failure primarily occurs because they forget to take a pill or take it at inconsistent times o if one forgets for awhile, abstain from sex (use condom) for 7 days Side Effects - many large side effects have no evidence - slight increases in certain disease of the circulatory system  blood clotting (thrombi)  high blood pressure - no evidence that it causes infertility or difficulty with fertility - protects women from endometrial cancer and ovarian cancer - may aggravate existing conditions (breast cancer) - rare but 5+ years increase risk of benign liver tumors - increases amount of vaginal discharge and susceptibility to vaginitis - may cause nausea - increased susceptibility to chlamydia and gonorrhea - weight gain by increasing appetite and water retention - psychological effects: depression, irritability - changes with sexual desire Advantages and Disadvantages - close to 100% effective if used properly - does not interfere with intercourse - reduces menstrual flow - iron deficiency and anemia less likely -acne - protective against certain cancers and pelvic inflammatory disease - cost - burden of contraception, must take at the same time every day - no protection against STI’s Reversibility - stops taking pill after a cycle and can become pregnant 2-3 months later Drug Interactions - some drugs can decrease effectiveness and interfere - can increase the metabolism of some drugs Other Kinds of Pills - dose of estrogen is important since higher doses lead to blood clotting - no more than 30-35 micrograms - current pills have lower doses than early pills - Yasmin combines estrogen with synthetic form of progestin (drospiernone) - high progestin pills can cause vaginitis and depression - triphasic pill: contains a steady level of estrogen like the combination pill but there are 3 phases in the levels of progesterone. The idea is to reduce total hormone exposure although they do not appear to have an advantage over monophasic pills - progestin- only pills: a low dose of progestin and no estrogen and were designed to avoid the estrogen related side effects of the standard pills - the woman takes one beginning of the first day of her period and takes 1 every day afterwards  important to take at the same time every day - work by changing the cervical mucus to prevent sperm from proceeding, inhibiting implantation and inhibiting ovulation (but 40% still ovulate) - TPU: 5 (higher than combination pills) - major side effect: irregular periods - most useful for women who can not take combination pills  +35, smoking, breastfeeding, high blood pressure, clotting  neither pill should be used during first 6 weeks of birth when breast feeding because trace amount of the hormones can reach the infant through the breast milk The Patch - Evra contains the same hormones as combination birth control but is administered transdermal - patch lasts 7 days, and replace each week for 3 weeks then you have a patch free week - use backup method for first couple weeks since it takes a couple days for the hormones to reach effective levels - advantage of not having to remember to take a pill everyday - new and do not have extensive data - hypothesized to have similar side effects to the pill since it contains similar levels of hormones - UFR: less than 1% - somewhat less effective in woman overweight, and potential concern that a woman gets more estrogen from the patch than form the combination pill The Vaginal Ring - flexible, transparent ring made of plastic and filled with the same hormones as those in the pill at slightly lower doses - remains in place for 21 days - data on it is limited (but assumed same side effects as pill) - extremely effective at stopping ovulation - it is expected to be even more effective than the pill because of removing the problem of missed pills - UPR: less than 1% (50% of pregnancies result from incorrect method use) Emergency Contraception Plan B  Levonoregestreal (a progestin)  Treatment is effective if done between 12-24 hrs but no longer than 120  Nausea common side effect  Potential irregular bleeding, fatigue, headache, dizziness, breast tenderness May work in several ways  May stop ovulation  Inhibit functioning of sperm  Prevent fertilization  Inhibit development of nourishing endometrium Its action is to prevent pregnancy and it will not cause an abortion is the woman is already pregnant - it is 75%-89% effective (underestimate)  actual pregnancy rates : 0.5-2%  therefore it is actually highly effective May 2008  Can get it without a prescription  Opponents say that this lets woman be irresponsible Study in BC found that the less the restrictions it doubles its use  But not because of increased irresponsibility  The vast majority use EC only once during the time period for birth control failure  Found that making plan B accessible to teenagers has no effect on whether they have unprotected intercourse or their number of partners Insertion of a copper IUD up to 7 days after unprotected sex is also effective as a form of EX and is more than 98% effective Implants - thin rode or tubes containing progestin - inserted under the skin in a woman’s arm and are effective for 3 years - not approved in Canada Depro-Provera Injections - is a progestin administred by injection - injections must be repeated every 3 months for maximum effectiveness How it Works - inhibiting ovulation, thickening cervical mucus, inhibiting the growth of the endometrium - TUFR: 3%  more effective than the pill Advantages and Disadvantages - it does not interfere with lovemaking - requires far less reliance on memory than birth control - available for woman who can not take the combination pill - users experience amenhorrhea (no menstrual period )  may be a disadvantage or advantage - it can relive anemia (due to heavy periods) - can be used in the treatment of endometriosis Side Effects - No lethal side effects - can result in irreversible bone loss after only 2 years on the drug and that it should only be used for women who are unable to use other contraceptive methods - women using DP should make sure they get enough calcium and vitamin D Reversibility - method is reversible simply by not getting another injection - however woman are infertile for 6-12 months but then are able to become pregnancy at normal rates The IUD and IUS - intrauterine device: small piece of plastic, it comes in various shapes. Metal or a hormones may also be a part of the device - inserted by a doctor or nurse - one of 2 plastic strings hang down from cervix so woman can check if its properly in place - History  1909: Burton Richter: silkworm gut IUD  1920: Ernst Grafenberg, 2000 insertions of silk or silver wire rings very effective  1950: development of plastic and stainless steels, gain in popularity  1970-1980: reduction in popularity because of lawsuits o Dalkon Sheild - only 1 available in Canada: Nova T, Flexi T, T-shaped and contains copper IUS  Intra Uterine System - T shaped and also contains progesterone ( Mirena). Inserted like an IUS but is actually a hormonal method of contraception - 106 million use IUD, 40 million from China, expected increase in popularity How it works - prevents fertilization - produces changes in uterus and fallopian tubes and in this environment sperm that reach the uterus are immobilized and cannot move in the fallopian tube - the egg may also move ore swiftly through the fallopian tube reducing the chances of fertilization - the small amount of copper that is added to the copper T is thought to have an additional contraceptive effect  is alters the functioning of the enzymes involved in implantation IUS Releases progesterone directly into the uterus One effect is to reduce the endometrium Results in reduced menstrual flow and reduced risk of anemia Progestin thickens cervical mucus, disrupts ovulation and changes the endometrium Effectiveness Pregnancy rate: 0.7 after first year  Decreases even further afterwards Copper T IUD  effective for 12 years IUS  effective for 5 years Most failures occur because of expulsion during the first 3 months of use  Most likely to occur to young woman, never been pregnant, women during menstruation  1-7% Side Effects - most common side effects: increased menstrual camps, irregular bleeding, increased menstrual flow  occur in 10-20% of women  most likely immediately after insertion Minera in contrast reduces menstruation  Woman sensitive to progesterone may experiences weight gain, depression, decreased sexual interest - no evidence that the IUD and IUS causes cancer Advantages and Disadvantages - not a high cost -very effective  more effective than the pill but as effective as Depro Provera - once inserted woman has to periodically check strings - can be used safely by woman after giving birth and while breastfeeding - IUD does not interfere with the use of a tampon during menstruation nor does it have any effect on intercourse Reversibility - physician removes devices and woman can get pregnant immediately Cervical Caps and the Sponge - diaphragms no longer available in Canada Cervical Caps FemCap: rubber cap that fits over cervix  3 sizes (smallest being for women who has never been pregnant) Lea’s Shield: soft pliable barrier contraceptive device that prevents sperm from entering cervix - can be inserted several hours before sexual activity and left there for up to 48 hours - should be used with spermicide How it Works Mechanical: blocks the entrance to the uterus so that sperm can not swim up into it - the cream kills any sperm that manage to get past the barrier - any sperm remaining in vagina die after 8 hours  this is why they should not be removed until at least 6 hours after intercourse Effectiveness Typical user failure rate: 20% Most failures are due to improper use  Does not fit well, does not leave it in long enough, not use spermicide Perfect use: 9% To get to 100%, use condom For women who have had children the failure rate can be higher Side Effects - possible irritation of vagina or penis - switch brands of jelly Advantages and Disadvantages - some women dislike touching their genitals - require some thought and presence of mind on the woman’s part - no expensive - have very few side effects and are effective when used properly - do not interfere with sensations or sensitivity or either partner - reduction among cervical cancer rates of diaphragm which may also apply to cap users - can prevent some STI’s  chlamydia since it covers cervix  but does not protect against most STI’s The sponge A method made of polyurethane that contains a spermicide and is placed over the cervix Shaped like a pillow with a concave dimple on one side Effective for 24 hours  Should not be left in longer because of risk of toxic shock syndrome Over the counter without prescription: 5$ each Condoms The Male Condom - thin sheath that fits over penis - can be made of latex, polyurethane, intestinal tissue of lambs - modern condom dates to 1843 when vulcanized rubber was developed - Casanova (1725-1798) one of the first to popularize it - increasingly popular because they protect against STI’s and HIV - must be put on erect penis, and before penetration - come with either plain ended one or pointed end - after man has ejaculated he should take penis out while holding the base - spermicide lubricated ones may create allergies to spermicide Effectiveness - perfect user failure rate: 2%, typical user rate: 18% (but many failures result from improper or inconsistent use) - combined with contraceptive foam: close to 100% effective Side Effects - no side effects, expect some users are allergic to latex Advantages and Disadvantages - ruins spontaneity - some men say it reduces sensation  May be a good thing for some partners  Polyurethane condoms are thinner and should provide more sensation - only contraceptive available for men - cheap and readily available - provide protection against many STI’s  chlamydia, gonorrhea, trichomoniasis, Hep B, HIV - Substantial protection against  herpes, syphilis, human papillomavirus - animal skin condoms are much less effective because they have larger pores that allow some viruses to pass through The Female Condom - made of polyurethane and resembles a clear balloon - there are 2 rings at either end, and inside is prelubricated - penis must be guided in so that penis does not slip in between condom and vaginal wall - condom is removed because woman stands up after intercourse - outer ring is squeezed together and twisted to keep semen inside Effectiveness Typical user failure rate: 21%  unacceptable for some women Perfect user rate 5% Side effects: vaginal or penial irritation Advantages and Disadvantages - made of polyurethane which is less susceptible to tearing and does not deteriorate with exposure to oil based substances - no latex reactions - method that a woman can use herself to reduce her risk of contracting an STI  impermeable to HIV - can be inserted 8 hours before intercourse - spontaneity problem - awkard and loud - least effective method - higher cost than male condoms FC2: synthetic latex and is less expensive and quieter VA: sponge to hold it in place in the vaginal rather than internal ring PATH: urethane foam on the condom pouch so that the condom clings lightly to the vaginal wall Spermicides - a substance that kills sperm - inserted
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