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Back to Birth Control Methods.

IUD
Fertility Awareness
Abstinence
Withdrawal
Please read our disclaimer

IUD

The IUD is a T shaped device that is inserted into the uterus to prevent pregnancy. We offer two different types of IUDs at Aradia, one with copper (ParaGard©) and one with a progestin hormone (Mirena©).

ParaGard©: The metallic copper of the ParaGard© IUD enhances its contraceptive effect. The copper IUD causes an interference with sperm transport, fertilization and implantation. Copper IUDs do not prevent ovulation.

Mirena©: The contraceptive effect of the hormonal IUD is believed to be based on the local effects of the progestin in the uterus. It is believed to thicken the cervical mucus (decreasing sperm penetration), slow down sperm movement and function inside the uterus and fallopian tubes to prevent fertilization, and thin the endometrium (which may reduce the likelihood of implantation). Ovulation will be inhibited in some women.

How well it works:

THe IUD is very effective. IUDs are between 99.2 percent and 99.9 percent effective at preventing pregnancy. This means for every 100 sexually active women using the IUD, less then one of them will become pregnant in the first year. The copper IUD is effective for 10 years and the hormonal IUD for five years.

When can an IUD be inserted?

  • Anytime during the menstrual cycle with the use of hormonal birth control
  • Following two weeks of abstinence at anytime during your cycle
  • At least six weeks following a complete abortion or miscarriage
  • At least six weeks after you've given birth. Neither IUD interferes with breast feeding

No back-up method is required following an IUD insert. However, if you are on a hormonal contraception, you should complete the remainder of the cycle.

What are the requirements for an IUD to be inserted?

  • A recent consult with a Health Care Advocate at Aradia
  • An annual exam and normal pap smear within the last year
  • A negative Chlamydia and Gonorrhea screening within the last two months
  • A negative pregnancy test at the time of insert

How is the IUD inserted?

First, the practitioner will perform a pelvic exam to feel the size, shape and location of your uterus. Next, a speculum is inserted into the vagina and then the cervix is swabbed with an antiseptic soap. The practitioner may then do a series of injections with numbing medication in the cervix. Not all women feel these; if you do, you may feel a pinch or poking sensation. After your cervix is numb, the practitioner will insert an instrument into your uterus to check the size for accurate placement of the IUD. Most women experience this as a strong cramp. Once the size of your uterus is known, the IUD is inserted which may also feel like a strong cramp. Once the IUD is in place, the practitioner will trim the thin strings that are connected to the IUD and used for removal. You should check these strings with each period after the IUD has been inserted.

How is the IUD removed?

A speculum is placed in the vagina and, with a pair of forceps, the practitioner holds onto the strings and gently pulls on them to remove the IUD. Another IUD can be inserted at this same time.

Check-ups:

It is important to have a routine follow-up one to three months after the IUD is inserted. After that, if you are not having problems, you should have your annual exam and pap smear once a year.

Disadvantages:

  • No protection from Sexually Transmitted Infections
  • Spotting between menstrual periods
  • Heavier and longer menstrual periods with an increase in cramps (with ParaGard©)
  • Possible decrease in or absence of menstrual periods (with the Mirena©)
  • Expulsion of the IUD. This mostly likely occurs with one's period, so be sure to always check for the strings of the IUD.
  • Immediate medical care must be received if there is any sign of vaginal infection

Some women with a Mirena© IUD also note an increase in headaches, breast tenderness, mood changes and nausea in the first three months.

Who should NOT use the IUD?

You should NOT use an IUD if you:

  • Think you might be pregnant
  • Have a history of a pelvic infection (PID)
  • Have unexplained vaginal bleeding
  • Have a recent abnormal pap smear, cervical or uterine cancer
  • Have multiple sexual partners or your partner has multiple sexual partners
  • Have Wilson's disease or copper allergy (ParaGard© IUD)
  • Have an allergy to levonorgestrel, silicone or polyethylene (Mirena© IUD)

Warning signs:

The following problems may be warning signs of a serious problem. Do not ignore these signs or wait to see if they go away. Contact your health care provider if you experience:

  • A missed or late menstrual cycle
  • Pregnancy symptoms (especially with Mirena© because of the lack of menstruation)
  • Pain or bleeding during sexual intercourse
  • Unexplained fever or chills
  • Unusual vaginal discharge or were potentially exposed to a sexually transmitted infection
  • Unable to feel strings or able to feel the IUD

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Fertility Awareness Method (FAM)

Fertility awareness-based methods can be somewhat effective when they are used correctly. However, they are not effective when used incorrectly because, with incorrect use, unprotected intercourse takes place when the woman is potentially fertile.

Couples need an instructor's help to learn how to observe, chart and interpret the woman's fertility signs and patterns. It is important to meet with your health care provider before using this method.

The fertility awareness method entails using a birth control method or abstaining from intercourse during unsafe fertile times of a woman's cycle in order to prevent pregnancy. When a woman is fertile, she is able to become pregnant. Using a barrier method such as a diaphragm, cervical cap, female condom or male condom can help to prevent pregnancy during these times. FAM is most reliable for women with regular menstrual cycles. As a woman becomes more familiar with the signs of ovulation and the pattern of her menstrual cycle, FAM becomes more effective. In order to use this method most effectively, a woman must:

  1. Abstain from intercourse during fertile times of cycle
  2. Identify beginning/ending of fertile times of cycle
  3. Observe and track cervical secretions

    • Estrogen changes cervical secretions due to increased amounts by the growing follicle in the ovary. The initial secretions can be sticky, thick and cloudy; at peak, secretions are clear, stretchy and slippery. The secretions help to facilitate sperm transport.


    • Near mid-cycle the pituitary gland releases LH (lutenizing hormone), which triggers ovulation causing the follicle to transform into the corpus luteum; this begins to produce progesterone while continuing to produce estrogen. The progesterone counteracts the estrogen, causing cervical secretions to dry up and form the mucus plug, thus preventing sperm from traveling through the cervix.

  4. Monitor change in position and feel of cervix

    • Estrogen and progesterone cause changes in the position and feel of the cervix. As ovulation approaches, the opening of the cervix becomes softer and wider and the cervix itself pulls higher in the vagina. After ovulation, the cervix returns to a lower position and the opening closes and becomes more firm.

  5. Monitor change in basal (resting) body temperature

    • Progesterone also acts on the hypothalamus increasing basal body temperature during ovulation.

  6. Use calendar calculations

How well it works:

Fertility awareness methods are only somewhat effective as birth control methods as commonly used. The rate of efficacy is about 80 percent. This means for every 100 sexually active women using fertility awareness, 20 of them will become pregnant in the first year.

Fertility awareness can be effective or very effective when used consistently and correctly. It can be about 91 percent-99 percent effective. This means for every 100 sexually active women using fertility awareness, one to nine of them will become pregnant in the first year.

This success is based on: accuracy of method in identifying fertile time, ability to correctly identify this time and ability to follow rules of method. Instruction and training is essential to increase the efficacy of this method.

Advantages:

  • Can have minimal costs
  • Increases knowledge of reproductive potential and self-reliance
  • Partner cooperation

Disadvantages:

  • No protection against Sexually Transmitted Infections
  • Lack of partner cooperation
  • Certain conditions can increase difficulty of use:
    • Recent discontinuation of hormonal birth control method
    • Beginning period for the first time
    • Approaching menopause
    • Recent childbirth, abortion or miscarriage
    • Currently breastfeeding
  • Not all women can interpret fertility signs correctly
  • Persistent reproductive tract infections can make awareness more difficult

For more information, check out Taking Charge of your Fertility, by Toni Weschler.

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Abstinence

Abstinence used as a method of birth control means abstaining from vaginal intercourse only. While an individual may decide to refrain from other sexual activities such as anal or oral intercourse, which may put her or him at risk for AIDS or other Sexually Transmitted Infections, abstinence to prevent pregnancy is a contraceptive method. Deciding whether one should engage in sexual intercourse forces one to weigh cultural, ethical, religious, moral and psychological factors. "Outercourse," intimate sex without intercourse, can provide great fulfillment. Non-coital forms of sexual intimacy range from holding hands, hugging, kissing, and dancing to mutual masturbation, petting, oral-genital sex, and the use of stimulating devices such as vibrators.

How well it works:

Continuous abstinence is 100 percent effective when used correctly. Outercourse is 99 percent effective. This means for every 100 sexually active women practicing outercourse, one of them will become pregnant in the first year.

Advantages:

  • Some protection from Sexually Transmitted Infections
  • No medical or hormonal side effects
  • 100 percent effective in preventing pregnancy when used correctly
  • No medications or devices necessary

Disadvantages:

  • Can be difficult to maintain for extended periods of time
  • Immediate need for protection upon stopping use

Instructions for use:

  1. Decide about sex when you feel clearheaded, sober and good about self.
  2. Decide in advance which sexual activities you will engage in and discuss this with your partner.
  3. Clearly communicate the "No's" in advance with your partner.
  4. Avoid high-pressure sexual situations and remain sober.
  5. If you say "No," say it clearly.
  6. Educate yourself about other forms of contraception and safer sex in case you stop abstaining from intercourse.
  7. Always have a back-up method such as condoms or Emergency Contraception/Plan B on hand and refrain from intercourse if no such method is available.

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Withdrawal

This method refers to penile-vaginal intercourse where the man will pull his penis out of the woman's vagina before he ejaculates (comes). The male must rely on personal sensation to know when to withdraw. If no sperm is spilled, this method prevents fertilization by preventing the contact between sperm and the egg.

How well it works:

This method is 80 percent effective for typical users. This means for every 100 sexually active women using withdrawal, 20 of them will become pregnant in the first year.

Advantages:

  • No expense
  • No devices
  • No chemicals or hormones
  • Readily available
  • No medical side effects
  • Works as back up method in all situations

Disadvantages:

  • No protection from Sexually Transmitted Infections
  • Increased probability of pregnancy if misused or with inconsistent use
  • Greater need for self control, trust, and experience of the male partner
  • Not withdrawing in sufficient time to avoid ejaculating in or near vagina
  • Not all men foresee when they will ejaculate
  • Interruption of sexual act may decrease pleasure
  • Not good for repeat ejaculation

Instructions for use:

  1. Male should urinate and wipe tip of penis to remove any remaining sperm from previous ejaculation.
  2. Withdraw penis from vagina when male feels like he is about to ejaculate, making sure ejaculation takes place away from vagina or external genitalia.
  3. Keep supply of contraceptive film and/or spermicide available in the event of unintentional ejaculation in or on female genitalia.
  4. Educate self on condoms, Emergency Contraception/Plan B.

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