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Contraception - Introduction
 
     Most women can become pregnant from the time they are in their early teens until they are in their late 40s. About half of all pregnancies are unplanned. . Birth control (or contraception) allows a woman to plan her family--both the number and spacing of children.

     This information leaflet will tell you more about:
     How birth control works
     What types of birth control are available
     How to choose the best method for you
 
How Birth Control Works
 
     To understand how birth control works, you should know what happens during reproduction. A woman has two ovaries, one on each side of the uterus. Each month, one of the ovaries releases an egg into a fallopian tube. This is called ovulation. In most women, it occurs about 12-14 days before the start of the menstrual period. Counting Day 1 as the first day of bleeding, in someone who has cycles every 28 days this will be around day 14 / 15.

     A woman can get pregnant if she has sex around the time of ovulation. During sex, the man ejaculates sperm into the vagina. The sperm travel up through the cervix, through the uterus, and into the tubes. If a sperm meets an egg in the fallopian tube, fertilization--union of egg and sperm--can occur (see figure). The fertilized egg then moves down the fallopian tube to the uterus where it attaches and grows.

     Birth control methods work in many ways. They may:
     Block the sperm from reaching the egg (condom)
     Kill the sperm (spermicide)
     Keep the eggs from being released (birth control pills, injections)
     Change the lining of the uterus or endometrium (IUCD)
     Thicken the cervical mucus to prevent sperm from going across the cervix (pills)
 
 
Methods of Birth Control
 
     There are many methods of birth control. Each method has good points as well as side effects. All of these methods are safe when used appropriately. Some methods of birth control have other non contraceptive benefits. Some also help protect against sexually transmitted diseases (STDs), including acquired immunodeficiency syndrome (AIDS). Today there are many choices of birth control for women and men. More than one method may be used at the same time. For instance, a barrier method may be used with any other method. Using a barrier method with another method increases the effectiveness. It also may help protect against STDs. Some methods such as patch, vaginal rings, diaphragm and cervical caps are not available in India.
 
Barrier Methods
 
     Barrier methods are effective when used the correct way every time you have sex. Even one act of sex without birth control can result in pregnancy. Barrier methods include spermicides, and condoms (male and female):
     Spermicides are chemicals that kill sperm. They are placed in the vagina close to the cervix. They include tablets, foam, cream, jelly, and film (thin sheets that contain spermicide).
     The male condom is a thin sheath made of latex (rubber), polyurethane (plastic), or animal membrane. The man wears it over his erect penis.
     The female condom is a thin plastic pouch that lines the vagina. It is held in place by a closed inner ring at the cervix and an outer ring at the opening of the vagina. The female condom is not freely available in India.

     Another type of barrier method is the sponge. The sponge is a doughnut-shaped device. It is made of soft foam that is coated with spermicide. It is pushed up in the vagina to cover the cervix. It acts as a physical and chemical barrier between the sperm and the cervix.

     Spermicides are chemical barriers. The other methods are physical barriers. They keep the sperm from getting to the egg. Combining spermicides with physical barrier methods provides more protection. Some people may be allergic to latex. These people might consider using condoms made from plastic or animal membrane. Keep in mind, however, that condoms made from animal skin do not provide the same protection against STDs.
 
How to use a condom
 
     Proper condom use also helps protect you and your partner against STDs. A condom should be used any time you have sex. Only water-based lubricants can be used safely with a condom. It is unsafe to use oils or lotions, such as petroleum jelly, olive oil, or cold cream.

     To use the male condom, place the rolled-up condom over the tip of the erect penis. Hold the end of the condom to allow a little extra space at the tip, then unroll the condom over the penis. Right after ejaculation, grasp the condom around the base of the penis as it is withdrawn. Throw the condom away. It should never be reused.
 
Intrauterine Device
 
     The IUD is a small, plastic device that is inserted and left inside the uterus to prevent pregnancy. Until now only the copper containing IUCD was available in India. Now a hormonal IUD is also available for contraceptive use.

     Both types of IUDs are T-shaped, but they work in different ways. The hormonal IUD releases a small amount of progestin into the uterus. This thickens the cervical mucus, which blocks the sperm from entering the cervix. It also thins the endometrium. This keeps a fertilized egg from attaching and makes menstrual periods light. The hormonal IUCD or mirena, has also a lower failure rate than the copper IUCD.

     The copper IUD releases a small amount of copper into the uterus. A copper IUD does not affect ovulation or the menstrual cycle. It causes a reaction inside the uterus and fallopian tubes. This can prevent the egg from being fertilized or attaching to the wall of the uterus. It also reduces the sperm's ability to fertilize an egg.
     The IUD is often inserted during or right after your menstrual period. The doctor puts the IUD in a long, slender, plastic tube. He or she places it into the vagina and guides it through the cervix into the uterus. The IUD is then pushed out of the plastic tube into the uterus. The IUD springs open into place, and the tube is withdrawn. Insertion of the IUD does not require anesthesia (pain relief), although you may have some discomfort.

     Once the IUD is inserted, the doctor will show you how to check that it is in place. Each IUD comes with a string or "tail" made of a thin plastic thread. After insertion, the tail is trimmed so that 1-2 inches hang out of the cervix inside your vagina. You will be able to tell the placement of the IUD by the location of this string. The string will not bother you or interfere with sexual intercourse.

     Menstrual pain and bleeding may be increased with the copper IUD, but usually settle down after the first 2 cycles. Both pain and bleeding are decreased with the hormonal IUD. Some women have some cramping and spotting during the first few weeks after the IUD is inserted. Vaginal discharge also can occur. These symptoms are common and should disappear within a month.
 
Warning Signs
 
     These symptoms may signal there is a problem with your IUD. Call your doctor if you have any of the following symptoms:

     Severe abdominal pain
     Pain during sex
     A missed period or other signs of pregnancy
     Unusual vaginal discharge
     A change in length or position of the string

     A doctor must insert and remove the IUD. The hormonal IUD must be replaced every 5 years. The copper IUD can remain in your body for as long as 3 to 5 years. The IUD does not protect against STDs. It may make them worse if you do get an infection.

     Hormonal Contraception: With hormonal birth control, a woman takes hormones similar to those her body makes naturally. These hormones prevent ovulation. When there is no egg to be fertilized, pregnancy cannot occur. The hormones also cause changes in the cervical mucus and uterus that help prevent pregnancy. Hormonal pills, injections, (rings and patches - not available in India) are all very effective.

     For most women, the risk of serious complications is small. However, women older than 35 years who smoke should not use most types of hormonal methods because it increases their risk of heart attack and stroke.
 
Birth Control Pills
 
     One of the most popular methods of hormonal birth control is the birth control pill (oral contraceptive). Most birth control pills are combination pills. They contain the hormones estrogen and progestin. There are many different brands of pills with different doses of hormones. This variety allows a woman to find a pill that is right for her. Some pills contain only progestin.

     Most pills have to be started on Day 5 of the menstrual cycle and continued for 21 days. Somemof the lower dose pills will have to be strarted on Day 1 of the cycle. It is I,portant to be regular with the pill since missing more than 2 tablets may increase the chance of failure.

     Birth control pills help protect against certain types of cancer, such as cancer of the ovary and endometrium. Most experts agree that women who have no other risk factors do not have an increased risk of getting breast cancer. These women can take the pill.

     The pill also helps to keep your periods regular, lighter, and shorter. This makes women less likely to have anemia (low blood iron). The pill also reduces menstrual cramps. It lowers your risk of ectopic pregnancy. Some types of birth control pills also can help treat acne.

     Injections: One type of injection of hormonal birth control, called depot-medroxyprogesterone acetate (DMPA), provides protection against pregnancy for 3 months. This means a woman needs only four injections each year. During the time that the injection is effective, you don't have to do anything else to prevent pregnancy. Injections may be good for people who find daily birth control methods inconvenient. Women who take DMPA injections tend to have no periods but have some spotting or slight irregular bleeding.
 
Emergency Contraception:   
If a woman has sex without any type of birth control or if she thinks her method has failed (for instance, a condom slipped or broke), she may want to use emergency contraception. In this method, certain doses of combination birth control pills are taken within 72 hours of sex without birth control. Talk to your doctor right away if you think you might need this protection. If you use emergency contraception within 72 hours of unprotected sex, your chance of getting pregnant is greatly reduced. Emergency contraception should not be used instead of birth control on a routine basis. Regular use of a birth control method is more effective and has health benefits that emergency contraception does not have.
 
Natural Family Planning
     Natural family planning used to be called the rhythm method or "safe period." It also is called periodic abstinence or, more recently, fertility awareness. It isn't a single method but a variety of methods. Natural family planning does not require drugs or devices. The success of these methods depends on you knowing when you ovulate and not having sex during the fertile period or using another method, such as condoms, during that time.

     Types of natural family planning include:
     Basal body temperature method -- Taking your temperature every day to detect the slight increase just after ovulation
     Ovulation/cervical mucus method -- Noting changes in your cervical mucus
     Symptothermal method -- Combining the basal body temperature and ovulation methods, as well as checking for other signs of ovulation
     Calendar method -- Keep a menstrual calendar for 6 months to figure out your fertile period (also called the rhythm method)
     Lactational amenorrhea -- Ovulation and menstruation usually are postponed in breastfeeding women. If a woman does not ovulate, she cannot become pregnant.

     These methods often are combined to prevent pregnancy. You need to know your body well and you and your partner must be willing to follow the method. This method can only work when you follow it correctly at all times.
 
Withdrawal
     The withdrawal method prevents pregnancy by not allowing sperm to be released in the woman's vagina. This requires the man to take his penis out of the woman before he ejaculates. For this method to work, he must withdraw every time the couple has sex. Drawbacks are that sperm can be present in the fluid produced by the penis before ejaculation and some men fail to withdraw completely or in time.
 
Sterilization
 
     Sterilization for women and men works by permanently blocking the pathways of egg and sperm. This can be done by surgery. The sterilization procedure for women is called tubal sterilization. The procedure for men is called vasectomy.

     Tubal sterilization is done by laparoscopy and minilaparotomy. The fallopian tubes are closed by tying, banding, clipping, blocking, or cutting them, or by sealing them with electric current. The surgery often is performed under general anesthesia. Sometimes women have sterilization right after the birth of a child. This is called postpartum sterilization.

     Vasectomy involves cutting a man's vas deferens so that sperm cannot mix with semen. The tubes that carry sperm to the penis are clamped, cut, or sealed so that the ends do not join again. The man is given local anesthesia. Surgery is done in the doctor's office or a clinic.

     Sterilization is meant to be a permanent form of birth control. If there is a chance you may want to have a baby later, you should not choose this method. Attempts to reverse it may not work. Reversal procedures require major surgery and are expensive.
 
Choosing a Method
 
     At any given time, a couple may find one method of birth control suits their needs better than others. Most women and couples use many methods over their lifetime. Here are some things to think about when choosing a method:
     How well the method works
     How likely you are to use it
     What side effects it has
     How much it costs, month by month and over time
     Whether it helps protect against STDs
     All methods have a chance of failure. When a method is used correctly each time, the failure rates are lower. Any method of birth control described here can work well if it is used correctly. Choose a method you will be able to use on a regular basis. If your method fails, you may want to consider emergency contraception.

     When choosing a method of birth control, you should also think about preventing STDs. Use of condoms is the best way to prevent STDs. They should be used with other methods if you are at risk of STDs.
 
Finally...
 
     No matter which method of birth control you choose, be sure that you know how it works, how to use it, and what side effects may occur. Even with methods that do not need a prescription, you need to learn how to use the method. A doctor, nurse, or family planning counselor can teach you. The more you know about birth control and your own needs, the easier it will be to choose a method that's right for you.
 
Glossary
 
Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in the fallopian tubes.

Estrogen: A female hormone produced in the ovaries that stimulates the growth of the lining of the uterus.

General Anesthesia: The use of drugs that produce a sleeplike state to prevent pain during surgery.

Laparoscopy: A surgical procedure in which a slender, light-transmitting instrument, the laparoscope, is used to view the pelvic organs or perform surgery.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Minilaparotomy: A small abdominal incision used for a sterilization procedure in which the fallopian tubes are closed off.

Progestin: A synthetic form of progesterone (a female hormone that is produced in the ovaries and makes the lining of the uterus grow) that is similar to the hormone produced naturally by the body.

Sexually Transmitted Disease (STD): A disease that is spread by sexual contact, including chlamydial infection, gonorrhea, genital warts, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Vas Deferens: A small tube that carries sperm from a male testis to the prostate gland.