Hormonal Methods - Page 10

The term "hormonal contraception or birth control" refers to birth control that contain estrogen and/or progestins.  These ingredients are similar to those hormones produced by the ovaries and are responsible for the process of ovulation and the menstrual cycle.

Important general information:

Hormonal contraception offers NO PROTECTION against sexually transmitted infections.  Condoms may be used to reduce the risk of STD's.

All forms of hormonal contraception requires a prescription from a health care provider.

There are two categories of hormonal contraception:

• Combined hormonal contraceptives (CHC) - those containing both estrogen and progestin (i.e. the pill, the vaginal ring and the patch)

• Progestin-only agents - those containing only progestin (i.e. the Progestin-only pill and DepoProvera^®)

IT IS IMPORTANT THAT EACH WOMAN DISCUSS HER MEDICAL HISTORY WITH HER HEALTH CARE PROVIDER BEFORE BEGINNING ANY HORMONAL CONTRACEPTIVE METHOD.

Combined hormonal contraception (CHC) include birth control pills, NuvaRing^® and OrthoEvra Patch™.  Because these three methods all contain estrogen and progestin, there are similarities between them.  In order to avoid repetition these similarities will be discussed, then some specific information about each method will be reviewed.

Combined hormonal contraceptives have excellent effectiveness ratings - in the 97-99 percentiles - because they work in three ways:

1. Ovulation (the release of an egg) does not occur

2. Cervical mucus becomes thickened, making it more difficult for sperm to enter the uterus

3. The uterine lining is thinner than normal.  This change helps prevent a fertilized egg from implanting in the uterus.

Fertility returns quickly after a method is discontinued.  Therefore when a woman stops using a CHC method she must make plans to have another method of birth control immediately available unless a pregnancy is planned.  Years and years of research reveal no connection between the use of CHC and birth defects.

CHC usually help regulate menstrual periods, lessen cramps and decrease the amount of period flow. They are often prescribed to treat medical conditions such as ovarian cysts, severe cramps, irregular or absent periods, hormone imbalances, etc., even when a woman does not need the contraceptive effect.

Risks related to combined hormonal contraceptives:

Abnormal blood clotting is the primary risk related to use of combined hormonal contraception.  In a small number of women the estrogen changes the way that the body forms blood clots.  Blood clots may form in the legs, lungs, brain or other vital organs and cause serious health problems.  Factors contributing to the risk include:

Smoking: contributes to narrowing of the blood vessels and slows blood flow; blood clotting occurs more quickly if blood flow is not adequate.  Therefore, women are encouraged to STOP SMOKING when they are using any combined hormonal contraceptive method.  The risk is greater when a woman smokes 15 cigarettes or more per day.  The risk is greatest when a women reaches 35 years of age.

Migraine headaches may cause a higher risk of stroke.  This risk increases when women who have migraine headaches take estrogen, especially when they experience auras or symptoms such as flashing lights, visual disturbances, weakness affecting one side of the body, difficulty walking, etc. with their headache.  It is important to realize that for most women the risk of taking CHC's are lower than those risks associated with pregnancy and childbirth.

Other contributing factors increasing the risk of blood clotting problems include being overweight, having diabetes, high cholesterol and high blood pressure.

If you experience any of the following symptoms, you should seek medical care immediately.  Inform them that you are using hormonal contraception.

A - Abdominal pain (severe, sudden onset)
C - Chest pain, shortness of breath, coughing up blood
H - Headache (severe, unrelenting), numbness, or weakness in arms or legs
E - Eye problems: sudden vision changes, blurring, flashing lights
S - Severe leg pain in calf or thigh

SIDE EFFECTS are also similar among all CHC methods.  Most side effects are temporary and seldom serious.  Most will occur within the first 1-3 months of use and should resolve quickly as the body adjusts to the medication.  Most women will experience only a few of these side effects.  If you experience any severe side effects or if they last more than three cycles, you should consult with your health care provider.

The most common side effects are listed below:

• Spotting or break through bleeding refers to bleeding that occurs while a woman is taking active birth control pills, or is wearing the patch or the ring.  The bleeding may be only light spotting or may seem as heavy as a regular period.  Contact your health care provider if you have cramps or fever along with the bleeding, or if you notice a change in your normal vaginal discharge prior to the onset of bleeding.  If you are on the pill be sure you are taking it at the same time everyday.  DO NOT discontinue the pill, patch or ring until you have talked to your health care provider; the bleeding will often subside within the first two months of use.

• Nausea usually will occur when a woman first begins using the CHC method.  It does not usually last more than a few days and rarely causes vomiting. Nausea may be reduced by eating small frequent meals; if on the pill - try taking it at night with food.

• Breast tenderness may occur at any time in the menstrual cycle but may be worst just prior to the period.  A few women report an increase in breast size/fullness.  Contact your provider if you notice a breast lump or notice changes only in one breast. Decreasing your caffeine intake may reduce tenderness.

• Skin changes/acne may occur initially but with continued use your complexion will often improve.  Infrequently, areas of the skin may spontaneously darken.  Contact your health care provider if this occurs.

• Mood swings, irritability and depression may increase during the first few weeks of CHC use.  If it persists or develops into depression it is important to talk with your health care provider.  Vitamin B-6, 50-100 mg. per day may help relieve minor symptoms.

• Fatigue may occur in the first month of use but usually tapers off quickly.

• Weight changes of usually only 3-4 pounds may occur and with the newer low dose hormonal methods available, is less a problem.  Some women report changes in appetite.  Sometimes weight gain is related to fluid retention.

• Headaches (1) that are more severe than most headaches experienced in the past (2) that do not respond to over-the-counter remedies (3) that are occurring much more frequently, contact your health care provider right away.

These are the most common side effects but there are many more potential side effects that you as an individual may experience.  Refer to the health information flyer that comes with each package of hormonal contraceptives for a complete list.  If any symptom is severe or persistent, contact your health care provider.  McKinley students may call the Dial-A-Nurse at 333-2700 (select Women's Health).

If you experience persistent or very unpleasant side effects, we urge you to talk with your provider before you stop your birth control method.  It may be possible to offer some suggestions that will help you adjust to the medication.  If you stop your birth control method you may be immediately at risk for pregnancy.

We will now briefly review information on the individual methods of combined hormonal contraception.  Each section contains hyperlinks to the complete handout for that specific method.  You are asked to read that handout if you have a definite interest in that method of birth control.

BIRTH CONTROL PILLS:

• Prescriptions at McKinley Health Center require a Co-pay.  This co-pay may vary depending on the pill brand.

• Swallow the pill at the same time every day.  This helps make the pill more effective and lessens the likelihood that you will forget it.

• Monthly pill packages contain 21 active pills and 7 reminder or placebo pills.  The active pills contain the needed hormones.  The reminder pills contain no medication but taking the reminder pills daily will help you remember to start your new pill pack on time.  The 7 reminder pills are always the last 7 pills in the pill package and will be a significantly different color than the other pills in the package.

• Contraceptive protection is continuous even during the placebo week of pills, as long as all of the active pills were taken as directed.

• Your period will usually start after taking 2-4 reminder pills and will usually end about the time you finish taking the reminder pills.

• How to START the Pill: There are 3 common methods of starting the pill:

Sunday Start: Take the first active pill in your first pill pack on the FIRST SUNDAY after your period STARTS.  If you use the Sunday start, it is necessary to use condoms until you have taken seven active pills.

First Day Start: Take the first active pill in your first pill pack on the day you start your period.  It is not necessary to use any additional method of birth control.

Quick Start: Take your first pill the day of your appointment with your provider, regardless of where you are in your menstrual cycle. This allows you to start your pills immediately, without waiting until you get your period. If you use the Quick Start method, it is necessary to use condoms or another back-up method of birth control until you have taken seven active pills. Women concerned about a possible pregnancy before starting the pill should wait until they get their period and choose either the first day start or Sunday start method. If using the Quick Start method, your period may be delayed until you take your placebo pills. If you do not get a period during the placebo week, take a urine pregnancy test. You may experience break-through bleeding; continue taking your pills if unscheduled bleeding occurs.

• Forgotten/Missed Pills: Refer to the birth control pill handout or the pill insert for specific instructions if you forget to take a pill.  If you have any doubt about what to do about making up missed pills, begin using a back up method of birth control until you can talk to your health care provider.

Additional Information:
The Pill

OrthoEvra™ Patch:

The OrthoEvra™ Patch is a thin, beige square with one sticky side that is applied directly to the skin surface. The medication is absorbed from the patch into the blood stream through the skin.

• The patch can be worn on the upper back, or below the waist on the abdomen or buttocks. It should not be worn on or near the breasts. Each new patch should be placed in a new location. The patch may be visible to others when bathing or changing clothes. 
  

• Apply a patch each week, on the same day each week for three weeks. Remove the old patch when the new one is applied. When applying the patch, move your finger over the surface of the patch, pressing firmly for 15-20 seconds. This will help the patch stay in place. Remove the 3rd patch at the beginning of the fourth week and do not reapply. Your period will generally come during this week. Contraceptive protection continues throughout the patch-free week. 
  

• The patch is designed to stay on even if you are swimming, bathing or exercising. 
  

• Occasionally a woman will have a sensitivity to the adhesive in the patch. Those who have a known allergy to adhesive bandages may not be good candidates for the patch. 
  

• The patch is not recommended for women who weigh more the 198 pounds/90 kg because it may not provide adequate birth control. 
  

• The patch is available to registered University of Illinois students in the McKinley Health Center Pharmacy. There is an additional charge for this prescription. 
  

• Refer to OrthoEvra™ Contraceptive Patch handout or package insert for specific instructions about starting the patch because instructions vary depending on what method of birth control you have been previously using.

Additional Information:
OrthoEvra™ Contraceptive Patch

NuvaRing^®:

NuvaRing^® is a soft, flexible ring that is approximately 2 inches in diameter.  It is worn in the vagina for three weeks and removed for one week.  The period starts 3-4 days after removing the ring.

• The medications are instilled in the ring and are absorbed directly from the ring into the blood stream through the vaginal wall.

• NuvaRing^® is available at McKinley Health Center.  There is an additional cost for this prescription.

• The ring should not cause any discomfort to either partner during intercourse.

• NuvaRing^® offers a very discreet and private method of birth control.

• Refer to the NuvaRing^® handout or package insert for specific instructions about starting the NuvaRing^®, because instructions vary depending on what method of birth control you have previously been using.

• The ring is inserted by pinching the sides of the ring together and placing it inside the vagina.  Use the index finger to gently push it deeper inside the vagina.

• To remove the ring, insert a finger inside the vagina, locate the ring and gently pull.  The ring will come out without any pain.  Contraceptive protection continues throughout the ring-free week.

Additional Information:
NuvaRing

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