Contraception

The Society of Obstetricians

and Gynaecologists of Canada

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 Introduction

Contraception
Contraception, also known as birth control, is used In this section, we review the methods that are available
to prevent pregnancy. There are many different birth to help you understand the options and help you narrow
control methods to help you and your partner prevent an down the choices. You can always talk over your choices
unplanned pregnancy. You may be starting with a pretty with your health care provider.
good idea of what you are looking for, or you may not be
sure where to start – or which method to choose.

*These summaries are for information purposes only and are incomplete. When considering contraception, patients should
review all potential risks and benefits on a medicine, device or procedure with their health care providers prior to selecting
the option that is most appropriate for their needs.

Topics Covered

Emergency Contraception

Hormonal Contraception
Oral Contraceptive Pill Contraceptive Patch
Vaginal Ring Intrauterine Contraception (IUC)
Injectable Contraception

Non-Hormonal Contraception
Male Condom Female Condom
Sponge Cervical Cap
Diaphragm Spermicides
Vasectomy Tubal Ligation & Tubal Occlusion
Intrauterine Contraception (IUC)

Natural Methods
Fertility-Awareness Based Methods Lactational Amenorrhea Method (LAM)
Withdrawal (Coitus interruptus) Abstinence

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 Emergency Contraception

Emergency Contraception
Emergency contraception is not to be used as a regular method of birth control but, if needed, it can
help prevent unplanned pregnancies.

If you have had unprotected sex and you already know that you do not want to get pregnant,
emergency contraception can help prevent unplanned pregnancies if used as soon as possible.

Some of the reasons that you may consider using emergency

contraception include:
• Missed birth control pill, patch, or injection • The condom slipped, broke, or leaked

• No contraception was used • Error in the calculation of the fertility period

• Non-consensual sexual intercourse (sexual assault)

Emergency contraception is intended for occasional use only, not as a regular method of birth control.

There are two types of emergency contraception to choose from

in Canada:
1. “Morning after pills”
“Morning after pills” are the original method of emergency A second morning after pill, UPA-EC (Ulipristal acetate
contraception. In the past, morning after pills were regular 30 mg, ella®), is now available in Canada, currently
birth control pills, taken in higher doses, 12 hours apart. by prescription only. It is recommended for its greater
There are better and more effective methods available effectiveness over a longer period of time after
on the market today, with fewer side effects. unprotected sex (up to 5 days) and appears to be
equally as effective for those who have a higher BMI.
LNG-EC pills (Plan B, Norlevo, Option 2, and Next Choice)
all contain a progestin called levonorgestrel. These pills are 2. Copper Intrauterine Device (IUD)
available in Canadian pharmacies without a prescription. The most effective method of emergency contraception
The effectiveness of LNG-EC pills is highest when taken is a copper intrauterine device (IUD), which is inserted by
within 24 hours of unprotected sex and declines the later a doctor within 7 days of unprotected intercourse. While
they are taken; but they can be taken up to five days later. currently available by prescription only, the copper IUD
LNG-EC pills will not harm the fetus, should it not be able provides ongoing secure birth control.
to prevent the pregnancy. A high body weight (a body
mass index (BMI) greater than 25) may decrease the
effectiveness of these pills, so it is a good idea to speak
with a health care professional to make sure these pills
are the right choice for you.

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 Hormonal Contraception
Hormonal birth control regulates the change in hormone levels during a woman’s cycle
by using different forms of synthetic hormones that mimic the estrogen and progesterone
that is naturally produced in a woman’s body.

Topics Covered

Hormonal Contraception
Oral Contraceptive Pill Contraceptive Patch
Vaginal Ring Intrauterine Contraception (IUC)
Injectable Contraception

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 Hormonal Contraception

Oral Contraceptive Pill

The oral contraceptive pill, also known as birth control pill, is suitable for most healthy women, regardless of age,
and can be used long-term. It is one of the world’s most prescribed medications – over 100 million women
across the globe rely on it. There are two kinds of oral contraceptives, the combined oral contraceptive (COC),
which contains both estrogen and progestin, and the progestin-only contraceptive (POP). The Pill is available
at pharmacies but requires a prescription.

How does it work? How effective is it?

• The oral contraceptive pill works by preventing the • Typical use failure rate: 90 of 1000 women
ovary from releasing an egg, thickening the cervical during first year of use
mucus making it difficult for the sperm to reach the • Perfect use failure rate: 3 of 1000 women
egg, and changing the lining of the uterus making during first year of use
implantation difficult.

• The Pill is taken every day, ideally at the same time

each day. Traditional pills are set up with pills for
three weeks, followed by a pill-free week or a week
of placebo pills.

• Newer pill options have adjusted the regimen

to provide effective contraception with lower doses
of hormones and as little as two days of placebo to
minimize hormone fluctuations and side effects.

Advantages
++ Highly effective ++ Does not interfere with sex ++ Regulates menstrual cycle
++ Reversible ++ May reduce or e liminate menstrual ++ Decreases premenstrual symptoms
flow and cramps

Disadvantages
-- Effectiveness may be reduced -- May cause breasttenderness, nausea, -- May increase the risk ofblood clots,
by othermedications or headaches particularly inwomen who have
certainblood disorders or afamily
-- May cause irregular bleeding -- Must be taken every day, at the history ofblood clots
or spotting same time
-- Does not protectagainst STIs

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 Hormonal Contraception

There are two kinds of oral contraceptives, the combined oral contraceptive (COC)
and the progestin-only contraceptive (POP)

Combined Oral Contraceptive (COC)

Contains both estrogen and progestin
Advantages
++ Decreases acne ++ Reduces the risks of endometrial, ++ May reduce perimenopausal
ovarian and colon cancers symptoms
++ Decreases body and facial hair growth
++ Reduces the risk of fibroids and
ovarian cysts

Disadvantages
-- Should not be used by women over
the age of 35 who smoke

Progestin-Only Contraceptive (POP)

Contains progestin only
Advantages
++ May be suitable for women who ++ May be suitable for breastfeeding ++ May be suitable for women over
cannot take estrogen women 35 years old who smoke

Disadvantages
-- Some women may have hormonal
side effects: acne, headaches,breast
sensitivity, mood issues, unwanted
hair growth

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 Hormonal Contraception

Contraceptive Patch
The contraceptive patch is a contraception method that has been available in Canada since January 2004.
It is a 4 x 4 cm beige patch that sticks to a woman’s skin and continuously releases the hormones estrogen
and progestin into the bloodstream.

How does it work? How effective is it?

• The patch prevents pregnancy primarily by stopping • Typical use failure rate: 90 of 1000 women
the ovaries from releasing an egg, but it may also during first year of use
thicken the cervical mucus (making it harder for sperm
• Perfect use failure rate: 3 of 1000 women
to get into the uterus) and make the uterine lining thin.
during first year of use
Its method of action is very similar to the Pill.
• The patch may be a bit less effective in women
• Each patch is worn on the skin for seven days.
who weigh more than 90 kg (198 pounds)
One patch is worn each week for 3 weeks. The patch
should be changed on the same day each week (called
the “Patch Change Day”). The fourth week is patch-
free, allowing a period to occur. The patch should
never be off for more than seven days. Following the
seven patch-free days, a new cycle is started when
you apply a new patch on your Patch Change Day.

• The patch can be worn on the buttocks, stomach,

back or upper arms, but not on the breasts. It may
help to change the location a bit each week. The patch
should be applied to clean, dry skin. You should not
use any creams or lotions near a patch you’re already
wearing, or where you’ll be applying a new one.
The patch is very “sticky”. You can exercise, shower,
swim or go in a sauna or hot tub and it still sticks 98%
of the time!

Advantages
++ Highly effective, reversible and safe ++ Regulates menstrual cycle ++ Reduces the risk of fibroids
and o
 varian cysts
++ Does not interfere with sex ++ Decreases premenstrual symptoms
++ May reduce menstrual flow ++ Reduces the risks of endometrial,
and cramps ovarian and colon cancers

Disadvantages
-- May cause irregular bleeding nausea,or headaches -- May be less effectivein women
or spotting who weigh m ore than 90 kg
-- May cause skin irritation
-- May cause breasttenderness, -- Does not protectagainst STIs

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 Hormonal Contraception

Vaginal Ring
The vaginal ring is a soft, flexible, clear plastic ring that measures 54 mm in diameter and is inserted
into a woman’s vagina where it slowly releases the hormones, estrogen and progestin, for three weeks.

How does it work? How effective is it?

• The vaginal ring prevents pregnancy primarily by • Typical use failure rate: 90 of 1000 women
stopping the ovaries from releasing an egg, but it during first year of use
may also thicken the cervical mucus (making it
• Perfect use failure rate: 3 of 1000 women
harder for sperm to get into the uterus) and make
during first year of use
the uterine lining thin. Its method of action is very
similar to the Pill.

• The ring comes in only one size, and does not need
to be in a particular position in the vagina to be
effective. It is held in place by the walls of the vagina
and a woman usually cannot feel the ring once it is in.
The woman inserts and removes the ring herself and
most women find this easy to do.

• The ring is worn inside the vagina for three weeks,

followed by a one-week ring-free interval allowing
a period to occur. At the end of the ring-free week,
the woman inserts another ring to begin a new cycle.

Advantages
++ Highly effective, reversible and safe ++ Decreases premenstrual symptoms ++ Does not have to be r emembered
each day
++ May reduce menstrual f low ++ Reduces the risks of endometrial,
and cramps ovarian and colon cancers

++ Regulates menstrual cycle ++ Reduces the risk of fibroids and

ovarian cysts

Disadvantages
-- May cause irregular bleeding or -- May cause vaginal irritation, -- Does not protectagainst STIs
spotting discomfort or discharge

-- May cause breasttenderness, -- Requires remembering tochange

nausea,or headaches the ring once per month

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 Hormonal Contraception

Intrauterine Contraception (IUC)

Intrauterine contraceptives (IUCs) are long-acting reversible contraceptive (LARC) methods that are used by over
150 million women worldwide. They are the most effective forms of birth control available. IUCs are small T-shaped
devices that are inserted in the uterus by a health care professional in a clinic. There are two types of intrauterine
contraception: the Copper intrauterine device (Cu-IUD) and the levonorgestrel-releasing intrauterine system
(LNG-IUS), which contains a progestin.

How does it work? How effective is it?

• LNG-IUS: The small cylinder on the IUC contains • Typical use failure rate: 2 of 1000 women
the hormone levonorgestrel, which is slowly released. during first year of use
The lining of the uterus becomes thinner and the
• Perfect use failure rate: 2 of 1000 women
cervical mucus becomes thicker which makes it
during first year of use
harder for sperm to enter the uterus.
• IUCs are one of the most effective methods
• The IUC is inserted by a health professional,
of contraception available
in a clinic. The procedure is fairly simple, does not
require anaesthesia, and only takes a few minutes.

• Depending on the device, the IUC can remain inserted

for 3-10 years, before needing to be replaced.

Advantages
++ Highly effective, reversible and safe ++ Cost-effective ++ May be suitable for
breastfeeding women
++ Long term, forgettable and invisible ++ May be suitable for women
who cannot t ake estrogen ++ Reduces risk of endometrial cancer

Disadvantages
-- Initially, irregular bleeding or spotting -- Some pain or discomfortduring -- Does not protect against STIs
may occur insertion

-- Expensive -- Rare risks with the insertioncould

include infection,perforation of the
uterus,or expulsion of the IUC

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 Hormonal Contraception

There are two types of intrauterine contraception: the Copper intrauterine

device (Cu-IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS),
which contains a progestin.

Levonorgestrel-Releasing Intrauterine System (LNG-IUS)

contains a progestin
Advantages
++ A minimal amount of hormones ++ May reduce menstrual flow ++ Regulates menstrual cycle
is absorbed in your blood and cramps
++ Improves symptoms of endometriosis
++ May lead to absence of period

Disadvantages
-- Some women may experience -- Irregular periods, light or no menstrual
hormonal s
 ide effects: acne, periods – which some think of as an
headaches, b reast tenderness, advantage, others as a disadvantage
mood issues

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 Hormonal Contraception

Injectable Contraception
Injectable contraception, also known as the birth control shot, is a highly effective and reversible method of
contraception. The injection contains a progestin, but does not contain estrogen. It is administered four times
a year, so it may be a good choice for women who have trouble following a daily, weekly, or monthly routine.

How does it work? How effective is it?

• The injection is given by a health-care professional in • Typical use failure rate: 60 of 1000 women
the muscle – commonly in the upper arm or buttocks, during first year of use
of a woman, every 12 to 13 weeks (four times a year). • Perfect use failure rate: 2 of 1000 women
• The progestin hormone prevents the ovaries from during first year of use
releasing an egg. It also thickens the cervical • Injectable contraception is one of the most
mucus making it difficult for sperm to reach the effective methods of contraception available
egg and changes the lining of the uterus making
implantation difficult.

Advantages
++ Highly effective and long lasting ++ May be suitable for women w
 ho ++ Reduces menstrual cramps and PMS
cannot take estrogen
++ Reversible ++ Reduces the risk of endometrial
++ May be suitable for breastfeeding cancer and fibromas
++ Safe, convenient a nd discreet women
++ May improve symptoms of
++ Does not interfere with sex ++ May be suitable for women o ver endometriosis and chronic p
 elvic pain
the age of 35 who smoke
++ Effectiveness is not affected by ++ May decrease the incidence o f
most medications ++ Reduces or eliminates periods seizures in women who have epilepsy

Disadvantages
-- Initially, irregular bleedingis the most -- May be associated with change -- It can take a longer time to g  et
common side effect of appetite and/or w
 eight gain in pregnant after getting y our last shot.
some women For some, it can be approximately
-- Less/lighter bleeding, to no periods 6 to 10 months after the last injection
-- Some women may havehormonal for the ovaries to start releasing
-- Heavier and more frequentbleeding, side effects: acne, headaches, eggs again
including spottingin between periods breast sensitivity,mood issues/
depression and achange in sex drive -- Must be administered by a health-care
-- Causes a decrease in bone mineral professional every 3 months
density whichmay return to normal
whena woman stops usingthe -- Does not protect against STIs
injection

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 Non-Hormonal Contraception
Non-hormonal birth control can involve creating a barrier between sperm and the egg,
changing the chemistry in the reproductive tract or a combination of both methods.

Topics Covered

Non-Hormonal Contraception
Male Condom Female Condom
Sponge Cervical Cap
Diaphragm Spermicides
Vasectomy Tubal Ligation & Tubal Occlusion
Intrauterine Contraception (IUC)
 Non-Hormonal Contraception

Male Condom
Male condoms are inexpensive, readily available without a prescription, and used only at the time of sexual
activity. They are worn over the penis during sexual intercourse or oral sex and they come in a variety of sizes,
thinness, textures, and colours/flavours. They are also available with a wide selection of lubricants on the condom
to help enhance sensitivity and pleasure for both partners (i.e. warming/tingling sensations, premium silicone-base,
climax-control).

Most condoms are made of latex, but non-latex condoms are also available in polyurethane and polyisoprene.
Latex, polyurethane and polyisoprene condoms are also effective for preventing most sexually transmitted
infections (STIs).

How does it work? How effective is it?

• The condom is worn over the penis during sexual • Typical use failure rate: 180 of 1000
activity. It should be put on before any skin-to-skin women during first year of use
genital contact occurs.
• Perfect use failure rate: 20 of 1000
• The condom acts as a physical barrier preventing women during first year of use
direct contact between the penis and the vagina.
It prevents the exchange of body fluids and also traps
the sperm in the condom so it cannot fertilize the egg.

• The condom is thrown away after intercourse. A new

one must be used for each repeated act of intercourse.

Advantages
++ Widely available w
 ithout a prescription ++ Both partners participate in their ++ May help the wearer avoid premature
use – shared responsibility ejaculation
++ Inexpensive, safe and effective
++ Hormone-free ++ May be used with other
++ Protect against most STIs contraception methods to increase
++ May decrease the risk of their contraceptive effectiveness
++ Non-latex options available f or those cervical cancer
with latex allergies or sensitivities

Disadvantages
-- Must be available at t ime of -- May slip or breakduring intercourse -- People with latex allergiesor latex
sexual activity sensitivity cannotuse latex condoms,
-- May reduce sensitivityfor either butmay be able to use non-latex
-- Must be storedand handled properly partner condoms
– be sure to check theexpiration date
-- May interfere with themaintenance -- Requires participationof both
-- May reduce sexualspontaneity of an erection partners

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 Non-Hormonal Contraception

Female Condom
The female condom is a soft, loose-fitting, seamless nitrile polymer sheath containing two flexible rings, one at
each end. It is inserted into the vagina before sex and works by holding in the sperm, preventing it from entering
the vagina.

How does it work? How effective is it?

• The female condom is a barrier contraception method, • Typical use failure rate: 210 of 1000 women
preventing contact between the sperm and the vagina. during first year of use

• The external ring at the open end of the condom • Perfect use failure rate: 50 of 1000 women
sits outside the vagina, providing some protection. during first year of use
The internal ring at the closed end of the condom is
inserted into the vagina and helps to keep it in place.

• The sheath is coated on the inside with a

silicone-based lubricant.

• It can be placed in the vagina up to 8 hours

before sexual intercourse.

• A new female condom should be used for each

repeated act of sexual intercourse.

Advantages
++ Protects against both p regnancy ++ Can be used with o il-based lubricants ++ The internal and external r ings of the
and STIs female condom m
 ay increase sexual
++ Male partner may find it more stimulation
++ The woman has control and comfortable and less constricting
autonomy in placing t he condom than m
 ale condoms ++ Available at pharmacies w
 ithout
a prescription
++ Can be used by people w
 ith latex
allergies

Disadvantages
-- Some women may havetrouble -- Potential challenges includeslippage -- Female condoms maybe noisier than
inserting it correctly and breakage malecondoms during sex

-- More expensivethan male condoms -- The rings on the female condom may
cause discomfort during sex

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 Non-Hormonal Contraception

Contraceptive Sponge
The contraceptive sponge is a small, disposable, polyurethane foam device that is placed in the vagina. It fits over
the cervix to provide a physical barrier to prevent sperm from entering. The sponge also contains a spermicide,
which helps to absorb and trap sperm.

How does it work? How effective is it?

• The contraceptive action of the sponge is primarily • The sponge is less effective for women who have
provided by the spermicide, which is slowly released given birth. Effectiveness can be increased by using
over a period of 24 hours. the sponge in combination with a male condom.

• The spermicide absorbs and traps the sperm and • Parous women – women who have given birth
destroys the sperm cell membrane. • Nulliparous women – women who have not
• The sponge itself also provides a physical barrier given birth
to prevent sperm from entering the cervix. • Typical use failure rate - parous women:
• The sponge can be inserted into the vagina by the 240 of 1000 women during first year of use.
women using it up to 24 hours before intercourse. • Perfect use failure rate - parous women:
One side has a concave dimple that fits over the cervix. 200 of 1000 women during first year of use.
The other side has a loop to facilitate removal.
• Typical use failure rate - nulliparous women:
• The sponge comes in one size only and is available 120 of 1000 women during first year of use.
in pharmacies without a prescription.
• Perfect use failure rate - nulliparous women:
• Protection begins immediately when inserted 90 of 1000 women during first year of use.
and lasts for 24 hours even with repeated acts of
intercourse. It should be left in the vagina for at least
6 hours after the last act of intercourse but should
not remain in the vagina for more than 30 hours total.

Advantages
++ It offers a barrier method and ++ Enhances the effectiveness of ++ Available at pharmacies w
 ithout
spermicide in one other forms of contraception s
 uch a prescription
as condoms
++ Provides 12-hour protection, 
and doesn’t need to be replaced for ++ No hormones
repeated sex during this time

Disadvantages
-- Increases the risk of vaginaland -- Some women may have trouble -- Higher failure rate compared t o other
cervical irritation orabrasions, inserting it correctly types of contraception
which increases the risk of
transmission of HIV -- Does not protect against STIs

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 Non-Hormonal Contraception

Cervical Cap
The cervical cap is a deep silicone cap that fits against the cervix and prevents sperm and bacteria from entering.

How does it work? How effective is it?

• The cervical cap serves as a physical barrier between • There is currently no data on the efficacy/
sperm and the cervix. effectiveness of the only cervical cap and gel that
is available in Canada. Some preliminary studies have
• It should always be used with a gel that immobilizes or
shown that the cervical cap has a higher failure rate
kills sperm. The gel forms a physical cellulose barrier
compared to other types of contraception.
in front of the cervix and lowers the pH of the vaginal
fluid, thereby inhibiting sperm motility.

• The cap can be inserted into the vagina by the women

using it up to 2 hours before having sex.

• The gel should be reapplied, using and applicator,

for each repeated act of intercourse or after 2 hours
has passed.

• It should be left in the vagina for at least 6 hours after

intercourse but should not remain in the vagina for
more than 48 hours total.

• Cervical caps can be purchased online or from a

pharmacy with a prescription. It should be replaced
every year.

Advantages
++ No hormones ++ Can be used by women who ++ Available in three different sizes
are breastfeeding

Disadvantages
-- Higher failure rate compared to other -- Some women may have trouble -- A poor fit or silicone allergywill
types of contraception inserting it correctly prevent some women from using
the cap
-- Increased risk of recurrent urinary -- Gel must be reapplied after e
 ach
tract infections act of intercourse -- Does not protect against STIs

-- Increased risk of toxic shock

syndrome

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 Non-Hormonal Contraception

Diaphragm
The diaphragm is a cap, made of latex or silicone and nylon, that covers the cervix and prevents sperm and from
entering. The diaphragm should always be used with a gel, which is placed inside the diaphragm to immobilize
or kill sperm.

How does it work? How effective is it?

• The diaphragm serves as a physical barrier between • Data is lacking on the efficacy/effectiveness of the
sperm and the cervix. diaphragm with the g  el that is currently available in
Canada. Previous studies based on d  iaphragm use
• It should always be used with a gel that immobilizes
with spermicidal gel (no longer available in Canada)
or kills sperm.
have shown that the diaphragm has a higher failure
• The gel forms a physical cellulose barrier in front rate compared to o ther types of contraception.
of the cervix and lowers the pH of the vaginal fluid,
thereby inhibiting sperm motility.

• The diaphragm can be inserted into the vagina by

the women using it up to 2 hours before having sex.

• The diaphragm should be left in the vagina for at least

6 hours after intercourse but should not remain in the
vagina for more than 24 hours total.

• If there is repeated intercourse within the first

6 hours, more gel should be inserted with an
application (the diaphragm should not be removed).

Advantages
++ No hormones ++ The diagphragm is one size and fits ++ Available at pharmacies w
 ithout
most women a prescription
++ Can be used by women who are
breastfeeding

Disadvantages
-- Higher failure rate compared to other -- Some women may have trouble -- A latex or silicone allergywill
types of contraception inserting it correctly prevent some womenfrom using
the diaphragm
-- Increased risk of recurrent urinary -- Water-based gel must be reapplied
tract infections after each actof intercourse -- Does not protect against STIs

-- Increased risk oftoxic shock

syndrome

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 Non-Hormonal Contraception

Spermicides
A chemical called nonoxynol-9 comes in the form of cream (only for use with diaphragms), gel, foam, film,
or suppository. By inserting spermicide in front of the cervix, in the vagina, it destroys sperm on contact.
Spermicides should be used along with another method of contraception, such as a condom, because alone
they are not highly effective.

How does it work? How effective is it?

• Nonoxynol-9 is a surfactant that destroys the sperm • Vaginal spermicides are among the least effective
cell membrane. of all contraception o
 ptions. Failure rates in the first
year of use vary from 18% with perfect use to 28%
• Spermicides are available at pharmacies without
with typical use.
a prescription, in the form of cream, gel, foam, film,
or suppository. • Spermicides should be used with another barrier
method of contraception, such as a diaphragm
• Spermicidal film must be inserted into the vagina at
or sponge.
least 15 minutes before intercourse. It will melt and
disperse. If more than 3 hours have passed before
intercourse, another film must be inserted.

• Spermicidal foam is inserted into the vagina using an

applicator. It is effective immediately and for up to one
hour after insertion. It must be applied again for each
act of intercourse.

Advantages
++ No hormones ++ When used with another b arrier ++ May also protect against b acterial
method, effectiveness increases infections and p
 elvic inflammatory
disease

Disadvantages
-- Not highly effective -- Must be inserted right before sex, -- May increase the riskof HIV
because it’s only effective for one hour transmission
-- Using spermicide can be messy
-- May irritate the entranceof the vagina -- Does not protect against STIs
or the tip of the penis

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 Non-Hormonal Contraception

Vasectomy
Male sterilization by vasectomy is a permanent surgical procedure to close or block the vas deferens (the tubes that
carry sperm to the penis). Since it is permanent, this option is especially for those who have decided that their family
is complete or that they don’t want to have children. Compared to tubal ligation, vasectomy is safer, more effective,
less expensive, and less invasive.

How does it work? How effective is it?

• In a vasectomy procedure, the vas deferens is partially • Although vasectomy is highly effective, failures do
removed or blocked, so that no sperm is released to occur and can occur many years after the procedure.
fertilize the egg. For every 100 women who rely on vasectomy for
contraception, 2 women will become pregnant.
• Using local anaesthesia, a health professional will
reach the vas deferens either by making a small
incision on the skin of the scrotum (conventional
vasectomy) or by making a small puncture on the
skin of the scrotum (no-scalpel vasectomy).

• Another form of contraception is required until

a semen analysis shows no sperm.

Advantages
++ Safe and highly effective ++ Does not interfere with sex ++ Less invasive and fewer complications
than female sterilization
++ Long-lasting – permanent ++ No hormones
++ No significant long-term side effects
++ Simple procedure, no follow up ++ Discreet and cost-effective
required (aside from sperm analysis) ++ Allows the male partner to assume
++ Does not affect sexual function some responsibility f or contraception

Disadvantages
-- Permanent and irreversible -- Possible short-term surgery-related -- Does not protect against STIs
complications: pain, bleeding,
-- Risk of having regrets later on vasovagal reaction, infection at the
incision site, bruising and swelling 
-- Not effective immediately –must use of the scrotum
another contraceptionmethod for
3 months and do a f ollow-up sperm -- Rarely, the vas deferenscould
analysis thatshows no sperm reconnect by themselves
are presentin the semen

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 Non-Hormonal Contraception

Tubal Ligation & Tubal Occlusion

Female sterilization by tubal ligation is a permanent surgical procedure where the two fallopian tubes,
which transport the eggs from the ovaries to the uterus, get disconnected. Tubal ligation is considered
permanent, because reversal is costly, difficult, and not guaranteed.

Female sterilization by tubal occlusion is a permanent procedure where a micro-insert is placed into each of the
fallopian tubes. The micro-inserts work with your body to form a natural barrier that keeps sperm from reaching
the eggs, preventing pregnancy.

How does it work? How effective is it?

• There are a few types of one-day surgeries/ • Although female sterilization is highly effective, failures
procedures for female sterilization, which is do occur and can occur many years after the procedure.
performed by a gynaecologist: Failure rates vary on which technique is used.

Tubal ligation: • Be sure to review the latest data available with your
health care provider before selecting the option that
• Laparoscopy – using a general anesthesia, the doctor
is most appropriate for your needs.
will make small incisions over the abdomen and either
clip, burn or remove the fallopian tubes.

• Abdominally – during a caesarean section,

a gynaecologist can access the fallopian tubes
to either clip or remove them.

Tubal occlusion:
• Hysteroscopy – using only local anesthesia,
a gynaecologist will put micro-inserts in your fallopian
tubes through a vaginal approach. It takes 3 months
for this method to be effective, at which time a
confirmation test (e.g. x-ray, ultrasound) is done
to make sure the tubes are fully blocked.

Advantages
++ Safe and highly effective ++ Does not affect sexual function ++ No incisions or scars (specific to
tubal occlusion w
 ith micro-inserts)
++ Long-lasting – permanent ++ Discreet and cost-effective
++ Can be safely performed in an
++ Simple procedure ++ No hormones outpatient setting (specific totubal
occlusion with micro-inserts)
++ Does not interfere with sex ++ May reduce the risk of ovarian c ancer
(specific to tubal ligation)

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 Non-Hormonal Contraception

Disadvantages
-- Permanent and irreversible -- Possible short-term surgery-related -- Rarely, risk of not being ableto put in
complications: p  ain, bleeding, the micro-inserts or of them slipping
-- Risk of having regrets later on infection at the incision site, trauma out (specific to tubal o
 cclusion with
to adjacent o rgans in the abdomen micro-inserts)
-- Not effective immediately when
micro-inserts are used – must use -- Possible procedure-related -- Follow-up may be required (x-ray)
another contraception method complications during andfollowing (specific to tubal ligation)
for 3 months and do a follow-up the micro-inserts placement: pain,
confirmation test (e.g. x-ray, cramping and v aginal bleeding -- Rarely, the fallopian tubes c
 ould
ultrasound) that shows if tubes (specific to tubal o
 cclusion with reconnect by themselves (specific
are fully blocked (specific to tubal micro-inserts) to tubal ligation)
occlusion with micro-inserts)
-- Risk of ectopic p
 regnancy if -- Does not protect against STIs
failure occurs

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 Non-Hormonal Contraception

Intrauterine Contraceptives (IUCs)

Intrauterine contraceptives (IUCs) are long-acting reversible contraceptive (LARC) methods that are used by over
150 million women worldwide. They are the most effective forms of birth control available. IUCs are small T-shaped
devices that are inserted in the uterus by a health care professional in a clinic. There are two types of intrauterine
contraception: the Copper intrauterine device (Cu-IUD) and the levonorgestrel-releasing intrauterine system
(LNG-IUS), which contains a progestin.

How does it work? How effective is it?

• Cu-IUD: The presence of the foreign body, the IUC • Typical use failure rate: 8 of 1000 women
itself, creates a hostile environment leading to during first year of use
prevention of a pregnancy. • Perfect use failure rate: 8 of 1000 women
• The IUC is inserted by a health professional, in a clinic. during first year of use
The procedure is fairly simple, does not require • IUCs are one of the most effective methods
anaesthesia, and only takes a few minutes. of contraception available
• Depending on the device, the IUC can remain inserted
for 3-10 years, before needing to be replaced.

Advantages
++ Highly effective ++ Long term, forgettable and invisible ++ May be suitable for breastfeeding
women
++ Reversible, safe and cost-effective ++ May be suitable for women who can-
not take estrogen ++ Reduces risk of endometrial cancer

Disadvantages
-- Initially, irregular bleedingor spotting -- Some pain or discomfort during -- Does not protect against STIs
may occur insertion

-- Expensive -- Rare risks with the insertion c

 ould
include infection,perforation of
the uterus,or expulsion of the IUC

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 Non-Hormonal Contraception

There are two types of intrauterine contraception: the Copper intrauterine device
(Cu-IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS),
which contains a progestin.

Copper Intrauterine Device (Cu-IUD)

Advantages
++ May be used as emergency ++ Does not contain hormones
contraception w
 ithin 7 days
of unprotected sex

Disadvantages
-- May increase menstrual flow and -- May increase pain during periods
cramps

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 Natural Methods
Natural methods of birth control do not involve medications or devices to prevent pregnancy
but rather rely on behavioural practices and/or making observations about a woman’s body
and menstrual cycle.

Topics Covered

Natural Methods
Fertility-Awareness Based Methods Lactational Amenorrhea Method (LAM)
Withdrawal (Coitus interruptus) Abstinence
 Natural Methods

Fertility-Awareness Based Methods

Ovulation is the time during a woman’s menstrual cycle when she is most likely to get pregnant. Conception can
occur when sexual intercourse takes place during the fertile window, from 5 days before to 1 day following ovulation.
Fertility awareness-based methods (FABs) rely upon avoiding unprotected sex during this fertile window.

How does it work?

When using fertility awareness-based methods, the first • Checking your urine with an ovulation
thing to do is to become familiar with your menstrual kit to measure the LH hormone;
cycle. There are several methods to determine when • Observing changes in your cervical mucus;
ovulation occurs:
• Using an app to follow the calendar method
• Measuring your basal body temperature every day and track your menstrual cycles and ovulation;
and charting it on a special form;
• Or a combination of all of these methods.

Using these methods, you can calculate your fertile window and then avoid having sex during this time.

How effective is it?

24 out of every 100 couples who use fertility awareness-based methods each year will have a pregnancy,
based on typical use.

Advantages
++ Safe ++ Little cost ++ No hormones
++ No side effects ++ These methods are ++ Allows you to learn about
considered natural your own body

Disadvantages
-- This method is the least effective -- It can be tricky, because not all -- Requires both partners to be fully
in preventing pregnancy menstrual cycles are regular committed to using the method

-- Requires a lot of practice to learn -- Can be challenging to avoid sex -- Does not protect against STIs
how to use this method correctly at certain times

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 Natural Methods

Lactational Amenorrhea Method (LAM)

Lactational Amenorrhea Method (LAM) is used by a woman who has just given birth and is exclusively breastfeeding.
This method is highly effective for the first six months after childbirth, provided the woman breastfeeds the baby at
least every four hours during the day and every six hours through the night, and that her menstrual period has not
yet returned. After six months fertility may return at any time.

How does it work? How effective is it?

The hormones that trigger lactation (producing About 2 out of 100 women who use continuous
breastmilk) interfere with the release of the hormones breastfeeding will become pregnant in the first
that trigger ovulation. The more you nurse your baby, six months, based on typical use.
the less likely you are to ovulate.

Advantages
++ It is a natural way to prevent ++ Safe and convenient ++ Breastfeeding has many other
pregnancy after giving birth advantages for the mother and
++ No cost the baby.

Disadvantages
-- Effectiveness is limited to only -- Breastfeeding may reduce vaginal
6 months following childbirth lubrication when a woman is
having sex
-- May be difficult for some to
exclusively breastfeed and not -- Does not protect against STIs
use any formula

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 Natural Methods

Withdrawal (Coitus interruptus)

Withdrawal, also known as the pull out method, is an attempt to avoid having any sperm ejaculated into the vagina
or on the vulva during sex. The male withdraws his penis from the vagina and away from the external genitalia of the
female partner prior to ejaculation. Both partners must be in agreement on this method, and must be prepared to deal
with an unplanned pregnancy, which can occur in 1 out of 5 users.

How does it work? How effective is it?

During sex, the male withdraws his penis from the Withdrawal is a risky method. About 22 out of 100
vagina and away from the external genitalia of the women who use the withdrawal method will become
female partner prior to ejaculation. It can be difficult pregnant in a year.
and both partners have to be really careful because
right before ejaculation, there is some fluid released
from the penis that contains sperm.

Advantages
++ It is considered a natural method ++ No hormones ++ No consultation or prescription
required
++ Safe and convenient ++ It is immediate for partners who
have entered into a sexual act without
++ No cost having an alternative method

Disadvantages
-- It’s not easy, it takes a lot -- It is a risky practice – even if a -- Does not protect against STIs
of self-control man pulls out in time, pregnancy
can still happen

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 Natural Methods

Abstinence
Abstinence refers to not having sex. There are many forms of sexual abstinence, but in terms of using this as
a method of contraception, it means avoiding vaginal intercourse. This type of abstinence can be effective for
preventing unwanted pregnancy while allowing a couple to be involved in other forms of closeness, but it has
a significant failure rate.

How does it work? How effective is it?

Choosing not to have sex may seem to be the most Total abstinence is theoretically 100% effective in
certain way to prevent pregnancy. It takes a very high preventing pregnancy. In practice, however, abstinence
level of self-control and communication between is not particularly effective. Abstinence education
partners. If abstinence is used as a contraception programs have not been found to reduce the risk of
method, both partners must make sure to avoid any unplanned pregnancy, nor reduce STIs. This method is
contact between the penis and the vagina and also much more effective with older, mature couples and less
be cautious not to have the pre-ejaculate or ejaculate, effective when alcohol or drugs are involved and when
come in close contact with the vagina. there are strong sexual feelings between a couple.

Advantages
++ Theoretically the most effective ++ Safe and no cost ++ No side effects
method of contraception

Disadvantages
-- Can be challenging over time -- Partners are unprepared if a change -- Requires both partners to be fully
of mind suddenly occurs committed to using the method

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