Understanding Contraception
Information about the most common
methods of birth control for
administrative staff in healthcare
settings
Introduction
• From the very first interaction, the patient should know
that her contraceptive knowledge and choice is our
priority
• Each staff member plays an important role in a
woman’s contraceptive visit and should have a working
knowledge of all forms of birth control
• “Know what you don’t know”—refer patient to
counselor or clinician if she asks you a question beyond
your training level
PATIENT
Hi! I’d like to
make an
appointment to
get on birth
control.
MEDICAL RECEPTIONIST
Okay, so you’re
interested in getting
on the pill…let me see
when we can get you
in…
One assumption could affect her entire family planning visit!
Objectives
Equip administrative staff with working
knowledge of contraception by:
• Reviewing the most common, reversible
contraceptive methods
• Preparing them for frequently asked questions
about each method
Long-Acting Reversible Contraception
(LARC)
• Most effective reversible contraception
• Over 99% effective, or 3 out of 1000
women will get pregnant in the first year
• Includes 2 intrauterine devices (IUDs)
and a subdermal arm implant
• Fertility returns once device is removed
• Considered first-line options for all
women, including teens
Hormonal IUD (Mirena®)
•
•
•
•
•
Over 99% effective
Inserted by a clinician into uterus
Lasts up to 5 years—can have it removed sooner
T-shaped device made out of plastic
Releases small dose of the hormone progestin primarily
into the uterus
• May experience some irregular bleeding
– Greatest 3-6 months after insertion
– After this time, periods become much lighter, much shorter
– 20% of women stop having their period after the first year
A Sample of Frequently Asked Questions:
Hormonal IUD
Question
I’ve never been pregnant before. Can I
still use an IUD?
Can I use tampons with an IUD?
Is it safe to stop having a period with
the hormonal IUD ?
Answer
Absolutely! Many women who have never been
pregnant use IUDs. At the time of your visit you and
your clinician can decide if the IUD is a good method
for you.
Sure. We encourage women to wait 24 hours after their
IUD insertion to use tampons. This will allow some time
for the strings to soften and make it less likely for the
accidental removal of your IUD.
It is completely healthy and safe to stop having a period
when using the hormonal IUD. This IUD makes the
uterine lining very thin; there is nothing built up that
needs to shed
Non-Hormonal IUD (Copper IUD or
ParaGard®)
•
•
•
•
Over 99% effective
Inserted by a clinician into uterus
Lasts for up to 10 years-can have it removed sooner
T-shaped device made out of plastic and copper—
contains no hormones
• May experience some spotting for the first few months
after insertion
• Some women experience heavier or crampier periods
– Greatest 3-6 months after insertion
– May get better over time
A Sample of Frequently Asked Questions:
Copper IUD
Question
Answer
The copper IUD is effective immediately once it is
How soon after the copper IUD is
placed is it effective?
It’s been a month and I’m having
heavy, crampy periods. Is there
anything I can do?
Will my partner feel the strings
during sex?
placed. That’s why it can also be used as emergency
contraception. However, many clinicians recommend
using a condom during the first 21 days after
insertion to prevent infection. In fact, barrier
methods like condoms are always recommended to
prevent infection.
You can take over-the-counter ibuprofen (Advil or
Motrin) or Naprosyn(Anaprox or Aleve) to help with
the cramping. Feel free to give us a call back if that
doesn’t help.
The strings usually get soft and lay next to your
cervix so it should not be a problem for you or your
partner during sex.
Implant (Implanon®/Nexplanon®)
• Over 99% effective
• A small single rod, about the size of a matchstick,
placed by a clinician on underside of arm
• Releases the hormone progestin
• Unable to see the rod, should be able to feel it
• Lasts up to 3 years—can have it removed sooner
• May experience irregular bleeding
– some women have irregular bleeding for a month, six
months, a year, or even the entire three years
– some women have no bleeding at all
– Unable to predict who will experience irregularity
A Sample of Frequently Asked Questions:
Implant
Question
Answer
You should use a back up method of birth control for a week
I just had my implant placed. How long do I after getting the implant placed. Remember, the implant will
not protect you from sexually transmitted infections, so you
need to use a condom for back up
can continue to use condoms for protection from sexually
protection ?
transmitted infections.
Why an I having all of this irregular
bleeding?
It can be normal to experience irregular bleeding with the
implant. This method releases a small amount of
progesterone that keeps the lining of the uterus thin.
Although it may be somewhat annoying, it is not harmful. If
the bleeding persists for a long time and is bothersome,
discuss this with your clinician. There are some medications
that may help.
Will people know I’m using the implant?
The implant is about the size of a matchstick. You should be
able to feel the implant under your skin but you usually
can’t see it. Most likely, no one will know unless you tell
them.
Birth control shot (Depo-Provera®)
• 94% effective, meaning that 6 out
of 100 women will become
pregnant in the first year with
typical use
• Shot given in muscle of butt or arm
• Must be given every 3 months by
health care provider
• May experience some irregular
bleeding
– usually improves after third injection
– 50% of women stop having their period
after the first year
A Sample of Frequently Asked Questions:
Birth Control Shot
Question
Answer
I just had my first birth control shot.
How long do I need to use a condom
for back up protection?
You should use condoms for a week after getting
your shot. Remember, the shot will not protect you
from sexually transmitted infections, so you can
continue to use condoms for protection from
sexually transmitted infections.
My mom said it is not safe to not
have a period. My body needs to
clean itself out.
It is completely healthy and safe not to have a period
when using the birth control shot or “Depo.” The shot
makes the lining of your uterus very thin, so there is
nothing built up that needs to shed.
How often do I need to return to get
a shot?
You should return to the clinic every 3 months (12-14
weeks) to get your shot.
Pills, Patch, and Vaginal Ring
• 91% effective, meaning that 9 out of
100 women will become pregnant in
the first year with typical use
• Combined hormonal
contraceptives—contain both
estrogen and progestin
• Side effects may include the
following:
–
–
–
–
nausea
headache
moodiness
breast tenderness
Combined Hormonal
Birth Control Pills
• Contains the hormones estrogen and progestin
• To be most effective, a pill needs to be taken every
day at the same time
• On the 4th week, a woman takes a row of placebo
pills—this is the week a woman has her period
Patch (Ortho-Evra®)
• Apply the patch on the skin of the upper arm,
shoulder, upper back, abdomen, hip or buttock. Do
not place on genitals or breasts
• Replace patch on the same day of every week
• Don’t wear a patch on the 4th week—this is the
week a woman will have her period
• Should check it every day for placement
Vaginal Ring (NuvaRing®)
• Inserted by patient high into vagina.
• Leave in for 3 weeks then remove for the 4th week—
this is the week a woman will have her period
• Comfortable for both partners during sex
• May remove for up to 3 hours in a 24-hour period
then rinse off with cool water and reinsert
A Sample of Frequently Asked Questions:
Pills, Patch and Ring
Question
I just started my pill/patch/ring. How
long do I need to use a condom for
back up protection?
What should I do if I miss a pill?
Answer
You should use a back up method of birth control for
a week after starting your method. Remember,
these methods will not protect you from sexually
transmitted infections, so you can continue to use
condoms for protection from sexually transmitted
infections.
You should take the pill as soon as you remember
and use a back up method for seven days. If you had
sex and did not use a condom, you may want to
consider taking emergency contraception.
Progestin-Only Pills
• 91% effective, meaning that 9 out of 100 women will
become pregnant in the first year with typical use
• Contains the single hormone progestin
• To be most effective, a pill needs to be taken every
day at the same
• Take an active pill every day of the month
• If you are 3 or more hours late taking your pill, you
must use a back-up method, such as condoms for 48
hours
A Sample of Frequently Asked Questions:
Progestin-Only Pills
Question
Will I be able to predict or schedule my
bleeding times?
How do I take a POP?
Answer
Probably not. You may experience irregular
bleeding with POPs, such as spotting in
between periods, or may stop having your
period altogether. This is completely normal.
You should use a back up method of birth
control , such as condoms, for a week after
starting POPs. With POPs it is also important
to take the pill at the same time every day to
make it most effective. You also will not have
a “pill –free” week or a placebo week. When
you finish with one pack you simply start
another pack. If you are late taking you POP
or if you miss a day, take a pill when you
remember, take your next pill on time, and
use a back-up method of birth control for
one week.
Condoms
• 82% effective meaning 18 out of 100 women will
become pregnant the first year with typical use
• Only use one condom at a time
• Never use the same condom twice
• Always look for an expiration date
• Never use an expired condom
• Can be purchased without a prescription
• Only method that protects against STIs
A Sample of Frequently Asked Questions:
Condoms
Question
What can I do if I’m allergic to latex?
The condom broke when we were
having sex. What should we do?
Answer
You can use latex-free condoms or
female condoms.
You can take emergency contraception
up to five days after an act of
unprotected sex, although the sooner
you take it the better. You may also
want to make an appointment to get
tested for sexually transmitted
infections.
Emergency Contraception (EC)
• Two types
– EC Pills (Examples include; Plan B®, Next Choice®,
ella®)
• Plan B® or Next Choice® available over the counter
• ella® available with a prescription
– Copper IUD (ParaGard®)
• needs to be inserted by a clinician
• Pills most effective when taken ASAP after
unprotected sex
– can be taken as much as 120 hours or 5 days after
• Copper IUD can be placed up to 5 days after
unprotected sex and can continue to use as
highly effective contraception
A Sample of Frequently Asked Questions:
Emergency Contraception
Question
Is emergency contraception the same as the
abortion pill?
Where can I get emergency contraception?
When should I take emergency contraception?
Answer
No, emergency contraceptive pills prevent or delay
the release of an egg, and thus prevent the sperm
and egg from coming together (or fertilization).
Emergency contraceptive pills will not harm a
pregnancy that has already occurred.
Anyone can purchase emergency contraceptive pills
without a prescription from a pharmacy.
You can take emergency contraception up to five
days after an act of unprotected sex, although the
sooner you take it the better. The copper IUD is
actually the most effective form of emergency
contraception. The copper IUD can be placed up to
five days after unprotected sex and you can
continue to use it to provide highly effective
contraception.
MEDICAL RECEPTIONIST
PATIENT
Hi! I’d like to make
an appointment to
get on birth control.
Great! In our practice, we make
sure women are aware of all of
their birth control options,
especially the most effective,
reversible long-acting methods,
which includes 2 IUDs and the
implant. Let’s get you scheduled
for your appointment with our
contraceptive counselor.
One informed statement can affect her entire family planning visit!