What is the Vaginal Sponge?

The Vaginal Sponge is a donut-shaped polyurethane device containing spermicide and a woven polyester loop that hangs down into the vagina for removal. Note: In 1995, the sponge was taken off the market in the United States by its manufacturer. The Birth Control Sponge is currently available in Canada and expected to return to the U.S. market soon. How is the Birth Control Sponge inserted and used? The Vaginal Sponge can be inserted by the husband or wife, insuring that the sponge is inserted deep enough into her/your vagina - and insuring thesponge covers the cervix. The Vaginal Sponge can be left in place for 24 hours and multiple acts of intercourse; however, it must be left in the vagina for 6 hours after the last act of intercourse.
Instructions for Inserting the Vaginal Sponge 1. Remove the vaginal sponge from package and wet it thoroughly with clean water. 2. Squeeze the vaginal sponge until it foams completely, to activate the spermicide. There is more than enough spermicide in the sponge, so squeeze until it foams generously while adding plenty ofwater, but stop squeezing after it begins foaming 3. Fold the sides of the vaginal sponge upward and insert it deeply in your/her vaginamaking sure it covers the cervix. 4. The Vaginal Sponge can be inserted up to 24 hours prior to intercourse and provides immediate and continuous contraception during this period, regardless of the frequency of intercourse. 5. The Vaginal Sponge should be left in place for six hours after the last act of intercourse but no longer than 30 hours after insertion. 6. You/your wife may swim or tub bathe with the Vaginal Spongeproperlyplaced in your/her vagina.

NOTE: Strenuous activity and some sexual activity could dis-lodge the proper placementof the Vaginal Sponge inside your/her vagina. 7. Do not use the Vaginal Sponge during your menstrual period. Another method of birth control should be used during this time. 8. The Vaginal Sponge should be removed by grasping the loop that is attached to the back of the sponge. Do not attempt to pull on the sponge, as it may fragment.

Does the Vaginal Sponge protect against STDs? No. Does the Vaginal Sponge protect against pregnancy? Yes. What are the chances of getting pregnant while using the Vaginal Sponge? Typical use: 20% Perfect use: 9% What are the advantages to using the Vaginal Sponge? The Birth Control Sponge protects for 24 hours and multiple acts of intercourse during that time. Many couples find it more exciting, and helps her arousal if the husband inserts the vaginal sponge prior to intercourse. Are there any disadvantages to using the Vaginal Sponge? The Vaginal Sponge must not be left in the vagina for more than 30 hours or the female runs the risk of toxic shock syndrome.

What Is the Sponge?

The sponge is made of plastic foam and contains spermicide. It is soft, round, and about two inches in diameter. It has a nylon loop attached to the bottom for removal. It is inserted deep into the vagina before intercourse. The Today Sponge is the only brand of contraceptive sponge available in the United States today.

+How Does the Sponge Work?

The sponge prevents pregnancy by keeping sperm from joining with an egg. It works in two ways:
o o

The sponge covers the cervix and blocks sperm from entering the uterus. The sponge also continuously releases a spermicide that keeps sperm from moving.

+How Effective Is the Sponge?

Effectiveness is an important and common concern when choosing a birth control method. Like all birth control methods, the contraceptive sponge is more effective when you use it correctly. The sponge is more effective for women who have never given birth. If women who have never given birth always use the sponge as directed, 9 out of 100 will become pregnant each year. o If women who have never given birth don't always use the sponge as directed, 12 out of 100 will become pregnant each year. Women who have previously given birth have a higher risk of pregnancy.
o

If women who have given birth always use the sponge as directed, 20 out of 100 women will become pregnant each year. o If women who have given birth don't always use the sponge as directed, 24 out of 100 will become pregnant each year. Your partner can help you make the sponge more effective by using a latex condom or pulling out before ejaculation.
o

Keep in mind that the contraceptive sponge does not protect you fromsexually transmitted infections. Use a latex condom to reduce the risk of infection.

+How Safe Is the Sponge?

Most women can use the contraceptive sponge safely. But some conditions may make it difficult or impossible for some women to use the sponge. The sponge may not be right for you if you

o o o o o o o

are allergic to sulfa drugs or the things that make up the sponge polyurethane and spermicide are not comfortable touching your vagina or vulva have certain physical problems with your vagina have difficulty inserting the sponge have had a recent abortion, childbirth, or miscarriage have a history of toxic shock syndrome have a reproductive tract infection You should not use the sponge when you have any kind of vaginal bleeding including during your period. It could increase your risk of toxic shock syndrome.

Toxic Shock Syndrome Sponge users may be at slightly increased risk of toxic shock syndrome. Toxic shock syndrome is rare, but serious. To minimize the risk
o o o

Do not leave the sponge in place longer than 30 hours. Do not use the sponge soon after giving birth or having a miscarriage or abortion. Ask your health care provider when it is safe to use it again. Never use the sponge during any vaginal bleeding including your period. Warning Signs Tell your health care provider if you experience any signs of toxic shock syndrome. The symptoms include

o o o o o o o o o

aching muscles and joints diarrhea dizziness feeling faint sore throat sudden high fever sunburn-type rash throwing up weakness

+What Are the Benefits of the Sponge?

The contraceptive sponge is safe, simple, and convenient. You can buy it in a drugstore without a prescription. It does not need to be fitted by a health care provider. And with some practice, inserting and using the sponge is easy. Women like the sponge because

o o o o

It can be carried in pocket or purse. It generally cannot be felt by you or your partner. It has no effect on a woman's natural hormones. It does not interrupt sex play the sponge can be inserted hours ahead of time and can be worn for up to 30 hours after you put it in. During that time, you can have intercourse as many times as you like during the first 24 hours without removing or reinserting the sponge. It can be used during breastfeeding.

+What Are the Disadvantages of the Sponge?

There are few risks to using the contraceptive sponge. Some women may not like the sponge because

It may be difficult for some women to insert or remove the sponge. If you cannot remove a sponge, or if one breaks into pieces and you cannot remove all of the pieces, see your health care provider immediately to have the sponge removed. It may cause vaginal irritation. It may make sex too messy or too dry. Some women complain that the sponge is messy because it requires too much liquid. Others have complained the sponge makes sex too dry. Using a water-based lubricant may help dryness. Using Spermicide

o o

The sponge contains the spermicide nonoxynol-9. Nonoxynola day, or by people at risk forHIV, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections.

+How Do I Use the Sponge?

With a little practice, the contraceptive sponge is easy to use. And the sponge is more effective when you use it correctly.

INSERTING A SPONGE

Wash your hands with soap and water. Before inserting the sponge, wet it with at least two

tablespoons of clean water.

Gently squeeze the sponge. The spermicide will become active when the sponge is completely wet.

Fold the sides of the sponge upward and away from the loop on the bottom to make it look long and narrow. Then slide the sponge as far back into your vagina as your fingers will reach.

The sponge will unfold and cover the cervix when you let go of it. To make sure the cervix is covered, slide your finger around the edge of the sponge and check its position. You also should be able to feel the nylon loop on the bottom of the sponge.

How long do I leave the sponge in? The sponge can be ins

REMOVING A SPONGE

Wash your hands with soap and water.

To remove the sponge, put a finger inside your vagina and through the loop. Pull the sponge out slowly and gently.

Use a sponge only once. Always discard a used sponge in a waste container. Do not flush it down the toilet.

+How Do I Get the Sponge? How Much Does the Sponge Cost?
The sponge is available at your local Planned Parenthood health center, other family planning clinics, drugstores, online, and in some supermarkets. A package of three sponges costs $9$15. The costs may be slightly lower or higher depending on where you live.

What Are Condoms?

Condoms are worn on the penis during intercourse. They are made of thin latex or plastic that has been molded into the shape of a penis. Sometimes they are called rubbers, safes, or jimmies. They prevent pregnancy and reduce the risk of sexually transmitted diseases. Condoms are available in different styles and colors, and are available dry, lubricated, and with spermicide.

+How Do Condoms Work?

Condoms prevent pregnancy by collecting pre-cum and semen when a man ejaculates. This keeps sperm from entering the vagina. Pregnancy cannot happen if sperm cannot join with an egg. By covering the penis and keeping semen out of the vagina, anus, or mouth, condoms also reduce the risk of sexually transmitted infections.

+How Effective Are Condoms?

Effectiveness is an important and common concern when choosing a birth control method. Like all birth control methods, condoms are more effective when you use them correctly.

Each year, 2 out of 100 women whose partners use condoms will become pregnant if they always use condoms correctly. o Each year, 18 out of 100 women whose partners use condoms will become pregnant if they don't always use condoms correctly. You can make condoms more effective if you
o

o o

use spermicide with them pull out before ejaculation. Using Spermicide The most commonly used spermicide in the U.S. is called nonoxynol-9. Nonoxynol-9 has certain risks. If it is used many times a day, if it is used by people at risk for HIV, or if it is used for anal sex, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections. Effectiveness is also a concern when it comes to safer sex. Condoms also protect both you and your partner from sexually transmitted infections. Condoms that are made of latex offer very good protection against HIV. Latex condoms also reduce the risk of other sexually transmitted infections,

including

o o o o o o o o

chlamydia chancroid gonorrhea hepatitis B herpes HPV pelvic inflammatory disease (PID)

syphilis o trichomoniasis Condoms can also prevent urinary tract infections in men who wear them.

Condoms and Oral Sex Sexually transmitted infections can be passed from one person to another during oral sex. The risk of passing infections is lower during oral sex than during vaginal or anal intercourse. People who want to further reduce their risk can use condoms during oral sex.

+How Safe Are Condoms?

Almost everyone can use a condom safely. Some people are allergic to latex. If you are allergic to latex, you can try using a condom that is made from plastic.

+What Are the Benefits of Condoms?

Using condoms is safe, simple, and convenient. Women and men like condoms because they

o o o o o o o o

let men help prevent pregnancy and sexually transmitted infections are inexpensive and easy to get are lightweight and disposable do not require a prescription can help relieve premature ejaculation may help a man stay erect longer can be put on as part of sex play can be used with all other birth control methods except the female condom to provide very effective pregnancy prevention and to reduce risk of sexually transmitted diseases

Many women and men say they have better sex when they use condoms. They are able to focus on their sexual pleasure without worrying about unintended pregnancy and sexually transmitted infection. Some couples put the condom on as part of their foreplay.

Special Advantage for Teens and Pregnant Women

get sexually transmitted infections. And the cervix in pregnant women, young girls, and teen women is especially vulnerable to infection. No matter how old you are, it is very important to use condoms with your other method of birth control whenever you are at risk for getting a sexually transmitted infection.

+What Are the Disadvantages of Condoms?

Most women and men can use condoms with no problem. Condoms have no side effects except for people who are allergic to latex. Up to 6 out of 100 people have such allergies. If you are allergic to latex, you can use condoms or female condoms made of plastic instead. Some men and women feel that the condom dulls sensation. Others become frustrated and lose some of their sexual excitement when they stop to put on a condom. Some men are self-conscious about using condoms. Others feel pressured to ejaculate. And some men feel pressured about having to maintain an erection to keep the condom on. (If this is a concern, maintaining an erection is not necessary when using the female condom.) Many men overcome these pressures and learn to enjoy using condoms by using them during sex play before intercourse. It may also help to try different styles and sizes to find the condom that is most comfortable for you and your partner.

+How Do I Use Condoms?

With a little practice, condoms are very easy to use. Be sure to handle condoms properly. Keep in mind that certain types of lubricants can damage a latex condom. Use only water-based lubricants, such as K-Y jelly or AstroGlide, with latex condoms. Oil-based lubricants like petroleum jelly, cold cream, butter, or mineral and vegetable oils damage latex and will make the condom ineffective at preventing pregnancy and infection. Putting on a Condom Each package of condoms includes detailed instructions. Be sure to read and understand the instructions and check the expiration date before you use a condom.

Put the condom on before the penis touches the vulva. Men leak fluids from their penises before and after ejaculation. This fluid can carry enough germs to pass sexually transmitted infections and possibly cause pregnancy. Use a condom only once. Use a fresh one for each erection ("hard-on"). Have a good supply on hand. Condoms usually come rolled into a ring shape. They are individually sealed in aluminum foil or plastic. Be careful don't tear the condom while unwrapping it. If it is torn, brittle, stiff, or sticky, throw it away and use another. Put a drop or two of lubricant inside the condom. Pull back the foreskin, unless circumcised, before rolling on the condom. Place the rolled condom over the tip of the hard penis. Leave a half-inch space at the tip to collect semen. Pinch the air out of the tip with one hand while placing it on the penis. Unroll the condom over the penis with the other hand. Roll it all the way down to the base of the penis. Smooth out any air bubbles. (Friction against air bubbles can cause condom breaks.) Lubricate the outside of the condom. You can also learn how to put on a condom by watching this brief film. Taking Off a Condom

o o o o o o o o o

o o o o

Pull out before the penis softens. Don't spill the semen hold the condom against the base of the penis while you pull out. Throw the condom away. Wash the penis with soap and water before having sex play again. Practice Makes Perfect It is best if both you and your partner know how to put on and use a condom. It will make using a condom easier and more pleasurable and will make the condom more effective. To learn without feeling pressured or embarrassed, practice putting on and taking off a condom on a penis or a penisshaped object like a ketchup bottle, banana, cucumber, or squash.

If the Condom Breaks Sometimes condoms break. If a condom breaks, it is less effective.

If the condom breaks during intercourse, pull out quickly and replace it. Men should be able to tell if a condom breaks during intercourse. To learn what it feels like, men can break condoms on purpose while masturbating.

If the condom breaks and semen leaks out, wash the semen away from the vulva or penis with soap and water. If the condom breaks and semen leaks into the vagina, emergency contraception is a good option. Emergency contraception can prevent pregnancy if started up to five days after unprotected intercourse. The sooner you start it, the better it will work.

+How Do I Take Care of Condoms?

It is important to handle and store condoms properly. Long exposure to air, heat, and light makes them more likely to break.
o o o

Store them in a cool, dry place. Dont store them in a back pocket, wallet, or glove compartment for long periods of time. Keep them in their individual foil or plastic pouch. When you are ready to use the condom, dont use it if the pouch is punctured or torn. Do not use your teeth or sharp objects, like scissors, to open the pouch. Use only water-based lubricants, such as K-Y jelly or Astroglide, with latex condoms. Oil-based lubricants like petroleum jelly, cold cream, butter, or mineral and vegetable oils damage latex. Unsafe with latex condoms Aldara Cream baby oil Bag Balm butter cold cream head and body lotions massage oils mineral oil petroleum jelly rubbing alcohol shortening suntan oil and lotions certain vaginal yeast infection medicine vegetable or cooking oils whipped cream

Safe with all condoms

Aqua Lube Astroglide Corn Huskers Lotion deLUBE ForPlay glycerin Gynol II H-R lubricating jelly K-Y lubricating jelly PrePair silicone lubricant water and saliva Wet silicone and water-based only

+-

How Can I Talk About Using Condoms?

Its important to talk with your partner about using condoms. Talking about condoms with your partner for the first time may make you nervous. It can help to practice what you are going to say beforehand. Then, choose the right time to talk don't wait until the heat of passion takes over. It may overwhelm your good intentions. Don't be shy be direct. Be honest about your feelings and needs. It can help create a relaxed mood to make sex more enjoyable. Talking is easier if you are in a respectful relationship that makes you feel happy and good about yourself and your partner. If you havent had a talk about condoms before starting sex play, here are some simple and common things to say when you talk about using a condom with your partner: If Your Partner Says: What's that? You Can Say: A condom, baby. If Your Partner Says: What for? You Can Say: To use when we're making love. If Your Partner Says: I don't like using them. You Can Say: Why not? If Your Partner Says: It doesn't feel as good with a condom. You Can Say: I'll feel more relaxed. If I'm more relaxed, I can make it feel better for you. If Your Partner Says: But we've never used a condom before. You Can Say: I don't want to take any more risks. If Your Partner Says: Condoms are gross. You Can Say: Being pregnant when I don't want to be is worse. So is getting AIDS. If Your Partner Says: Don't you trust me? You Can Say: Trust isn't the point. People carry sexually transmitted infections without knowing it. If Your Partner Says: I'll pull out in time. You Can Say: Pulling out doesnt help much with sexually transmitted infections. Plus theres a small chance women can get pregnant from pre-cum. If Your Partner Says: I thought you said using condoms made you feel cheap. You Can Say: I decided to face facts. I like having sex, and I want to stay healthy and happy. If Your Partner Says: Condoms aren't romantic. You Can Say: Making love and protecting each other's health sounds romantic enough to me. If Your Partner Says: Let's face it. Making love with a condom on is like taking a shower with a raincoat on. You Can Say: Well, doing it without a condom is playing Russian roulette.

If Your Partner Says: It just isn't as sensitive. You Can Say: With a condom you might last even longer, and that'll make up for it. If Your Partner Says: I don't stay hard when I put on a condom. You Can Say: I can do something about that. If Your Partner Says: Putting it on interrupts everything. You Can Say: Not if I help put it on. If Your Partner Says: I'll try, but it might not work. You Can Say: Practice makes perfect. If Your Partner Says: But I love you. You Can Say: Then you'll help me protect myself. If Your Partner Says: I guess you don't really love me. You Can Say: I'm not going to "prove my love" by risking my life. If Your Partner Says: I'm not using a condom, no matter what. You Can Say: Well, then I guess we're not having sex. If You Are a Virgin and Have Decided to Have Sex and Want to Use a Condom and Your Partner Says: Just this once without it. Just the first time. You Can Say: It only takes once to get pregnant. It only takes once to get a sexually transmitted infection. It only takes once to get AIDS. If your partner absolutely refuses to wear a latex condom, you can use a female condom. Some men have said that the sensation is not so reduced with a female condom. Don't be afraid of being rejected. Besides, the partner who doesn't care about protecting your health and well-being is not worth your sexual involvement.

+How Do I Get Condoms? How Much Do Condoms Cost?

Condoms are available in drugstores, Planned Parenthood health centers, other community health centers, some supermarkets, and from vending machines. Individually, condoms usually cost a dollar or more. Packs of three can cost from about $2 to $6. In packages of 12, condoms can cost less than a dollar each. Some family planning centers give them away or charge very little. The cost in clinics or when authorized by a private doctor is covered by Medicaid in some states. Be sure to examine the condoms that you are buying. All condoms are tested for defects. But, like rubber bands, condoms deteriorate with age. If properly stored, they should stay effective until the expiration date printed on the wrapper of each condom.

Beware of "Novelty" Condoms Some condoms are not supposed to be used for pregnancy protection. These are called "novelty" condoms. Read labels on "novelty" condoms to be sure they protect against pregnancy and sexually transmitted infections.

Don't Let Embarrassment Become a Health Risk Don't be embarrassed by the thought of going into a store and asking for condoms. Be proud. Buying condoms says that you are responsible and that you accept your sexuality as a normal part of living. Nearly as many women as men buy and carry condoms. And many people use them every time they have sexual intercourse.

The Diaphragm at a Glance

A shallow silicone cup inserted into the vagina to prevent pregnancy Safe, effective, and convenient

Lasts up to two years Costs about $15$75

Is The Diaphragm for Me? All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. Here are some of the most common questions we hear women ask about the diaphragm. We hope you find the answers helpful.

Expand All +

+What Is the Diaphragm?

The diaphragm (DIE ah fram) is a shallow, dome-shaped cup with a flexible rim. It is made of silicone. You insert it into the vagina. When it is in place, it covers the cervix.

+How Does the Diaphragm Work?

Diaphragms prevent pregnancy by keeping sperm from joining with an egg. In order to be as effective as possible, the diaphragm must be used with spermicide cream, gel, or jelly. Diaphragms work in two ways:

o o

The diaphragm blocks the opening to the uterus. The spermicide stops sperm from moving.

+How Effective Is the Diaphragm?

Effectiveness is an important and common concern when choosing a birth control method. Like all birth control methods, the diaphragm is more effective when you use it correctly.

o o

If women always use the diaphragm as directed, 6 out of 100 will become pregnant each year. If women don't always use the diaphragm as directed, 12 out of 100 will become pregnant each year.

You can make the diaphragm more effective if you

o o

Make sure it covers your cervix before each time you have intercourse. Make sure spermicide is used as recommended. Your partner can help you make the diaphragm more effective by using a latex condom or pulling out before ejaculation. Keep in mind that diaphragms do not protect you from sexually transmitted infections. Use a latex condom to reduce the risk of infection.

+How Safe Is the Diaphragm?

Most women can use the diaphragm safely. But some conditions may make it difficult or impossible for some women to use a diaphragm. The diaphragm may not be right for you if you

o o o o o o o o o o

are not comfortable touching your vagina and vulva are sensitive to silicone or spermicide gave birth in the last six weeks have certain physical problems with your uterus or vagina have difficulty inserting the diaphragm have frequent urinary tract infections have a history of toxic shock syndrome have poor muscle tone in your vagina recently had surgery on your cervix recently had an abortion after the first trimester of pregnancy Your health care provider can help you decide if the diaphragm is likely to be safe for you. Only for You Your diaphragm should be used by you and only you. Do not share it with friends. And don't ever use anyone else's diaphragm.

+-

What Are the Benefits of the Diaphragm?

Using a diaphragm is safe, simple, and convenient. Women like the diaphragm because

o o o o o o

It can be carried in your pocket or purse. It can be used during breastfeeding. It generally cannot be felt by you or your partner. It has no effect on a woman's natural hormones. It is immediately effective and reversible. There is no interruption of sex play it can be inserted hours ahead of time.

+What Are the Disadvantages of the Diaphragm?

The diaphragm
o o o o

may be difficult for some women to insert may be pushed out of place by some penis sizes, heavy thrusting, and certain sexual positions must be in place every time a woman has vaginal intercourse may need to be refitted Using Spermicide Most spermicides that are used with the diaphragm contain nonoxynol-9. Nonoxynol-9 has certain risks. If it is used many times a day, or by people at risk for HIV, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections. Side Effects Most women can use the diaphragm with no problems. Serious problems are very rare. But some women may experience some side effects.

Some women who use diaphragms may develop frequent urinary tract infections. To avoid infection, you can urinate before inserting the diaphragm and after intercourse. If you get frequent bladder infections, ask your health care provider to check to see if your diaphragm fits correctly. Some women who use diaphragms may develop vaginal irritation. This can be a sign of a sensitivity to silicone or to spermicide. If you have a mild reaction, try switching brands of spermicide to clear up the problem. If that doesn't work, stop using the diaphragm until you speak with your health care provider. Check with your health care provider if you

o o o o o o

feel a burning sensation while urinating are uncomfortable when the diaphragm is in place have irregular spotting and bleeding feel irritation or itching in the genital area have redness or swelling of the vulva or vagina have unusual discharge from the vagina These symptoms may be a sign of infection or other condition. Most conditions are easily treated.

+How Do I Use the Diaphragm?

With a little practice, the diaphragm is easy to use. Your health care provider will show you how to insert and remove your diaphragm and will then watch you insert and remove it. Practice inserting and removing it at home, too. INSERTING A DIAPHRAGM

Wash your hands with soap and water.

Put about a tablespoon of spermicide in the cup. Spread some around the rim.

Find a comfortable position. You can stand with one foot on a chair, sit on the edge of a chair, lie down, or squat.

Separate the lips of your vulva with one hand. Pinch the rim of the diaphragm to fold it in half with the other hand.

Place your index finger in the center of the fold for a firmer grip. The spermicide must be inside the fold.

Push the diaphragm as far up and back in your vagina as possible. Tuck the edge of the diaphragm behind your pubic bone. Make sure your cervix is covered.

How long do I leave the diaphragm in? What if I have sex again? The diaphragm must stay in place six hours after the last time you had vaginal intercourse. If have intercourse again, or if you have intercourse more than six hours after you put the diaphragm in, leave the diaphragm in place and insert more spermicide deep into your vagina. Do not leave the diaphragm in place for more than 24 hours. REMOVING A DIAPHRAGM

Wash your hands with soap and water.

Hook a finger over the top of the rim to break the suction.

Pull the diaphragm down and out.

A special inserter can be used to help with placement and removal. If you are having trouble inserting the diaphragm, talk to your health care provider about getting an inserter.

Make Sure It Fits Diaphragms are available in many sizes and designs. A new size may be needed after any of the following: a full-term pregnancy abdominal or pelvic surgery a 20-percent change in weight

o o o o

+How Do I Take Care of My Diaphragm?

If you take good care of your diaphragm, it may last about two years. Taking care of the diaphragm is simple.
o o o o

After you remove the diaphragm, wash it with mild soap and warm water. Allow it to air dry. Do not use any powders on the diaphragm they can cause infections. Do not use oil-based lubricants such as Vaseline or cold cream with your diaphragm. They can damage silicone. Be sure to examine the diaphragm regularly. You can look for small holes or weak spots by holding it up to the light. If there is a hole or weak spot, light will shine through the diaphragm. You can also fill the cup of the diaphragm with water and look for leaks. Diaphragms can still be used if the silicone becomes discolored. But if the silicone develops cracks or holes it has become too thin.

Stop using your diaphragm if you find that it has holes, weak spots, cracks, or wrinkles. Talk to your health care provider about getting a replacement. In the meanwhile, use another form of birth control, such as a condom, female condom, or sponge.

+How Do I Get a Diaphragm? How Much Does a Diaphragm Cost?

You must see a health care provider to get a diaphragm. Visit aPlanned Parenthood health center, a clinic, or a private health care provider for a diaphragm. When you go to get your diaphragm, your provider will examine you to make sure you do not have a condition that would rule out using a diaphragm. Then your provider will find the correct size for you and will give you information about using, inserting, and removing the diaphragm. Your health care provider will give you a prescription for the diaphragm. Diaphragms may be purchased at a drugstore or clinic with a prescription. An examination costs from $50 to $200. Diaphragms average from $15 to $75. Spermicide gel, jelly, or cream costs from about $8 to $17 a kit. Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs. Call your local Planned Parenthood health center to get specific information on costs.

Female Condoms at a Glance

A pouch inserted into the vagina to prevent pregnancy Reduces the risk of sexually transmitted infection Can be used for vaginal and anal intercourse Safe, effective, and convenient Easy to get Cost about $4 each

Are Female Condoms Right for Me? All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. There are two main kinds of condoms female condoms and latexcondoms. Here are some of the most common questions we hear women ask about female condoms. We hope you find the answers helpful.

Expand All + +What Are Female Condoms?

The female condom is a plastic pouch that is used during intercourse to prevent pregnancy and reduce the risk of sexually transmitted diseases. It has flexible rings at each end. Just before vaginal intercourse, it is inserted deep into the vagina. The ring at the closed end holds the pouch in the vagina. The ring at the open end stays outside the vaginal opening during intercourse. And during anal intercourse, it is inserted into the anus.

+How Do Female Condoms Work?

Female condoms work to prevent pregnancy by covering the inside of the vagina. They collect precum and semen when a man ejaculates. This keeps sperm from entering the vagina. Pregnancy cannot happen if sperm cannot join with an egg. By covering the inside of the vagina or anus and keeping semen and pre-cum out, condoms reduce the risk of sexually transmitted infections.

+How Effective Are Female Condoms?

Effectiveness is a common concern when choosing a birth control method. Like all birth control methods, the female condom is more effective when you use it correctly.

o o

If women always use the female condom correctly, 5 out of 100 will become pregnant each year. If women don't always use the female condom correctly, 21 out of 100 will become pregnant each year. You can make the female condom more effective if you usespermicide or if your partner pulls out before ejaculation. Using Spermicide Most spermicides contain nonoxynol-9. Nonoxynol-9 has certain risks. If it is used many times a day, or by people at risk for HIV, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections. Effectiveness is also a concern when it comes to safer sex. The female condom also reduces the risk of many sexually transmitted infections, including HIV.

+How Safe Are Female Condoms?

Almost everyone can use female condoms safely. In fact, female condoms can be used by just about any woman who can use a tampon. They are also safe to use during anal sex.

+What Are the Benefits of Female Condoms?

Using a female condom is safe, simple, and convenient. Women and men like female condoms because female condoms
o o o o o o o o o

allow women to share responsibility for preventing infection are easy to get can be purchased in drugstores and some supermarkets can be inserted by a partner as part of sex play can be used by people who are allergic to latex can be used with oil-based as well as water-based lubricants do not have an effect on a woman's natural hormones do not require a prescription may enhance sex play the external ring may stimulate the clitoris during vaginal intercourse stay in place whether or not a man maintains his erection

+What Are the Disadvantages of Female Condoms?

Most people can use female condoms with no problems for themselves or their partners. Some women and men may not like the female condom because it may
o o

cause irritation of the vagina, vulva, penis, or anus slip into the vagina during vaginal intercourse, or into the anus during anal intercourse

o o

reduce feeling during intercourse be noisy adding extra lubricant can help if the female condom is noisy

+How Do I Use Female Condoms?

With a little practice, female condoms are very easy to use. To insert the female condom
o o

Put spermicide or lubricant on the outside of the closed end. Find a comfortable position. You can stand with one foot on a chair, sit on the edge of a chair, lie down, or squat. Squeeze together the sides of the inner ring at the closed end of the condom and insert it into the vagina like a tampon. Push the inner ring into the vagina as far as it can go until it reaches the cervix. Pull out your finger and let the outer ring hang about an inch outside the vagina. If you want to use the female condom for anal intercourse, follow above instructions for inserting it into the anus. During vaginal intercourse, it is normal for the female condom to move side to side. Stop intercourse if the penis slips between the condom and the walls of the vagina or if the outer ring is pushed into the vagina. As long as your partner has not yet ejaculated, you can gently remove the condom from the vagina, add extra spermicide or lubricant, and insert it once again. If your partner has ejaculated outside the female condom into your vagina, you may want to consider using emergency contraception (morning after pill). Emergency contraception can prevent pregnancy if started up to five days after unprotected intercourse. The sooner you start it, the better it will work. To remove the female condom

o o

o o o

Squeeze and twist the outer ring to keep semen inside the pouch. Gently pull it out of the vagina or anus. Throw it away. Do not flush it down the toilet. Do not reuse the female condom. You can also learn how to insert a female condom by watching this brief video.

+-

How Do I Get Female Condoms? How Much Do Female Condoms Cost?

The female condom is available at your local Planned Parenthood health center, other family planning clinics, drugstores, online, and in some supermarkets. Nationwide and online, a female condom costs about $2-4. But costs vary from community to community.

Fertility Awareness-Based Methods at a Glance

Charting your fertility to help prevent pregnancy Safe and convenient

Want to learn how to track your fertility? FIND A HEALTH CENTER

Are Fertility Awareness-Based Methods Right for Me?

All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. Here are some of the most common questions we hear women ask about fertility awareness-based methods. We hope you find the answers helpful.

Expand All + +What Are Fertility Awareness-Based Methods?

Fertility awareness-based methods (FAMs) are ways to track ovulation the release of an egg in order to prevent pregnancy. Some people call FAMs "natural family planning."

+How Do Fertility Awareness-Based Methods Work?

FAMs work by keeping sperm out of the vagina in the days near ovulation, when a woman is most fertile most likely to become pregnant. To prevent pregnancy, women can abstain from vaginal intercourse on their fertile days. Or they can use withdrawal, a condom, a sponge, a diaphragm, or a cap on those days. Or they may enjoy other kinds of sex play instead of vaginal intercourse on their fertile days. Emergency Contraception If you have unprotected sex on a day that you may be fertile,emergency contraception is a good option. Emergency contraception can prevent pregnancy if started up to five days after unprotected intercourse. The sooner you start it, the better it will work. UNDERSTANDING YOUR FERTILITY PATTERN In order to know when you are most likely to get pregnant, you have to become familiar with your menstrual cycle. Before pregnancy can begin, a woman's egg must join with a man's sperm. This is called fertilization. For a healthy woman, there are days when fertilization can happen. There are days when it can't. And there are some days when it's unlikely but still possible. To begin a pregnancy, a woman can have vaginal intercourse without protection during the days when it's possible for the egg and sperm to join. We call those days your fertile days. A woman's fertile days depend on the life span of the egg and the sperm. Her egg lives for about a day after ovulation. Sperm can live inside her body for about six days. A woman has a chance of her egg joining a sperm about seven days of every menstrual cycle.

o o o

This includes the five days before ovulation. It includes the day of ovulation. It also includes the day or two after ovulation even though it's less likely to happen then. Knowing when your fertile days will happen can help you avoid a pregnancy. It can also help you plan one. The key is to figure out when you will ovulate. This will let you figure out the other fertile days that come before and after you ovulate. Then you can track your fertility pattern the days of the month when you are fertile and the days of the month when you are not. You must do this carefully. Women don't all have the same fertility pattern. And some women have different patterns from one month to the next. Ovulation Predictors Test kits that attempt to predict ovulation are available for home use. They may be useful for planning pregnancies. But they are not reliable for preventing pregnancy.

+What Are the Different Fertility Awareness-Based Methods?

There are several methods you can use to predict when you will ovulate.
o

Temperature Method You will take your temperature in the morning every day before you get out of bed. Cervical Mucus Method You will check the changes in your cervical mucus every day for the first part of your cycle until you are sure you have ovulated. Calendar Method You will chart your cycles on a calendar. It is most effective to combine all three of these methods. Together, they are called the symptothermal method.

Standard Days Method You will track your cycle for several months to be sure that your cycle is always between 26 and 32 days long. Never longer or shorter. Then, you will not have unprotected vaginal intercourse on days 819.

+What is the Calendar Method?

To prevent pregnancy, women can keep track of their menstrual cycles and abstain from unprotected vaginal intercourse when they are most likely to become pregnant. The methods you can use to do this are called fertility awareness-based methods (FAMs). One way that women track their fertility patterns is called the calendar method. Some women also track their fertility patterns when trying to get pregnant to know when they should have unprotected vaginal intercourse. The Calendar Method

With the calendar method, you need to keep a record of the length of each menstrual cycle in order to determine when you are fertile. You can use an ordinary calendar. Circle day one of each cycle, which is the first day of your period. Count the total number of days in each cycle. Include the first day when you count. Do this for at least eight cycles (12 is better). Cycle Record First Day of Period Number of Days in Cycle

Jan. 20 Feb. 18 Mar. 18 Apr. 16 May 12 June 9 July 9 Aug. 5

29 29 28 29 26 28 30 27

Don't use the calendar method if all your cycles are shorter than 27 days. Chart Your Calendar Pattern To predict the first fertile day in your current cycle
o o o

Find the shortest cycle in your record. Subtract 18 from the total number of days. Count that number of days from day one of your current cycle, and mark that day with an X. Include day one when you count. The day marked X is your first fertile day. To predict the last fertile day in your current cycle

o o o

Find the longest cycle in your record. Subtract 11 days from the total number of days. Count that number of days from day one of your current cycle, and mark that day with an X. Include day one when you count.

The day marked X is the last fertile day. Here is an example: Predicting your first fertile day. If your shortest cycle is 26 days long, subtract 18 from 26. That leaves 8. If day one was the fourth day of the month, the day you will mark X will be the 11th. That's the first day you're likely to be fertile. So on that day, you should start abstaining from sex or start using a cervical cap, condom, diaphragm, or female condom. Predicting your last fertile day. If your longest cycle is 30 days, subtract 11 from 30. That leaves 19. If day one was the fourth day of the month, the day you will mark X will be the 22nd. That's the last day you're likely to be fertile during your current cycle. So you may start to have unprotected vaginal intercourse after that day. In this example, the 11th through the 22nd are unsafe days. All the others are safe days.

The Role of the Calendar Method The calendar method can only predict what are most likely to be safe days. It is especially risky if your cycles are not always the same length. That's why it should always be used with other methods. Do not have unprotected intercourse on any day that the calendar method says is unsafe. This information is not meant as a substitute for professional advice.

+What is the Cervical Mucus Method?

To prevent pregnancy, women can keep track of their menstrual cycles and abstain from unprotected vaginal intercourse during their peak fertile times. The methods you can use to do this are called fertility awareness-based methods(FAMs). One way that women track their fertility cycles is called the cervical mucus method.

Some women also pay attention to their cervical mucus when trying to get pregnant to know when they should have unprotected vaginal intercourse.

Cervical Mucus Method The hormones that control your cycle also make the cervix produce mucus. It collects on the cervix and in the vagina. And it changes in quality and quantity just before and during ovulation. With personal instruction, many women can learn to recognize these changes. Instruction is usually given one-to-one. This method is also known as the ovulation method or the Billings method. The Mucus Pattern
o o

During your period, your flow covers the mucus signs. After your period, there are usually a few days without mucus. These are called "dry days." These may be safe days if the cycle is long. When an egg starts to ripen, more mucus is produced. It appears at the opening of the vagina. It is generally yellow or white and cloudy. And it feels sticky or tacky. Usually, you will have the most mucus just before ovulation. It looks clear and feels slippery like raw egg white. When it can be stretched between the fingers, it is called spinnbarkeit German for stretchable. These are the "slippery days." It is the peak of your fertility. After about four slippery days, you may suddenly have less mucus. It will become cloudy and tacky again. And then you may have a few more dry days before your period starts. These are also safe days.

Charting Your Mucus Pattern You should mark a calendar every day. Record your period days, the dry days, tacky days, cloudy days, wet days, and slippery days. Your mucus may feel different in between those stages. It may be granular, rubbery, wet, or creamy. Have someone with experience help you learn your own pattern.

You can check your mucus in several ways. Do what is most comfortable for you. Check several times a day. You can
o o o

Wipe the opening of the vagina with tissue before you urinate. Check the color and texture. Check the color and texture of the discharge on your underpants. Put clean fingers into the vagina and check the color and texture of the mucus on them. This method isn't the best for women who don't produce much mucus. Women who ovulate on day seven or eight may also have too little mucus. A woman's mucus pattern may be altered by

o o o o o o o o

breastfeeding cervical surgery especially with cryotherapy or electrocautery douches or other "feminine hygiene" products perimenopause recent use of hormonal contraceptives, including emergency contraception spermicide sexually transmitted infections vaginitis Safe Days Using the Mucus Method Do not have unprotected vaginal intercourse on your unsafe days.

The days of your period are not safe days, especially during short cycles. The flow can cover the mucus signs. In a long cycle, the dry days after your period may be safe. Days that are not safe begin two or three days before the first sign of slippery mucus. They last for about three days after slippery mucus peaks. Safe days may begin after peak slippery mucus drops off and is cloudy and tacky again. But the dry days that follow are even safer. It's best to abstain from unprotected vaginal intercourse for at least one whole cycle before you start to use this method for birth control. The Two-Day Method The Two-Day Method is a mucus method. It works best for a woman who is sure she can tell whether or not she has secretions. To use the method, she asks herself two questions:

o o

o o

Do I have cervical mucus today? Did I have cervical mucus yesterday? If she can answer "no" to both questions, it is considered a safe day for unprotected intercourse. Women who use this method may have only 12 safe days in each of their cycles. Effectiveness Of 100 couples who use the cervical mucus method correctly for one year, 3 will have a pregnancy. Of 100 couples who use the Two-Day Method correctly for one year, 4 will have a pregnancy. This information is not meant as a substitute for professional advice.

+What is the Standard Days Method?

To prevent pregnancy, women can keep track of their menstrual cycles and abstain from unprotected vaginal intercourse during their peak fertile times. The methods you can use to do this are called fertility awareness-based methods(FAMs). One way that women track their fertility patterns is called the Standard Days Method. Standard Days Method The Standard Days Method is a kind of calendar method. It is a way to keep track of your cycle. You may find it simpler to use than other methods. You can only use it if
o o o o

You have regular cycles. Your cycle is never shorter than 26 days. Your cycle is never longer than 32 days. You will not have unprotected vaginal intercourse from day 8 through day 19 of each cycle. Most women use special strings of beads for the Standard Days Method. They are called CycleBeads. It helps keep track of their cycles. There are 33 colored beads and a moveable rubber ring on the string. The first bead is black with a white arrow. The next one is red. The next six are

brown. The next 12 are white. And the last 13 are brown. Each one, except the black one, represents a day.
o o o

On the first day of your period, day one, you put the ring on the red bead. You move the ring from one bead to another each day in the direction of the arrow. Brown beads stand for safe days. You can have unprotected vaginal intercourse when the ring is on one of them. White beads stand for unsafe days. Do not have vaginal intercourse unless you use a cervical cap, condom, diaphragm, or female condom when the ring is on one of them.

Effectiveness Of 100 couples who use the Standard Days Method correctly for one year, 5 will have a pregnancy. Certain things may make the Standard Days Method less effective. They include the use of hormonal contraception (includingemergency contraception), IUDs, breastfeeding, or a recent pregnancy. Read more about the Standard Days Method at CycleBeads. This information is not meant as a substitute for professional advice.

+What is the Symptothermal Method?

To prevent pregnancy, women can keep track of their menstrual cycles and abstain from unprotected vaginal intercourse during their peak fertile times. The methods you can use to do this are called fertility awareness-based methods (FAMs). One way that women track their fertility patterns is by combining several fertility awareness-based methods. This is sometimes called the symptothermal method. Some women also track their fertility patterns when trying to get pregnant to know when they should have unprotected vaginal intercourse. Symptothermal Method When women use the symptothermal method, they use more than one fertility awareness method at once. These methods include
o o o

Temperature Method Cervical Mucus Method Calendar Method

The signs of one method can confirm those of the other. This lets you be more accurate when you predict your safe days than if you use one method alone. For example, keeping track of your mucus pattern can be useful when your temperature chart is confused by illness or emotional stress. And you may be able to identify more days when you can have unprotected vaginal intercourse than you can only using the temperature method. Using a fertility pattern chart helps women keep track of the signs of their fertile times. Post-Ovulation Method Another combined method is called post-ovulation. All the days from day one until the morning of the fourth day after predicted ovulation are unsafe days. But this means that the safe days are limited to less than half of a woman's cycle. Effectiveness Of 100 couples who use the symptothermal method correctly for one year, 0.4 (fewer than one) will have a pregnancy. This information is not meant as a substitute for professional advice.

+What is the Temperature Method?

To prevent pregnancy, women can keep track of their menstrual cycles and abstain from unprotected vaginal intercourse during their peak fertile times. The methods you can use to do this are called fertility awareness-based methods(FAMs). One way that women track their fertility patterns is called the temperature method. Some women also track their temperature when trying to get pregnant to know when they should have unprotected vaginal intercourse. Temperature Method Your body temperature is lower during the first part of your cycle. It usually rises slightly after ovulation when an egg is released. Your body temperature stays elevated for the rest of your cycle. It falls again just before your next period. Tracking your temperature every day can help you know when you ovulate. To prevent pregnancy, you will not have unprotected vaginal intercourse until three days afteryou ovulate each cycle. You will need to chart your basal body temperature (BBT) every day. BBT is the temperature of the body when it is completely at rest. It varies slightly from person to person. Before ovulation, 96 to 98F is normal for most women. After ovulation, 97 to 99F is normal. The changes will be in fractions of a degree from 1/10 to 1/2 a degree. So it's best to get a special, large-scale thermometer that only registers 96 to 100F. It will be much easier to read. You can buy a basal thermometer for about $10 at most drugstores. Some basal thermometers are to be used in the mouth and some are to be used in the rectum. Rectal thermometers are generally more reliable. Whatever you choose, be sure to take your temperature the same way every day. Taking Your Temperature

Take your temperature every morning as soon as you wake up. Do it before getting out of bed, talking, eating, drinking, having sex, or smoking. Keep the thermometer in place for five full minutes. Read it to within 1/10 of a degree. Record the reading. Charting Your Temperature Pattern You must record every reading. You can get charts from your health care provider or women's health center. As each day's reading is put on the chart, you will begin to see a pattern. The rise in your temperature may be sudden, gradual, or in steps. The pattern may vary from cycle to cycle. Your BBT may change when you are upset or don't get enough sleep. Illness, stress, jet lag, and smoking may also affect your body temperature. So can drinking more than you're used to or using an electric blanket. Putting these kinds of events on your chart can help you understand the pattern. At first, you should have help to read your chart. A doctor, nurse, or family planning specialist can do that for you. In time, you'll have the confidence to use the chart by yourself. Be sure to chart at least three months before relying on this method.

Safe Days Using the Temperature Method The safe days are those that are not fertile days. They are safe for unprotected vaginal intercourse if you are trying to prevent pregnancy. They begin after the temperature rise has lasted for at least three days. They end when the temperature drops just before your next period begins. The temperature method is quite good at telling when ovulation has happened. But it can't predict when it will happen. So, you have to make sure that sperm is not waiting in your body when it does happen. It is best to treat as unsafe all the days of the first part of your cycle. This is from the start of your period to the start of the fourth day of your next rise in temperature. You can combine BBT with

another method to try to predict when ovulation will happen. This can increase the number of your safe days. After a while, you may become sure that you can tell what days are safe. If so, you may not have to take your temperature every day. You can go without taking it from the start of your safe days to the start of your next period. This information is not meant as a substitute for professional advice.

+How Effective Are Fertility Awareness-Based Methods?

Effectiveness is an important and common concern when choosing a birth control method. Like all birth control methods, fertility awareness-based methods are more effective when you use them correctly. Twenty-four out of every 100 couples who use fertility awareness-based methods each year will have a pregnancy if they don't alwaysuse the method correctly or consistently. Always practicing these methods correctly will make them more effective. How well fertility awareness-based methods work depends on both partners. That's why it is important for both to learn about the methods and support each other in their use. These methods can work best for you if you
o o

have received careful instruction have only one sex partner and he is as committed to fertility awareness-based methods as you are have the discipline you need to check and chart your fertility signs don't mind abstaining or using withdrawal, a cervical cap or diaphragm, a sponge, spermicide, or latex or female condoms on your unsafe days

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+How Safe Are Fertility Awareness-Based Methods?

Fertility awareness-based methods are very safe there are no side effects.

+What Are the Benefits of Fertility Awareness-Based Methods?

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They cost very little. They are safe. They can be stopped easily to plan a pregnancy.

o o

Calendars, thermometers, and charts are easy to get. Medication is not needed.

+What Are the Disadvantages of Fertility Awareness-Based Methods?

Fertility awareness-based methods may not work for you if you
o o o o o

have more than one sex partner have a sex partner who isn't as committed to fertility awareness-based methods as you are don't want to keep close track of your safe days are not able to abstain or use another method for at least 10 unsafe days during each cycle take medicine that may affect reading the signs of these methods

Do not depend on tracking your fertility if you

o o o o

have irregular periods have a partner who is not cooperative have a sexually transmitted infection or frequent abnormal vaginal discharges cannot keep careful records

It may be more difficult to track your fertility if you are breastfeeding, are a teenager, or are getting close to menopause. The hormone shifts may make the signs unpredictable. Don't switch to a fertility awareness-based method after using a hormonal one, such as the pill. The hormones will affect your cycle. Use a method without hormones while you're learning to track your fertility.

+How Do I Learn How to Use a Fertility Awareness-Based Method? How Much Does It Cost?
Couples can learn how to use fertility awareness-based methods by taking a course. Or they can be taught by a specially trained health professional. Both partners should learn the methods together. This way, both will know exactly what needs to be done to make the methods work. This will make them work better. And many couples report that they become more intimate by sharing responsibility for birth control.

Classes on charting fertility patterns and keeping ovulation calendars for contraception are offered by women's health centers, church-affiliated instructors, and Catholic hospitals. There is often little or no cost. You can find instructors in certain religious settings. But they may not give you information about other methods. And they may not allow the use of barrier methods. For instruction that is not associated with a religion, ask for a referral from a women's clinic with no religious association. Or contact your state or county health department or your nearest Planned Parenthood health center. Fertility charts or ovulation calendars cost little or nothing. They are easy to get from women's health centers and from private instructors and organizations. You can also print out this fertility pattern chart.Basal body temperature thermometers cost about $10 to $12. You may have to pay a fee for classes to learn fertility awareness-based methods. In some states, Medicaid will cover the cost of classes taken at a clinic or when authorized by a private physician.

Spermicide at a Glance

A substance that prevents pregnancy by stopping sperm from moving Safe and convenient Easy to use Costs about $8 per package

Is Spermicide Right for Me? All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. Here are some of the most common questions we hear women ask about spermicide. We hope you find the answers helpful.

Expand All + +What Is Spermicide?

Spermicide is a birth control method that contains chemicals that stop sperm from moving. Spermicides are available in different forms, including creams, film, foams, gels, and suppositories. Spermicide can be used alone, or it can be used with other birth control methods to make them more effective. It is always used with the diaphragm and cervical cap.

+How Does Spermicide Work?

Spermicides prevent pregnancy by keeping sperm from joining with an egg. Spermicides are inserted deep into the vagina shortly before intercourse. They
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block the cervix, so sperm cannot reach an egg keep sperm from moving, so they cannot join with an egg

+How Effective Is Spermicide?

Effectiveness is an important and common concern when choosing a birth control method. Like all birth control methods, spermicide is more effective when you use it correctly. If women always use spermicide as directed, 15 out of 100 will become pregnant each year. o If women don't always use spermicide as directed, 29 out of 100 will become pregnant each year. When used alone, spermicide is not very effective. You can make it more effective if you also use a female condom. Your partner can help you make spermicide more effective by using a latex condom or pulling out before ejaculation. But even if you don't use another method along with spermicide, your chance of getting pregnant is much less than if you use no birth control at all.
o

Keep in mind that spermicide cannot reduce the risk of sexually transmitted infections. Use latex or female condoms to reduce the risk of infection.

+-

How Safe Is Spermicide?

Most women can use spermicide safely. Some people are allergic to spermicides or get skin irritations from them. If a spermicide irritates your vagina or your partner's penis, you might try changing brands.

+What Are the Benefits of Spermicide?

Using spermicide is simple and convenient. Once you learn how, inserting the spermicide is easy. Women like spermicide because
o o o o o o

It can be carried in your pocket or purse. It can be inserted by a partner as part of sex play. It does not have an effect on a woman's natural hormones. It is very easy to get in drugstores and some supermarkets. It does not require a prescription. It can be used during breastfeeding.

+What Are the Disadvantages of Spermicide?

Spermicide has several disadvantages:
o

If not used exactly as directed, spermicides may not form a good barrier over the cervix. This may make the spermicide less effective. Some women complain that spermicides are messy or that they leak from their vaginas. Spermicide may irritate the penis or vagina. Switching brands may solve this problem. Nonoxynol-9 The most commonly used spermicide in the U.S. is called nonoxynol-9. Nonoxynol-9 has certain risks. If it is used many times a day, or if it is used by people at risk for HIV, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections.

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+How Do I Use Spermicide?

Each form of spermicide is used in a slightly different way. Be sure to read the instructions that are included in the packaging. Make sure you read and understand them before you use any of these products. If you do not use the spermicide as directed, it will be less effective. In general, inserting spermicide is easy. You will lie down or squat, then gently insert the spermicide deep into your vagina using your fingers or an applicator.

For many types of contraceptive creams, film, foams, gels, and suppositories, you need to wait 10 minutes after you insert the spermicide before you can have intercourse. These methods typically remain effective for only one hour after insertion. You need to insert more spermicide each time you have vaginal intercourse. Women should not douche, unless they are told to by a health care provider. If you do douche, do not douche until 6-8 hours after intercourse.

+How Do I Get Spermicide? How Much Does Spermicide Cost?

Spermicide is available at your local Planned Parenthood health center, other family planning clinics, drugstores, and some supermarkets. Applicator kits of foam and gel cost about $8. Refills cost $4-$8. Large cans of foam contain between 20 and 40 applications. Film and suppositories are also about $8. Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs. Call your local Planned Parenthood health center to get specific information on costs.

Birth Control Pills at a Glance

Take a pill each day to prevent pregnancy Safe, effective, and convenient Easy to get with a prescription Cost about $15$50 each month

Want the pill? FIND A HEALTH CENTER

Are Birth Control Pills Right for Me?

All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. Here are some of the most common questions we hear women ask about the pill. We hope you find the answers helpful.

Expand All + +What Are Birth Control Pills?

Birth control pills are a kind of medication that women can take daily to prevent pregnancy. They are also sometimes called the pill or oral contraception.

+How Do Birth Control Pills Work?

It's pretty common for people to be confused about how birth control pills work. Heres what it boils down to: birth control pills are made of hormones. Hormones are chemicals made in our bodies. They control how different parts of our bodies work. Some birth control pills contain two hormones estrogen andprogestin. These are called combination pills. Some are progestin-only pills. Most women on the pill take combination pills. The hormones in the pill work by keeping a womans ovaries from releasing eggs ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormones in the pill also prevent pregnancy by thickening a womans cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. The hormones also thin the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching to the uterus.

+How Effective Are Birth Control Pills?

Effectiveness is an important and common concern when choosing a birth control method. Birth control pills are very effective. Combination pills work best when taken every day. Progestin-only pills must be taken at the same time every day. That keeps the correct level of hormone in a womans body.

o o

Less than 1 out of 100 women will get pregnant each year if theyalways take the pill each day as directed. About 9 out of 100 women will get pregnant each year if theydont always take the pill each day as directed. The pill may be slightly less effective for women who are very overweight. Talk with your health care provider if you are concerned about how well the pill may work for you. Certain medicines and supplements may make the pill less effective. These include

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the antibiotic rifampin other antibiotics do not make the pill less effective certain medicines that are taken by mouth for yeast infections certain HIV medicines certain anti-seizure medicines St. John's wort Vomiting and diarrhea may also keep the pill from working. Ask your health care provider for advice. Use a backup method of birth control like a condom, female condom, diaphragm, sponge, or emergency contraception (morning after pill) until you find out you dont need to. Keep in mind the pill doesnt protect against sexually transmitted infections. Use a latex or female condom to reduce the risk of infection.

+How Safe Are Birth Control Pills?

Most women can use birth control pills safely. But all medications have some risks, so safety is a concern when choosing a birth control method. Certain conditions increase the risk of serious side effects. Some of these conditions may even rule out using the pill. Talk with your health care provider to find out if the pill is likely to be safe for you. You should not take any kind of birth control pill if you have had breast cancer or think you might be pregnant. You should not take the progestin-only pill if you have blood clotting problems that are not being treated successfully. You should not take the combination pill during prolonged bed rest or if you get migraine headaches with aura have certain inherited blood-clotting disorders have or are being treated for blood clots or vein inflammation have had a heart attack, stroke, angina, or other serious heart problems

 have had serious heart valve problems have lupus with certain conditions have serious liver disease or have had liver cancer have very bad diabetes or have had diabetes for longer than 20 years have uncontrolled high blood pressure smoke and are 35 or older smoke and have high blood pressure have had complications after organ transplant need to stay in bed for a long time YASMIN and Yaz You should not take the birth control pill YASMIN or Yaz if you have ever had kidney, liver, or adrenal gland disease. YASMIN and Yaz contain a special progestin that may increase potassium levels and cause serious heart and other problems. If you have a condition that makes it unsafe to take the pill, dont worry. There are many other methods of birth control that may be safe for you if you cannot take the pill. Read about other methods to find one that may be right for you.

+What Are the Benefits of Birth Control Pills?

Taking the pill is simple, safe, and convenient. It does not interfere with having sex. Many women say it improves their sex lives because it helps them feel more spontaneous. Women who do not need birth control often choose to take the pill for the other benefits it offers. Combination and progestin-only pills

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reduce menstrual cramps make periods lighter offer some protection against pelvic inflammatory disease, which often leads to infertility when left untreated The combination pill offers many other benefits, including some protection against acne bone thinning breast growths that are not cancer ectopic pregnancy endometrial and ovarian cancers

o o o o o

o o o o o o

serious infection in the ovaries, tubes, and uterus iron deficiency anemia cysts in the breasts and ovaries premenstrual symptoms, including headaches and depression bad cramps heavy and/or irregular periods Combination pills can be used to control when and how often you have your period. Some pills are specially packaged for women to have only a few periods a year. Other pills can also be used continuously to prevent having periods. With these pills, women take an active pill every day to keep from getting their periods. It is normal for them to have spotting or bleeding the first 6 months. It

may get less over time. Some stop having any bleeding at all. This is normal and will not harm your body. But its a good idea to get tested if you think you might be pregnant.

+What Are the Disadvantages of Birth Control Pills?

Some women may have undesirable side effects while taking birth control pills. But many women adjust to the pill with few or no problems. Some of the most common side effects usually clear up after two or three months. They include bleeding between periods (most often with progestin-only pills) breast tenderness nausea and vomiting Nausea and vomiting may be helped by taking the pill in the evening or at bedtime. But do not stop taking the pill because you feel sick to your stomach you will be at risk of pregnancy if you do. The hormones in the pill may change a womans sexual desire. Its important that you find a method that wont make you feel sick or uncomfortable. If you continue to experience side effects after taking the pill for three months, talk with your health care provider about changing your prescription. After stopping the pill, it usually takes one or two months for a womans periods to return to the cycle she had before taking the pill. Once in a while, a woman may have irregular periods or no periods at all. This may go on for as long as six months after stopping. This is more likely if her periods were irregular before starting the pill. Serious Side Effects of the Pill

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Many women have concerns about the possible risks of taking birth control pills. Serious problems do not occur often. And progestin-only pills have a lower risk of serious side effects than combination pills. Combination pill users have a slightly greater chance of certain rare, but serious, problems than nonusers. These problems, that may be fatal in very rare cases, include heart attack, stroke, having a blood clot in the legs, lungs, heart, or brain, or developing high blood pressure, liver tumors, gallstones, or yellowing of the skin or eyes (jaundice). The risk for these problems increases if you

o o o o o o o o

are age 35 or older are very overweight have certain inherited blood-clotting disorders have diabetes have high blood pressure have high cholesterol need prolonged bed rest smoke Serious problems usually have warning signs. Report any of these signs to your health care provider as soon as possible:

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a new lump in your breast a sudden very bad headache achy soreness in the leg aura seeing bright, flashing zigzag lines, usually before a very bad headache bad pain in your abdomen or chest headaches that are different, worse, or happen more often than usual no period after having a period every month trouble breathing yellowing of the skin or eyes The Pill and Breast Cancer You may have heard claims linking the pill to breast cancer. The most recent medical literature suggests that the pill has little, if any, effect on the risk of developing breast cancer.

See the insert from your pack of pills for more information about possible side effects.

+How Do I Take Birth Control Pills?

It depends on what kind of pill you are taking. Most combination pillscome in 28-day or 21-day packs. Both types have 21 "active" pills that contain hormones. The last seven pills in 28-day packs of combination pills are called "reminder" pills. They do not contain hormones. In 21-day packs, one pill is taken every day for three weeks in a row. No pills are taken for the next week, and then a new pack of pills is started. Some combination pills contain a few months worth of active pills. They are specially packaged to reduce the number of periods a woman has each year. Women can also take the active pills in 21day or 28-day packs continuously to reduce how often they have periods. Progestin-only pills come only in 28-day packs. All progestin-only pills are active. With combination pills, youll get your period during the fourth week unless you choose to avoid menstruation by using active combination pills during the fourth week, as well. With progestin-only pills, you may

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get your period the fourth week get no periods have bleeding on and off throughout the month The hormones in birth control pills prevent pregnancy throughout the entire month even during the fourth week.

Helpful Tips About Birth Control Pills

Taking the pill at the same time each day makes it more effective. Pick a time of day that is easy to remember. You might find it helpful to take it when you do something else you do every

day like brushing your teeth or eating dinner. Many women set an alarm on their cell phones or watches. A missed period does not always mean you are pregnant, especially if you have not skipped any pills. Even though the chance of pregnancy is very low, you may want to take a pregnancy test if you miss two periods in a row. Talk with your health care provider if you have any questions or concerns while using the pill. There is a very slight chance that you will become pregnant even if you take the pill as directed. It is unlikely that taking the pill during early pregnancy will increase the risk of birth defects. However, the likelihood of ectopic pregnancy is greater if you become pregnant while taking the progestin-only pill. If you decide you want to become pregnant, stop taking the pill. Its possible to get pregnant right after stopping. It usually takes about one or two months for your period to return to the cycle you had before taking the pill.

+How Do I Start Birth Control Pills?

Women used to be told that they could only start the pill on the first day of their period or on the first Sunday after the start of their period. We now know that its also perfectly fine to start the pill on any day of the month. Talk with your health care provider about what day is best for you to start taking the pill. Combination Pills You may start the combination pill at any time. If you start within five days after the start of your period, you are protected against pregnancy right away. You will not need to use a backup method of birth control. That means that if your period starts on a Wednesday morning, you can start the pill up to Monday morning to be protected right away. If you start at any other time during your menstrual cycle, you will be protected from pregnancy after seven days. Use another method of birth control like a condom, female condom, diaphragm, or sponge if you have vaginal intercourse during the first week of use. Progestin-Only Pills You may start the progestin-only pill at any time. Use another method of birth control if you have vaginal intercourse during the first 48 hours of progestin-pill use protection will begin after two days. Taking the progestin-only pill at the same time each day is essential. If you take it more than three hours past the regular time, you need to use a backup method of birth control for 48 hours after taking the late pill. Starting the Pill After Pregnancy Its possible to get pregnant again shortly after being pregnant. Starting birth control after pregnancy is an important concern for many women. And many of these women choose the pill. You can start taking the combination pill after waiting at least three weeks after giving birth

vaginally. You should wait at least six weeks after birth if you are nursing or if you have an increased risk of blood clots. Women have a higher risk of blood clots if they

are obese are over age 35 had a cesarean section (C-section) had heavy bleeding after delivery had preeclampsia have certain inherited blood clotting disorders have had blood clots in the past have a close family member who has had blood clots need prolonged bed rest received a blood transfusion at delivery smoke You can start using the combination pill right after an abortion or miscarriage.

You can start taking the progestin-only pill right after an abortion, miscarriage, or childbirth.

Breastfeeding and Birth Control Pills Progestin-only pills will not affect your milk during nursing. You should wait to start using combination pills if you are nursing because they may reduce the amount and quality of milk in the first six weeks of breastfeeding. Breast milk will contain traces of the pill's hormones. It is unlikely that these hormones will have any effect on your child. But talk with a health care provider about what birth control methods might be right for you after giving birth.

+What Do I Do If I Forget to Take the Pill?

Almost all women on the pill forget to take it at some time. The pill works best when taken on time, every day but knowing what to do when you forget could save you from having an unplanned pregnancy. Here are some general instructions. Talk with your health care provider for more information.

What to do depends on the kind of pill you take. Some birth control pills have two hormones estrogen and progestin. These are called combination pills. Some are progestin-only pills. Most women on the pill take combination pills. Ask your health care provider if you are not sure what kind of pill you are on. Combination Pills You could become pregnant depending on when you miss pills and how many of them you miss. There is a highly increased chance of pregnancy if you go without hormones for seven or more days in a row. This could happen if you dont start a new pack on time and/or forget to take the last one or two pills in the pack. You may need a backup method of birth control if you have vaginal intercourse during the seven days after a missed pill. Some backup methods are the condom, female condom, diaphragm, or sponge. You can also use emergency contraception (morning after pill) as backup. This is a great option if you have vaginal intercourse before you realize you have missed pills. Emergency contraception can prevent pregnancy if started up to five days after unprotected intercourse. The sooner you start it, the better it will work. This table tells you what to do if you miss any pills from a 21-day or 28-day pack of combination pills. Number of Pills Missed When Pills Missed

What to do ... Take a pill as soon as you remember. Take the next pill at the usual time. (This means you may take two pills in one day.)

Seven-Day Backup Needed?

First 12 pills

Beginning of pack

Yes

Take a pill as soon as you remember. Take the next pill at the usual time. (This means you may take two pills in one day.) No

12 pills

Day 3day 21

Take a pill as soon as you remember. Take the next pill at the usual time. (This means you may take two pills in one day.) Yes

3 or more pills

First two weeks

3 or more pills

Third week

Do not finish pack. Throw away remaining pills. Start next pack.

Yes

17 reminder pills

Fourth week

Throw away the missed reminder pill(s). Take next reminder pill at the usual time.

No

Progestin-Only Pills You could become pregnant if you take your progestin-only pill more than three hours past your regular time. If you do

Take a pill as soon as you remember. Take the next pill at the usual time. Continue to take the rest of the pack on schedule. Use a backup method for 48 hours after taking the late pill. Some backup methods are the condom, female condom, diaphragm, sponge, or emergency contraception. Emergency contraception is a great backup method if you had vaginal intercourse before you realized you missed pills. Many women have spotting or light bleeding when they miss a birth control pill even if they make it up later. Women also sometimes feel a little sick to their stomachs if they take two pills to make up for a missed pill. If you do feel a bit sick after taking two pills in a day, dont worry. The nausea wont last long. Are you still not sure what to do about pills you have missed?

Use a backup method anytime you have vaginal intercourse. Take one active pill each day until you can talk with your health care provider.

+How Do I Get Birth Control Pills? How Much Do Birth Control Pills Cost?
First, youll need to get a prescription. Visit a Planned Parenthood health center, a clinic, or a private health care provider for a prescription. Your health care provider will discuss your medical history with you, check your blood pressure, and give you any othermedical exam that you may need. If you need an exam, it may cost about $35$250. Birth control pills may be purchased with a prescription at a drugstore or clinic. They cost about $15 $50 a month. Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs. Call your local Planned Parenthood health center to get specific information on costs.

Sterilization for Women at a Glance

Surgery that prevents pregnancy Safe and highly effective Costs between $1,500 and $6,000 Meant to be permanent

Thinking about sterilization? FIND A HEALTH CENTER

Is Sterilization Right for Me? All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. Here are some of the most common questions we hear about sterilization for women. We hope you find the answers helpful.

Expand All +

+What Is Sterilization?
Sterilization is a form of birth control. All sterilization procedures are meant to be permanent. During a sterilization procedure, a health care provider closes or blocks a woman's fallopian tubes. Closing the tubes can be done in several ways. One way is by tying and cutting the tubes this is called tubal ligation. The fallopian tubes also can be sealed using an instrument with an electrical current. They also can be closed with clips, clamps, or rings. Sometimes, a small piece of the tube is removed. Sometimes, tiny inserts are put in the tubes. Tissue grows around them and blocks the tubes. The brand names for these types of sterilization are Adiana and Essure.

+How Does Sterilization Work?

Eggs are made in a woman's ovaries. One egg is released each month. It passes through one of the fallopian tubes toward the uterus. Sterilization blocks each tube. Pregnancy cannot happen if sperm cannot reach the egg.

+How Safe Is Sterilization?

Most women can be sterilized safely. But like any medical procedure, there are risks. One possible risk is that the tubes may reconnect by themselves but this is rare. When women get pregnant after being sterilized, about 1 out of 3 has a pregnancy that develops in a fallopian tube. This is called ectopic pregnancy. Ectopic pregnancy is serious and may be life threatening.

The Signs of Ectopic Pregnancy The signs of ectopic pregnancy include

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irregular bleeding from the vagina pain in the abdomen or tip of the shoulder sudden weakness or fainting If you think you may have an ectopic pregnancy and can't reach your health care provider, go to a hospital emergency room right away. Other risks depend on the type of sterilization. Read below about the different types of sterilization and their risks. And talk with your health care provider about whether sterilization is likely to be safe for you.

+-

What Are the Benefits of Sterilization?

Sterilization is safe and, because it lasts for life, it is simple and convenient. It allows a woman to enjoy sex without worrying about pregnancy. Many women and men report that they have more sexual pleasure because they don't have to think about unwanted pregnancy anymore. Sterilization does not change your hormones. The hormones that affect hair, voice, sex drive, muscle tone, and breast size, are still made in the ovaries. Those hormones still flow through the body after sterilization. It will not cause symptoms of menopause or make menopause happen earlier. And most women who have been sterilized will still have normal periods. Sterilization may be right for you if
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You don't want to have a child biologically in the future. You have concerns about the side effects of other methods. Other methods are unacceptable. Your health would be threatened by a future pregnancy. You don't want to pass on a hereditary illness or disability. You and your partner agree that your family is complete, and no more children are wanted. You and your partner have decided that sterilization is better for you than vasectomy is for him.

+What Are the Disadvantages of Sterilization?

There are several possible disadvantages of sterilization. Sterilization may not be a good choice for you if you
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may want to have a child biologically in the future are being pressured by a partner, friends, or family are using it to solve problems that may be temporary such as marriage or sexual problems, short-term mental or physical illnesses, financial worries, or being out of work You should consider any possible life changes, such as divorce, remarriage, or death of children. You don't need your partner's permission to be sterilized, but it may be helpful to discuss it with your partner or anyone else who could be part of the decision-making process. There are risks with any medical procedure, including sterilization. It's important to understand the risks before being sterilized. Read below about the risks of each type of sterilization.

Considering Other Birth Control Options It is important to consider other methods before you choose sterilization. IUDs and the implant are as effective as sterilization, simple to use, offer long-term protection, but are not permanent.

Can Sterilization Be Reversed? If you are thinking about reversal, sterilization may not be right for you. Reversals require complicated surgery and cost thousands of dollars. Even though tubes can sometimes be rejoined, there are no guarantees. For many women, reversals are not possible because there is not enough of their tubes left to reconnect.

+What Are the Types of Sterilization?

There are a few different types of sterilization. One type does not require an incision a cut. It is called hysteroscopic sterilization. All the other methods require an incision. NO-INCISION (HYSTEROSCOPIC) METHODS ADIANA, ESSURE o INCISION METHODS LAPAROSCOPY, MINI-LAPAROTOMY, LAPAROTOMY o HIGH-RISK METHOD HYSTERECTOMY Your health care provider will help you decide which kind of sterilization might be right for you. Your medical history, including your weight and previous surgeries, may influence which kind will be best and safest for you.
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+-

How Effective Is Sterilization?

Effectiveness is an important and common concern when choosing a birth control method. Sterilization is nearly 100 percent effective.
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For every 1,000 women who have Essure, fewer than 3 will become pregnant. For every 1,000 women who have traditional incision methods, about 5 will become pregnant. For every 1,000 women who have Adiana, fewer than 20 will become pregnant. Most kinds of sterilization for women are effective right away. But it takes about three months before Adiana and Essure are effective. Keep in mind that sterilization provides no protection against sexually transmitted diseases. Latex or female condoms can reduce your risk of STDs.

+What Happens During Sterilization with Adiana?

To use Adiana, a health care provider puts a tiny insert into each of the fallopian tubes. Natural tissue grows around the inserts, blocking the tubes. During the procedure, the health care provider uses local anesthesia to numb the cervix. You may be offered other medication to help you relax and reduce your discomfort. A small, rigid, tube-like instrument called a hysteroscope is inserted into the vagina and through the cervix. A small amount of heat is applied to each fallopian tube. Two inserts the size of a grain of rice are placed in the spots where the heat was applied. While Adiana is being inserted and for a short time after you may have
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pain or cramping, like strong menstrual cramps mild nausea or vomiting (sick to your stomach) You may have a vaginal discharge, like a light menstrual period, for a few days. Like Essure and vasectomy, Adiana is not effective right away. Three months after insertion, a special x-ray is performed to make sure the tubes are fully blocked. You must use another form of birth control until then, or you may get pregnant. Adiana offers some advantages over other methods of sterilization:

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The procedure is safer than methods that require an incision. General anesthesia is not needed. A surgical setting is not needed. Recovery is faster some women return to normal activities the same day.

With Adiana, no incisions are necessary. So you won't have any visible scars.

+What Are the Risks with Adiana?

Studies have shown that Adiana is safe, but there are still some possible risks:
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One or both of the inserts may not be put in place correctly the first time. A second procedure may be needed. The uterus may be injured during the insertion. This rare complication may require surgery. The tubes may not be completely blocked after three months. It may be necessary to wait three more months to see if they become blocked. If they dont, a second procedure may be needed. Other rare complications include too much fluid build up in your bloodstream, changes in the menstrual cycle, infection, and pelvic or back pain. Talk with your health care provider about the benefits and risks of Adiana to help you decide if it may be right for you.

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+What Happens During Sterilization with Essure?

To use Essure, a health care provider puts a tiny insert called a microinsert into each of the fallopian tubes. Once in place, the inserts cause natural tissue to grow, blocking the tubes. During the procedure, the health care provider uses local anesthesia to numb the cervix. You may be offered other medication to help you relax and reduce your discomfort. Some women report mild to moderate pain while the inserts are being placed. A small, rigid, tube-like instrument called a hysteroscope is inserted into the vagina and through the cervix. The inserts are placed in the opening of the tubes. Like Adiana and vasectomy, Essure is not effective right away. Three months after insertion, a special x-ray is performed to make sure the tubes are fully blocked. You must use another form of birth control until then, or you may get pregnant. Essure offers some advantages over other methods of sterilization:
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The procedure is safer than methods that require an incision. General anesthesia is not needed. A surgical setting is not needed. Recovery is faster some women return to normal activities the same day. With Essure, no incisions are necessary. So you won't have any visible scars.

+What Are the Risks with Essure?

Studies have shown that Essure is safe, but there are still some possible risks:
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One or both of the inserts may not be put in place correctly the first time. A second procedure may be needed. The inserts may move out of place. The tubes may not be completely blocked after three months. It may be necessary to wait three more months to see if they become blocked. If they don't, a second procedure may be needed. The uterus may be injured during the insertion. This rare complication may require surgery. The inserts may be damaged during other medical procedures. Other rare complications include too much fluid build up in your bloodstream, changes in the menstrual cycle, infection, and pelvic or back pain. Talk with your health care provider about the benefits and risks of Essure to help you decide if it may be right for you.

+What Happens During Sterilizations that Require an Incision?

Laparoscopy Laparoscopy is one of the two most common types of sterilization. First you will get either general, regional, or local anesthesia. Then, your abdomen is inflated with an injection of harmless gas (carbon dioxide). This allows your health care provider to see your organs clearly. Then the provider makes a small cut near your navel and inserts a laparoscope (a rod-like instrument with a light and a viewing lens) to locate the fallopian tubes. The health care provider also may insert an instrument for closing the tubes, usually through a second small opening. Sometimes only one incision and one instrument are used. The procedure can be performed in outpatient surgical clinics. It usually takes 2030 minutes. Very little scarring occurs. Women often go home the same day. Mini-Laparotomy Mini-laparotomy is another common type of sterilization. It is often performed after childbirth. No gas or laparoscope is used. Usually, local anesthesia is used. A small cut is made in the lower abdomen, just above the pubic hair or just below the navel. The health care provider locates the tubes, then ties, clips, or uses a probe with an electrical current to block them off. Women usually recover in a few days. Laparotomy Laparotomy is major surgery. It is less commonly used than the other incision methods. The health care provider makes a two-to-five-inch cut in the abdomen. The provider locates and closes off the tubes. The operation requires general or regional anesthesia. You may need to be

hospitalized for 24 days. It may take several weeks at home to completely recover. If the procedure is done after delivery, your hospital stay may be extended by 12 days.

+What Are the Risks of Sterilizations that Require an Incision?

Complications can occur with any kind of surgery. These incision methods are considered low-risk surgeries. The complications that can occur during or after these them include
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bleeding infection reaction to the anesthetic Infection is rare. It is treated with antibiotics. Very rarely, the bowel, bladder, uterus, or blood vessels are injured. You may need additional surgery to repair this. Complications may develop in 14 out of every 100 sterilizations that are performed through the abdomen. Death resulting from sterilization is extremely rare and is usually caused by a reaction to general anesthesia.

+What Happens During Hysterectomy?

Hysterectomy is the removal of the uterus. It is major surgery and is not usually used for sterilization. It is used to correct serious medical conditions. If you have a hysterectomy, you will no longer have your period. Usually, it will not affect your fallopian tubes. However, some medical conditions also call for the removal of a tube and/or ovary, on one side or both. Hysterectomy is performed through the abdomen and/or vagina. Women need to spend several days in the hospital. They usually spend several weeks at home recovering. They should abstain from sexual intercourse for 46 weeks, until the health care provider says it is safe to have sex.

+What Are the Risks with Hysterectomy?

Complications after hysterectomy, such as infection or blood loss, occur in 1020 out of every 100 cases. Because hysterectomy is usually performed as a result of a serious medical problem, the risk of death is much greater than it is for more common sterilization methods.

+-

Does Sterilization Hurt?

Your health care provider will give you medicine to make sterilization as comfortable as possible. Numbing medication and/or sedatives will be used. The choice depends on your health and the method of sterilization being used. Conscious sedation allows you to be awake but deeply relaxed. Local and regional anesthesia block the feeling of pain in certain areas of your body. These are much safer than general anesthesia. General anesthesia is entirely painless. It allows you to sleep through the procedure. When you get local or regional anesthesia, you may feel brief discomfort. The pain is relieved with medications and, sometimes, sedatives. Most likely, you will feel little or no discomfort during the procedure.

+How Will I Feel After Sterilization?

The discomfort you feel after the procedure depends on your general health, the type of procedure, and how well you deal with pain. You may feel tired and have slight pain in your abdomen. You may occasionally feel dizzy, nauseous, bloated, or gassy, or have shoulder pain or abdominal cramping. Women who use Adiana or Essure may have vaginal discharge, like a light menstrual period. Most symptoms will last 13 days. Contact your health care provider immediately if you
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bleed from an incision develop a rash or fever have difficulty breathing have fainting spells have severe, continuous abdominal pain have unusual discharge or odor from your vagina

+How Long Does It Take to Recover from Sterilization?

It depends on your general health, lifestyle, and the method of sterilization that you use. With minilaparotomy and laparoscopy, recovery is usually complete in a day or two. You may want to take it easy for the next week or so. In any case, you should avoid heavy lifting for about one week. Recovery from sterilization with Adiana or Essure is faster some women return to normal activities the same day as the procedure. Others take a day or two. Talk with your health care provider about when it's safe to start having sex again. Remember, if you've had Adiana or Essure, you need to use another birth control method until your health care provider confirms that your tubes are blocked.

+How Do I Get Sterilized? How Much Does It Cost?

If you are interested in getting sterilized, talk with a health care provider. Contact your local Planned Parenthood health center, your gynecologist, family doctor, a local hospital, or a local public health department. Sterilization can be performed in a medical office, hospital, or clinic. There may be state or federal requirements for sterilization, such as age restrictions or waiting periods. Ask if there are any restrictions when you make an appointment.

After Birth, Miscarriage, or Abortion About 1 out of 2 sterilizations are performed shortly after childbirth or abortion. You need to make arrangements with your health care provider in advance if you want to combine sterilization with other procedures. Nationwide, the cost of sterilization ranges from $1,500 to $6,000. (The cost of vasectomy is much less.) If you need to have your procedure in a hospital, it may be more expensive. Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs. Call your local Planned Parenthood health center to get specific information on costs.

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Vasectomy at a Glance

Sterilization for men that prevents pregnancy Safe and effective Costs $350 to $1,000 Meant to be permanent

Thinking about getting a vasectomy? FIND A HEALTH CENTER

Is Vasectomy Right for Me? All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. Here are some of the most common questions we hear people ask about vasectomy. We hope you find the answers helpful.

Expand All +

+What Is Vasectomy?
Vasectomy is a form of birth control for men that is meant to be permanent. During vasectomy, a health care provider closes or blocks the tubes that carry sperm. When the tubes are closed, sperm cannot leave a man's body and cause pregnancy.

+How Does Vasectomy Work?

Sperm are made in the testicles. They pass through two tubes called the vasa deferentia to other glands and mix with seminal fluids to form semen. Vasectomy blocks each vas deferens and keeps sperm out of the seminal fluid. The sperm are absorbed by the body instead of being ejaculated. Without sperm, your "cum" (ejaculate) cannot cause pregnancy.

+How Effective Is Vasectomy?

Effectiveness is an important and common concern when choosing a birth control method. Vasectomy is the most effective birth control for men. It is nearly 100 percent effective. However, vasectomy is not immediately effective. Sperm remains beyond the blocked tubes. You must use other birth control until the sperm are used up. It usually takes about three months. A simple test semen analysis shows when there are no more sperm in your ejaculate.

How Is Semen Analysis Done? You will provide a sample of your semen by masturbating or by using a special condom during sexual intercourse. The semen will be examined under a microscope to see if there are any sperm.

Very rarely, tubes grow back together again and pregnancy may occur. This happens in about 1 out of 1,000 cases. Keep in mind that vasectomy offers no protection against sexually transmitted infection. Sexually transmitted infections can be carried in ejaculate, whether or not it contains sperm. Latex or female condomscan reduce your risk of infection.

+What Are the Types of Vasectomy?

There are different ways for men to be sterilized. One type does not require an incision a cut. The other types of vasectomy require an incision. Incision methods take about 20 minutes. The noincision method takes less time. INCISION METHODS Usually, a local anesthetic is injected into the pelvic area. Then, the doctor makes an incision on each side of the scrotum to reach each vas deferens the tubes that carry sperm. Sometimes a single incision is made in the center. Each tube is blocked. In most procedures, a small section of each tube is removed. Tubes may be tied off or blocked with surgical clips. Or, they may be closed using an instrument with an electrical current. NO-INCISION METHOD With the no-incision ("no-scalpel") method, the skin of the scrotum is not cut. One tiny puncture is made to reach both tubes. The tubes are then tied off, cauterized, or blocked. The tiny puncture heals quickly. No stitches are needed, and no scarring takes place. The no-scalpel method reduces bleeding and decreases the possibility of infection, bruising, and other complications.

+How Safe Is Vasectomy?

Most men can have a vasectomy safely. But like any medical procedure, there are risks. Talk with your health care provider about whether vasectomy is likely to be safe for you.

+-

What Are the Benefits of Vasectomy?

Vasectomy is safe and, because it lasts for life, it is simple and convenient. It allows women and men to enjoy sex without worrying about pregnancy. Vasectomy does not change your hormones or masculinity. And it will not affect your ability to get and stay erect. It also will not affect your sex organs, sexuality, and sexual pleasure. No glands or organs are removed or altered. Your hormones and sperm continue being produced. Your ejaculate will look just like it always did. And there will be about the same amount as before. Vasectomy may be right for you if
o o o o o o o o

You want to enjoy having sex without causing pregnancy. You don't want to have a child biologically in the future. Other methods are unacceptable. You don't want to pass on a hereditary illness or disability. Your partner's health would be threatened by a future pregnancy. You and your partner have concerns about the side effects of other methods. You and your partner agree that your family is complete, and no more children are wanted. You want to spare your partner the surgery and expense of tubal sterilization sterilization for women is more complicated and costly.

+What Are the Disadvantages of Vasectomy?

Vasectomy may not be a good choice for you if you
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may want to have a child biologically in the future are being pressured by a partner, friends, or family want to use it to solve problems that may be temporary such as marriage or sexual problems, short-term mental or physical illnesses, financial worries, or being out of work Considering Other Birth Control Options It is important to consider other methods before you choose vasectomy, like condoms, outercourse, withdrawal, and abstinence. Women have other options. IUDs and the implant are as effective as vasectomy, simple to use, offer long-term protection, but are not permanent. You should consider any possible life changes, such as divorce, remarriage, or death of children. You don't need your partner's permission to have a vasectomy, but it may be helpful to discuss it with your partner or anyone else who could be part of the decision-making process.

Saving Sperm in Sperm Banks

If you're thinking of getting a vasectomy and banking sperm just in case you change your mind, vasectomy may not be the best choice for you. Sperm banks collect, freeze, and thaw sperm for alternative insemination. However, some men's sperm do not survive freezing. And it is generally easier for a woman to get pregnant with fresh sperm than frozen sperm.

Can Vasectomy Be Reversed? If you are thinking about reversal, vasectomy may not be right for you. Sometimes it is possible to reverse the operation, but there are no guarantees. Reversal involves complicated surgery and costs thousands of dollars. Success in restoring fertility is uncertain. The success of reversal surgery depends on
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the length of time since the vasectomy was performed whether or not antibodies to sperm have developed the method used for vasectomy and the length and location of the segments of vas deferens that were removed or blocked

Possible Risks of Vasectomy There are risks with any medical procedure, including vasectomy. Major complications with vasectomy are rare and are usually caused by infection. Complication rates for vasectomy are generally lower for the no-incision method than for methods that include cutting the skin. After you've had a vasectomy, look for signs of infection:
o o o

a fever over 100 F blood or pus oozing from the site of the incision excessive pain or swelling See a health care provider if you have signs of infection. You may need an antibiotic. Other potential problems include

o o

bruising, which usually clears up on its own hematomas swellings that contain blood. They usually clear up by themselves, or with bed rest or ice packs. In rare cases, they need to be drained by a health care provider. hydroceles swellings that contain fluid and tenderness near the testicles. They usually clear up in about a week. Applying heat and wearing an athletic supporter can help. In rare cases, they need to be drained with by a health care provider.

granuloma sperm that leaks from the tubes and causes a small lump under the skin near the site of the surgery. This usually clears up by itself. Surgical treatment is sometimes required. pain or discomfort in the testicles. This is usually temporary, but in about 2 out of 100 cases the pain may be chronic and severe. Most of the time, pain is relieved by taking anti-inflammatory drugs or other medications. Very rarely, an injection called a spermatic cord block can be used to deaden the pain temporarily. Vasectomy reversal is very rarely needed to relieve pain permanently.

Very rarely, the cut ends of a tube grow back together. This most often happens within four months of the operation and may allow pregnancy to happen. Decreased sexual desire or an inability to have an erection occurs in 4 out of 1,000 cases. The most likely cause is emotional there is no physical cause for sexual dysfunction associated with vasectomy.

+What Are the Risks of Vasectomy?

Major complications with vasectomy are rare and are usually caused by infection. Complication rates for vasectomy are generally lower for the no-incision method than for methods that include cutting the skin. After you've had a vasectomy, look for signs of infection:
o o o

a fever over 100 F blood or pus oozing from the site of the incision excessive pain or swelling See a health care provider if you have signs of infection. You may need an antibiotic. Other potential problems include

o o

bruising, which usually clears up on its own hematomas swellings that contain blood. They usually clear up by themselves, or with bed rest or ice packs. In rare cases, they need to be drained by a health care provider. hydroceles swellings that contain fluid and tenderness near the testicles. They usually clear up in about a week. Applying heat and wearing an athletic supporter can help. In rare cases, they need to be drained with by a health care provider. granuloma sperm that leaks from the tubes and causes a small lump under the skin near the site of the surgery. This usually clears up by itself. Surgical treatment is sometimes required. pain or discomfort in the testicles. This is usually temporary, but in about 2 out of 100 cases the pain may be chronic and severe. Most of the time, pain is relieved by taking anti-inflammatory

drugs or other medications. Very rarely, an injection called a spermatic cord block can be used to deaden the pain temporarily. Vasectomy reversal is very rarely needed to relieve pain permanently.
o

Very rarely, the cut ends of a tube grow back together. This most often happens within four months of the operation and may allow pregnancy to happen. Decreased sexual desire or an inability to have an erection occurs in 4 out of 1,000 cases. The most likely cause is emotional there is no physical cause for sexual dysfunction associated with vasectomy.

+Does Vasectomy Hurt?

Your health care provider will give you medicine to make it as comfortable as possible. Numbing medication and/or sedatives will be used. The choice depends on your health and the method of sterilization being used. Conscious sedation allows you to be awake but deeply relaxed. Local anesthesia blocks the feeling of pain in a certain area of your body. It is much safer than general anesthesia. General anesthesia is entirely painless. It allows you to sleep through the procedure. When you get local anesthesia, you may feel brief discomfort. You may also feel some pain when the tubes are brought out through the incision.

+How Will I Feel After Vasectomy?

As with any surgery, there's some discomfort after the operation. It will be different for each man. However, most men say the pain is "slight" or "moderate" and not "excessive." An athletic supporter, ice bag, and non-aspirin pain reliever may help ease the pain. Avoid strenuous physical work or exercise for about a week. There seems to be less pain associated with no-incision procedures.

+How Long Does Recovery Take After Vasectomy?

That depends on your general health and lifestyle. Most men lose little or no time from work. A few need a day or two to rest. You will have to avoid strenuous work or exercise for about a week. Rare complications may require more days at home. However, prompt medical attention usually clears up any problems. For most men, sexual activity can begin again within a week. Others have sex sooner. Some wait longer. But remember, after the procedure, it takes about three months to clear sperm out of your system. Use another form of birth control for vaginal intercourse until a semen analysis shows there are no longer any sperm in your seminal fluid.

+How Do I Get a Vasectomy? How Much Does a Vasectomy Cost?

If you are interested in getting a vasectomy, talk with a health care provider. Contact your local Planned Parenthood health center, your family doctor, a local hospital, a local public health department, or a urologist. A vasectomy can be performed in a medical office, hospital, or clinic. Nationwide, the cost of a vasectomy ranges from $350$1,000, including the follow-up sperm count. (Sterilization for women costs up to six times as much.) Some clinics and doctors use a sliding scale according to income. There may be state or federal requirements for sterilization, such as age restrictions or waiting periods. Ask if there are any restrictions when you make an appointment. Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs. Call your local Planned Parenthood health center to get specific information on costs. The IUD at a Glance

Small, "T-shaped" device inserted into the uterus to prevent pregnancy Safe, effective, and long lasting Must be inserted by a health care provider Costs between $500 and $1,000 up front, but lasts up to 12 years

Want an IUD? FIND A HEALTH CENTER

Is an IUD Right for Me? All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. Here are some of the most common questions we hear women ask about IUDs. We hope you find the answers helpful.

Expand All +

+What Is an IUD?
The letters IUD stand for "intrauterine device." IUDs are small, "T-shaped" devices made of flexible plastic. A health care providerinserts an IUD into a woman's uterus to prevent pregnancy. There are two brands of IUD available in the United States ParaGard and Mirena.

The ParaGard IUD contains copper. It is effective for 12 years.

The Mirena IUD releases a small amount ofprogestin, a hormone. It is effective for five years.

+How Does an IUD Work?

Both the ParaGard and the Mirena IUDs affect the way sperm move, preventing them from joining with an egg. If sperm cannot join with an egg, pregnancy cannot happen. Both types also alter the lining of the uterus. Some people say that this keeps a fertilized egg from attaching to the lining of the uterus. But there is no proof that this actually happens. The progestin in the Mirena IUD helps prevent pregnancy. Progestin works by keeping a woman's ovaries from releasing eggs ovulation. Pregnancy cannot happen if there is no egg to join with sperm. Progestin also prevents pregnancy by thickening a woman's cervical mucus. The mucus blocks sperm and keeps it from joining with an egg.

+-

How Effective Is the IUD?

Effectiveness is an important and common concern when choosing a birth control method. IUDs are one of the most effective forms of birth control available. Less than 1 out of 100 women will get pregnant each year if they use the ParaGard or the Mirena IUD. Keep in mind that the IUD doesn't protect against sexually transmitted infections. Use a latex or female condom along with the IUD to reduce the risk of infection. The ParaGard IUD can be used as emergency birth control, to prevent pregnancy after unprotected intercourse. It can reduce the risk of pregnancy by 99.9 percent if inserted within 120 hours (five days) after unprotected intercourse.

+How Safe Is the IUD?

Most women can use either the ParaGard or the Mirena IUD safely. But all medications have some risks, so safety is a common concern when choosing a birth control method. Certain conditions increase the risk of side effects. Talk with your health care provider about your health and whether an IUD is likely to be safe for you. There are many other methods of birth control that may be safe for you if you cannot use an IUD. You should not use an IUD if you
o o o o o o o o

have had a pelvic infection following either childbirth or an abortion in the past three months have or may have a sexually transmitted infection or other pelvic infection think you might be pregnant have cervical cancer that hasn't been treated have cancer of the uterus have unexplained bleeding in your vagina have pelvic tuberculosis have a uterine perforation during IUD insertion A health care provider may find that the unique size, shape, or condition of a womans uterus does not allow correct placement of an IUD. This is not common. You should not use the ParaGard IUD if you

have, or may have, an allergy to copper or have Wilson's Disease an inherited disease that blocks the bodys ability to get rid of copper You should not use the Mirena IUD if you

have severe liver disease

have, or may have, breast cancer If you have a condition that makes it unsafe to use an IUD, dont worry. There are many other methods of birth control that may be safe for you. Read about other methods to find one that is right for you.

+What Are the Benefits of an IUD?

The ParaGard and the Mirena IUDs are two of the least expensive, longest lasting forms of birth control available to women today. There are many other benefits.
o

IUDs may improve your sex life. There is nothing to put in place before intercourse to prevent pregnancy. Some women say that they feel free to be more spontaneous because they do not have to worry about becoming pregnant. The ParaGard IUD does not change a woman's hormone levels. The Mirena IUD may reduce period cramps and make your period lighter. On average, menstrual flow is reduced by 90 percent. For some women, periods stop altogether. IUDs can be used during breastfeeding. The ability to become pregnant returns quickly once the IUD is removed. Some women may worry that they are pregnant if they do not have a regular period. But the IUD is very effective. If you are concerned about a possible pregnancy, you can always take a pregnancy test. Overall, most women who get an IUD are satisfied with their choice. Ninety-nine percent of IUD users are pleased with them.

o o

o o

+What Are the Disadvantages of an IUD?

It's important to think about the possible side effects of using an IUD. You may have
o o o o o

mild to moderate pain when the IUD is put in cramping or backache for a few days spotting between periods in the first 36 months irregular periods in the first 36 months with Mirena heavier periods and worse menstrual cramps with ParaGard

Pain relievers can usually reduce bleeding, cramping, and other discomforts. If they are severe and do not seem to lessen, tell your health care provider. Serious problems with the IUD are rare. There are three main things to watch out for when using an IUD:
o

The IUD can sometimes slip out of the uterus. Sometimes it comes all the way out. Sometimes it only comes out a little. This is more likely to happen to women who are younger and who have never had a baby. If the IUD slips out of place, pregnancy can happen. If it comes out only part of the way, it has to be removed.

In rare situations, a woman could develop an infection when using the IUD. This happens if bacteria get into the uterus when the IUD is inserted. Most infections develop within three weeks of having the IUD inserted. If the infection is not treated, it can affect a woman's ability to become pregnant in the future. In very rare situations, when the IUD is inserted, it can push through the wall of the uterus. This might sound painful, but it usually isn't. Usually, when this happens, the health care provider will notice it and it can be fixed right away. But if not, the IUD can move around and harm other parts of the body. When this happens, surgery may be needed to remove the IUD. Most often, if complications happen, they are easy to treat with medicine or other treatments. It's important to pay attention to any symptoms you might have after starting the IUD. Tell your health care provider immediately if you

find the length of the string ends to be shorter or longer than they were at first, when you feel for them with your fingers are not able to feel the string ends when you check feel the hard plastic bottom of the "T" part of the IUD against the cervix, when you check think you might be pregnant have periods that are much heavier than normal or last much longer than normal have severe abdominal cramping, pain, or tenderness in the abdomen have pain or bleeding during sex have unexplained fever and/or chills have flu-like symptoms, such as muscle aches or tiredness have unusual vaginal discharge have a missed, late, or unusually light period have unexplained vaginal bleeding IUDs and Pregnancy

o o o o o o o o o o o

The risk of pregnancy while using a ParaGard or Mirena IUD is very low. But if the IUD slips out of place, pregnancy can happen. If you become pregnant, have the IUD removed as soon as you find out that you are pregnant. If you are pregnant with an IUD in place, there is an increased risk of o ectopic pregnancy
o o o

dangerous pelvic infection miscarriage early labor and delivery Even with the risks, some women may choose not to have the IUD removed during pregnancy. If you don't want to have the IUD removed while you are pregnant, you need to work with your health care provider through your pregnancy. Ectopic pregnancies are a serious concern. They can be life-threatening. Women who use IUDs are much less likely to have an ectopic pregnancy than women who are not using birth control. But if a woman does become pregnant while using an IUD, it is more likely to be ectopic than if she was not using the IUD. Symptoms of an ectopic pregnancy include

o o o

irregular vaginal bleeding pain in the abdomen or tip of the shoulder sudden weakness or fainting If you have any of these symptoms while using an IUD, get medical care right away.

+How Soon After Getting an IUD Can I Have Sex?

You can have sex as soon as you like after the IUD is inserted.
o o

The ParaGard IUD is effective immediately. The Mirena IUD is effective immediately if inserted within seven days after the start of your period. If you have Mirena inserted at any other time during your menstrual cycle, use another method of birth control like a condom, female condom, or spermicide if you have vaginal intercourse during the first week after insertion. Protection will begin after seven days.

+What Happens When I Have an IUD Inserted?

To get an IUD, you need to visit a health care provider. Your health care provider will ask you some questions about your medical history and the way you live your life. It is important to be open about your sex life because the IUD may not be right for you. But dont worry. There are many other birth control methods to choose from if you cannot use the IUD. If an IUD seems to be a good choice for you, your health care provider will check your vagina and internal organs. You may be tested forsexually transmitted infections or for other infections to make sure its safe for you to get an IUD. If you have any kind of pelvic infection, you may need treatment before getting an IUD.

An IUD can be inserted at any time of the month. But it is usually more comfortable if you have it inserted in the middle of your menstrual cycle. That is when the cervix the opening to the uterus is the most open. An IUD can be inserted after a pregnancy or abortion. You can have an IUD inserted
o o o o

up breastfeeding should wait four weeks before having a Mirena IUD inserted. immediately after an aspiration abortion four weeks after a D&E abortion when the abortion is complete after taking the abortion pill. Your health care provider can help you decide when to get the IUD inserted.

A health care provider will insert the IUD. The IUD is inserted into the uterus through the cervix using special instruments. It is common for women to feel some cramping when the IUD is inserted. Many women only feel mild discomfort. The cramps go away after you rest, or if you take some pain medication. Some health care providers suggest that women take pain medication before the IUD is inserted to lessen the cramps. Some health care providers inject a local anesthetic around the cervix to reduce discomfort. When the IUD is inserted, some women may feel dizzy. Rarely, a woman might faint. You can ask someone to come with you when you get the IUD inserted so you dont have to drive or go home alone. You should plan to rest at home until any discomfort goes away. When the IUD is in place, a string will hang down into the vagina. It will be about one to two inches long.

+What Should I Do After Getting an IUD?

You should have a checkup after your first period. Don't wait longer than three months after you get your IUD to make sure it is still in place. Women using an IUD should have regular checkups to make sure everything is all right. This can be done at the same time as your periodic GYN exam. Remember when you have your IUD inserted. That way, if you see other health care providers, you can tell them when it needs to be replaced. The ParaGard IUD should be replaced after 12 years. The Mirena IUD should be replaced after five years.

+How Do I Check My IUD?

If an IUD is going to slip out of place, it will most likely happen in the first few months of use. But it may occur later. The IUD is most likely to slip out of place during your period. Check your pads,

tampons, or cups to see if the IUD has fallen out. If it has, you must check with your health care provider. Until then, use another form of birth control such as latex or female condoms. Between your periods, you can check for the string ends. It is especially important to check every few days for the first few months. To check for the string ends ...
o o

Wash your hands. Then either sit or squat down. Put your index or middle finger up into your vagina until you touch the cervix. Your cervix will feel firm and somewhat rubbery, much like the tip of your nose. Feel for the string ends that should be coming through. If you find them, it means that the IUD is in place and working. However, if the string ends feel longer or shorter than before, or if you feel the hard part of the IUD against your cervix, it may be that the IUD has moved and needs to be put back in place by your health care provider. You should not attempt to put the IUD back in place yourself. Be sure to use another form of birth control until it is put back in place. Do not pull on the string ends. Pulling might make the IUD move out of place or even come out.

+How Is an IUD Removed?

Having an IUD removed or replaced is usually simple. Your health care provider will do it for you. Women should never try to remove IUDs themselves or ask nonprofessionals to do it for them. Serious damage could result. In rare cases, IUDs cannot be easily pulled free. In these cases, the cervix may have to be dilated and a surgical tool may be used to free the IUD. In very rare cases, surgery becomes necessary.

+Where Can I Get an IUD? How Much Does an IUD Cost?

You need to see a health care provider to get a ParaGard or Mirena IUD. Your health care provider can help you decide if an IUD is right for you. You can find a health care provider who can help you with getting an IUD at your local Planned Parenthood health center or at other clinics. The IUD is the most inexpensive long-term and reversible form of birth control you can get. Unlike other forms of birth control, the IUD only costs money in the beginning. The cost for the medical exam, the IUD, the insertion of the IUD, and follow-up visits to your health care provider can range from $500 to $1,000. That cost pays for protection that can last from 5 to 12 years, depending on which IUD you choose. In general, the Mirena IUD costs more than the ParaGard.

Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs. Call your local Planned Parenthood health center to get specific information on costs.

Implanon at a Glance

A matchstick-sized rod that is inserted in the arm to prevent pregnancy Safe, effective, and convenient Must be inserted by a health care provider Costs between $400 and $800 up front, but lasts up to three years

Want Implanon? FIND A HEALTH CENTER

Is Implanon Right for Me? All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. Here are some of the most common questions we hear women ask about Implanon. We hope you find the answers helpful.

Expand All + +What Is Implanon?

Implanon is a thin, flexible plastic implant about the size of a cardboard matchstick. It is inserted under the skin of the upper arm. It protects against pregnancy for up to three years.

+How Does Implanon Work?

Like several other methods of birth control, such as the birth control shot, Implanon releases a hormone progestin. Hormones are chemicals made in our bodies. They control how different parts of our bodies work. The progestin in Implanon works by keeping a woman's ovaries from releasing eggs ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormone in the implant also prevents pregnancy by thickening a woman's cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. The hormone also thins the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching to the uterus.

+How Effective Is Implanon?

Effectiveness is an important and common concern when choosing a birth control method. Implanon is very effective. Less than 1 out of 100 women a year will become pregnant using Implanon. It lasts up to three years. Certain medicines and supplements may make Implanon less effective. These include
o o o o

the antibiotic rifampin other antibiotics do not make Implanon less effective certain medicines that are taken by mouth for yeast infections certain HIV medicines certain anti-seizure medicines

St. John's wort Keep in mind Implanon doesn't protect against sexually transmitted diseases. Use a latex or female condom to reduce the risk of infection.

+How Safe Is Implanon?

Most women can use Implanon safely. But all medications have some risks, so safety is a concern when choosing a birth control method. Talk with your health care provider about your health and whether Implanon is likely to be safe for you. You should not use Implanon if you are pregnant or have breast cancer. There are many other methods of birth control that may be safe for you if you cannot use Implanon. Read about other methods to find one that may be right for you.

+What Are the Benefits of Implanon?

Using Implanon is safe, simple, and convenient. Women like the implant because
o o o o o o

The ability to become pregnant returns quickly when you stop using Implanon. It can be used while breastfeeding. It can be used by women who cannot take estrogen. It gives continuous long-lasting birth control without sterilization. There is no medicine to take every day. Nothing needs to be put in place before vaginal intercourse.

+What Are the Disadvantages of Implanon?

Some women may have undesirable side effects while using Implanon. But many women adjust to it with few or no problems. Irregular bleeding is the most common side effect, especially in the first 612 months of use.
o

For most women, periods become fewer and lighter. After one year, 1 out of 3 women who use Implanon will stop having periods completely. Some women have longer, heavier periods. Some women have increased spotting and light bleeding between periods. These side effects are completely normal. Some woman may worry that they are pregnant if they do not have a regular period. But when Implanon is used correctly, it is very effective. If you are concerned about a possible pregnancy, you can always take a pregnancy test. Less common side effects of Implanon include

o o

o o o o o o

change in sex drive discoloring or scarring of the skin over the implant headache nausea pain at the insertion site sore breasts Serious Side Effects of Implanon Many women have concerns about the possible risks of taking hormones in birth control. Serious problems do not occur often. Serious problems usually have warning signs. Tell your health care provider immediately if

o o o o o

You have bleeding, pus, or increasing redness, or pain at insertion site. You have a new lump in your breast. You have no period after having a period every month. You have unusually heavy or prolonged bleeding from your vagina. The implant comes out or you have concerns about its location.

+How Is Implanon Inserted and Removed?

After taking your medical history and giving you a physical exam, your health care provider will numb a small area of your arm with a painkiller. Implanon is inserted under the skin. Insertion takes only a few minutes. After insertion, be sure to tell any health care provider you may see that you are using Implanon. The implant is effective for three years after it is inserted. After that, it should be removed. Even though it stops working, it may interfere with your period. Implanon can be removed at any time. Your health care provider will numb the area with a painkiller and will usually make one small cut to remove the implant. Removal usually takes just a few minutes, but it generally takes longer than insertion. A new implant may be inserted at this time. Pregnancy can happen anytime after the implant is removed. If you get the implant during the first five days of your period, you are protected against pregnancy immediately. Otherwise, you need to use some form of backup birth control like a condom, female condom, diaphragm, sponge, or emergency contraception (morning after pill) for the first week after getting the implant.

+-

How Do I Get Implanon? How Much Does Implanon Cost?

You need to see a health care provider to get Implanon. You can find a provider who has been specially trained in inserting and removing Implanon by contacting your local Planned Parenthood health centeror by finding a provider on the Implanon website. The cost of the exam, Implanon, and insertion ranges from $400$800. Removal costs between $100 and $300. The total cost pays for pregnancy protection that can last for three years. Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs. Call your local Planned Parenthood health center to get specific information on costs.

Birth Control Patch at a Glance

A small patch that sticks to your skin to prevent pregnancy Safe, effective, and convenient Easy to get with a prescription Costs about $15$70 a month

Want the patch? FIND A HEALTH CENTER

Is the Birth Control Patch Right for Me? All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. Here are some of the most common questions we hear women ask about the birth control patch. We hope you find the answers helpful.

Expand All + +What Is the Birth Control Patch?

The birth control patch is a thin, beige, plastic patch that sticks to the skin. It is used to prevent pregnancy. A new patch is placed on the skin once a week for three weeks in a row, followed by a patch-free week. The birth control patch is commonly called Ortho Evra, its brand name.

+How Does the Birth Control Patch Work?

Like other methods of birth control, the birth control patch releases hormones. Hormones are chemicals made in our bodies. They control how different parts of our bodies work. The hormones in the patch are the same hormones as in the birth control pill estrogen and progestin. The hormones work by keeping a womans ovaries from releasing eggs ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormones in the Ortho Evra patch also prevent pregnancy by thickening a womans cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. The hormones also thin the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching to the uterus.

+How Effective Is the Birth Control Patch?

Effectiveness is an important and common concern when choosing a birth control method. The birth control patch is very effective. It works best when it is always placed on the skin on time. That keeps the correct level of hormone in a womans body. o Less than 1 out of 100 women will get pregnant each year if theyalways use Ortho Evra as directed.

About 9 out of 100 women will get pregnant each year if theydont always use Ortho Evra as directed. The patch may be less effective for women who weigh more than 198 pounds. But it may still be a good option for women of all sizes. Talk with your health care provider if you are concerned about how well Ortho Evra may work for you. Certain medicines and supplements may make the birth control patch less effective. These include

o o o o o

the antibiotic rifampin other antibiotics do not make the patch less effective certain medicines that are taken by mouth for yeast infections certain HIV medicines certain anti-seizure medicines St. John's wort Keep in mind the patch doesnt protect against sexually transmitted infections. Use a latex or female condom to reduce the risk of infection.

+How Safe is the Patch?

Most women can use Ortho Evra safely. But all medications have some risks, so safety is a concern when choosing a birth control method. Serious side effects of the birth control patch, though rare, may be more likely if you have certain conditions. Some of these conditions may even rule out using the patch. Talk with your health care provider to find out if the patch is likely to be safe for you. You should not use the patch during prolonged bed rest or if you
o o o o o o o o o o o o o

are pregnant get migraine headaches with aura have certain inherited blood-clotting disorders have had blood clots or vein inflammation have had breast or liver cancer have had a heart attack, stroke, or angina have had serious heart valve problems have lupus with certain conditions have serious liver disease have uncontrolled high blood pressure have very bad diabetes smoke and are 35 or older smoke and have high blood pressure

If you have a condition that makes it unsafe to use the patch, dont worry. There are many other methods of birth control that may be safe for you if you cannot use it. Read about other methods to find one that is right for you.

+What Are the Benefits of the Birth Control Patch?

Using Ortho Evra is safe, simple, and convenient. There is nothing to do right before having sex. Some women say it improves their sex lives because it helps them feel more spontaneous. Many women who use the patch have more regular, lighter, and shorter periods. And a womans ability to become pregnant returns quickly when use of the patch is stopped. Because the patch works like the pill, it probably offers the same benefits. These health benefits may include some protection against
o o o o o o o o o o o o

acne bad menstrual cramps bone thinning breast growths that are not cancer ectopic pregnancy endometrial and ovarian cancers serious infection in the ovaries, tubes, and uterus iron deficiency anemia cysts in the breasts and ovaries pelvic inflammatory disease, which often leads to infertility when left untreated premenstrual symptoms, including headaches and depression heavy and/or irregular periods

+What Are the Disadvantages of the Birth Control Patch?

Because the birth control patch works like the pill, it probably carries the same possible disadvantages. Possible Side Effects of the Birth Control Patch Some women may have undesirable side effects while using Ortho Evra. But many women adjust to it with few or no problems. Some of the most common side effects usually clear up after two or three months. They include
o

bleeding between periods

o o

breast tenderness nausea and vomiting Ortho Evra may also cause more long-lasting side effects. The hormones in the patch may change a womans sexual desire. A woman may also have a reaction or irritation where she puts the patch on her skin. Its important that you find a method that wont make you feel sick or uncomfortable. If you continue to experience side effects after using the birth control patch for three months, talk with your health care provider. After a woman stops using the patch, it usually takes one or two months for her periods to return to the cycle she had before using it. Once in a while, a woman may have irregular or absent periods. This may go on for as long as six months after stopping. This is more likely if her periods were irregular before using the patch. Serious Side Effects of the Birth Control Patch Many women have concerns about the possible risks of taking hormones in birth control. Serious problems do not occur often. Women who use birth control with estrogen like Ortho Evra have a slightly greater chance of certain rare, but serious, problems than nonusers. The most serious in very rare cases may be fatal. These include heart attack, stroke, having a blood clot in the legs, lungs, heart, or brain. Studies have found that women using the patch may have a higher risk of getting blood clots than women taking most kinds of birth control pills. But a womans overall risk of any major problem while using the patch is low. Other rare risks include developing high blood pressure, liver tumors, gallstones, or yellowing of the skin or eyes (jaundice). The risk for these problems increases if you

o o o o o o o o

are age 35 or older are very overweight have certain inherited blood-clotting disorders have diabetes have high blood pressure have high cholesterol need prolonged bed rest smoke Serious problems usually have warning signs. Report any of these signs to your health care provider as soon as possible:

o o o o o o o o o

a new lump in your breast a sudden very bad headache achy soreness in the leg aura seeing bright, flashing zigzag lines, usually before a very bad headache bad pain in your abdomen or chest headaches that are different, worse, or happen more often than usual no period after having a period every month trouble breathing yellowing of the skin or eyes See the insert from your Ortho Evra package for more information about possible side effects. The Birth Control Patch and Breast Cancer You may have heard claims linking the hormones in the patch to breast cancer. The most recent literature suggests that the use of these hormones in birth control has little, if any, effect on the risk of developing breast cancer.

+How Do I Start the Patch?

To find out what day is best for you to start using the patch, talk with your health care provider. Most often, women start using the patch within the first five days after the start of their periods. That way, they are protected against pregnancy right away. That means that if your period starts on a Wednesday morning, you can apply the patch as late as the following Monday morning to be protected right away. If you start the patch later than five days after the start of your period, protection will begin after seven days. Use another method of birth control like a condom, female condom, diaphragm, or sponge if you have vaginal intercourse during the first week of use. Starting the Patch After Pregnancy Its possible to get pregnant again shortly after being pregnant. Starting birth control after pregnancy is an important concern for many women. You can start using the patch after waiting at least three weeks after giving birth vaginally. You can start using the patch after waiting at least six weeks if you are nursing it may reduce the amount and quality of milk in the first six weeks of breastfeeding. Also, the milk will contain traces of the patch's hormones. It is unlikely that these hormones will have any effect on your child. But talk with a health care provider about what birth control methods might be right for you after giving birth.

You should wait at least six weeks after birth if you have an increased risk of blood clots. Women have a higher risk of blood clots if they are obese are over age 35 had a cesarean section (C-section) had heavy bleeding after delivery had preeclampsia have certain inherited blood clotting disorders have had blood clots in the past have a close family member who has had blood clots need prolonged bed rest received a blood transfusion at delivery smoke You can start using the patch right after an abortion or miscarriage.

+How Do I Use the Birth Control Patch?

Most women find that the patch is easy to use. Youll stick one new patch on the skin of your buttocks, stomach, upper outer arm, or upper torso once a week for three weeks in a row. You wont put on a patch for the fourth week.

Here are some more specific details about using the patch:
o o

Store your unused, sealed patches at room temperature and out of direct sunlight. Consider the first day you apply the patch as "patch change day." So if you first apply the patch on a Tuesday, you will always apply, change, or remove it on a Tuesday. Gently tear the package along the top and side edges. Peel the foil pouch apart and open it flat. Then peel the patch and plastic layer off the foil liner. Next, peel half of the clear plastic away from the patch itself do not touch the sticky part. Apply the sticky half of the patch to a clean and dry area of skin on your buttocks, stomach, upper outer arm, or upper torso. Never put it on your breasts. Do not use body lotion, oil, powder, or makeup on skin where you are going to put the patch. They could keep the patch from sticking.

o o o o

Remove the other half of the plastic and press the full patch to the skin with your palm for 10 seconds. Check your patch every day to make sure it is sticking in place. Avoid using body lotion, oil, powder, or makeup on the skin around the patch so it doesnt become loose. Remove it after one week. Reapply a new patch once a week on "patch change day" of the second and third weeks. After removal, fold the patch in half so that it sticks to itself, seal it in plastic bag, and throw it out in the trash. Do not flush. Used patches still contain some hormones. Folding the patch in half reduces the chance that hormones will get into the soil and water supply. During the one-week break, you will usually have your period. You may still be bleeding when it is time to put on another patch. This is normal, too. But the patch must be applied on the same day of the week as it was applied in the last cycle, or pregnancy may occur.

Helpful Tips About Using the Birth Control Patch

o o

The patch will work best if you always remember to apply or remove it at the right time. A missed period does not always mean you are pregnant, especially if you have used Ortho Evra correctly. Even though the chance of pregnancy is low, you may want to take a pregnancy test if you miss two periods in a row. Talk with your health care provider if you have any questions or concerns while using the patch. There is a very slight chance that you will become pregnant even if you use the patch correctly. It is unlikely that using the patch during early pregnancy will increase the risk of birth defects. If you decide you want to become pregnant, stop using the patch. Its possible to get pregnant right after stopping. It usually takes about one or two months for your period to return to the cycle you had before using the patch.

o o

+What Happens if the Patch Falls Off or I Make a Mistake?

Its pretty common for women to make a mistake at some time when using the birth control patch. If you use the patch, you may forget to change the patch on time. You may forget to put the patch on after your patch-free week. Or you may make no mistakes, and the patch may become loose or fall off. The key to protecting yourself from an unplanned pregnancy is knowing what to do if any of these things happen to you. Here are some general instructions. Talk with your health care provider for more information. If You Forget to Change or Apply the Patch on Time If You Apply the Patch Late During What to Do Apply a new patch as soon as you remember. This will become your new patch change day the day of the week you normally change your patch. Wear the late patch for one week. Use a backup method like a condom, female condom,diaphragm, or sponge for seven days after you apply the new patch. If you have had vaginal intercourse without using a backup method, take emergency contraception (morning after pill). You can take it up to five days after unprotected intercourse to prevent pregnancy. But the sooner you take it, the better it works. If you are one or two days late changing your patch
o o

Week one

Change it as soon as you remember. Change to your next patch on your regular patch change day. If you are more than two days late changing your patch

Week two or o three

Change it as soon as you remember. Wear it for one week. Change to your next patch on this day of the week this becomes your new patch change day. That means that if its a Tuesday when you remember to change your patch, you will continue to apply, change, or remove your patches on Tuesdays from then on even if you had been changing your patches on a different day. Use a backup method for seven days after you apply the new patch. If you have had vaginal intercourse without using a backup method, use emergency contraception up to five days after you have unprotected intercourse.

o o

If you forget to remove the patch on time during the fourth week, simply remove the patch when you remember. Apply a new patch on your regular patch change day. If a patch becomes loose or falls off
o

for less than one day, reapply the patch. If the patch will not stick well, apply a new patch. Change the patch on your regular patch change day.

for more than one day or if you are unsure how long it has been loose or off, apply a new patch. This day of the week will become your new patch change day. Use a backup method for seven days after you apply the new patch. Wear the replacement patch for one week. If you have had vaginal intercourse without using a backup method, use emergency contraception up to five days after you have unprotected intercourse.

+How Do I Get the Birth Control Patch? How Much Does the Birth Control Patch Cost?
First, youll need to get a prescription. Visit a Planned Parenthood health center, another health center, or a private health care provider for a prescription. Your health care provider will discuss your medical history with you, check your blood pressure, and give you any other medical exam that you may need. If you need an exam, it may cost about $35$250. Ortho Evra may be purchased with a prescription at a drugstore or clinic. A one-month supply costs about $15$70. Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs.

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Vaginal Ring at a Glance

A small ring you put in your vagina once a month for three weeks to prevent pregnancy Safe, effective, and convenient Easy to get with a prescription Costs about $15$70 a month

Want the ring? FIND A HEALTH CENTER

Is the Vaginal Ring Right for Me? All of us who need birth control want to find the method that is best for us. Use My Method to find out which birth control methods may be right for you. Here are some of the most common questions we hear women ask about the vaginal ring. We hope you find the answers helpful..

Expand All + +What Is the Vaginal Ring?

The vaginal ring is a small, flexible ring a woman inserts into her vagina once a month to prevent pregnancy. It is left in place for three weeks and taken out for the remaining week each month. The vaginal ring is commonly called NuvaRing, its brand name.

+How Does the Vaginal Ring Work?

Like other methods of birth control, NuvaRing releases hormones. Hormones are chemicals made in our bodies. They control how different parts of our bodies work. The hormones in NuvaRing are the same hormones as in the birth control pill estrogen and progestin. The hormones work by keeping a womans ovaries from releasing eggs ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormones in NuvaRing also prevent pregnancy by thickening a womans cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. The hormones also thin the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching to the uterus.

+-

How Effective Is the Vaginal Ring?

Effectiveness is an important and common concern when choosing a birth control method. The vaginal ring is very effective. It works best when a woman inserts it, keeps it in place for three weeks, takes it out for one week, and then inserts a new ring. That keeps the correct level of hormone in a womans body.
o

Less than 1 out of 100 women will get pregnant each year if theyalways use NuvaRing as

directed. o About 9 out of 100 women will get pregnant each year if theydont always use NuvaRing as directed. Certain medicines and supplements may make NuvaRing less effective. These include
o o o o o

the antibiotic rifampin other antibiotics do not make the ring less effective certain medicines that are taken by mouth for yeast infections certain HIV medicines certain anti-seizure medicines St. John's wort Keep in mind the ring doesnt protect against sexually transmitted infections. Use a latex or female condom to reduce the risk of infection.

+How Safe Is the Vaginal Ring?

Most women can use NuvaRing safely. But all medications have some risks, so safety is a concern when choosing a birth control method. Serious side effects of the ring, though rare, may be more likely if you have certain conditions. Some of these conditions may even rule out using the ring. Talk with your health care provider to find out if the ring is likely to be safe for you. You should not use the vaginal ring during prolonged bed rest or if you are pregnant get migraine headaches with aura have certain inherited blood-clotting disorders have or are being treated for blood clots or vein inflammation have had breast or liver cancer have had a heart attack, stroke, angina, or other serious heart problems have had serious heart valve problems have lupus with certain conditions have serious liver disease or have had liver cancer have uncontrolled high blood pressure have very bad diabetes or have had diabetes for longer than 20 years

 have weak pelvic floor muscles smoke and are 35 or older smoke and have high blood pressure have had complications after organ transplant need to stay in bed for a long time If you have a condition that makes it unsafe to use the ring, dont worry. There are many other methods of birth control that may be safe for you if you cannot use it. There are many other methods of birth control that may be safe for you if you cannot use the ring. Read about other methods to find one that may be right for you.

+What Are the Benefits of the Vaginal Ring?

Using the vaginal ring is safe, simple, and convenient. There is nothing to do right before having sex. Some women say it improves their sex lives because it helps them feel more spontaneous. Many women who use the vaginal ring have more regular, lighter, and shorter periods. And a womans ability to become pregnant returns quickly when use of the ring is stopped. Because the ring works like the pill, it probably offers the same benefits. These health benefits may include some protection against
o o o o o o o o o o o o

acne bone thinning bad menstrual cramps breast growths that are not cancer cysts in the breasts and ovaries ectopic pregnancy endometrial and ovarian cancers heavy and/or irregular periods iron deficiency anemia pelvic inflammatory disease, which often leads to infertility when left untreated premenstrual symptoms, including headaches and depression serious infection in the ovaries, tubes, and uterus The ring can be used to control when and how often you have your period. It can also be used continuously without a monthly break to eliminate monthly periods.

+-

What Are the Disadvantages of the Vaginal Ring?

Because NuvaRing works like the pill, it probably carries the same possible disadvantages. Possible Side Effects of the Vaginal Ring

Some women may have undesirable side effects while using NuvaRing. But many women adjust to it with few or no problems. Some of the most common side effects usually clear up after two or three months. They include
o o o

bleeding between periods breast tenderness nausea and vomiting NuvaRing may also cause more long-lasting side effects. It may cause increased vaginal discharge, vaginal irritation, or infection. The hormones in NuvaRing may change a womans sexual desire. Its important that you find a method that wont make you feel sick or uncomfortable. If you continue to experience side effects after using the vaginal ring for three months, talk with your health care provider. After ring use is stopped, it usually takes one or two months for a womans periods to return to the cycle she had before using it. Once in a while, a woman may have irregular or absent periods. This may go on for as long as six months after stopping. This is more likely if her periods were irregular before using the ring. Regularly using oil-based medicines in the vagina for yeast infections while the ring is in place may increase the level of hormones released into the blood. This will not reduce the effectiveness of the ring. The effect of using these types of yeast infection medications with the vaginal ring long-term is unknown. Talk with your health care provider if you need long-term treatment for yeast infections while you are using the ring. Serious Side Effects of the Vaginal Ring Many women have concerns about the possible risks of taking hormones in birth control. Serious problems do not occur often. Women who use birth control with estrogen like NuvaRing have a slightly greater chance of certain serious problems than nonusers. The most serious in very rare cases may be fatal. These include heart attack, stroke, or having a blood clot in the legs, lungs, heart, or brain.

Other rare risks include developing high blood pressure, liver tumors, gallstones, or yellowing of the skin or eyes (jaundice). The risk for these problems increases if you
o o o o o o o o

are age 35 or older are very overweight have certain inherited blood-clotting disorders have diabetes have high blood pressure have high cholesterol need prolonged bed rest smoke Serious problems usually have warning signs. Report any of these signs to your health care provider as soon as possible:

o o o o o o o o o

a new lump in your breast a sudden very bad headache achy soreness in the leg aura seeing bright, flashing zigzag lines, usually before a very bad headache bad pain in your abdomen or chest headaches that are different, worse, or happen more often than usual no period after having a period every month trouble breathing yellowing of the skin or eyes The Vaginal Ring and Breast Cancer You may have heard claims linking the hormones in the vaginal ring to breast cancer. The most recent literature suggests that the use of these hormones in birth control has little, if any, effect on the risk of developing breast cancer. See the insert from NuvaRing for more information about possible side effects.

+How Do I Start the Vaginal Ring?

To find out what day is best for you to start using the ring, talk with your health care provider. Most often, women start using the ring within the first five days after the start of their periods. That way, they are protected against pregnancy right away. That means that if your period starts on a Wednesday morning, you can insert the vaginal ring as late as the following Monday morning to be protected right away.

If you insert the vaginal ring later than five days after the start of your period, protection will begin after seven days. Use another method of birth control like a condom or spermicide if you have vaginal intercourse during the first week of ring use. The ring can interfere with the placement of the cervical cap,diaphragm, and sponge. They cannot be used as backup methods with the vaginal ring. Starting the Vaginal Ring After Pregnancy Its possible to get pregnant again shortly after being pregnant. Starting birth control after pregnancy is an important concern for many women. You can start using the ring after waiting at least three weeks after giving birth vaginally. You can start using the ring after waiting at least six weeks if you are nursing it may reduce the amount and quality of milk in the first six weeks of breastfeeding. Also, the milk will contain traces of the ring's hormones. It is unlikely that these hormones will have any effect on your child. But talk with a health care provider about what birth control methods might be right for you after giving birth. You should wait at least six weeks after birth if you have an increased risk of blood clots. Women have a higher risk of blood clots if they

are obese are over age 35 had a cesarean section (C-section) had heavy bleeding after delivery had preeclampsia have certain inherited blood clotting disorders have had blood clots in the past have a close family member who has had blood clots need prolonged bed rest received a blood transfusion at delivery smoke You can start using the ring right after an abortion or miscarriage.

+How Do I Use the Vaginal Ring?

Most women find that NuvaRing is very easy to use. Insert one new ring into your vagina and keep it in place for three weeks in a row. Then remove it for one week three weeks in, one week out. Insert a new ring after one week.

Here are some more specific details about using the ring:

Store your unused rings at room temperature and out of direct sunlight. Check the expiration date of each ring package before insertion. Wash your hands with soap and water. Use your fingers to press the sides of the ring together. Gently push the ring into your vagina. The exact position of the ring doesnt matter. Theres no need to remove the ring during vaginal intercourse. Remove it in three weeks on the same day of the week that it was inserted. Hook your finger under the forward rim and gently pull it out of the vagina. Wrap it up in the original foil wrapper, and throw it out in the trash do not flush. Used rings still contain some hormones. Using the foil wrapper protects children and pets who might play with a used ring. It also reduces the chance that hormones will get into the soil and water supply. After one week without the ring, insert a new one on the same day of the week that the previous one was inserted in your last cycle. During the one-week break, you will usually have your period. You may still be bleeding when it is time to insert a new ring. This is normal, too. But the vaginal ring must be inserted on the same day of the week as it was inserted in the last cycle, or you could get pregnant.

Some women use the ring every day without a one-week break to keep from getting their periods. They simply replace the ring every three weeks with a new ring. If you use the ring

continuously, it is normal to have spotting or bleeding the first six months. It may get less over time. Some women stop having any bleeding at all. This is normal and will not harm your body.

Helpful Tips About Using the Vaginal Ring The ring will work best if you always remember to insert the ring and take it out at the right time. A missed period does not always mean you are pregnant, especially if you have used the ring correctly. Even though the chance of pregnancy is very low, you may want to take a pregnancy test if you miss two periods in a row. Talk with your health care provider if you have any questions or concerns while using the ring. There is a very slight chance that you will become pregnant even if you use the ring as directed. It is unlikely that using the ring during early pregnancy will increase the risk of birth defects. If you decide you want to become pregnant, stop using NuvaRing. Its possible to get pregnant right after stopping. It usually takes about one or two months for your period to return to the cycle you had before using the ring.

+What Do I Do if the Ring Slips Out or I Make a Mistake Using It?

Its pretty common for women to make a mistake at some time when using the vaginal ring. If you use the ring, the key to protecting yourself from an unplanned pregnancy is knowing what to do if you make a mistake or if the ring slips out of your vagina. Pregnancy can happen if

the ring slips out of your vagina and is not replaced within three hours the ring does not stay in your vagina for three weeks in a row the ring is left in your vagina for more than three weeks you forget to insert a new ring more than a week after taking out the previous ring Here are some general instructions if any of these things happen to you. Talk with your health care provider for more information. If the Ring Slips Out of Your Vagina

Wash the ring with lukewarm or cool water and put it back in as soon as possible. Use a backup method of birth control for seven days if the ring is out of your vagina for more than three hours. If You Leave the Ring in Your Vagina for Longer than You Should

Up to four weeks after insertion

Remove the ring. Take a ring-free week. Insert a new ring after the ring-free week. More than four weeks after insertion

Remove the ring. You may have become pregnant if you had vaginal intercourse more than four weeks after you inserted the ring. You may want to take a pregnancy test. When you restart with a new ring, use backup birth control for seven days. When Backup Birth Control Is Needed Use a backup method of birth control for seven days in a row

if the ring stays out of your vagina for more than three hours if your ring-free time lasts for more than a week when you restart with a new ring after you left the ring in place for more than four weeks

Do not use a diaphragm, cap, or sponge as a backup method. The ring could keep them from being placed properly in your vagina. Latex condoms or spermicide, used separately or together, are good choices for backup protection. You can also use emergency contraception (morning after pill) as backup. This is a great option if you had vaginal intercourse before you realized your ring was not in place or had been in place too long. Emergency contraception can prevent pregnancy if started up to five days after unprotected intercourse. The sooner you start it, the better it will work.

+How Do I Get the Vaginal Ring? How Much Do Vaginal Rings Cost?
First, youll need to get a prescription. Visit a Planned Parenthood health center, a clinic, or a private health care provider for a prescription. Your health care provider will discuss your medical history with you, check your blood pressure, and give you any other medical exam that you may need. If you need an exam, it may cost about $35$250. You wont need a fitting from a health care provider NuvaRing only comes in one size that fits all women. NuvaRing may be purchased with a prescription at a drugstore or clinic. It costs about $15$70 a month. Planned Parenthood works to make health care accessible and affordable. Some health centers are

able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs.