Pills, Patches & Rings Birth control to prevent unintended pregnancies

Transcription

1 Pills, Patches & Rings Birth control to prevent unintended pregnancies General Hormonal contraception 1. What is hormonal contraception (birth control)? 2. How well does it work? 3. What are the different types of hormonal birth control? 4. Which birth control method is the best for me? 5. What is the risk of a stroke or blood clot when taking hormonal birth control? 6. Can I be on hormonal birth control if I am breastfeeding? 7. Am I protected from sexually transmitted infections (STI)? 8. Can I have my period less often and how can I do this? Birth control pill 1. What is the difference between 21 and 28-pack birth control pills? What about 24/4 or 84-pack pills? 2. Can I take the birth control pill with food? With alcohol? 3. What side effects can I expect when taking birth control pills? 4. What should I do if I am late for one pill of my birth control (<24hours since your last pill)? 5. What should I do if I missed one or more of my birth control pills ( 24 hours since your last pill)? 6. I forgot to start my new pack and it s been more than a day late. What should I do? 7. I ve started bleeding but it is not time for my period yet. Am I pregnant? 8. I haven t had my period yet and I m on my off-week or taking sugar pills. Am I pregnant? 9. Will I gain weight while taking birth control pills? 10. Can I start taking birth control pills if I m a smoker? 1

2 11. What should I do if my home pregnancy test comes back positive and I m taking birth control pills? 12. What is the minipill (Micronor )? Patch 1. Where can I apply the birth control patch? 2. Can I cut the patch into smaller pieces and apply those to my body? 3. What should I do if I am a day late changing my patch? 4. What are some common side effects I can expect while on the patch? 5. My skin gets irritated and red at the spot I put the patch. How can I prevent this? 6. How should I dispose of the patch after I take it off? 7. What should I do if the patch fell off, or if a corner peeled off (<24 hours since detachment)? 8. What should I do if the patch fell off for longer than a day ( 24hours) or I am uncertain of how long it was off? 9. Should I always keep the patch on or only when I am having sex? 10. Will the patch work if I am overweight? 11. I am on my patch-free week and I haven t had my period yet. Am I pregnant? Vaginal ring 1. Will the ring fall out? 2. What should I do if I feel the ring inside of me or I have minor discomfort due to the ring? 3. Can the ring get lost inside me? 4. What should I do if it slips out and it has been more than 3 hours? 2

3 5. What should I do if I forgot to take the ring out? 6. What are some common side effects I can expect while on the ring? 7. Can I use a tampon while the ring is still inserted? 8. There are two different expiry dates on my package; one that the pharmacist put and one that came from the manufacturer. Which one should I follow? Resources References 3

4 General Hormonal contraception What is hormonal contraception (birth control)? Hormonal birth control is a medication you can take to prevent pregnancy How well does it work? With perfect use, birth control prevents almost 100% of pregnancies; however, most women don t use them perfectly. 1,2 Things such as missing pills or not taking it at the same time each day will lower how well the birth control works and puts you at higher risk of getting pregnant. What are the different types of hormonal birth control? Pill that you take by mouth once a day Patch you apply on your body once a week Ring you insert vaginally once a month Intrauterine device (IUD) a doctor inserts Note: all forms of hormonal birth control require a prescription. Please see your doctor or nurse practitioner for further information. Which birth control method is the best for me? Your doctor or nurse practitioner has customized the choice of birth control just for you. Some women prefer the patch, ring, and IUD when you don t want to or can t remember to take a pill every day. What is the risk of a stroke or blood clot when taking hormonal birth control? The risk of having a stroke or blood clot when taking hormonal birth control is higher than the risk for women not taking hormonal birth control. However, this risk is very small and lower than the risk of having a blood clot when you become pregnant. 3 4

5 Can I be on hormonal birth control if I am breastfeeding? Breastfeeding women can take hormonal birth control. However, it is recommended to take a progestin-only birth control pill, Micronor, also known as the mini-pill if starting immediately after birth. 2 Breastfeeding women should wait at least 6 weeks or until the milk supply has been established before starting combined hormonal birth control, which most women traditionally take. Am I protected from sexually transmitted infections (STI)? Hormonal birth control do not protect you against sexually transmitted infections. For protection against STI and the best protection to prevent pregnancy, use a condom in combination with the hormonal birth control. Can I have my period less often and how can I do this? It is possible to have less frequent periods when taking birth control. There are birth control options such as an injection or continuous-use birth control pill that can do this. Talk to your doctor, nurse practitioner or pharmacist to see if these options are suitable for you. To help select which birth control is most suitable for you, visit Choosing Wisely (Birth Control Selection Tool) Birth control pill What is the difference between 21 and 28-pack birth control pills? What about 24/4 or 84- pack pills? Most birth control pills come in a 21-day and 28-day pack that contains 21 days of active pills. The 28-day pack contains 7 days of placebo or sugar pills that contain no active ingredient and are a different pill colour than the active pills. They are a reminder pill for women so they remember to take their pills every day. You don t have to take these sugar pills for your birth control pills to work. Some women may take birth control pills with 24 active pills and 4 sugar pills. Other women may be taking birth controls continuously where they take a pill each day for 84 days, and then have a pill-free break for 7 days. This will reduce common side effects of 5

6 birth control pills and also result in less frequent periods (~4 times per year). Talk to your healthcare provider if you are interested in these options. Can I take the birth control pill with food? With alcohol? The pill can be taken with or without food. It is easier to take your pills when you do something at the same time. Many women will take their pills with their breakfast meal or when they brush their teeth because this makes it easier for them to remember. You can drink alcohol while on the birth control pill. What side effects can I expect when taking birth control pills? The most common side effects from the birth control pill are 1,4 : Nausea o Take the pill with food to reduce the amount of nausea you are experiencing. If it continues to bother you, talk to your doctor or nurse practitioner about switching to a different pill Headache o Tends to get better with time and typically occurs during your off week. If it is bothersome, talk to your doctor or nurse practitioner about options available Breakthrough bleeding or spotting o Most often occurs within the first 3 months of starting the pill. Your bleeding should go back to a regular cycle as your body gets used to the pill What should I do if I am late for one pill of my birth control (<24hours since your last pill)? Take the pill immediately, and resume your regular schedule. You are still protected and do not need to take emergency contraception (ie. morning after pill). 2 Continue taking one pill a day at the same time you were previously taking. What should I do if I missed one or more of my birth control pills ( 24 hours since your last pill)? If it has been longer than 24 hours since you last took your pill, then consult your pharmacist or healthcare provider for advice. 6

7 SOS SexualityandU.ca has a great tool that can help with missed pills, and you can access it at S.O.S (Stay on Schedule) I forgot to start my new pack and it s been more than a day late. What should I do? Start your new pack as soon as possible and continue taking 1 pill per day until the end of the pack. 2 If you have sex, use back-up methods, such as a condom, until you have taken the birth control pill again for 7 consecutive days. Consider taking emergency contraception (ie. morning after pill ) if you had unprotected sex within the last 5 days. 2 I ve started bleeding but it is not time for my period yet. Am I pregnant? Breakthrough bleeding, also known as spotting, is a common side effect of birth control pills. It occurs most often during the first 3 months of starting birth control and tends to get better with time. Spotting does not mean you are pregnant or that the pill is not working. You are still protected as long as you take your pills everyday without missing any. 2,4 I haven t had my period yet and I m on my off-week or taking sugar pills. Am I pregnant? As long as you take the pills every day without missing any, then you are likely not pregnant. The pill is more than 99% effective if used perfectly. 1 It is common for some women to not get a period during their off week. 1 Continue to take the pills everyday as directed and talk to your prescriber if you continue to not have your period and it is concerning to you. Will I gain weight while taking birth control pills? Studies comparing birth control pills to placebo (sugar) pills showed no weight gain for women taking birth control pills. 1 Can I start taking birth control pills if I m a smoker? It is not recommended to take combined birth control pills if you are over 35 years old and a smoker due to an increase risk of having a heart attack and stroke. 1 7

8 Taking progestin-only birth control pills (Micronor ) may be an option if you are a smoker. Please ask your doctor, nurse practitioner, or pharmacist for more information to determine if that is a suitable option for you. These healthcare professionals are also great resources if you are looking to stop smoking. What should I do if my home pregnancy test comes back positive and I m taking birth control pills? Please see your doctor or nurse practitioner to confirm if you are pregnant. If pregnant, stop taking your birth control pills. Taking birth control pills will not harm your baby but it will not prevent a pregnancy after it has occurred. What is the minipill (Micronor )? The minipill is a birth control pill that does not contain the hormone estrogen. It is used for women who want to take birth control but should not be taking estrogen, such as: Women who are over 35 years old and smoke Breastfeeding women seeking birth control immediately after giving birth Women experiencing migraines Patch Women taking the mini-pill must take the pill at the same time every day. It is less forgiving for late and missed pills than the traditional combined birth control pill. Where can I apply the birth control patch? The patch can be applied to the buttock, abdomen, upper outer arm or upper torso. It should not be applied to breast, or red, irritated, or cut skin. Apply the patch somewhere you can check every day to ensure it has not peeled or fallen off. Can I cut the patch into smaller pieces and apply those to my body? No, the patch should not be cut or altered in any way. Apply the full patch every time that you use it 8

9 What should I do if I am a day late changing my patch? The patch contains enough medication to work for 9 days, and so you are still protected as long as the previous patch was still on. 2 Change the patch as soon as possible but keep the original patch change date. What are some common side effects I can expect while on the patch? Some of the more common side effects from the patch are 1,4 : Skin irritation/redness o Apply the patch to a different part of your body each time you apply a new patch Breast tenderness o Tends to get better with time. Talk to your doctor or nurse practitioner if it does not get better Breakthrough bleeding/spotting o Most often occurs within the first 3 months of starting the pill. Your bleeding should go back to a regular cycle as your body gets used to the patch Nausea o Tends to get better with time. Talk to your doctor or nurse practitioner if it is very bothersome Headache o Tends to get better with time. Talk to your doctor or nurse practitioner if it is very bothersome My skin gets irritated and red at the spot I put the patch. How can I prevent this? One of the most common side effects of the patch is skin irritation. 1,4 To prevent this from happening, apply the patch to a different part of your body each time you apply a new patch. You can apply a new patch at the same spot the week after if it is not irritated. How should I dispose of the patch after I take it off? The patch still contains medication after you take it off. Carefully fold the patch so the sticky sides stick together and throw it in the garbage, away from small children and pets. 9

10 What should I do if the patch fell off, or if a corner peeled off (<24 hours since detachment)? Reapply the old patch by gently applying pressure with your hand for 10 seconds, or apply a new patch as soon as possible. The patch change day will remain the same (for example, if you normally change your patch on Tuesdays but the patch fell off on Wednesday, keep the change date on Tuesday even if that means you will not have your patch on for 7 days) and continue with your regular schedule. 2,6 What should I do if the patch fell off for longer than a day ( 24hours) or I am uncertain of how long it was off? Consult your pharmacist or healthcare provider for advice if the patch has been off for longer than 24 hours. SexualityandU.ca has a great tool that can help with missed patches, you can access it at: S.O.S (Stay on Schedule) Should I always keep the patch on or only when I am having sex? You should always keep the patch on, even if you are not having sex at the time. The patch should be worn for 24 hours per day, and changed every 7 days as directed by your doctor, nurse practitioner or pharmacist. Will the patch work if I am overweight? There is some evidence that the patch may not work as well in women weighing over 90kg (198lb). Women that weigh more than 90kg should talk to their doctor or nurse practitioner about other options. 1,4,5 I am on my patch-free week and I haven t had my period yet. Am I pregnant? As long as you used the patch as directed without having it peel off, then you are likely not pregnant. The patch is 99% effective if used as perfectly. 1 It is common for some women to not get a period during their off week. 2 Continue to use the patch and talk to your doctor or nurse practitioner if you continue to miss your period during your patchfree week. 10

11 However, if the patch peeled off for longer than 24 hours then you may be pregnant. Talk to your healthcare provider for a pregnancy test. Stop the patch immediately if you are pregnant. Vaginal ring Will the ring fall out? The ring will not fall out during regular activities, such as walking or physical exercise. It may fall out during intercourse or when pulling out a tampon; if it does fall out and it has been less than 3 hours, rinse the ring under lukewarm water and re-insert it as soon as possible. What should I do if I feel the ring inside of me or I have minor discomfort due to the ring? Once inserted, you should not be able to feel the ring inside you. If you do, then the ring is not inserted high enough and you should gently use a clean finger to push the ring further into your vagina. Can the ring get lost inside me? No, the ring will not get lost inside you. The ring can fall out, but it will not go in any further than the vagina. What should I do if it slips out and it has been more than 3 hours? If the ring has slipped out for longer than 3 hours consult your pharmacist or healthcare provider for advice. SexualityandU.ca has a great tool that can help with rings that are not inserted or fall out. You can access it here S.O.S (Stay on Schedule) What should I do if I forgot to take the ring out? As long as your ring has not been inserted for longer than 28 days (4 weeks), then you can remove the ring and have a 7 day ring-free break. You can then re-insert a new ring after 7 days. However, if the ring has been inserted for longer than 28 days, then you may not be protected and should get checked for potential pregnancy. 2 11

12 What are some common side effects I can expect while on the ring? The most common side effects are 1,4 : Headache o Most often occurs during the ring-free week. Talk to your doctor or nurse practitioner if it is very bothersome Breast tenderness o Tends to get better with time. Talk to your doctor or nurse practitioner if it is very bothersome Spotting/breakthrough bleeding o Most often occurs within the first 3 months of starting the pill. Your bleeding should go back to a regular cycle as your body gets used to the patch Can I use a tampon while the ring is still inserted? Yes, a tampon can be used while the ring is inserted. Insert the ring first before inserting a tampon. Be careful not to pull out the ring with the tampon. If this does occur, rinse the ring under lukewarm water and re-insert the ring as soon as possible. There are two different expiry dates on my package; one that the pharmacist put and one that came from the manufacturer. Which one should I follow? The ring is only stable at room temperature for 4 months and will not work if used after the expiry date indicated by the pharmacist. 7 Use the ring to the most recent expiry date, or 4 months from when you picked up the prescription. You should keep the ring at room temperature and throw it out after 4 months. The fridge at the pharmacy is set to a certain temperature and your fridge at home may not be set the same. Resources

13 References 1. Black A, Francoeur D, Rowe T, Collins J, et. Miller D. Canadian Contraception Consensus No. 2. JOGC. 2004; Guilbert E, Black A, Dunn S, et. Senikas V. Missed Hormonal Contraceptives: New Recommendations. JOGC. 2008; SOGC.org [Internet]. Ottawa: The Society of Obstetricians and Gynaecologists ofcanada. c2013 [cited 2014 July 02] Available from: 4. Sexualityandu.ca [Internet]. Ottawa: The Society of Obstetricians and Gynaecologists of Canada. c2012 [cited 2014 July 02]. Available from: 5. WomensHealthMatters.ca [Internet]. Ontario: Women s College Hospital. c2014 [cited 2014 July 02]. Available from: 6. Ortho Inc. Evra. Product Monograph. July Merck Inc. NuvaRing. Product Monograph. July