On-Line Contraceptive Class Eastern Illinois University Health Service
Objectives Upon completion the student will Be knowledgeable of the current recommendations for Pap and STI screening Learn about current contraceptive options Be aware of common benefits and possible adverse reactions of contraceptive use
The Women s Health Appointment During the women s health appointment you may receive the following Sexually Transmitted Infection Screening Pelvic Exam Pap Smear Blood pressure and other vital signs assessment Breast Exam Thyroid assessment Heart and lung assessment with a stethoscope Abdominal exam
Pap Smear Screening Defined The pap smear is a screening test of cells from the uterine cervix (mouth of the uterus). Many types of cells can be identified and examined for abnormalities. Over a long period of time, a small percentage of untreated abnormal cells may result in progressively severe changes or even cancer of the cervix. Regular pap smears may lead to earlier detection and treatment of abnormal cervical cells.
Pap Smear Recommendations It is currently recommended that pap smear screening begin at age 21. STI screening is recommended annually for at-risk sexually active females under the age of 25. At EIU health service women requesting hormonal contraceptives will be required to have an annual appointment.
The Pap Smear During the pap smear your health care provider will place a small instrument called a speculum into the vagina. The speculum will allow the provider to visualize your cervix. A small soft cervix brush is used to remove loose microscopic cells from the outer surface and inner transformation zone of the cervix.
The Pap Smear The cells are then placed into a preservative solution and sent to a pathologist for evaluation. At EIU we use the SurePath pap test. At EIU the wait for pap smear reports is approximately 1-2 weeks.
Pap Smear Results If your pap is normal, it is recommended to be repeated in 3 years If your pap has mild cellular changes, you will be asked to repeat it in a year If your pap shows cells that do not fit into the above, you may be referred to a gynecologist for further evaluation. Most changes, if any, are mild
The Pelvic Exam This is an examination of the uterus, fallopian tubes and ovaries. Each of these will be examined for size, position, tenderness, and abnormal growths. During the pelvic exam the provider will place two fingers into the vagina to move the organs to be examined while pressing down with the other hand over your abdomen. This will be done with all Pap Smears and STI exams.
The Breast Exam Breast exams are commonly done annually by your health care provider. Your provider can instruct you on how to do a self breast exam. The best time to do a breast exam is just after your menstrual period. Any changes in breast tissue should be evaluated by your health care provider.
Monthly Self Breast Exam Breast self-exam is the best way to detect abnormal lumps or changes in the breast. Your ability to detect changes will improve with practice so be sure to examine your breasts every month.
Sexually Transmitted Infections (STI) These infections are spread through sexual contact with infected persons. There are several types of STIs. If a treatment is available, the type or method will depend upon the particular infection. Many STIs can be spread even when a condom is utilized. Abstinence is the best way to ensure safety from sexually transmitted infections. Many people with STIs are asymptomatic and therefore are not aware of the infection and can spread the infection to a partner.
True or False: Most people with Chlamydia infection have noticeable symptoms?
False More than 70% of women with Chlamydia have no symptoms More than 90% of men with Chlamydia have no symptoms Screening for STI s is Vital!
Screenings Available at EIU Standard STI/Vaginal infection exam Chlamydia Gonorrhea Trichamoniasis Yeast and Bacterial Vaginosis (These are not STIs) Syphilis (blood test) HIV (blood test): additional $15.00 fee
Bacterial STI s Chlamydia- Don t let yourself become a number According to the U.S. Centers for Disease Control and Prevention, 40 percent of Chlamydia cases are reported among young people 15 to 19 years old. Research has shown that women infected with Chlamydia are three to five times more at risk of acquiring HIV if exposed to the virus than women not infected.
Bacterial STI s Gonorrhea- When the numbers get personal Gonorrhea is a curable sexually transmitted disease (STD), second only to Chlamydia as the most frequently reported STD in the U.S. Women ages 15 to 19 are at greatest risk for gonorrhea. In the U.S., approximately 7.5 percent of all reported gonorrhea is found in younger persons aged 15 to 19 years of age. The highest rates of infection are usually found in 15 to 19-year-old women and 20 to 24- year-old men. Approximately 50 percent of women infected with gonorrhea have no symptoms. Diagnosis most often results from partner notification as a result of infection in men, which usually produces symptoms. Up to 40 percent of women with gonorrhea who are not treated will develop pelvic inflammatory disease (PID). About 20 percent of women with PID become infertile and 18 percent experience chronic pelvic pain.
True or False: Most people are aware that they have a sexually transmitted infection (STI).
False Many STIs remain undetected without testing. We recommend yearly testing for sexually active people at risk.
Additional STI Concerns Viruses: Herpes Simplex Virus can be identified by visual inspection when symptoms are present. Testing is available to aid in diagnosis and typing of the virus. Genital Warts (HPV) can be identified by visual inspection and treated when they are present. Cervical HPV the pap smear is the best detection for this infection.
HPV HPV is the most common STI among sexually active people. HPV is transmitted by skin to skin contact and by contact with infected body fluids.
HPV VACCINATION HPV vaccination is indicated in males and females 9-26 years of age for the prevention of certain diseases caused by HPV (Human Papilloma Virus) types 6, 11, 16 and 18. These diseases include cervical cancer, genital warts and precancerous cervical lesions.
HPV Vaccination Continued The vaccine is a series of 3 injections given over a 6 month period Gardasil is available at Health Service Both women and men can receive this vaccination Please call or come to Health Service for more information regarding this vaccine
HIV Testing HIV testing is available Monday through Friday at Health Service Testing is obtained with a blood sample. Testing is $15.00. Risk assessment is also available through the HERC (581-7786).
Viral STI s Genital Herpes- When the numbers get personal An estimated two out of every three persons infected with genital herpes don t know they are infected because they have no visible or recognized symptoms. Up to 30 percent of genital herpes infections are caused by HSV-1 (oral herpes), primarily resulting from oral-genital sex. Although herpes vaccine research is being conducted, no vaccine is currently available.
Contraceptive Choices Abstinence is the only method of contraception that is 100% effective With the continual rise in sexually transmitted infections and the risk of unplanned pregnancy, abstinence is a valuable option.
Barrier Contraception Male Condom 97% effective when used correctly Available at EIU pharmacy 4-6 condoms/$2.00 Female Condom 95% effective when used correctly Available at local pharmacies Diaphragm 94% effective when fitted and used correctly Fitting available at EIU health service
Effectiveness of Condom Use Of 100 women whose partners use condoms, about 14 will become pregnant during the first year of typical use. ( Typical use refers to failure rates for women and men whose condom use is not consistent or always correct.) Only two will become pregnant with perfect use. ( Perfect use refers to failure rates for women and men whose condom use is consistent and always correct.) Perfect use is the KEY WORD and is something many people fail to do correctly EACH TIME. Only condoms provide some protection against STI s. Condoms inhibit exchange of potentially infected body fluids.
Comparing Birth Control Methods Barrier Methods Male Condom 97% effective perfect use 85% effective typical use Diaphragm 94% effective perfect use 84% effective typical use Female Condom 95% effective perfect use 79% effective typical use Withdrawal 96% effective perfect use 73% effective typical use Hormonal Methods Depo-Provera 99.7% effective perfect use 97% effective typical use The Pill 99.7% effective perfect use 92% effective typical use Nuva Ring 99.7% effective perfect use Unknown new product
A Guide to Condom Lubrications Safe with All Condoms: Aloe-9 Aqua Lube AstroGlide delube ForPlay Glycerin Gynol II H-R lubricating jelly K-Y Jelly PrePair Ramses Personal Spermicide Silicone lubricant Spermicides Touch Personal Lubricant Water and saliva Wet Unsafe with Latex Condoms: Baby oil Cold creams Cornhuskers lubricant Edible oils (olive, peanut, corn, sunflower) Hand and body lotions Massage oils Mineral oil Petroleum jelly Shortening Suntan oil and lotions Bag Balm Whipped cream Certain vaginal yeast infection medications
Hormonal Contraceptives at EIU Health Service Combination Oral Birth Control Pills, both monthly cycle and extended cycle types Vaginal Ring Nuva-Ring Progesterone only Injectable Depo-Provera
Combination Hormonal Contraceptives These contraceptives contain various amounts of estrogen and progesterone. These hormones are normally present in females and work to regulate the female reproductive cycle. In hormonal contraceptives, estrogen and progesterone are used to suppress egg (follicle) production and fertilization. They also work by thickening cervical mucus thus blocking sperm from reaching an egg.
Benefits for combination hormonal contraception Many known benefits exist. Some include Regulation of menses Reduction of menstrual cramps Prevention of pregnancy Reduction of ovarian cysts May improve bone density Reduced occurrence of iron deficiency anemia Prevention of non-cancerous breast diseases May play a role in the prevention of rheumatoid arthritis Improvement of menstrual migraines, mood swings, acne
Risks/Side Effects for combination hormonal contraception Side effects may include nausea, breast tenderness, weight changes, mild spotting, changes in libido, mild blood pressure elevation and changes in mood. These symptoms are generally mild and should subside within 2-3 cycles. If they do not subside, make an appointment to discuss this with your healthcare provider, as changing to another pill may reduce side effects.
Adverse Events for combination hormonal contraception Certain physical or mental changes warrant alerting your healthcare provider. Blood clot is a rare potential side effect. These include (ACHES): A stands for abdominal pain C stands for chest pain, cough, or shortness of breath H stands for headache, dizziness, or weakness E stands for eye problems, vision loss or blurring S stands for severe leg pain in calf or thigh (due to potential blood clot)
Potential Medication Interactions for combination hormonal contraception Antibiotics Some interfere with the combined hormonal contraception. Condoms are recommended as additional contraception while on antibiotics. Antacids Tums, Rolaids, Maalox, etc Avoid use within two hours of taking oral contraceptives. Anticonvulsants controls seizure and epilepsy May reduce the effectiveness. Talk to the prescribing doctor prior to initiating any hormonal contraception.
True or False: Antibiotics may interfere with the effectiveness of birth control pills?
True Use condoms as additional contraception while on antibiotics.
Smoking When taking any of the combination hormonal contraceptives, smoking is not advised. Smoking significantly increases the likelihood that an adverse event, such as a blood clot, can occur. Smokers over the age of 35 have an even higher risk of experiencing an adverse event.
True or False: Women who take hormonal contraception, such as birth control pills, should not smoke.
TRUE Smoking while using hormonal contraception increases a woman s risk for blood clot, heart attack and stroke. Smoking and hormones do not mix!
Oral Contraceptives When taken correctly oral contraceptives are 99% effective in prevention of pregnancy. Oral contraceptives do not prevent the transmission of STIs.
True or False Oral contraceptives (birth control pills) protect against STIs (Sexually Transmitted Infections)?
FALSE Oral contraceptives do not protect against infections. Consider condom use everytime!
Oral Contraceptives When to start? Day 1 start You may start the first pill on the 1 st day of your menstrual cycle. You will not need additional contraception for this method. Sunday Start You may start the pill on the Sunday after your period starts. If you use this method, you will need to use another form of contraception for first 7 days (ie. condom).
Oral Contraceptives When to start? Anyday start In many instances you may be able to start your first pill any day of the month. Please discuss this option with your women s health provider.
Considerations When Taking the Pill Schedule the pill take the pill at the same time everyday. Take the pill after a meal this will minimize nausea and vomiting. If you are consistently nauseated take the pill in the evening at bedtime.
What If I Forget to take the pill? (first of two pages) 1 missed pill take it as soon as you remember. Take the next pill at the regular time. You do not need to use back-up contraception. When more than one pill is forgotten, use additional contraception for 7 full days. 2 missed pills - during week 1 or 2, take two pills on the day you remember and two pills the next day. Then take one pill daily. 2 missed pills week 3, for Sunday starters take one pill daily through Sunday. Begin new pill pack on Sunday. For day one starters, discard remaining pills and start new pack.
Missed Pills Continued 3 or more missed pills Sunday starters take one pill per day until Sunday and start a new pack on Sunday. For day one starters, throw away remaining pills and start a new pack. For most oral contraceptive packs the pills in week 4 are reminders. They do not contain any contraceptive medication. Throw away any forgotten pills from week 4. If you are confused, always use back up contraception until you speak with a nurse or provider at health services.
True or False I don t need to worry if I forget to take my birth control pill?
False Refer to previous slides, your birth control pill package insert or call Health Service or your pharmacist. Taking your pills correctly is the best way to prevent pregnancy.
Oral Contraceptives available at EIU pharmacy Sronyx (generic Alesse) Low-Ogestrel (generic Lo/Ovral) Reclipsen (generic Desogen) Quasense (generic Seasonale 91 day pack) Microgestin 1/20 and 1.5/30 (generic Loestrin Fe) Azurette (generic Mircette) Lo Loestrin FE Necon 1/35 (generic Ortho Novum 1/35) Levora (generic Nordette) Mononessa (generic Ortho- Cyclen) Trinessa (generic Ortho Tri- Cyclen)
NuvaRing The Ring Is a small (about 2 diameter), soft ring that is inserted into the vagina Works similarly to combination oral contraceptives Like birth control pills, the Nuva-Ring is highly effective in preventing pregnancy when used correctly. While the ring is worn, it continuously delivers hormones to the vaginal wall and into the bloodstream
NuvaRing Unique Benefits/Side Effects Benefits Once per cycle dosing Discreet Side Effects Increased vaginal discharge Also has same potential side effects as oral birth control pills
NuvaRing What To Do Ring is inserted and left in place for 21 days After 21 days, ring is removed and period occurs New ring is inserted 1 week after removal Ring conforms to the body; very few women have the ring fall out Most women (and their partners) cannot feel the ring Check with health care provider about when to insert
Nuvaring continued Ring can also be placed on the 1 st day of each month and removed the last 3-4 days of each month Please discuss this option with your Healthcare Provider if you are interested.
NuvaRing When to start? If you are currently on the pill/patch start when you would normally begin a new pack at the end of your cycle. If you are not currently using hormonal contraception Counting the first day of your menstrual period as Day 1 insert your first Nuva-Ring between day 1 and day 5 of your menstrual period. Insert the ring by no later than day 5 even if you are still bleeding. We recommend using condoms as additional contraception the first week of Nuvaring use.
NuvaRing How to insert? You just squeeze the nuvaring between your index finger and thumb to insert it into the vagina. It does not need to be in any special location to be effective. Can be placed inside tampon applicator to insert. To remove, just insert your finger and pull it out.
NuvaRing What if it falls out? Less than 2.2% of users have reported problems with the ring falling out. If the ring falls out or gets pulled out just rinse with warm water and re-insert. If reinserted within three hours, no back up contraception is necessary.
Review of Combined Hormonal Contraception Available at EIU Oral contraceptives and NuvaRing (vaginal ring) are available at EIU pharmacy. All of these methods are highly effective in preventing pregnancy when they are used correctly. Hormonal contraception does not protect against HIV infection and other sexually transmitted infections.
Common Question How long can I continue to take the pill? It is not necessary to take a break from the pill or ring. Some experts believe that the risks identified with these types of contraception start to rise after age 30, especially if you smoke.
Common Question Will the use of hormonal contraception affect my future fertility? Approximately 80% of women regain normal fertility within three months after discontinuing the pill, 95% within one year. Use of oral contraception may increase fertility by decreasing the incidence of ovarian cysts and pelvic inflammatory disease.
Depo-Provera The Shot Depo-Provera, the shot is a progesterone only injection widely utilized for contraception. When used correctly, it is one of the most effective methods for preventing pregnancy. The injection is effective for at least 12 weeks.
Depo-Provera How does it work? The injection acts by inhibiting the release of follicles (eggs) from the ovaries. It also changes the lining of your uterus, making pregnancy less likely to occur.
Depo-Provera Benefits It does not contain estrogen which reduces the risk of certain side effects, especially for smokers. Convenience, no daily pill to remember. May be used by nursing mothers. It becomes effective 48 hours after an injection.
Depo-Provera Side Effects Irregular, unpredictable bleeding - should improve with consecutive injections. Mild increased risk of breast cancer in patients starting Depo-Provera after age 35. Difficulty achieving pregnancy during the first 12-18 months after discontinuing Depo-Provera.
Side Effects Continued Weight Gain approximately 5.4 lbs. in the first year and up to 13.2 lbs. over time. Headache Stomach pain or cramps Fatigue Decreased libido Many women who experience side effects during the first few months of use report that these decrease over time. Elevated blood pressure
Depo-Provera and Your Bones BONE LOSS/OSTEOPOROSIS RISK: Depo-Provera can cause a reversible decrease in bone density. Most women can safely use Depo-Provera for up to 2 consecutive years. Women at low risk for bone loss or osteoporosis between the ages of 18 and 45 can continue Depo-Provera for greater than 2 consecutive years. Women at high risk for osteoporosis (heavy smokers, anorexics, amenorrheic athletes, chronic steroid users, women with strong family history of osteoporosis, women with osteopenia or osteoporosis) will be counseled to consider alternative birth control.
Depo-Provera and Bone Health Women should exercise daily and consume adequate Calcium and Vitamin D intake. We recommend 1,000 mg of calcium per day (3-4 servings of dairy per day) and 400-600 IU of Vitamin D per day (fortified in milk and cereals and other foods).
EIU Women s Health Services Appointment Fees STI screening $50.00 Pap Smear $50.00 Pap Plus (pap smear and STI screening) $70.00
EIU Health Service Missed Appointment Fees If you need to cancel or reschedule your appointment you need to do so at least 24 hours prior to your scheduled appointment time. If you forget your appointment or do not reschedule 24 hours in advance, the appointment fee will be charged to your student account.
EIU H.S. Staff Providing Women s Health Services Sheila Baker, M.D. Family Physician Kathie Blesch, PA-C Physician Assistant John Hutchinson, M.D. Family Physician