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Action, Effectiveness and Medical Side-Effects of Common Methods of Family Planning
Hanna Klaus, MD
| Method
|
Action
|
Perfect
Use |
Typical Use
1st 12 Months |
Medical Side Effects and Disadvantages
|
Fertility Acceptance Methods 1.
| Calendar rhythm |
Calculates fertile phase
from menstrual history. |
9 |
20 |
Still widely used but far less reliable than modern
methods of Natural Family Planning. |
Sympto-Thermal
(STM) |
Observation of cervical
mucus, BBT, cervical
changes and secondary
signs. |
0-2 |
2-8.9 |
None
|
Ovulation Method
(OM) |
Observation of cervical
mucus. |
3 |
2.5-14.9 |
None |
Fertility Suppression Methods 2. Adults
| Withdrawal |
Interrupts sperm entry
into the vagina. |
4 |
19 |
Frustration of partners. |
| Barriers and
Devices |
|
|
|
|
Female Condom
Male Condom |
Prevents sperm entry
into the vagina. |
5
3
|
21
14 |
Aesthetic objections, decreased sensitivity, possible
latex allergies . |
| Diaphragm
Cervical Cap |
Blocks sperm entry into
the cervix. |
9
9
|
26
18 |
Aesthetic objections, possible latex allergy, bladder
infections. Weight gain or loss can require refitting
of device. |
| Spermicides |
Kills sperm in vagina. |
6 |
26 |
Occasional allergies. |
| Vaginal sponge |
Provides barrier to
cervix and spermicidal
agent kills sperm. |
9-20 |
20-40 |
Problems with removal are common; vaginal
dryness; and toxic shock syndrome reported when
left in place beyond recommended time. |
| IUD
All Types |
1. Inhibits sperm
function and survival.
2. Prevents
implantation of early
embryo if conception
occurs.
3. Disturbs tubal
motility. |
0.1-1.5 |
0.1-2.0 |
Infection of the uterus and tubes leading to infertility;
ectopic pregnancy; increased menstrual bleeding;
uterine perforation; and septic abortion. |
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|
|
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| Tubal Ligation |
Mechanically blocks the
Fallopian tubes to
prevent the egg and
sperm from uniting. |
0.5 |
0.5 |
Risks of any surgery; 3-5% experience menstrual
disturbance or pelvic pain; some require
hysterectomy. |
| Vasectomy |
Blocks vas deferens to
prevent sperm from
leaving scrotum. |
0.1 |
0.15 |
Ligation of vas deferens causes sperm to be forced
into scrotum resulting in rise of sperm antibodies
which persist in 25% of men. The implications are
still in the process of study. Increased risk of prostate
cancer described in 2 studies: also increase in lung
cancer if surgery was over 20 years ago. |
"The Pill"
(oral contraceptives) |
1. Prevents ovulation
by blocking luteinizing
hormone surge.
2. Alters cervical
mucus to block sperm
entry.
3. Alters uterine lining
to prevent implantation
(early abortion).
4. Inhibits capacitation
of sperm. |
0.1 |
5 |
Increased risk of cervical cancer; blood clots; high
blood pressure; benign liver tumors, migraine
headaches; gallbladder disease; cervicitis; heart
disease; depression, weight gain, acne, loss of libido
and more.
|
Progesterone- only
pill
(mini pill) |
1. Inhibits ovulation
2. Alters cervical mucus
to block sperm entry.
3. Alters uterine lining
to prevent implantation
(early abortion).
4. Diminishes function
of corpus luteum. |
0.5 |
0.5 |
Menstrual irregularity; breast tenderness; certain
breast cancers; liver conditions; cardiovascular
conditions; migraine headaches and many of the
same risks associated with the combined pill.
Requires strict adherence to dosage schedule. |
Injections
(Depo-provera) |
1. Inhibits ovulation by
suppression of the
luteinizing hormone
surge.
2. Thickens and
decreases cervical
mucus preventing sperm
penetration.
3. Alters uterine lining
to prevent implantation
(early abortion). |
0.3 |
0.3 |
No immediate discontinuation; weight gain;
depression; breast tenderness; menstrual
irregularities; delay of up to one year in return to
fertility; bone density decrease; decrease in HDL
cholesterol levels; allergic reactions; premenstrual
tension; repeated, painful headaches. |
| Norplant system |
1. Suppresses
luteinizing hormone
surge necessary for
ovulation.
2. Thickens and
decreases cervical
mucus.
3. Prevents implantation
should fertilization
occur (early abortion). |
0.5 |
0.5 |
Surgical procedure to insert and remove. Over half
the users discontinue, mostly due to irregular
bleeding or no menses. Removal or rods is
sometimes difficult. Higher rate of pregnancy among
heavy women; increased risk of ovarian cysts;
blurred vision; migraine headaches; nervousness;
weight gain; arm pain; infection or inflammation at
site of implants; nausea; hair growth or loss and
many of the other side effects of oral contraceptives.
The five year cumulative pregnancy rate is 3.9%. |
| Anti-Nidation
Methods
RU-486
(mifepristone),
Preven, (combined
estrogen and
progestin), Ovral, Levlen,
Levora, Lo-Ovral,
Nordette, Alesse,
Levlite (progestin-estrogen
combined oral
contraceptives) Ovrette
(progestin-only oral
contraceptive). Copper-bearing
IUD |
Emergency
Contraception
1. Alters endometrium
inhibiting implantation.
2. Inhibits ovulation
(only proven with
mifepristone).
3. Regression of corpus
luteum causing loss of
pregnancy (especially
with mifepristone) after
implantation.
4. Alters tubal transport
of sperm and/or ova
inhibiting fertilization. |
If treatment
initiated within
72 hours of
intercourse, the
risk of pregnancy
is reduced by at
least 75% |
|
Abortion if conception has occurred; nausea;
vomiting; breast tenderness; headaches; dizziness;
any other potential risks of oral contraceptives.
Potential for causing developmental abnormalities
should embryo survive. |
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Some Definitions
Natural Family Planning: Methods for achieving and avoiding pregnancy that are based on the observation of the naturally occurring signs and symptoms of the fertile
and infertile phases of the menstrual cycle. Couples using natural family planning methods to achieve pregnancy, engage in intercourse during the fertile phase of the
woman's cycle while those wishing to avoid pregnancy abstain from intercourse and genital contact during the fertile time. No drugs, devices, or surgical procedures are used
to avoid pregnancy.
Natural Family Planning reflects the dignity of the human person within the context of marriage and family life, promotes openness to life and the value of the child. By
complementing the love-giving and life-giving nature of marriage, Natural Family Planning can enrich the bond between husband and wife.
Sympto-Thermal Method (STM): STM utilizes the woman's observation of her primary (cervical mucus, basal body temperature, cervical changes) and secondary signs of
fertility (breast tenderness, mid-cycle pain, etc.). Differences surface among the schools of STM in how the temperature is recorded as well as with regard to the definition of
the basic STM rule.
Ovulation Method (OM): OM utilizes the woman's observation of one sign of fertility (cervical mucus). Differences surface among the schools of OM with regard to
emphasis. Some schools emphasize "sensation," others "observation" of the cervical mucus.
Perfect Use: The percentage of method effectiveness for pregnancy avoidance without factoring in human error.
Typical Use: The percentage of method effectiveness for pregnancy avoidance factoring in human error.
In contraceptive research, the person's intention to achieve pregnancy or not will separate them into groups of those who "plan" to become pregnant and those
who do not". Because NFP is the only method of family planning which can be used to achieve a pregnancy, these definitions do not sufficiently represent NFP user related
pregnancies. NFP researchers therefore separate user rates as follows:
(A) Informed choice: A couple who had previously indicated that they were using the method to avoid pregnancy and chose to have intercourse on a day of
recognized fertility.
[Similar to this category is that of "achieving pregnancy" as defined by NFP researchers of the Pope Paul VI Institute for the Study of Human Reproduction. They define
pregnancies which result from couples who have intercourse on a day of known fertility (regardless of intent) as "achieving pregnancy" and therefore tabulated in the "planned
pregnancies" rate.]
(B) Teaching Related: Misunderstanding of the rules of the method.
(C) Unresolved: No or inadequate information to categorize the unplanned pregnancy.
The purpose of this Focus series is to serve the Roman Catholic diocesan NFP programs of the United States through providing them with up-to-date information on research
within the field of fertility, family planning, and related issues. Fertility acceptance methods are morally acceptable according to the Roman Catholic Church's teaching on
conjugal love and responsible parenthood. Fertility suppression and anti-nidation methods are not morally acceptable according to these same teachings. The diocesan NFP
teacher should be equipped to understand the various methods of contraception and be able to explain their incompatibility with the practice of the natural methods of family
planning.
Copyright @ 1999, 2002, Diocesan Development Program for Natural Family Planning, United States Conference of Catholic Bishops. The text and illustrations may be reproduced in whole
without alteration or change by Catholic dioceses, parishes, schools, organizations, and newspapers, provided such reprints include the following notice:
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Reprinted from FOCUS NFP Series, Copyright @ 1999, 2002, Diocesan Development Program for Natural Family Planning, United States Conference of Catholic Bishops,
Washington, D.C. All rights reserved.
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| End Notes
1. Effectiveness rates taken from: Klaus, H. Natural Family Planning: A Review. OB-GYN Survey 37 (February 1982): 128-150; 2nd edition 1995, published, NFP Center
of Washington, D.C., Bethesda, MD; and Fu, et al. Contraceptive Failure Rates: New Estimates from the 1999 National Survey of Family Growth. Family Planning
Perspectives 31 (March/April 1999): 56-63. For a thorough discussion of the difficulties regarding scientific studies on the effectiveness of NFP see Kambic, R.The
Effectiveness of Natural Family Planning Methods for Birth Spacing: A Comprehensive Review in Girotto, S. & Bressan, F. (eds.) Human Fertility Regulation:
Demographic and Statistical Aspects. Verona, Italy: Edizioni Libreria Cortina Verona, 1999 (pp.63-90).
2. Effectiveness rates and general information taken from: Fu, et al. Contraceptive Failure Rates: New Estimates from the 1999 National Survey of Family Growth.
Family Planning Perspectives 31 (March/April 1999): 56-63. See also Hatcher, R., et al. Contraceptive Technology. New York: Ardent Media, Inc., 1998.
3. See Hatcher, R., et al. Contraceptive Technology. New York: Ardent Media, Inc., 1998. Grou, F., Rodrigues, I. The Morning-After Pill: How Long After? American
Journal of Obstetrics and Gynecology 171 (1994): pp.1529-34. Moore, Keith L.; Persaud, T.V.N. The Developing Human, Clinically Oriented Embryology, 6th edition.
Philadelphia: W.B. Saunders Company, 1998. p.58. Glasier, Anna. Emergency Postcoital Contraception. The New England Journal of Medicine 337 (1997): pp.1058-
64. Couzinet, B., LeStrat, N., Silvestre, L., Schaison, G. Late Luteal Administration of the Antiprogesterone RU-486 in Normal Women: Effects on the Menstrual Cycle
Events and Fertility Control in a Long-Term Study. Fertility Sterility 54 (1990): 1039-44. Spinnato, J.A. Mechanism of Action of Intrauterine
Contraceptive Devices and its Relationship to Informed Consent. American Journal of Obstetrics and Gynecology 176 (1997): pp. 503-6. Beck, W.W. (ed.)
Obstetrics and Gynecology 4th edition. Baltimore: Williams & Wilkins, 1997: pp.241-52. Larimore, Walter, Stanford, Joseph. Postfertilization Effects of Oral
Contraceptives and Their Relationship to Informed Consent. Archives of Family Medicine 9 (Feb., 2000): pp.126-133. Kahlenborn, C., Stanford, J., Larimore, W.
Postfertilization Effect of Hormonal Contraception. Annals of Pharmacotherapy (Mar., 2000): www.theannals.com |
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