Oral Contraceptive Pills (OCPs)(Sunaulo Gulaf and Nilocon White)
1. Should a woman take a “rest” from OCPs after taking them for a time?
No. There is no evidence that taking a “rest” is helpful. In fact, taking a “rest” from OCPs can lead to unintended pregnancy. OCPs can safely be used for many years without having to stop taking them periodically.
2. If a woman has been taking OCPs for a long time, will she still be protected from pregnancy after she stops taking OCPs?
No. A woman is protected only as long as she takes her pills regularly.
3. How long does it take to become pregnant after stopping OCPs?
Women who stop using OCPs can become pregnant as quickly as women who stop non hormonal methods. OCPs do not delay the return of a woman’s fertility after she stops taking them. The bleeding pattern a woman had before she used OCPs generally returns after she stops taking them. Some women may have to wait a few months before their usual bleeding pattern returns.
4. Do OCPs cause abortion?
No. Research on OCPs finds that they do not disrupt an existing pregnancy. They should not be used to try to cause an abortion. They will not do so.
5. Do OCPs cause birth defects? Will the fetus be harmed if a woman accidentally takes OCPs while she is pregnant?
No. Good evidence shows that OCPs will not cause birth defects and will not otherwise harm the fetus if a woman becomes pregnant while taking OCPs or accidentally starts to take OCPs when she is already pregnant.
6. Do OCPs cause women to gain or lose a lot of weight?
No. Most women do not gain or lose weight due to OCPs. Weight changes naturally as life circumstances change and as people age. Because these changes in weight are so common, many women think that OCPs cause these gains or losses in weight. Studies find, however, that, on average, OCPs do not affect weight.
7. Must a woman have a pelvic examination before she can start OCPs or at follow-up visits?
No. Instead, asking the right questions usually can help to make reasonably certain that a woman is not pregnant No condition that could be detected by a pelvic examination rules out OCP use.
8. Can a woman safely take OCPs throughout her life?
Yes. There is no minimum or maximum age for OCP use. OCPs can be an appropriate method for most women from onset of monthly bleeding (menarche) to menopause
9. Can women who smoke use OCPs safely?
Women younger than age 35 who smoke can use low-dose OCPs. Women age 35 and older who smoke should choose a method without estrogen or, if they smoke fewer than 15 cigarettes a day, monthly injectables.
10. What if a client wants to use OCPs but it is not reasonably certain that she is not pregnant after using the pregnancy checklist?
If pregnancy tests are not available, a woman can be given OCPs to take home with instructions to begin their use within 5 days after the start of her next monthly bleeding. She should use a backup method until then.
11. Can OCPs be used as emergency contraceptive pills (EcPs) after unprotected sex?
Yes. As soon as possible, but no more than 5 days after unprotected sex, a woman can take OCPs as ECPs
12. Is it important for a woman to take her OCPs at the same time each day?
Yes, for 2 reasons. Some side effects may be reduced by taking the pill at the same time each day. Also, taking a pill at the same time each day can help women remember to take their pills more consistently. Linking pill taking with a daily activity also helps women remember to take their pills.
1. Do ECPs disrupt an existing pregnancy?
No. ECPs do not work if a woman is already pregnant. When taken before a woman has ovulated, ECPs prevent the release of an egg from the ovary or delay its release by 5 to 7 days. By then, any sperm in the woman’s reproductive tract will have died, since sperm can survive there for only about 5 days.
2. Do ECPs cause birth defects? Will the fetus be harmed if a woman accidentally takes ECPs while she is pregnant?
No. Good evidence shows that ECPs will not cause birth defects and will not otherwise harm the fetus if a woman is already pregnant when she takes ECPs or if ECPs fail to prevent pregnancy.
3. How long do ECPs protect a woman from pregnancy?
Women who take ECPs should understand that they could become pregnant the next time they have sex unless they begin to use another method of contraception at once. Because ECPs delay ovulation in some women, she may be most fertile soon after taking ECPs. If she wants ongoing protection from pregnancy, she must start using another contraceptive method at once.
4. Are ECPs safe for women with HIV or AIDS? can women on antiretroviral therapy safely use ECPs?
Yes. Women with HIV, AIDS, and those on antiretroviral therapy can safely use ECPs.
5. If ECPs failed to prevent pregnancy, does a woman have a greater chance of that pregnancy being an ectopic pregnancy?
No. To date, no evidence suggests that ECPs increase the risk of ectopic pregnancy. Worldwide studies of progestin-only ECPs, including a United States Food and Drug Administration review, have not found higher rates of ectopic pregnancy after ECPs failed than are found among pregnancies generally.
6. Should women use ECPs as a regular method of contraception?
No. Nearly all other contraceptive methods are more effective in preventing pregnancy. A woman who uses ECPs regularly for contraception is more likely to have an unintended pregnancy than a woman who uses another contraceptive regularly. Still, women using other methods of contraception should know about ECPs and how to obtain them if needed—for example, if a condom breaks or a woman misses 3 or more combined oral contraceptive pills.
7. If a woman buys ECPs over the counter, can she use them correctly?
Yes. Taking ECPs is simple, and medical supervision is not needed. Studies show that young and adult women find the label and instructions easy to understand. ECPs are approved for over-the- counter sales or nonprescription use in many countries.
1. Can women who could get sexually transmitted infections (STIs) use injectables?
Yes. Women at risk for STIs can use injectables. The few studies available have found that women using DMPA were more likely to acquire chlamydia than women not using hormonal contraception. The reason for this difference is not known. There are few studies available on use of NET-EN and STIs. Like anyone else at risk for STIs, a user of injectables who may be at risk for STIs should be advised to use condoms correctly every time she has sex. Consistent and correct condom use will reduce her risk of becoming infected if she is exposed to an STI.
2. If a woman does not have monthly bleeding while using progestin-only injectables, does this mean that she is pregnant?
Probably not, especially if she is breastfeeding. Eventually most women using injectables will not have monthly bleeding. If she has been getting her injections on time, she is probably not pregnant and can keep using injectables. If she is still worried after being reassured, she can be offered a pregnancy test, if available, or referred for one. If not having monthly bleeding bothers her, switching to another method may help.
3. Can a woman who is breastfeeding safely use injectables?
Yes. This is a good choice for a breastfeeding mother who wants a hormonal method. Injectables are safe for both the mother and the baby starting as early as 6 weeks after childbirth. They do not affect milk production.
4. How much weight do women gain when they use progestin-only injectables?
Women gain an average of 1–2 kg per year when using DMPA. Some of the weight increase may be the usual weight gain as people age. Some women, particularly overweight adolescents, have gained much more than 1–2 kg per year. At the same time, some users of injectables lose weight or have no significant change in weight. Asian women in particular do not tend to gain weight when using DMPA.
5. Do DMPA cause abortion?
No. Research on injectables finds that they do not disrupt an existing pregnancy. They should not be used to try to cause an abortion. They will not do so.
6. Do progestin-only injectables make a woman infertile?
No. There may be a delay in regaining fertility after stopping progestin- only injectables, but in time the woman will be able to become pregnant as before, although fertility decreases as women get older. The bleeding pattern a woman had before she used injectables generally returns several months after the last injection even if she had no monthly bleeding while using injectables. Some women may have to wait several months before their usual bleeding pattern returns.
7. How long does it take to become pregnant after stopping DMPA?
Women who stop using DMPA wait about 4 months longer on average to become pregnant than women who have used other methods. This means they become pregnant on average 10 months after their last injection. A woman should not be worried if she has not become pregnant even as much as 12 months after stopping use. The length of time a woman has used injectables makes no difference to how quickly she becomes pregnant once she stops having injections. After stopping injectables, a woman may ovulate before her monthly bleeding returns—and thus can become pregnant. If she wants to continue avoiding pregnancy, she should start another method before monthly bleeding returns.
8. Does DMPA cause cancer?
Many studies show that DMPA does not cause cancer. DMPA use helps protect against cancer of the lining of the uterus (endometrial cancer).
9. Do progestin-only injectables cause birth defects? Will the fetus be harmed if a woman accidentally uses progestin-only injectables while she is pregnant?
No. Good evidence shows that progestin-only injectables will not cause birth defects and will not otherwise harm the fetus if a woman becomes pregnant while using injectables or accidentally starts injectables when she is already pregnant.
10. What if a woman returns for her next injection late?
In 2008 WHO revised its guidance based on new research findings. The new guidance recommends giving a woman her next DMPA injection if she is up to 4 weeks late, without the need for further evidence that she is not pregnant. Whether a woman is late for reinjection or not, her next injection of DMPA should be planned for 3 months later
Questions and Answers About Implants
1. Do users of implants require follow-up visits?
No. Routine periodic visits are not necessary for implant users. Annual visits may be helpful for other preventive care, but they are not required. Of course, women are welcome to return at any time with questions.
2. Can implants be left permanently in a woman’s arm?
Leaving the implants in place beyond their effective lifespan is generally not recommended if the woman continues to be at risk of pregnancy. The implants themselves are not dangerous, but as the hormone levels in the implants drop, they become less and less effective.
3. Do implants cause cancer?
No. Studies have not shown increased risk of any cancer with use of implants.
4. How long does is take to become pregnant after the implants are removed?
Women who stop using implants can become pregnant as quickly as women who stop nonhormonal methods. Implants do not delay the return of a woman’s fertility after they are removed. The bleeding pattern a woman had before she used implants generally returns after they are removed. Some women may have to wait a few months before their usual bleeding pattern returns.
5. Do implants cause birth defects? Will the fetus be harmed if a woman accidentally becomes pregnant with implants in place?
No. Good evidence shows that implants will not cause birth defects and will not otherwise harm the fetus if a woman becomes pregnant while using implants or accidentally has implants inserted when she is already pregnant.
6. Can implants move around within a woman’s body or come out of her arm?
Implants do not move around in a woman’s body. The implants remain where they are inserted until they are removed. Rarely, a rod may start to come out, most often in the first 4 months after insertion. This usually happens because they were not inserted well or because of an infection where they were inserted. In these cases, the woman will see the implants coming out. Some women may have a sudden change in bleeding pattern. If a woman notices a rod coming out, she should start using a backup method and return to the clinic at once.
7. Do implants increase the risk of ectopic pregnancy?
No. On the contrary, implants greatly reduce the risk of ectopic pregnancy. Ectopic pregnancies are extremely rare among implant users.
8. How soon can a breastfeeding woman start a progestin-only method—implants, progestin-only pills or injectables?
WHO guidance calls for waiting until at least 6 weeks after childbirth to start a progestin-only contraceptive.
9. Should heavy women avoid implants?
No. These women should know, however, that they need to have Jadelle replaced sooner to maintain a high level of protection from pregnancy. Among women who used Jadelle implants and who weighed 80 kg or more, the pregnancy rate was 6 per 100 in the fifth year of use. These women should have their implants replaced after 4 years.
10. Can a woman work soon after having implants inserted?
Yes, a woman can do her usual work immediately after leaving the clinic as long as she does not bump the insertion site or get it wet.
11. Must a woman have a pelvic examination before she can have implants inserted?
No. Instead, asking the right questions can help the provider be reasonably certain she is not pregnant. No condition that can be detected by a pelvic examination rules out use of implants.
1. Does the IUD cause pelvic inflammatory disease (PID)?
By itself, the IUD does not cause PID. Gonorrhea and chlamydia are the primary direct causes of PID. IUD insertion when a woman has gonorrhea or chlamydia may lead to PID, however. This does not happen often. When it does, it is most likely to occur in the first 20 days after IUD insertion.
2. Can young women and older women use IUDs?
Yes. There is no minimum or maximum age limit. An IUD should be removed after menopause has occurred—within 12 months after her last monthly bleeding
3. If a current IUD user has a sexually transmitted infection (STI) or has become at very high individual risk of becoming infected with an STI, should her IUD be removed?
No. If a woman develops a new STI after her IUD has been inserted, she is not especially at risk of developing PID because of the IUD. She can continue to use the IUD while she is being treated for the STI. Removing the IUD has no benefit and may leave her at risk of unwanted pregnancy.
4. Does the IUD make a woman infertile?
No. A woman can become pregnant once the IUD is removed justas quickly as a woman who has never used an IUD, although fertility decreases as women get older.
5. Can a woman who has never had a baby use an IUD?
Yes. A woman who has not had children generally can use an IUD, but she should understand that the IUD is more likely to come out because her uterus may be smaller than the uterus of a woman who has given birth.
6. Can the IUD travel from the woman’s uterus to other parts of her body, such as her heart or her brain?
The IUD never travels to the heart, brain, or any other part of the body outside the abdomen. The IUD normally stays within the uterus like a seed within a shell. Rarely, the IUD may come through the wall of the uterus into the abdominal cavity. This is most often due to a mistake during insertion. If it is discovered within 6 weeks or so after insertion or if it is causing symptoms at any time, the IUD will need to be removed by laparoscopic or laparotomic surgery. Usually, however,
the out-of-place IUD causes no problems and should be left where it is. The woman will need another contraceptive method.
7. Should a woman have a “rest period” after using her IUD for several years or after the IUD reaches its recommended time for removal?
No. This is not necessary, and it could be harmful. Removing the old IUD and immediately inserting a new IUD poses less risk of infection than 2 separate procedures. Also, a woman could become pregnant during a “rest period” before her new IUD is inserted.
8. Should antibiotics be routinely given before IUD insertion?
No, usually not. Most recent research done where STIs are not common suggests that PID risk is low with or without antibiotics. When appropriate questions to screen for STI risk are used and IUD insertion is done with proper infection-prevention procedures (including the no-touch insertion technique), there is little risk of infection. Antibiotics may be considered, however, in areas where STIs are common and STI screening is limited.
9. Must an IUD be inserted only during a woman’s monthly bleeding?
No. For a woman having menstrual cycles, an IUD can be inserted at any time during her menstrual cycle if it is reasonably certain that the woman is not pregnant. Inserting the IUD during her monthly bleeding may be a good time because she is not likely to be pregnant, and insertion may be easier. It is not as easy to see signs of infection during monthly bleeding, however.
10. Do IUDs increase the risk of ectopic pregnancy?
No. On the contrary, IUDs greatly reduce the risk of ectopic pregnancy. Ectopic pregnancies are rare among IUD users.
1. Are condoms effective at preventing pregnancy?
Yes, male condoms are effective, but only if used correctly with every act of sex. When used consistently and correctly, only 2 of every 100 women whose partners use condoms become pregnant over the first year of use. Many people, however, do not use condoms every time they have sex or do not use them correctly. This reduces protection from pregnancy.
2. How well do condoms help protect against HIV infection?
On average, condoms are 80% to 95% effective in protecting people from HIV infection when used correctly with every act of sex. This means that condom use prevents 80% to 95% of HIV transmissions that would have occurred without condoms.
3. Will using condoms reduce the risk of STI transmission during anal sex?
Yes. STIs can be passed from one person to another during any sex act that inserts the penis into any part of another person’s body (penetration). Some sex acts are riskier than others. For example, the risk of becoming infected with HIV is 5 times higher with unprotected receptive anal sex than with unprotected receptive vaginal sex. Whenusing a latex condom for anal sex, a water- or silicone-based lubricant is essential to help keep the condom from breaking.
4. Do condoms often break or slip off during sex?
No. On average, about 2% of condoms break or slip off completely during sex, primarily because they are used incorrectly. Used properly, condoms seldom break. In some studies with higher breakage rates, often a few users experienced most of the breakage in the entire study. Other studies also suggest that, while most people use condoms correctly, there are a few who consistently misuse condoms, which leads to breaks or slips. Thus, it is important to teach people the right way to open, put on, and take off condoms and also to avoid practices that increase the risk of breakage
5. What can men and women do to reduce the risk of pregnancy and STIs if a condom slips or breaks during sex?
If a condom slips or breaks, taking emergency contraceptive pills can reduce the risk that a woman will become pregnant (
6. Is allergy to latex common?
No. Allergy to latex is uncommon in the general population, and reports of mild allergic reactions to condoms are very rare.