• Acne
• Contraception (Birth Control)

There are many ways to prevent pregnancy. The simplest and safest choice for birth control is abstinence or not having sex at all. Many girls feel pressured to have sex before they are ready by their friends or boyfriends. However, there is nothing wrong with waiting to have sex. In fact, half of all teens say “no” to sex even though it may seem like everyone else is having sex. Most first time sexual experiences are unplanned, so make up your mind how you feel about sex BEFORE you find yourself in a position that may lead to sex. Also, avoid alcohol and drugs, which can lead to unplanned sex.

If you decide to become sexually active (start having sex), it is important to protect yourself from becoming pregnant. Preventing pregnancy is called contraception. There are many different types of contraceptive medications. One of the earliest forms of birth control is “the pill” and it is still the most widely used method of contraception today. Skin patches and injections are other popular contraceptive options. The contraceptive patch is applied to your skin each week. An injection can also be given every three months.

WHAT ARE CONTRACEPTIVE MEDICATIONS USED FOR? Young women are started on contraceptive medications for a variety of reasons. These reasons include: need for reliable birth control, heavy or irregular periods, severe cramping, taking another prescription drug that would make pregnancy dangerous, or evidence of a low estrogen state (such as missed or no periods). In addition, many contraceptive medications have also been shown to help improve acne.

HOW DO PILL AND PATCH CONTRACEPTIVES WORK? The pill and the patch work in a very similar way. Combined birth control pills and the birth control patch contain two hormones: estrogen and progestin. Estrogen works to develop the lining of your uterus (womb) and progestin adds thickness and depth to that lining. To use a tree image, the estrogen is like the branches and the progestin is like the leaves.  A tree is not the same without both.  The presence of estrogen and progestin, in the right amounts at just the right time in your cycle, is necessary for the release of an egg from the ovary. Contraceptives medications work to by preventing the release of an egg from your ovaries. Since pregnancy requires the union of a sperm and egg and there is no egg released, you will not get pregnant. Contraceptive medication also helps to stabilize conditions such as heavy periods, extreme cramping, and irregular cycles by providing a consistent and appropriate level of hormones in the body. It is important to use your pills or patch correctly. Improper use will not prevent the release of an egg and therefore will not prevent pregnancy. Also, the medication’s ability to stabilize hormone levels is lost if taken erratically.

STARTING CONTRACEPTIVE MEDICATIONS:
Oral Contraceptives (The Pill)
For the first month you are on the pill you will need to use a backup method of birth control (such as condoms) to prevent pregnancy.
There are several ways to start taking your pills. Options include:

1. Start on the first day of your next period
2. Start on the first Sunday after your period begins
3. Start today if you are certain that you are not pregnant

Take one pill each day at approximately the same time each day until you have finished all the pills. It helps to keep them near your makeup, toothbrush, on your pillow or some other such place where you will see them when you are rushed or tired and likely to forget.

Finish the entire pack. In most cases you will be prescribed 28-day packs, so you start the new pack the day after you finish the old pack, without skipping days. Skipping days is a good way to get pregnant. Always check the pack to make sure you remembered the previous day’s dose. Expect your period during the last week of each pack.
 
 If you miss a pill:

1. If you discover later in the day that you missed a pill, take it as soon as you remember.
2. If you missed one pill, take one pill as soon as you remember and take the next pill at the regular time. You should use a backup method of protection such as a condom for 7 days after a missed pill.
3. If you’ve missed two pills - take two pills on the day you remember and two pills the next day. For example: You’ve forgotten Saturday’s and Sunday’s pills but remember on Monday. Take two pills on Monday and two on Tuesday then continue with one pill each day thereafter. You need to use a backup method for the remainder of the cycle and some spotting may occur.
4. If you’ve missed three pills you will likely have some spotting or even a normal period. You are not protected against pregnancy. Start a new pack of pills the same way you started your first pack. (See above paragraph) Use a backup method of protection until you have completed the first week of your new pack.

Transdermal Contraceptives (The Patch)
There are two ways to start using the patch. Options include:

1. Start on the first day of your next period
2. Start on the first Sunday after your period begins

If you start the patch on the first day of your period, you do not need to use a backup method of birth control. If you start the patch on a Sunday, use a backup method of birth control for the first seven days of your cycle.

Apply the patch once a week on the same day each week for three weeks. During week 4, you do not wear a patch. Your period will start during the week that you do not wear the patch. Once you have finished week four, place a new patch on your skin start a new monthly cycle.

Where to apply the patch: You can place the patch on your buttock, abdomen, upper torso (not your breasts) or the outside of your upper arm. You can select a different site each week or just keep the same location. If you keep the same location, like you abdomen, try to alternate sides so one side doesn’t get irritated. Leave the patch in the same place for seven days. 
 

If you are late changing your patch:

1. Change your patch as soon as you remember.
2. If you are one or two days late changing your patch, remove the old patch and apply a new patch. You do not need to change your Patch Change Day.
3. If you are more than two days late changing you patch, remove the old patch and apply a new patch as soon as you remember. You must use a back-up method of birth control for seven days. Note: your new Patch Change Day will become the day you remembered to change your patch
4. If you forget to take your patch off during week 4, remove the patch as soon as you remember. Apply a new patch on your normal Patch Change Day (even if it has only been a couple of days). You do not need to use back-up birth control.

Be patient, very often it takes 1-3 cycles (months) for your body to adjust to the pills or patch. During this time you may experience a small amount of breakthrough bleeding. In this case, if you are sexually active, condoms should be used until your body appears to have made the adjustment.  If you are concerned that you are having any side effects please call your doctor/nurse practitioner to discuss them.

Please read the package insert: If you have questions about it contact your doctor/nurse practitioner to discuss them. Anytime you are prescribed a new medication you need to find out if there is any interaction with the pill or patch. Some medications, especially antibiotics, will interfere with the ability of the pill or patch to prevent pregnancy and you could become pregnant despite taking your medication properly!

Injectable Birth Control (Depo-Provera)
HOW DOES DEPO WORK? Depo contains, Medroxyprogesterone - a form of progesterone, which is produced by women. Just like with the pill and the patch, Depo is used to prevent pregnancy by inhibiting ovulation and by causing the cervical mucous to thicken, which makes it harder for sperm to move toward the uterus.

HOW DO I USE DEPO? Your provider will give you a prescription for Depo. You will pick up the prescription and bring it to the office so we can give you an injection (shot) of the medication once every three months.  You do not need to use a backup method of birth control after you get your first injection. It’s very important to get your injections on time, every 11 to 13 weeks.

WHEN CAN I START DEPO? The initial injection will be given during the first 5 days of a normal menstrual period. You will return to the office once every three months (between 11-13 weeks) for an injection. Please call ahead of time so we can call in a prescription that you will pick up and bring to the office with you. We do not have Depo at the office.

If you miss an injection

1. You can get another injection with the start of your period
2. You can come in for the injection. You will need to take a pregnancy test in the office before we give you an injection to make sure that you are not pregnant (you only need to take the pregnancy test if you are late getting the injection).

*If you miss and an injection, you must use a backup method of birth control until you get your next injection.

WHAT ARE SOME SIDE EFFECTS OF DEPO?
A lot of girls experience changes with their periods. You may not get a period while you are on Depo, which is not harmful. You may notice that during the first three months you have some spotty or irregular bleeding. Other side effects include headache, dizziness, nausea, breast tenderness, weight loss or weight gain, acne, and changes in hair growth.  Using depo more than 2 years can be associated with reversible bone density loss.

Intravaginal birth control (Nuva Ring)
HOW DOES THE RING WORK? The ring contains estrogen and progestin (the same hormones in birth control pills) which prevent ovulation from taking place.  They also cause thickened mucous in the top portion of the vagina (called the cervix) which makes it harder for sperm to get through. 

HOW DO I USE THE RING? The ring is a small flexible disc with a clear film of hormones in the middle.  The ring can be squeezed into a slender shape with your fingers.  Then it is inserted into the vagina by hand.  Some people feel more comfortable putting the ring into an empty/unused tampon applicator and inserting it that way.  Either way is fine.  It is not important where the ring ends up in the vagina.  As long as it doesn’t fall out, it’s in the right place.  The ring cannot get lost, either.  Once the ring is inserted, leave it in for three weeks.  After three weeks, remove the ring and throw it away (don’t flush it down the toilet).  Do not insert another ring for one week (this will be the week of your period).  After your period week, reinsert a new ring. 

WHEN CAN I START THE RING? Wait until your next period starts (count that as day one).  Insert the ring on day 5 of your period, even if your period hasn’t stopped yet.  Mark this day on your calendar and keep the ring in for three weeks.  The ring takes seven days to become effective, so you will need an extra birth control method for your first seven days with the ring.   

• If the ring falls out: It is unusual for the ring to fall out (even during exercise or sex), but if it does, simply rinse it off and re-insert it. You do not need an extra form of birth control if it falls out unless it has been out for three hours or more.
• What if I forget to take out the ring after three weeks? The ring is actually effective for 35 days. So if you forget to take it out after three weeks, you are still protected from pregnancy for two weeks. But it is best to mark your calendar because there is no pregnancy protection after 35 days.
• Do people feel the ring inside?  Most women cannot feel the ring once it is inserted into the vagina. S urveys have shown that most couples don’t notice the ring or aren’t bothered by it.

WHAT ARE THE SIDE EFFECTS OF THE RING?
You may experience lighter periods with less cramping while using the ring.  You may also notice some irregular bleeding (or “spotting”), especially in the first three months of using the ring while your body gets used to the hormones.  This should go away after the first three months of use. You may also have increased clear/white vaginal discharge, weight gain, headache, and nausea.  Side effects with the ring are generally less noticeable than side effects with birth control pills.   

HOW TO CHOOSE A BIRTH CONTROL METHOD: If you find yourself forgetting to take pills or change the patch on a regular basis they may not be the method of choice for you. Please contact your doctor/nurse practitioner to see if another method may be more suitable for your lifestyle. There are other devices (subdermal rods, IUDs) that can give you 6-10 years of protection. Only condoms are highly effective against sexually transmitted diseases. When used perfectly, less than 0.1% of women on the pill, patch, or ring will become pregnant. The rate of unintended pregnancy goes up to 5% with imperfect use. Keep in mind that in the United States one of every eight women between the ages of 15 and 19 becomes pregnant each year. It is estimated that more than 85% of these pregnancies are unintended.

SIDE EFFECTS AND COMPLICATIONS OF ALL CONTRACEPTIVE MEDICATIONS: Smoking while on the pill, patch, or depo increases your risk for blood clots, which can actually be fatal. It is best not to smoke, especially while taking these medications.
Please call us if you are experiencing:

1. Severe abdominal pain
2. Severe chest pain, cough, or shortness of breath
3. Severe headache, dizziness, weakness, numbness
4. Loss or blurring of vision
5. Severe leg pain in the calf or thigh

WHAT DO CONTRACEPTIVE MEDICATIONS NOT DO? There are many things that contraceptive medications do not do. 1) Contraceptive medications provide no protection against AIDS, herpes, syphilis, gonorrhea, chlamydia, genital warts or any of a dozen other infections that all sexually active people are at risk for contracting! Only the use of a latex condom every time you have sex can help prevent these diseases, and the only 100% guarantee is complete abstinence from any sexual contact. 2) A common misconception is that pregnancies and sexually transmitted diseases can only be transmitted by vaginal intercourse. Infections can occur from any contact between the penis and vaginal or oral (mouth) or anal mucous membranes. Any secretions that contain sperm can make you pregnant. For example, if a man ejaculates (the whitish discharge from the penis after a man has an orgasm) and has semen on his hand and then touches your vaginal area you could become pregnant. If you and your boyfriend are unclothed and he is rubbing his penis against you, you could contract genital warts. PLEASE ASK any questions you may have about safe sex! Your doctor/nurse practitioner is committed to the prevention of illnesses and unwanted pregnancies. Condoms are the only method of preventing the spread of sexually transmitted diseases and it is therefore safest to use them at all sexual encounters even when you are using another form of contraceptive medication to prevent pregnancy.

REMEMBER: NO SEX or Abstinence is the best way to protect against disease and pregnancy. The choice should always be YOURS.