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109-501: The Clinical Research Bureau was the first legal birth control clinic in the United States, and quickly grew into the leading contraceptive research center in the world. The CRB operated under numerous names and parent organizations from 1923 to 1974, providing birth control and infertility clinical services to thousands of patients, and serving as a site for medical research and education on these topics. Founded by Margaret Sanger ,

218-469: A medical exam —including birth control pills, injectable or implantable birth control, and condoms. For example, a pelvic exam , breast exam , or blood test before starting birth control pills does not appear to affect outcomes. In 2009, the World Health Organization (WHO) published a detailed list of medical eligibility criteria for each type of birth control. Hormonal contraception

327-493: A pacifier , and feeding solids all increase the chances of becoming pregnant while breastfeeding. In those who are exclusively breastfeeding, about 10% begin having periods before three months and 20% before six months. In those who are not breastfeeding, fertility may return as early as four weeks after delivery. Emergency contraceptive methods are medications (sometimes misleadingly referred to as "morning-after pills") or devices used after unprotected sexual intercourse with

436-424: A progestin ) and the progestogen-only pills (sometimes called minipills). If either is taken during pregnancy, they do not increase the risk of miscarriage nor cause birth defects . Both types of birth control pills prevent fertilization mainly by inhibiting ovulation and thickening cervical mucus. They may also change the lining of the uterus and thus decrease implantation. Their effectiveness depends on

545-434: A 6% first-year rate with the diaphragm. Condoms have the additional benefit of helping to prevent the spread of some sexually transmitted infections such as HIV/AIDS , however, condoms made from animal intestine do not. Contraceptive sponges combine a barrier with a spermicide. Like diaphragms, they are inserted vaginally before intercourse and must be placed over the cervix to be effective. Typical failure rates during

654-399: A UK study, when a three-month "bridge" supply of the progestogen-only pill was provided by a pharmacist along with emergency contraception after sexual activity, this intervention was shown to increase the likelihood that the person would begin to use an effective method of long-term contraception. Levonorgestrel pills, when used within 3 days, decrease the chance of pregnancy after

763-674: A base covered in oils or other gummy substances. Many of Soranus's methods were probably also ineffective. In medieval Europe, any effort to halt pregnancy was deemed immoral by the Catholic Church , although it is believed that women of the time still used a number of birth control measures, such as coitus interruptus and inserting lily root and rue into the vagina. Women in the Middle Ages were also encouraged to tie weasel testicles around their thighs during sex to prevent pregnancy. The oldest condoms discovered to date were recovered in

872-430: A failure rate; they simply reported the number of women who became pregnant after using an emergency contraceptive. Since 1980, clinical trials of emergency contraception have first calculated probable pregnancies in the study group if no treatment were given. The effectiveness is calculated by dividing observed pregnancies by the estimated number of pregnancies without treatment. Placebo-controlled trials that could give

981-576: A fellowship program for gynecologists and obstetricians for intensive training in birth control techniques. Due to budget deficits, the Bureau shut down in 1974 and combined its staff with Planned Parenthood of New York. Birth control clinic Birth control , also known as contraception , anticonception , and fertility control , is the use of methods or devices to prevent pregnancy . Birth control has been used since ancient times, but effective and safe methods of birth control only became available in

1090-497: A fertilized egg. Progestogen-only emergency contraceptive does not appear to affect the function of the fallopian tubes or increase the rate of ectopic pregnancies. The primary mechanism of action of progesterone receptor modulator emergency contraceptive pills like low-dose and mid-dose mifepristone and ulipristal acetate is to prevent fertilization by inhibition or delay of ovulation. One clinical study found that post-ovulatory administration of ulipristal acetate altered

1199-603: A fertilized egg. Language on implantation should not be included in LNG ECP product labeling." In June 2012, a New York Times editorial called on the FDA to remove from the label the unsupported suggestion that levonorgestrel emergency contraceptive pills inhibit implantation. In November 2013, the European Medicines Agency (EMA) approved a change to the label for HRA Pharma's NorLevo saying it cannot prevent implantation of

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1308-893: A given method during the first year, and sometimes as a lifetime failure rate among methods with high effectiveness, such as tubal ligation . Birth control methods fall into two main categories: male contraception and female contraception . Common male contraceptives are withdrawal , condoms , and vasectomy . Female contraception is more developed compared to male contraception, these include contraceptive pills (combination and progestin-only pill), hormonal or non-hormonal IUD , patch , vaginal ring , diaphragm , shot , implant , fertility awareness , and tubal ligation . The most effective methods are those that are long acting and do not require ongoing health care visits. Surgical sterilization, implantable hormones, and intrauterine devices all have first-year failure rates of less than 1%. Hormonal contraceptive pills, patches or vaginal rings, and

1417-452: A history of blood clots, stroke, or migraine. There are no medical conditions in which progestin-only ECPs are contraindicated. Current venous thromboembolism , current or history of breast cancer , inflammatory bowel disease , and acute intermittent porphyria are conditions where the advantages of using emergency contraceptive pills generally outweigh the theoretical or proven risks. ECPs, like all other contraceptives, reduce

1526-491: A man's erect penis and physically block ejaculated sperm from entering the body of a sexual partner. Modern condoms are most often made from latex , but some are made from other materials such as polyurethane , or lamb's intestine. Female condoms are also available, most often made of nitrile , latex or polyurethane. Male condoms have the advantage of being inexpensive, easy to use, and have few adverse effects. Making condoms available to teenagers does not appear to affect

1635-509: A pharmacist without a prescription, and available with a prescription in some other countries. The antiprogestin ulipristal acetate is available as a micronized emergency contraceptive tablet, effective up to 120 hours after intercourse. Ulipristal acetate ECPs developed by HRA Pharma are available over the counter in Europe and by prescription in over 50 countries under the brand names ellaOne, ella (marketed by Watson Pharmaceuticals in

1744-410: A precise measure of the pregnancy rate without treatment would be unethical, so the effectiveness percentage is based on estimated pregnancy rates. These are currently estimated using variants of the calendar method . Women with irregular cycles for any reason (including recent hormone use such as oral contraceptives and breastfeeding ) must be excluded from such calculations. Even for women included in

1853-527: A pregnancy, delivery and care of a newborn in the United States is on average $ 21,000 for a vaginal delivery and $ 31,000 for a caesarean delivery as of 2012. In most other countries, the cost is less than half. For a child born in 2011, an average US family will spend $ 235,000 over 17 years to raise them. Globally, as of 2009, approximately 60% of those who are married and able to have children use birth control. How frequently different methods are used varies widely between countries. The most common method in

1962-433: A previous delivery. Delaying another pregnancy after a miscarriage , however, does not appear to alter risk and women are advised to attempt pregnancy in this situation whenever they are ready. Teenage pregnancies , especially among younger teens, are at greater risk of adverse outcomes including early birth , low birth weight , and death of the infant . In 2012 in the United States 82% of pregnancies in those between

2071-435: A primary method have backup methods available (such as condoms or emergency contraceptive pills). The lactational amenorrhea method involves the use of a woman's natural postpartum infertility which occurs after delivery and may be extended by breastfeeding . For a postpartum woman to be infertile (protected from pregnancy), their periods have usually not yet returned (not menstruating), they are exclusively breastfeeding

2180-497: A result of rape, and public health efforts emphasizing abstinence to reduce unwanted pregnancy may have limited effectiveness, especially in developing countries and among disadvantaged groups . Deliberate non-penetrative sex without vaginal sex or deliberate oral sex without vaginal sex are also sometimes considered birth control. While this generally avoids pregnancy, pregnancy can still occur with intercrural sex and other forms of penis-near-vagina sex (genital rubbing, and

2289-554: A single episode of unprotected sex or condom failure by 70% (resulting in a pregnancy rate of 2.2%). Ulipristal , when used within 5 days, decreases the chance of pregnancy by about 85% (pregnancy rate 1.4%) and is more effective than levonorgestrel. Mifepristone is also more effective than levonorgestrel, while copper IUDs are the most effective method. IUDs can be inserted up to five days after intercourse and prevent about 99% of pregnancies after an episode of unprotected sex (pregnancy rate of 0.1 to 0.2%). This makes them

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2398-481: A single tablet (or historically, as a split dose of two tablets taken 12 hours apart), effective up to 72 hours after intercourse. Progestin-only ECPs are sold under many different brand names. Progestin-only ECPs are available over-the-counter (OTC) in many countries (e.g. Australia, Bangladesh, Bulgaria, Canada, Cyprus, Czech Republic, Denmark, Estonia, India, Malta, Netherlands, Norway, Portugal, Romania, Slovakia, South Africa, Sweden, United States), from

2507-506: A single use of EC. Using an example of "75% effective", the effectiveness calculation thus: ... these numbers do not translate into a pregnancy rate of 25 percent. Rather, they mean that if 1,000 women have unprotected intercourse in the middle two weeks of their menstrual cycles, approximately 80 will become pregnant. Use of emergency contraceptive pills would reduce this number by 75 percent, to 20 women. The progestin-only regimen (using levonorgestrel) has an 89% effectiveness. As of 2006 ,

2616-590: A survey of biological parents, 9% stated they would not have had children if they were able to do it over again. Although sterilization is considered a permanent procedure, it is possible to attempt a tubal reversal to reconnect the fallopian tubes or a vasectomy reversal to reconnect the vasa deferentia . In women, the desire for a reversal is often associated with a change in spouse. Pregnancy success rates after tubal reversal are between 31 and 88 percent, with complications including an increased risk of ectopic pregnancy . The number of males who request reversal

2725-474: A woman drink a copper salt dissolved in water, which it claimed would prevent pregnancy for a year. This method was not only ineffective, but also dangerous, as the later medical writer Soranus of Ephesus ( c. 98–138 AD) pointed out. Soranus attempted to list reliable methods of birth control based on rational principles. He rejected the use of superstition and amulets and instead prescribed mechanical methods such as vaginal plugs and pessaries using wool as

2834-405: A woman has forgotten to take a birth control pill or when a condom is torn during sex. However, for women facing reproductive coercion, who are not able to use regular birth control, repeated use of EC pills may be the most viable option available. Making ECPs more widely available does not increase sexual risk-taking. While they are effective for individuals who use them in a timely fashion,

2943-476: A woman with a known or suspected pregnancy because it is not effective in women who are already pregnant. The World Health Organization (WHO) lists no medical condition for which the risks of emergency contraceptive pills outweigh the benefits. The American Academy of Pediatrics (AAP) and experts on emergency contraception have concluded that progestin-only ECPs are preferable to combined ECPs containing estrogen for all women, and particularly those with

3052-421: A woman's menstrual period is delayed by two weeks or more, it is advised that she take a pregnancy test . (Earlier testing may not give accurate results.) Existing pregnancy is not a contraindication in terms of safety, as there is no known harm to the woman, the course of her pregnancy, or the fetus if progestin-only or combined emergency contraception pills are accidentally used, but EC is not indicated for

3161-496: A year. Part of the reason that many women are without birth control is that many countries limit access due to religious or political reasons, while another contributor is poverty. Due to restrictive abortion laws in Sub-Saharan Africa, many women turn to unlicensed abortion providers for unintended pregnancy , resulting in about 2–4% obtaining unsafe abortions each year. The Egyptian Ebers Papyrus from 1550 BC and

3270-404: Is 0.2%; the typical use first failure rate is 6%. Barrier contraceptives are devices that attempt to prevent pregnancy by physically preventing sperm from entering the uterus . They include male condoms , female condoms , cervical caps , diaphragms , and contraceptive sponges with spermicide . Globally, condoms are the most common method of birth control. Male condoms are put on

3379-410: Is a birth control measure taken to reduce the risk of pregnancy following unprotected sexual intercourse or when other regular contraceptive measures have not worked properly or have not been used correctly. It is intended to be used occasionally and is not the same as medical abortion . Emergency contraception is offered to women who do not wish to conceive but have had unprotected sex on any day of

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3488-486: Is a high concern, using two methods at the same time is reasonable. For example, two forms of birth control are recommended in those taking the anti- acne drug isotretinoin or anti-epileptic drugs like carbamazepine , due to the high risk of birth defects if taken during pregnancy. Contraceptive use in developing countries is estimated to have decreased the number of maternal deaths by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% of deaths if

3597-585: Is also a form of birth control, but abstinence-only sex education may increase teenage pregnancies if offered without birth control education, due to non-compliance. In teenagers , pregnancies are at greater risk of poor outcomes. Comprehensive sex education and access to birth control decreases the rate of unintended pregnancies in this age group. While all forms of birth control can generally be used by young people, long-acting reversible birth control such as implants, IUDs, or vaginal rings are more successful in reducing rates of teenage pregnancy. After

3706-403: Is available in a number of different forms, including oral pills , implants under the skin, injections , patches , IUDs and a vaginal ring . They are currently available only for women, although hormonal contraceptives for men have been and are being clinically tested. There are two types of oral birth control pills, the combined oral contraceptive pills (which contain both estrogen and

3815-575: Is available in the form of tubal ligation for women and vasectomy for men. Tubal ligation decreases the risk of ovarian cancer . Short term complications are twenty times less likely from a vasectomy than a tubal ligation. After a vasectomy, there may be swelling and pain of the scrotum which usually resolves in one or two weeks. Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1–2% of men. With tubal ligation, complications occur in 1 to 2 percent of procedures with serious complications usually due to

3924-414: Is between 2 and 6 percent. Rates of success in fathering another child after reversal are between 38 and 84 percent; with success being lower the longer the time period between the vasectomy and the reversal. Sperm extraction followed by in vitro fertilization may also be an option in men. Behavioral methods involve regulating the timing or method of intercourse to prevent introduction of sperm into

4033-488: Is completely ineffective for women who weigh over 80 kg (176 lb). After a review by European Medicines Agency , the statement was deleted from the leaflet. The agency communicated that levonorgestrel is safe and effective method of emergency contraception, regardless of body weight. The most common side effect reported by users of emergency contraceptive pills was nausea , reported by 14 to 23% of levonorgestrel-only users and 50.5% of Yuzpe regimen users. Vomiting

4142-672: Is equally effective as emergency contraception at all weight ranges. IUDs may be left in place following the subsequent menstruation to provide ongoing contraception for as long as desired (12+ years). One brand of levonorgestrel pills was marketed as an ongoing method of postcoital contraception. However, with typical use, failure rates are expected to be higher than with the use of other birth control methods. Like all hormonal methods, postcoital high-dose progestin-only oral contraceptive pills do not protect against sexually transmitted infections . ECPs are generally recommended for backup or "emergency" use – for example, if

4251-412: Is followed by a number of hormone-based methods including contraceptive pills , patches , vaginal rings , and injections . Less effective methods include physical barriers such as condoms , diaphragms and birth control sponges and fertility awareness methods . The least effective methods are spermicides and withdrawal by the male before ejaculation . Sterilization, while highly effective,

4360-439: Is imperative. In the developing world, birth control increases economic growth due to there being fewer dependent children and thus more women participating in or increased contribution to the workforce – as they are usually the primary caregiver for children. Women's earnings, assets, body mass index , and their children's schooling and body mass index all improve with greater access to birth control. Family planning , via

4469-517: Is much less common and unusual with levonorgestrel-only ECPs (5.6% of levonorgestrel-only users vs 18.8% of 979 Yuzpe regimen users in 1998 WHO trial; 1.4% of 2,720 levonorgestrel-only users in the 2002 WHO trial). Anti-emetics are not routinely recommended with levonorgestrel-only ECPs. If a woman vomits within 2 hours of taking a levonorgestrel-only ECP, she should take a further dose as soon as possible. Other common side effects (each reported by less than 20% of levonorgestrel-only users in both

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4578-451: Is not usually reversible; all other methods are reversible, most immediately upon stopping them. Safe sex practices, such as with the use of condoms or female condoms , can also help prevent sexually transmitted infections . Other methods of birth control do not protect against sexually transmitted infections. Emergency birth control can prevent pregnancy if taken within 72 to 120 hours after unprotected sex. Some argue not having sex

4687-704: Is recommended following sexual assault, room for improvement in clinical practice remains. The primary mechanism of action of progestogen-only emergency contraceptive pills is to prevent fertilization by inhibition of ovulation. The best available evidence is that they do not have any post-fertilization effects such as the prevention of implantation . The U.S. FDA -approved labels and European EMA -approved labels (except for HRA Pharma's NorLevo ) levonorgestrel emergency contraceptive pills (based on labels for regular oral contraceptive pills ) say they may cause endometrial changes that discourage implantation. Daily use of regular oral contraceptive pills can alter

4796-418: Is recommended that birth control be continued for one year after the last menstrual period . About 222 million women who want to avoid pregnancy in developing countries are not using a modern birth control method. Birth control use in developing countries has decreased the number of deaths during or around the time of pregnancy by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% if

4905-421: Is the copper-T intrauterine device (IUD) which is generally recommended up to 5 days after unprotected intercourse or up to 5 days after probable ovulation . Some studies have found it to be effective up to 10 days after unprotected intercourse to prevent pregnancy. A 2021 study found that the hormonal IUD was as effective at emergency contraception as the copper IUD, though it is not offered by clinicians at

5014-556: Is the practice of ending intercourse ("pulling out") before ejaculation. The main risk of the withdrawal method is that the man may not perform the maneuver correctly or in a timely manner. First-year failure rates vary from 4% with perfect usage to 22% with typical usage. It is not considered birth control by some medical professionals. There is little data regarding the sperm content of pre-ejaculatory fluid . While some tentative research did not find sperm, one trial found sperm present in 10 out of 27 volunteers. The withdrawal method

5123-459: Is to prevent fertilization because of copper toxicity to sperm and ova . The very high effectiveness of copper-releasing IUDs as emergency contraceptives implies that they must also prevent some pregnancies by post-fertilization effects such as prevention of implantation. In 1966, gynecologist John McLean Morris and biologist Gertrude Van Wagenen at the Yale School of Medicine , reported

5232-550: Is used as birth control by about 3% of couples. Sexual abstinence may be used as a form of birth control, meaning either not engaging in any type of sexual activity, or specifically not engaging in vaginal intercourse, while engaging in other forms of non-vaginal sex. Complete sexual abstinence is 100% effective in preventing pregnancy. However, among those who take a pledge to abstain from premarital sex , as many as 88% who engage in sex, do so prior to marriage. The choice to abstain from sex cannot protect against pregnancy as

5341-491: The Kahun Papyrus from 1850 BC have within them some of the earliest documented descriptions of birth control: the use of honey, acacia leaves and lint to be placed in the vagina to block sperm. Silphium , a species of giant fennel native to north Africa, may have been used as birth control in ancient Greece and the ancient Near East . Due to its desirability, by the first century AD, it had become so rare that it

5450-635: The anesthesia . Neither method offers protection from sexually transmitted infections. Sometimes, salpingectomy is also used for sterilization in women. Non-surgical sterilization methods have also been explored. Fahim et al. found that heat exposure, especially high-intensity ultrasound, was effective either for temporary or permanent contraception depending on the dose, e.g. selective destruction of germ cells and Sertoli cells without affecting Leydig cells or testosterone levels. Chemical, e.g. drug-based methods are also available, e.g. orally-administered Lonidamine for temporary, or permanent (depending on

5559-573: The lactational amenorrhea method (LAM), if adhered to strictly, can also have first-year (or for LAM, first-6-month) failure rates of less than 1%. With typical use, first-year failure rates are considerably higher, at 9%, due to inconsistent use. Other methods such as condoms, diaphragms, and spermicides have higher first-year failure rates even with perfect usage. The American Academy of Pediatrics recommends long acting reversible birth control as first line for young individuals. While all methods of birth control have some potential adverse effects,

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5668-535: The menstrual cycle , from day 21 after giving birth, or from day five after abortion or miscarriage . Emergency contraception measures include tablets taken by mouth or the insertion of a copper intrauterine device. Emergency contraception is not related to medical abortion , which is a drug regimen administered to terminate pregnancies in any trimester. Emergency contraceptive pills (ECPs) are sometimes referred to as emergency hormonal contraception (EHC). They are taken after unprotected sexual intercourse or

5777-429: The morning-after pill , are medications intended to disrupt or delay ovulation or fertilization , which are necessary for pregnancy. Intrauterine devices (IUDs) – usually used as a primary contraceptive method – are sometimes used as the most effective form of emergency contraception. However, the use of IUDs for emergency contraception is relatively rare. Emergency contraception

5886-407: The workforce , and/or less use of scarce resources. Birth control methods include barrier methods , hormonal birth control , intrauterine devices (IUDs), sterilization , and behavioral methods. They are used before or during sex while emergency contraceptives are effective for up to five days after sex. Effectiveness is generally expressed as the percentage of women who become pregnant using

5995-449: The 1960s, women who had been sexually assaulted were offered diethylstilbestrol (DES). Currently, the standard of care is to offer ulipristal or prompt placement of a copper IUD which is the most effective form of EC. However, adherence to these best practices varies by the emergency department. Before these EC options were available (in 1996), pregnancy rates among females of child-bearing age who had been raped were around 5%. Although EC

6104-530: The 1998 and 2002 WHO trials) were abdominal pain , fatigue , headache , dizziness , and breast tenderness . Side effects generally resolve within 24 hours, although temporary disruption of the menstrual cycle is commonly experienced. If taken before ovulation, the high doses of progestogen in levonorgestrel treatments may induce progestogen withdrawal bleeding a few days after the pills are taken. One study found that about half of women who used levonorgestrel ECPs experienced bleeding within 7 days of taking

6213-648: The 20th century. Planning, making available, and using human birth control is called family planning . Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable. The World Health Organization and United States Centers for Disease Control and Prevention provide guidance on the safety of birth control methods among women with specific medical conditions. The most effective methods of birth control are sterilization by means of vasectomy in males and tubal ligation in females, intrauterine devices (IUDs), and implantable birth control . This

6322-531: The Bureau's Marriage Consultation Service and steered the Research Department into a greater emphasis on infertility studies. While the Bureau continued to offer contraceptive services, the number of patients dropped as contraception became more widely available through private physicians. However, the Bureau grew as a teaching center, offering seminars, research projects and clinical work for visiting doctors, nurses, and medical students. The Bureau also offered

6431-805: The CRB opened in 1923 in New York City and operated under the direction of the American Birth Control League (ABCL). In 1928, Sanger resigned as president of the ABCL and assumed full control of the clinic, renaming it the Birth Control Clinical Research Bureau (BCCRB). The BCCRB and the ABCL merged in 1939 and became the Birth Control Federation of America (it became Planned Parenthood Federation of America (PPFA) in 1942 with

6540-542: The UK (Schering PC4), New Zealand (Schering PC4), South Africa (E-Gen-C), Germany (Tetragynon), Switzerland (Tetragynon), Denmark (Tetragynon), Norway (Tetragynon), Sweden (Tetragynon) and Finland (Neoprimavlar); and had been withdrawn from marketing in New Zealand in 1997 to prevent it being sold over-the-counter. Regular combined oral contraceptive pills (which were less expensive and more widely available) were more commonly used for

6649-546: The US and ethinylestradiol in the Netherlands by Haspels. In the early 1970s, the Yuzpe regimen was developed by A. Albert Yuzpe in 1974; progestin-only postcoital contraception was investigated (1975); and the copper IUD was first studied for use as emergency contraception (1975). Danazol was tested in the early 1980s in the hopes that it would have fewer side effects than Yuzpe, but

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6758-407: The United States that can be used in the emergency contraceptive Yuzpe regimen, when none of the more effective and better-tolerated options are available. Ulipristal acetate, and mid-dose mifepristone are both more effective than levonorgestrel, which is more effective than the Yuzpe method. The effectiveness of emergency contraception is expressed as a percentage reduction in pregnancy rate for

6867-838: The United States) but were withdrawn after more effective dedicated progestin-only (levonorgestrel) emergency contraceptive pills with fewer side effects became available. If other more effective dedicated emergency contraceptive pills (levonorgestrel, ulipristal acetate, or mifepristone) are not available, specific combinations of regular combined oral contraceptive pills can be taken in split doses 12 hours apart (the Yuzpe regimen), effective up to 72 hours after intercourse. The U.S. Food and Drug Administration (FDA) approved this off-label use of certain brands of regular combined oral contraceptive pills in 1997. As of 2014, there are 26 brands of regular combined oral contraceptive pills containing levonorgestrel or norgestrel available in

6976-838: The United States), Duprisal 30, Ulipristal 30, and UPRIS. The antiprogestin mifepristone (also known as RU-486) is available in five countries as a low-dose or mid-dose emergency contraceptive tablet, effective up to 120 hours after intercourse. Low-dose mifepristone ECPs are available by prescription in Armenia, Russia, Ukraine, and Vietnam and from a pharmacist without a prescription in China. Mid-dose mifepristone ECPs are available by prescription in China and Vietnam. Combined estrogen ( ethinylestradiol ) and progestin (levonorgestrel or norgestrel ) pills used to be available as dedicated emergency contraceptive pills under several brand names: Schering PC4 , Tetragynon , Neoprimavlar , and Preven (in

7085-597: The WHO conducted a large trial comparing Yuzpe and levonorgestrel in 1998, combined estrogen-progestin products were gradually withdrawn from some markets ( Preven in the United States discontinued May 2004, Schering PC4 in the UK discontinued October 2001, and Tetragynon in France) in favor of progestin-only EC, although prescription-only dedicated Yuzpe regimen products are still available in some countries. In 2002, China became

7194-457: The Yuzpe regimen even in countries where dedicated products were available. Over time, interest in progestin-only treatments increased. The Special Program on Human Reproduction (HRP), an international organization whose members include the World Bank and World Health Organization , "played a pioneering role in emergency contraception" by "confirming the effectiveness of levonorgestrel." After

7303-493: The absolute risk of ectopic pregnancy by preventing pregnancies and there is no increase in the relative risk of ectopic pregnancy in women who become pregnant after using progestin-only ECPs. The herbal preparation of St John's wort and some enzyme-inducing drugs (e.g. anticonvulsants or rifampicin ) may reduce the effectiveness of ECP, and a larger dose may be required, especially in women who weigh more than 165 lbs. An effective emergency contraception measure

7412-412: The age of 30, about 6% regret their decision, as compared with 20–24% of women who received sterilization within one year of delivery and before turning 30, and 6% in nulliparous women sterilized before the age of 30. By contrast, less than 5% of men are likely to regret sterilization. Men who are more likely to regret sterilization are younger, have young or no children, or have an unstable marriage. In

7521-464: The age of onset of sexual activity or its frequency. In Japan, about 80% of couples who are using birth control use condoms, while in Germany this number is about 25%, and in the United States it is 18%. Male condoms and the diaphragm with spermicide have typical use first-year failure rates of 18% and 12%, respectively. With perfect use condoms are more effective with a 2% first-year failure rate versus

7630-867: The ages of 15 and 19 years old are unplanned. Comprehensive sex education and access to birth control are effective in decreasing pregnancy rates in this age group. Birth control methods, especially hormonal methods , can also have undesirable side effects. Intensity of side effects can range from minor to debilitating, and varies with individual experiences. These most commonly include change in menstruation regularity and flow, nausea, breast tenderness, headaches, weight gain, and mood changes (specifically an increase in depression and anxiety). Additionally, hormonal contraception can contribute to bone mineral density loss, impaired glucose metabolism, increased risk of venous thromboembolism. Comprehensive sex education and transparent discussion of birth control side effects and contraindications between healthcare provider and patient

7739-559: The availability of EC pills does not appear to decrease abortion rates at the population level. In 2012 the American Academy of Pediatrics (AAP) stated: "Despite multiple studies showing no increased risk behaviour and evidence that hormonal emergency contraception will not disrupt an established pregnancy, public and medical discourse reflects that personal values of physicians and pharmacists continue to affect emergency-contraception access, particularly for adolescents." Beginning in

7848-450: The breakage of a condom . A variety of emergency contraceptive pills are available, including combined estrogen and progestin pills; progestin-only ( levonorgestrel , LNG) pills; and antiprogestin ( ulipristal acetate or mifepristone ) pills. Progestin-only and anti-progestin pills are available as specifically packaged pills for use as emergency contraceptive pills. Emergency contraceptive pills originally contained higher doses of

7957-681: The clinic retaining much of its independence). In 1940, it was renamed the Margaret Sanger Research Bureau in honor of its founder. In 1925, Sanger hired Hannah Mayer Stone as the Medical Director of the CRB. After Hannah Stone's death in 1941, Abraham Stone, her husband and successor, altered and expanded the MSRB to accommodate his growing interest in infertility. In 1945, Stone inaugurated a Fertility Service that offered counseling, testing, and treatment for infertile couples. He expanded

8066-411: The day of the cycle. They have typical first-year failure rates of 24%; perfect use first-year failure rates depend on which method is used and range from 0.4% to 5%. The evidence on which these estimates are based, however, is poor as the majority of people in trials stop their use early. Globally, they are used by about 3.6% of couples. If based on both basal body temperature and another primary sign,

8175-416: The delivery of a child, a woman who is not exclusively breastfeeding may become pregnant again after as few as four to six weeks. Some methods of birth control can be started immediately following the birth, while others require a delay of up to six months. In women who are breastfeeding, progestin-only methods are preferred over combined oral birth control pills . In women who have reached menopause , it

8284-513: The developed world is condoms and oral contraceptives, while in Africa it is oral contraceptives and in Latin America and Asia it is sterilization. In the developing world overall, 35% of birth control is via female sterilization, 30% is via IUDs, 12% is via oral contraceptives, 11% is via condoms, and 4% is via male sterilization. While less used in the developed countries than the developing world,

8393-399: The dose) fertility management. Boris provides a method for chemically inducing either temporary or non-reversible sterility, depending on the dose, "Permanent sterility in human males can be obtained by a single oral dosage containing from about 18 mg/kg to about 25 mg/kg". The permanence of this decision may cause regret in some men and women. Of women who have undergone tubal ligation after

8502-470: The endometrium (although this has not been proven to interfere with implantation), but the isolated use of a levonorgestrel emergency contraceptive pill does not have time to alter the endometrium. In March 2011, the International Federation of Gynecology and Obstetrics (FIGO) issued a statement that: "review of the evidence suggests that LNG [levonorgestreol] ECPs cannot prevent implantation of

8611-457: The endometrium, but whether the changes would inhibit implantation is unknown. The European EMA-approved labels for ulipristal acetate emergency contraceptive pills do not mention an effect on implantation, but the U.S. FDA-approved label says: "alterations to the endometrium that may affect implantation may also contribute to efficacy." The primary mechanism of action of copper-releasing intrauterine devices (IUDs) as emergency contraceptives

8720-460: The female reproductive tract, either altogether or when an egg may be present. If used perfectly the first-year failure rate may be around 3.4%; however, if used poorly first-year failure rates may approach 85%. Fertility awareness methods involve determining the most fertile days of the menstrual cycle and avoiding unprotected intercourse. Techniques for determining fertility include monitoring basal body temperature , cervical secretions , or

8829-438: The first country in which mifepristone was registered for use as EC. In 2020, Japan announced it would consider easing regulations on the sale of emergency contraceptive pills without a prescription. Non-profit groups submitted a petition to the health ministry calling for prescription-free access to the pill. They had collected more than 100,000 signatures. Early studies of emergency contraceptives did not attempt to calculate

8938-514: The first year depend on whether or not a woman has previously given birth, being 24% in those who have and 12% in those who have not. The sponge can be inserted up to 24 hours before intercourse and must be left in place for at least six hours afterward. Allergic reactions and more severe adverse effects such as toxic shock syndrome have been reported. The current intrauterine devices (IUD) are small devices, often T-shaped, containing either copper or levonorgestrel , which are inserted into

9047-454: The full demand for birth control were met. By lengthening the time between pregnancies, birth control can improve adult women's delivery outcomes and the survival of their children. In the developing world, women's earnings, assets, and weight, as well as their children's schooling and health, all improve with greater access to birth control. Birth control increases economic growth because of fewer dependent children, more women participating in

9156-428: The full demand for birth control were met. These benefits are achieved by reducing the number of unplanned pregnancies that subsequently result in unsafe abortions and by preventing pregnancies in those at high risk. Birth control also improves child survival in the developing world by lengthening the time between pregnancies. In this population, outcomes are worse when a mother gets pregnant within eighteen months of

9265-616: The hope of preventing pregnancy. Emergency contraceptives are often given to victims of rape. They work primarily by preventing ovulation or fertilization. They are unlikely to affect implantation, but this has not been completely excluded. A number of options exist, including high dose birth control pills , levonorgestrel , mifepristone , ulipristal and IUDs. All methods have minimal side effects. Providing emergency contraceptive pills to women in advance of sexual activity does not affect rates of sexually transmitted infections, condom use, pregnancy rates, or sexual risk-taking behavior. In

9374-539: The increased risk, they are included in decision tools such as the DASH score and PERC rule used to predict the risk of blood clots. The effect on sexual drive is varied, with increase or decrease in some but with no effect in most. Combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not change the risk of breast cancer. They often reduce menstrual bleeding and painful menstruation cramps . The lower doses of estrogen released from

9483-401: The infant, and the baby is younger than six months. If breastfeeding is the infant's only source of nutrition and the baby is less than 6 months old, 93–99% of women are estimated to have protection from becoming pregnant in the first six months (0.75–7.5% failure rate). The failure rate increases to 4–7% at one year and 13% at two years. Feeding formula, pumping instead of nursing, the use of

9592-490: The injectable version should be used. Progestin-only pills may improve menstrual symptoms and can be used by breastfeeding women as they do not affect milk production . Irregular bleeding may occur with progestin-only methods, with some users reporting no periods . The progestins drospirenone and desogestrel minimize the androgenic side effects but increase the risks of blood clots and are thus not first line. The perfect use first-year failure rate of injectable progestin

9701-484: The labeling on the U.S. brand Plan B explained this effectiveness rate by stating, "Seven out of every eight women who would have gotten pregnant will not become pregnant." In 1999, a meta-analysis of eight studies of the combined (Yuzpe) regimen concluded that the best point estimate of effectiveness was 74%. A 2003 analysis of two of the largest combined (Yuzpe) regimen studies, using a different calculation method, found effectiveness estimates of 47% and 53%. For both

9810-411: The method is referred to as symptothermal. First-year failure rates of 20% overall and 0.4% for perfect use have been reported in clinical studies of the symptothermal method. A number of fertility tracking apps are available, as of 2016, but they are more commonly designed to assist those trying to get pregnant rather than prevent pregnancy. The withdrawal method (also known as coitus interruptus)

9919-413: The moment due to the lack of research done into the subject. Insertion of an IUD is more effective than the use of emergency contraceptive pills – pregnancy rates when used as emergency contraception are the same as with normal IUD use. Unlike emergency contraceptive pills, which work by delaying ovulation, the copper-T IUD works by interfering with sperm motility. Therefore, the copper IUD

10028-417: The most effective form of emergency contraceptive. In those who are overweight or obese , levonorgestrel is less effective and an IUD or ulipristal is recommended. Dual protection is the use of methods that prevent both sexually transmitted infections and pregnancy. This can be with condoms either alone or along with another birth control method or by the avoidance of penetrative sex . If pregnancy

10137-783: The most widely used form of reversible contraception, with more than 180 million users worldwide. Evidence supports effectiveness and safety in adolescents and those who have and have not previously had children. IUDs do not affect breastfeeding and can be inserted immediately after delivery. They may also be used immediately after an abortion. Once removed, even after long term use, fertility returns to normal immediately. While copper IUDs may increase menstrual bleeding and result in more painful cramps, hormonal IUDs may reduce menstrual bleeding or stop menstruation altogether. Cramping can be treated with painkillers like non-steroidal anti-inflammatory drugs . Other potential complications include expulsion (2–5%) and rarely perforation of

10246-994: The number of women using IUDs as of 2007 was more than 180 million. Avoiding sex when fertile is used by about 3.6% of women of childbearing age, with usage as high as 20% in areas of South America. As of 2005, 12% of couples are using a male form of birth control (either condoms or a vasectomy) with higher rates in the developed world. Usage of male forms of birth control has decreased between 1985 and 2009. Contraceptive use among women in Sub-Saharan Africa has risen from about 5% in 1991 to about 30% in 2006. As of 2012, 57% of women of childbearing age want to avoid pregnancy (867 of 1,520 million). About 222 million women, however, were not able to access birth control, 53 million of whom were in sub-Saharan Africa and 97 million of whom were in Asia. This results in 54 million unplanned pregnancies and nearly 80,000 maternal deaths

10355-469: The penis exiting from anal intercourse ) where sperm can be deposited near the entrance to the vagina and can travel along the vagina's lubricating fluids. Abstinence-only sex education does not reduce teenage pregnancy . Teen pregnancy rates and STI rates are generally the same or higher in states where students are given abstinence-only education, as compared with comprehensive sex education . Some authorities recommend that those using abstinence as

10464-407: The pills. If levonorgestrel is taken after ovulation, it may increase the length of the luteal phase , thus delaying menstruation by a few days. Mifepristone, if taken before ovulation, may delay ovulation by 3–4 days (delayed ovulation may result in a delayed menstruation). These disruptions only occur in the cycle in which ECPs were taken; subsequent cycle length is not significantly affected. If

10573-426: The progestin-only and Yuzpe regimens, the effectiveness of emergency contraception is highest when taken within 12 hours of intercourse and declines over time. The World Health Organization (WHO) suggested that reasonable effectiveness may continue for up to 120 hours (5 days) after intercourse. For 10 mg of mifepristone taken up to 120 hours (5 days) after intercourse, the combined estimate from three trials

10682-466: The risk is less than that of pregnancy. After stopping or removing many methods of birth control, including oral contraceptives, IUDs, implants and injections, the rate of pregnancy during the subsequent year is the same as for those who used no birth control. For individuals with specific health problems, certain forms of birth control may require further investigations. For women who are otherwise healthy, many methods of birth control should not require

10791-670: The ruins of Dudley Castle in England, and are dated back to 1640. They were made of animal gut, and were most likely used to prevent the spread of sexually transmitted infections during the English Civil War . Casanova , living in 18th-century Italy, described the use of a lambskin covering to prevent pregnancy; however, condoms only became widely available in the 20th century. Emergency contraceptive There are different forms of EC. Emergency contraceptive pills (ECPs), sometimes simply referred to as emergency contraceptives (ECs), or

10900-599: The same hormones ( estrogens , progestins , or both) found in regular combined oral contraceptive pills . Combined estrogen and progestin pills are no longer recommended as dedicated emergency contraceptive pills (because this regimen is less effective and caused more nausea), but certain regular combined oral contraceptive pills (taken 2–5 at a time in what was called "the Yuzpe regimen ") have also been shown to be effective as emergency contraceptive pills. Progestin-only emergency contraceptive pills contain levonorgestrel, either as

11009-442: The successful use of oral high-dose estrogen pills as post-coital contraceptives in women and rhesus macaque monkeys, respectively. A few different drugs were studied, with a focus on high-dose estrogens, and it was originally hoped that postcoital contraception would prove viable as an ongoing contraceptive method. The first widely used methods were five-day treatments with high-dose estrogens, using diethylstilbestrol (DES) in

11118-499: The use of modern birth control, is one of the most cost-effective health interventions. For every dollar spent, the United Nations estimates that two to six dollars are saved. These cost savings are related to preventing unplanned pregnancies and decreasing the spread of sexually transmitted illnesses. While all methods are beneficial financially, the use of copper IUDs resulted in the greatest savings. The total medical cost for

11227-406: The user's adherence to taking the pills. Combined hormonal contraceptives are associated with a slightly increased risk of venous and arterial blood clots . Venous clots, on average, increase from 2.8 to 9.8 per 10,000 women years which is still less than that associated with pregnancy. Due to this risk, they are not recommended in women over 35 years of age who continue to smoke. Due to

11336-490: The uterus (less than 0.7%). A previous model of the intrauterine device (the Dalkon shield ) was associated with an increased risk of pelvic inflammatory disease ; however, the risk is not affected with current models in those without sexually transmitted infections around the time of insertion. IUDs appear to decrease the risk of ovarian cancer . Two broad categories exist, surgical and non-surgical. Surgical sterilization

11445-415: The uterus. They are one form of long-acting reversible contraception which are the most effective types of reversible birth control. Failure rates with the copper IUD is about 0.8% while the levonorgestrel IUD has a failure rates of 0.2% in the first year of use. Among types of birth control, they, along with birth control implants, result in the greatest satisfaction among users. As of 2007 , IUDs are

11554-433: The vaginal ring may reduce the risk of breast tenderness, nausea , and headache associated with higher dose estrogen products. Progestin-only pills, injections and intrauterine devices are not associated with an increased risk of blood clots and may be used by women with a history of blood clots in their veins. In those with a history of arterial blood clots, non-hormonal birth control or a progestin-only method other than

11663-510: Was an effectiveness of 83%. A review found that a moderate dose of mifepristone is better than LNG or Yuzpe, with delayed return of menstruation being the main adverse effect of most regimes. HRA Pharma changed its packaging information for Norlevo (levonorgestrel 1.5 mg, which is identical to many other EHCs) in November 2013 warning that according to studies the drug loses effectiveness in women who weigh more than 75 kg (165 lb) and

11772-692: Was found to be ineffective. The Yuzpe regimen became the standard course of treatment for postcoital contraception in many countries in the 1980s. The first prescription-only combined estrogen-progestin dedicated product, Schering PC4 (ethinylestradiol and norgestrel), was approved in the UK in January 1984 and first marketed in October 1984. Schering introduced a second prescription-only combined product, Tetragynon (ethinylestradiol and levonorgestrel) in Germany in 1985. By 1997, Schering AG dedicated prescription-only combined products had been approved in only 9 countries:

11881-463: Was worth more than its weight in silver and, by late antiquity, it was fully extinct. Most methods of birth control used in antiquity were probably ineffective. The ancient Greek philosopher Aristotle ( c. 384–322 BC) recommended applying cedar oil to the womb before intercourse, a method which was probably only effective on occasion. A Hippocratic text On the Nature of Women recommended that

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