The following are types of contraception available today that you may want to discuss with a member of your cystic fibrosis care team:
- Vasectomy; tubal ligation; tubal ligation and contraceptive tubal occlusion device and delivery system (Essure®)
- Copper intrauterine device (Paragard®); levonorgestrel intrauterine device (Mirena®, Skyla®, Liletta®, Kyleena®)
- Birth control pills; norelgestromin and ethinyl estradiol patch (Ortho Evra®); etonogestrel and ethinyl estradiol insert (NuvaRing®); medroxyprogesterone acetate (Depo-Provera®); etonogestrel implant (Implanon®, Nexplanon®); levonorgestrel tablet (Plan B®)
- Male condom; female condom; spermicides; nonoxynol-9 sponge (Today Sponge®); diaphragm; vaginal barrier contraceptive devices (FemCap®, Lea's Shield®)
- Abstinence; withdrawal; natural family planning; CycleBeads
Although all of these contraceptive methods can help prevent an unplanned pregnancy, each one goes about it in a different way.
For people with CF especially, unplanned pregnancies can have major health implications. Without the proper planning, getting pregnant may deteriorate your quality of life and well-being. Although birth control is important, certain forms of contraception can affect people with CF differently and should be discussed with a member of your CF care team. By understanding the implications that common birth control methods can have for you and your body, you can ultimately choose the method of contraception that is right for you.
Many people with CF or their partners who decide that they do not want to have children in the future opt for sterilization, or permanent birth control methods. A vasectomy, the sterilization method used for males, entails cutting or tying the vas deferens to prevent sperm from passing from the testes into the urethra. A tubal ligation, the sterilization method used for females, entails the cutting or tying of the fallopian tubes to block the pathway for sperm to reach the egg. Vasectomies tend to be easier and less expensive than tubal ligation.
For women, a form of permanent birth control, called Essure®, is available; small coils are placed in the fallopian tubes during an office visit and within three months, the fallopian tubes become blocked. However, Essure® is typically not recommended for females with CF because systemic steroids such as prednisone may prevent it from working to block the tubes. If you want to use Essure®, it is important that you talk to a member of your CF care team about the possibility of using it when you are not taking systemic steroids.
Intrauterine Device (IUD)
Both safe and effective, the IUD is a T-shaped plastic device inserted into the uterus by a health care provider. The IUD works by preventing sperm from traveling through the uterus to fertilize the egg. The FDA-approved IUDs include devices that release levonorgestrel (Mirena®, Skyla®,Liletta®, Kyleena®) and copper (Paragard®). The copper-releasing IUD does not use hormones and prevents pregnancy for up to 10 years. Levonorgestrel-releasing IUDs use the hormone progestin to thicken cervical mucus and block the cervix, and can stay in your body for up to three to five years depending on the type.
The Implant (Implanon® and Nexplanon®)
The implant is a silicone rod with progestin placed beneath the skin. Implants last for three years, at which point they need to be replaced by your health care professional.
For more information on the different brands of implants, visit DailyMed, a service from the National Library of Medicine that provides information about drugs, including dosages and possible side effects.
For more information on the different brands of IUDs, visit DailyMed, a service from the National Library of Medicine that provides information about drugs, including dosages and possible side effects.
The pill is an effective oral contraceptive that uses the hormones estrogen and progestin to thicken cervical mucus and prevent ovulation.
Although the pill can be a good option for some people with CF, lumacaftor/ivacaftor (Orkambi®) and certain antibiotics have been known to decrease its effectiveness.
It is important to note that taking enzymes helps facilitate better absorption and, therefore, efficacy, while taking any medication, including the pill.
Although elexacaftor/tezacaftor/ivacaftor (Trikafta®) does not impact the effectiveness of oral contraceptives, in clinical studies of Trikafta, a higher incidence of rash occurred in people who were taking oral contraception and Trikafta.
People with CF who have active gall bladder disease, frequent issues with malabsorption, or implanted devices like ports should be sure to discuss the pill with their CF care team or doctor first.
It is important to note that the use of hormonal birth control methods can affect people with CF in the following ways:
- Increasing blood sugar and the risk of blood clots with estrogen-containing products.
- Increasing the risk of vaginal infections and gallstones.
- Increasing salt and fluid retention with progestin-containing products such as drospirenone and ethinyl estradiol (YAZ®, Yasmin®).
- CF and CF-related factors can also affect the way that hormonal birth controls work by:
- Decreasing the amount of hormones that may be absorbed in the intestines.
- Decreasing the effectiveness of hormonal birth controls when taken with certain medications, such as antibiotics or lumacaftor/ivacaftor.
Because antibiotics can cause the pill to become less effective, it is important that you use a second form of birth control such as a condom while on antibiotics and for seven days after finishing your medication, especially when taking rifampin or griseofulvin. If you are taking antibiotics all of the time (azithromycin), it is a good idea to use a second method of birth control for the first two weeks after changing antibiotics.
For more information on the different brands of oral contraceptives, visit DailyMed, a service from the National Library of Medicine that provides information about drugs, including dosages and possible side effects.
The Patch (Xulane®)
The patch is an effective birth control method that is placed on the skin like an adhesive bandage. You use it by applying one patch a week for three weeks in a row, and then skipping the fourth week to have your period. Like oral contraceptives, the patch can also become less effective when taken with certain antibiotics.
The Ring (NuvaRing®)
The ring works by continuously releasing low doses of estrogen and progestin to thicken cervical mucus and prevent ovulation, and is inserted into the vagina every three weeks.
The Shot (Depo-Provera®)
The shot is a progestin-only birth control method administered by a health care provider every three months. The shot is may cause loss of bone density and increase the risk for osteoporosis. Because people with CF are predisposed to osteoporosis, this method should be used with caution.
Emergency contraception, such as the morning-after pill or copper IUDs, are forms of emergency contraception. The morning-after pill uses progestin to lower the chance of getting pregnant within five days of having unprotected sex. The morning-after pill should be taken as soon as possible and is 85 percent effective in preventing pregnancy. As the name suggests, the morning-after pill is intended for emergency situations and should not be used as your primary birth control method. Copper IUDs can be inserted up to 5 days after unprotected sex as an emergency contraceptive.
Condoms are inexpensive and, unlike most contraceptives, work to prevent sexually transmitted infections (STIs). They also have an 85 percent success rate with typical use. In addition, condoms are almost 100 percent effective when used to protect against STIs. For this reason, condoms are incredibly important for preventing sexually transmitted infections, including human immunodeficiency virus (HIV).
Spermicides are gels, foams, or creams that help kill sperm. Although they should not be used alone, spermicides can be very effective when used with a second birth control method such as a condom. However, some spermicides may increase the risk of vaginal infections and irritation.
For more information on the different brands of spermicides, visit DailyMed, a service from the National Library of Medicine that provides information about drugs, including dosages and possible side effects.
The Sponge (Today Sponge®)
The sponge is a small, soft, round plastic device with spermicide that is placed in the vagina before sex. It works by covering the cervix and can stay in the vagina for 24 hours. If you do use the sponge, it is important that you wait six hours after having sex to remove it. Since women with CF are already prone to experiencing increased vaginal irritation, you should visit a health care provider if you think you might have a vaginal infection after using the sponge.
The diaphragm is a dome-shaped device that covers the cervix to prevent sperm from entering the uterus. Diaphragms and barrier methods, such as FemCap® and Lea's Shield®, must be used with spermicide and should be left in for six hours after having sex. The fact that women with CF have thicker cervical mucus may make it harder for diaphragms and similar barrier methods to stay in place, so use the diaphragm, sponge, cap, or shield with another method (e.g. pill, ring, or condom) in the first month of use to see if the device stays in place over the cervix during sex.
For more information on the different brands of diaphragms, visit DailyMed, a service from the National Library of Medicine that provides information about drugs, including dosages and possible side effects.
Using the withdrawal method (“pulling out”) is only 20 percent effective. For this reason, it is important to use contraception for proper sexual safety and prevention.
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