Methods of Contraception

By understanding the effects that different forms of contraception can have on people with cystic fibrosis, you can choose the method that is right for you. 

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Summary
  • There are several contraceptive options available that you can discuss with your cystic fibrosis care team.
  • Each method can help prevent an unplanned pregnancy in a different way. 
  • 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.

The following are types of contraception available today that you may want to discuss with a member of your cystic fibrosis care team: 

Sterilization Methods

  • Vasectomy; tubal ligation; tubal ligation and contraceptive tubal occlusion device and delivery system (Essure®)

Intrauterine Contraception

  • Copper intrauterine device (Paragard®); levonorgestrel intrauterine device (Mirena®, Skyla®)

Hormonal Methods 

  • 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®)

Barrier Methods 

  • Male condom; female condom; spermicides; nonoxynol-9 sponge (Today Sponge®); diaphragm; vaginal barrier contraceptive devices (FemCap®, Lea's Shield®)

Behavioral Methods

  • 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.

Image of various contraceptive measures and their effectiveness.
Family planning methods have different levels of effectiveness.

For women with CF especially, unplanned pregnancies can have major health implications. Without the proper planning, lung function or body mass index (BMI), getting pregnant can 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.

Sterilization Methods

Many women 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 men, 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 women, 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 women 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®) 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 (Skyla®) or five (Mirena®) years.

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.

Hormonal Methods

The Pill

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 women with CF, lumacaftor/ivacaftor (Orkambi®) and certain antibiotics have been known to decrease its effectiveness. However, it is important to note that taking your 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 phase III studies of Trikafta®, a higher incidence of rash occurred in women who were taking oral contraception and Trikafta®.

Women 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 women 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 (Ortho Evra®)

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. Because the patch uses estrogen to help prevent pregnancy, it may increase your risk of experiencing the side effects commonly associated with estrogen for women with CF. Like oral contraceptives, it 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. Due to the fact that the hormones in the ring pass through the liver only once, it can help minimize some of the harmful side effects associated with hormonal birth controls while maintaining the ring's overall effectiveness. 

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 not recommended for women with CF since it may cause loss of bone density and increases the risk of osteoporosis, to which women with CF are already predisposed.

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.

The Morning-After Pill (Plan B®)

The morning-after pill is a form of emergency contraception that uses progestin to lower the chance of getting pregnant within five days of having unprotected sex. The morning-after pill, referred to as Plan B®, 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.

Barrier Methods

Condoms

Condoms are inexpensive and, unlike most contraceptives, work to prevent sexually transmitted infections (STIs). They also have a 98 percent success rate in preventing pregnancy when used perfectly, and 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

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

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.

No Method

Using no contraception or birth control method is only 15 percent effective and can lead to unplanned pregnancies. Similarly, 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.

***

Reference to any specific product, process or service does not necessarily constitute or imply its endorsement, recommendation or favoring by the Cystic Fibrosis Foundation. The appearance of external hyperlinks does not constitute endorsement by the Cystic Fibrosis Foundation of the linked websites, or the information, products or services contained therein.

Information contained on this site does not cover all possible uses, actions, precautions, side effects or interactions. This site is not intended as a substitute for treatment advice from a medical professional. Consult your doctor before making any changes to your treatment.

FDA-approved drug information is available at www.dailymed.nlm.nih.gov/dailymed

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Topics
Family Planning & Parenting | Fertility and Reproductive Health
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