On-Line Contraceptive Class
Eastern Illinois University
Health Service
Objectives

Upon completion the student will…
 Be knowledgeable of the current
recommendations for Pap and STI
screening
 Learn about current contraceptive options
 Be aware of common benefits and possible
adverse reactions of contraceptive use
The Women’s Health
Appointment

During the women’s health appointment you
may receive the following…
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Sexually Transmitted Infection Screening
Pelvic Exam
Pap Smear
Blood pressure and other vital signs assessment
Breast Exam
Thyroid assessment
Heart and lung assessment with a stethoscope
Abdominal exam
Pap Smear Screening
Defined
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The pap smear is a screening test of cells from the
uterine cervix (mouth of the uterus).
Many types of cells can be identified and examined
for abnormalities.
Over a long period of time, a small percentage of
untreated abnormal cells may result in progressively
severe changes or even cancer of the cervix.
Regular pap smears may lead to earlier detection and
treatment of abnormal cervical cells.
Pap Smear Recommendations
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It is currently recommended that pap smear
screening begin at age 21.
STI screening is recommended annually for
at-risk sexually active females under the age
of 25.
At EIU health service women requesting
hormonal contraceptives will be required to
have an annual appointment.
The Pap Smear
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During the pap smear your health care
provider will place a small instrument called a
speculum into the vagina. The speculum will
allow the provider to visualize your cervix.
A small soft cervix brush is used to remove
loose microscopic cells from the outer surface
and inner transformation zone of the cervix.
The Pap Smear
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The cells are then placed into a preservative
solution and sent to a pathologist for
evaluation.
At EIU we use the SurePath pap test.
At EIU the wait for pap smear reports is
approximately 1-2 weeks.
Pap Smear Results
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If your pap is normal, it is
recommended to be repeated in 3 years
If your pap has mild cellular changes,
you will be asked to repeat it in a year
If your pap shows cells that do not fit
into the above, you may be referred to
a gynecologist for further evaluation.
Most changes, if any, are mild
The Pelvic Exam
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This is an examination of the uterus, fallopian
tubes and ovaries. Each of these will be
examined for size, position, tenderness, and
abnormal growths.
During the pelvic exam the provider will place
two fingers into the vagina to move the
organs to be examined while pressing down
with the other hand over your abdomen.
This will be done with all Pap Smears and STI
exams.
The Breast Exam
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Breast exams are commonly done
annually by your health care provider.
Your provider can instruct you on how
to do a self breast exam.
The best time to do a breast exam is
just after your menstrual period.
Any changes in breast tissue should be
evaluated by your health care provider.
Monthly Self Breast Exam
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Breast self-exam is the best way to detect
abnormal lumps or changes in the breast.
Your ability to detect changes will improve
with practice so be sure to examine your
breasts every month.
Sexually Transmitted Infections
(STI)
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These infections are spread through sexual contact
with infected persons.
There are several types of STIs.
If a treatment is available, the type or method will
depend upon the particular infection.
Many STIs can be spread even when a condom is
utilized.
Abstinence is the best way to ensure safety from
sexually transmitted infections.
Many people with STIs are asymptomatic and
therefore are not aware of the infection and can
spread the infection to a partner.
True or False:

Most people with Chlamydia infection
have noticeable symptoms?
False
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More than 70% of women with
Chlamydia have no symptoms
More than 90% of men with Chlamydia
have no symptoms
Screening for STI’s is Vital!
Screenings Available at EIU

Standard STI/Vaginal infection exam
 Chlamydia
 Gonorrhea
 Trichamoniasis
 Yeast and Bacterial Vaginosis (These are
not STIs)
 Syphilis (blood test)
 HIV (blood test): additional $15.00 fee
Bacterial STI’s
Chlamydia- Don’t let yourself become a number
 According to the U.S. Centers for Disease
Control and Prevention, 40 percent of
Chlamydia cases are reported among young
people 15 to 19 years old.
 Research has shown that women infected
with Chlamydia are three to five times more
at risk of acquiring HIV if exposed to the virus
than women not infected.
Bacterial STI’s
Gonorrhea- When the numbers get personal

Gonorrhea is a curable sexually transmitted disease (STD), second only
to Chlamydia as the most frequently reported STD in the U.S.

Women ages 15 to 19 are at greatest risk for gonorrhea. In the U.S.,
approximately 7.5 percent of all reported gonorrhea is found in
younger persons aged 15 to 19 years of age. The highest rates of
infection are usually found in 15 to 19-year-old women and 20 to 24year-old men.

Approximately 50 percent of women infected with gonorrhea have no
symptoms. Diagnosis most often results from partner notification as a
result of infection in men, which usually produces symptoms.

Up to 40 percent of women with gonorrhea who are not treated will
develop pelvic inflammatory disease (PID). About 20 percent of
women with PID become infertile and 18 percent experience chronic
pelvic pain.
True or False:

Most people are aware that they have a
sexually transmitted infection (STI).
False
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Many STIs remain undetected without
testing.
We recommend yearly testing for
sexually active people at risk.
Additional STI Concerns
Viruses:
 Herpes Simplex Virus– can be identified by
visual inspection when symptoms are
present. Testing is available to aid in
diagnosis and typing of the virus.
 Genital Warts (HPV) – can be identified by
visual inspection and treated when they are
present.
 Cervical HPV – the pap smear is the best
detection for this infection.
HPV
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HPV is the most common STI among
sexually active people.
HPV is transmitted by skin to skin
contact and by contact with infected
body fluids.
HPV VACCINATION

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HPV vaccination is indicated in males
and females 9-26 years of age for the
prevention of certain diseases caused
by HPV (Human Papilloma Virus) types
6, 11, 16 and 18.
These diseases include cervical cancer,
genital warts and precancerous cervical
lesions.
HPV Vaccination Continued
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The vaccine is a series of 3 injections
given over a 6 month period
Gardasil is available at Health Service
Both women and men can receive this
vaccination
Please call or come to Health Service for
more information regarding this vaccine
HIV Testing
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HIV testing is available Monday through
Friday at Health Service
Testing is obtained with a blood sample.
Testing is $15.00.
Risk assessment is also available through the
HERC (581-7786).
Viral STI’s
Genital Herpes- When the numbers get
personal
 An estimated two out of every three persons
infected with genital herpes don’t know they
are infected because they have no visible or
recognized symptoms.
 Up to 30 percent of genital herpes infections
are caused by HSV-1 (oral herpes), primarily
resulting from oral-genital sex.
 Although herpes vaccine research is being
conducted, no vaccine is currently available.
Contraceptive Choices

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Abstinence is the only method of
contraception that is 100% effective
With the continual rise in sexually transmitted
infections and the risk of unplanned
pregnancy, abstinence is a valuable option.
Barrier Contraception
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Male Condom
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Female Condom
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97% effective when used correctly
Available at EIU pharmacy
4-6 condoms/$1.00
95% effective when used correctly
Available at local pharmacies
Diaphragm
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94% effective when fitted and used correctly
Fitting available at EIU health service
Effectiveness of Condom Use
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Of 100 women whose partners use condoms, about
14 will become pregnant during the first year of
typical use. (“Typical use” refers to failure rates for
women and men whose condom use is not consistent
or always correct.) Only two will become pregnant
with perfect use. (“Perfect use” refers to failure rates
for women and men whose condom use is consistent
and always correct.)
Perfect use is the KEY WORD and is something many
people fail to do correctly EACH TIME.
Only condoms provide some protection against STI’s.
Condoms inhibit exchange of potentially infected
body fluids.
Comparing Birth Control Methods
Barrier Methods
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Male Condom
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Diaphragm
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95% effective – perfect use
79% effective – typical use
Withdrawal
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94% effective – perfect use
84% effective – typical use
Female Condom
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97% effective – perfect use
85% effective – typical use
Hormonal Methods
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Depo-Provera
96% effective – perfect use
73% effective – typical use
The Pill
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99.7% effective – perfect use
97% effective – typical use
99.7% effective – perfect use
92% effective – typical use
Nuva Ring
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99.7% effective – perfect use
Unknown – new product
A Guide to Condom Lubrications
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Safe with All Condoms:
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Aloe-9®
Aqua Lube ®
AstroGlide ®
deLube ®
ForPlay ®
Glycerin
Gynol II ®
H-R lubricating jelly
K-Y ® Jelly
PrePair ®
Ramses ® Personal Spermicide
Silicone lubricant
Spermicides
Touch ® Personal Lubricant
Water and saliva
Wet ®
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Unsafe with Latex Condoms:
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Baby oil
Cold creams
Cornhuskers ® lubricant
Edible oils (olive, peanut, corn,
sunflower)
Hand and body lotions
Massage oils
Mineral oil
Petroleum jelly
Shortening
Suntan oil and lotions
Bag Balm ®
Whipped cream
Certain vaginal yeast infection
medications
Hormonal Contraceptives
at EIU Health Service

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Combination
 Oral – Birth Control Pills, both monthly
cycle and extended cycle types
 Vaginal Ring – Nuva-Ring
Progesterone only
 Injectable – Depo-Provera
Combination Hormonal
Contraceptives
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These contraceptives contain various
amounts of estrogen and progesterone.
These hormones are normally present in
females and work to regulate the female
reproductive cycle.
In hormonal contraceptives, estrogen and
progesterone are used to suppress egg
(follicle) production and fertilization. They
also work by thickening cervical mucus thus
blocking sperm from reaching an egg.
Benefits
for combination hormonal contraception
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Many known benefits exist. Some include…
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Regulation of menses
Reduction of menstrual cramps
Prevention of pregnancy
Reduction of ovarian cysts
May improve bone density
Reduced occurrence of iron deficiency anemia
Prevention of non-cancerous breast diseases
May play a role in the prevention of rheumatoid
arthritis
Improvement of menstrual migraines, mood
swings, acne
Risks/Side Effects
for combination hormonal contraception
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Side effects may include nausea, breast
tenderness, weight changes, mild spotting,
changes in libido, mild blood pressure
elevation and changes in mood.
These symptoms are generally mild and
should subside within 2-3 cycles.
If they do not subside, make an appointment
to discuss this with your healthcare provider,
as changing to another pill may reduce side
effects.
Adverse Events
for combination hormonal
contraception
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Certain physical or mental changes warrant alerting
your healthcare provider. Blood clot is a rare
potential side effect.
These include (ACHES):
 A stands for abdominal pain
 C stands for chest pain, cough, or shortness of
breath
 H stands for headache, dizziness, or weakness
 E stands for eye problems, vision loss or blurring
 S stands for severe leg pain in calf or thigh (due
to potential blood clot)
Potential Medication Interactions
for combination hormonal contraception
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Antibiotics
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Antacids – Tums, Rolaids, Maalox, etc
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Some interfere with the combined hormonal
contraception. Condoms are recommended as
additional contraception while on antibiotics.
Avoid use within two hours of taking oral
contraceptives.
Anticonvulsants – controls seizure and
epilepsy

May reduce the effectiveness. Talk to the
prescribing doctor prior to initiating any hormonal
contraception.
True or False:

Antibiotics may interfere with the
effectiveness of birth control pills?
True

Use condoms as additional
contraception while on antibiotics.
Smoking
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When taking any of the combination
hormonal contraceptives, smoking is not
advised.
Smoking significantly increases the likelihood
that an adverse event, such as a blood clot,
can occur.
Smokers over the age of 35 have an even
higher risk of experiencing an adverse event.
True or False:

Women who take hormonal
contraception, such as birth control
pills, should not smoke.
TRUE
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Smoking while using hormonal
contraception increases a woman’s risk
for blood clot, heart attack and stroke.
Smoking and hormones do not mix!
Oral Contraceptives
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When taken correctly oral
contraceptives are 99% effective in
prevention of pregnancy.
Oral contraceptives do not prevent the
transmission of STIs.
True or False
Oral contraceptives (birth control pills)
protect against STIs (Sexually Transmitted
Infections)?

FALSE
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Oral contraceptives do not protect
against infections.
Consider condom use everytime!
Oral Contraceptives
When to start?
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Day 1 start – You may start the first pill on
the 1st day of your menstrual cycle. You will
not need additional contraception for this
method.
Sunday Start – You may start the pill on the
Sunday after your period starts. If you use
this method, you will need to use another
form of contraception for first 7 days (ie.
condom).
Oral Contraceptives
When to start?

Anyday start – In many instances you
may be able to start your first pill any
day of the month. Please discuss this
option with your women’s health
provider.
Considerations
When Taking the Pill
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Schedule the pill –take the pill at the
same time everyday.
Take the pill after a meal – this will
minimize nausea and vomiting.
If you are consistently nauseated – take
the pill in the evening at bedtime.
What If I Forget to take the pill?
(first of two pages)
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1 missed pill – take it as soon as you remember.
Take the next pill at the regular time. You do not
need to use back-up contraception.
When more than one pill is forgotten, use
additional contraception for 7 full days.
2 missed pills - during week 1 or 2, take two pills on
the day you remember and two pills the next day.
Then take one pill daily.
2 missed pills – week 3, for Sunday starters take one
pill daily through Sunday. Begin new pill pack on
Sunday. For day one starters, discard remaining pills
and start new pack.
Missed Pills
Continued
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3 or more missed pills – Sunday starters take
one pill per day until Sunday and start a new
pack on Sunday. For day one starters, throw
away remaining pills and start a new pack.
For most oral contraceptive packs the pills in
week 4 are reminders. They do not contain
any contraceptive medication. Throw away
any forgotten pills from week 4.
If you are confused, always use back up
contraception until you speak with a nurse or
provider at health services.
True or False

I don’t need to worry if I forget to take
my birth control pill?
False
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Refer to previous slides, your birth
control pill package insert or call Health
Service or your pharmacist.
Taking your pills correctly is the best
way to prevent pregnancy.
Oral Contraceptives
available at EIU pharmacy
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Sronyx (generic Alesse)
Low-Ogestrel (generic
Lo/Ovral)
Reclipsen (generic Desogen)
Quasense (generic
Seasonale 91 day pack)
Microgestin 1/20 and 1.5/30
(generic Loestrin Fe)
Azurette (generic Mircette)
Lo Loestrin FE
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Necon 1/35 (generic Ortho
Novum 1/35)
Zarah (generic Yasmin)
Levora (generic Nordette)
Mononessa (generic OrthoCyclen)
Trinessa (generic Ortho TriCyclen)
Trivora (generic Triphasil)
NuvaRing – “The Ring”
 Is a small (about 2” diameter), soft ring that is
inserted into the vagina
 Works similarly to combination oral contraceptives
 Like birth control pills, the Nuva-Ring is highly
effective in preventing pregnancy when used
correctly.
While the ring is worn, it continuously delivers
hormones to the vaginal wall and into the bloodstream
NuvaRing
Unique Benefits/Side Effects
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Benefits
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Once per cycle dosing
Discreet
Side Effects
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Increased vaginal discharge
Also has same potential side effects as oral
birth control pills
NuvaRing
What To Do
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Ring is inserted and left in place for 21 days
After 21 days, ring is removed and period
occurs
New ring is inserted 1 week after removal
Ring conforms to the body; very few women
have the ring fall out
Most women (and their partners) cannot feel
the ring
Check with health care provider about when
to insert
Nuvaring continued
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Ring can also be placed on the 1st day
of each month and removed the last 34 days of each month
Please discuss this option with your
Healthcare Provider if you are
interested.
NuvaRing
When to start?
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If you are currently on the pill/patch start
when you would normally begin a new pack
at the end of your cycle.
If you are not currently using hormonal
contraception…
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Counting the first day of your menstrual period as
“Day 1” insert your first Nuva-Ring between day 1
and day 5 of your menstrual period.
Insert the ring by no later than day 5 even if you
are still bleeding.
We recommend using condoms as additional
contraception the first week of Nuvaring use.
NuvaRing
How to insert?
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You just squeeze the nuvaring between your
index finger and thumb to insert it into the
vagina.
It does not need to be in any special location
to be effective.
Can be placed inside tampon applicator to
insert.
To remove, just insert your finger and pull it
out.
NuvaRing
What if it falls out?
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Less than 2.2% of users have reported
problems with the ring falling out.
If the ring falls out or gets pulled out just
rinse with warm water and re-insert.
If reinserted within three hours, no back up
contraception is necessary.
Review of Combined Hormonal
Contraception Available at EIU

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Oral contraceptives and NuvaRing (vaginal
ring) are available at EIU pharmacy.
All of these methods are highly effective in
preventing pregnancy when they are used
correctly.
Hormonal contraception does not protect
against HIV infection and other sexually
transmitted infections.
Common Question

How long can I continue to take the pill?
It is not necessary to “take a break” from
the pill or ring. Some experts believe that the
risks identified with these types of
contraception start to rise after age 30,
especially if you smoke.
Common Question

Will the use of hormonal contraception affect
my future fertility?
Approximately 80% of women regain normal
fertility within three months after
discontinuing the pill, 95% within one year.
Use of oral contraception may increase
fertility by decreasing the incidence of
ovarian cysts and pelvic inflammatory
disease.
Depo-Provera
“The Shot”

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Depo-Provera, “the shot” is a progesterone
only injection widely utilized for
contraception.
When used correctly, it is one of the most
effective methods for preventing pregnancy.
The injection is effective for at least 12
weeks.
Depo-Provera
How does it work?

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The injection acts by inhibiting the release of
follicles (eggs) from the ovaries.
It also changes the lining of your uterus,
making pregnancy less likely to occur.
Depo-Provera
Benefits
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It does not contain estrogen which reduces
the risk of certain side effects, especially for
smokers.
Convenience, no daily pill to remember.
May be used by nursing mothers.
It becomes effective 48 hours after an
injection.
Depo-Provera
Side Effects
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Irregular, unpredictable bleeding - should improve with
consecutive injections.
Mild increased risk of breast cancer in patients starting
Depo-Provera after age 35.
Difficulty achieving pregnancy during the first 12-18
months after discontinuing Depo-Provera.
Side Effects Continued
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Weight Gain – approximately 5.4 lbs. in the
first year and up to 13.2 lbs. over time.
Headache
Stomach pain or cramps
Fatigue
Decreased libido
Many women who experience side effects
during the first few months of use report that
these decrease over time.
Elevated blood pressure
Depo-Provera and Your Bones
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BONE LOSS/OSTEOPOROSIS RISK: Depo-Provera can
cause a reversible decrease in bone density.
Most women can safely use Depo-Provera for up to 2
consecutive years.
Women at low risk for bone loss or osteoporosis between
the ages of 18 and 45 can continue Depo-Provera for
greater than 2 consecutive years.
Women at high risk for osteoporosis (heavy smokers,
anorexics, amenorrheic athletes, chronic steroid users,
women with strong family history of osteoporosis, women
with osteopenia or osteoporosis) will be counseled to
consider alternative birth control.
Depo-Provera and Bone Health
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Women should exercise daily and
consume adequate Calcium and Vitamin
D intake.
We recommend 1,000 mg of calcium
per day (3-4 servings of dairy per day)
and 400-600 IU of Vitamin D per day
(fortified in milk and cereals and other
foods).
EIU Women’s Health Services
Appointment Fees

STI screening
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Pap Smear
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$50.00
$50.00
Pap Plus (pap smear and STI screening)
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$70.00
EIU Health Service
Missed Appointment Fees
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If you need to cancel or reschedule your appointment
you need to do so at least 24 hours prior to your
scheduled appointment time.
If you forget your appointment or do not reschedule
24 hours in advance, the appointment fee will be
charged to your student account.
You will be allowed to use the fee for a rescheduled
appointment later in the semester.
If you miss the rescheduled appointment, you will be
required to pay for future appointments.
EIU H.S. Staff Providing
Women’s Health Services

Sheila Baker, M.D.
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Kathie Blesch, PA-C
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Family Physician
Physician Assistant
John Hutchinson, M.D.
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Family Physician