Talk:Contraception (medical methods)/Draft: Difference between revisions

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==New Start==
{{subpages}}
new start [[User:Nancy Sculerati|Nancy Sculerati]] 13:42, 3 May 2007 (CDT)


Ive made some major changes. I'd also like to fill in the history section, especially regarding the discovery of The Pill. BTW, N, same problems apply to my other recent starts, I'm working on it, but I could use your help just cleaning the closet, so to speakThen we can add good content.--[[User:Peter A. Lipson|Peter A. Lipson]] 13:43, 3 May 2007 (CDT)
==Clean restart==
Can I just note that this Draft is open for editing and improvement, without restrictions. There are certainly imperfections in the article, - so just go for it. Get it better. It needs copyediting and enriching; most changes and all minor changes don't need discussion.[[User:Gareth Leng|Gareth Leng]] 10:04, 13 February 2008 (CST)
:Thank you so much for the go-ahead, Gareth, and for archiving the talk page.  I really appreciate it.
:I'm now starting to implement some of the changes I had suggested on May 19 and 20, 2007.  Everyone, please feel free to revert selected changes, with or without explanation since these are minor changes;  if I happen to think something is important I might ask you about it.  --[[User:Catherine Woodgold|Catherine Woodgold]] 18:58, 14 February 2008 (CST)
==mechanism/mechanisms==
Re a minor change to the approved version:


:You might want to grab the old content about socio-religious issues and paste into a new article.--[[User:Peter A. Lipson|Peter A. Lipson]] 14:35, 3 May 2007 (CDT)
The approved version said ''"The mechanism of action for combination pills (estrogen-progestin) and progestin-only pills are different."''  It was pointed out that ''"mechanism ...are"'' is grammatically incorrect, and suggested to add an "s" to the end of "mechanism".


::im not so sure that expanding into vet science helps the article, but i suppose we could add it and just break it off later if we want.  I like the idea of a human contraception article that people can reference easily.--[[User:Peter A. Lipson|Peter A. Lipson]] 14:47, 3 May 2007 (CDT)
An editor approved the following change:
''"I'd vote for "The mechanisms are different" and unless there is any further objection, Stephen (or someone else) may kindly fix it. Supten 01:53, 25 September 2007 (CDT)"''


::Is there somewhere we could include sterilization, as tubal ligation and vasectomy are very commonly used in the U.S.[[User:Peter A. Lipson|Peter A. Lipson]] 14:54, 3 May 2007 (CDT)
However, the change actually implemented by a constable was this: ''"The mechanism of action for combination pills (estrogen-progestin) is different than the mechanism of action for progestin-only pills."''  This changes a lot more than one letter.  It isn't the change approved by Supten, and it contains the expression "different than," which is considered by many speakers to be grammatically incorrect, or to be accepted in spoken language only but not written language. (See [http://www.alt-usage-english.org/excerpts/fxdiffer.html here].)


EDIT CONFLICT I would like to break off sterilization as well, now. I would also like to make it clear, in the article that discusses that [[Sterilization (surgical)]], that there are methods of stopping transport of germ cells, (tube tying, vasectomy) as well as removal of testes/ovaries that have larger repercussions. Please realize that by doing it this way we are able to have fair articles that are clear cut -medical/veterinary (health science) and contraception with a precise definition, I split off [[Control of Contraception]], since that is ''not'' a health science article. Those people interested in exploring "natural birth control methods" such as abstinence and other means done behaviorally may do so in another article, also not health science - without this article having to try to cover what is already plenty- that being methods of contraception in people and animals, MEDICAL methods. I agree, if it gets to be too much even so, we can split off humans from animals, but let's get there first. [[User:Nancy Sculerati|Nancy Sculerati]] 14:56, 3 May 2007 (CDT)
I suggest that a constable change the sentence to what I understand Supten to have approved, i.e. ''"The mechanisms of action for combination pills (estrogen-progestin) and progestin-only pills are different."'' (exactly the same as the original approved version except that a letter "s" has been added to "mechanism".) --[[User:Catherine Woodgold|Catherine Woodgold]] 18:59, 15 February 2008 (CST)
::I see your point, however I really think we need to include such common surgical methods here.  Included elsewhere, or linked, should be discussions of forced sterilization, eugenics, etc.--[[User:Peter A. Lipson|Peter A. Lipson]] 15:00, 3 May 2007 (CDT)


:[http://en.citizendium.org/wiki?title=Contraception_%28medical_methods%29&curid=100017186&diff=100270989&oldid=100265004 Changed] in the Approved version [http://en.citizendium.org/wiki?title=Talk:Contraception_%28medical_methods%29/Draft&diff=next&oldid=100168692 per Supten] and brought to my attention. [[User:D. Matt Innis|D. Matt Innis]] 19:41, 15 February 2008 (CST)


== Comments ==


Why do you insist on mixing politics and religion in, instead of giving those their own articles? If you would follow my lead we could have a whold series of articles that each would be neutral and fair. Why do we have to decide NOW what thge article needs to contain? I know I could write it in a way that would be really good, and that we could cover everything to everyone's satisfaction. But I am running out of steam just arguing about it. I'll hold off writing anything on these articles under the circumstances, it's a waste of my time. The surgical methods of sterilization can be mentioned as existing, it cxan be expalined how they differ from the definition of contraception that e are using, and they can be linked. I'm taking a break. This is the sort of stuff that maes me wonder why I even try.[[User:Nancy Sculerati|Nancy Sculerati]] 16:25, 3 May 2007 (CDT)
I'm not implementing this suggestion now. Would need verification: The section "Pregnancy rates after IUD removal" could also mention the possibility of pregnancy if the IUD is removed within the 2 weeks following intercourse (for those IUDs that act by preventing implantation); perhaps this a reason for removing the IUD during the menstrual period, and that might be worth mentioning as well. --[[User:Catherine Woodgold|Catherine Woodgold]] 20:22, 19 February 2008 (CST)


Nancy, I do not understand why surgery, as well as NFP, are not considered "medical methods". [[User:Stephen Ewen|Stephen Ewen]] 16:40, 3 May 2007 (CDT)
Third paragraph of section "Hormonal medications (systemic):  It said, ''"Since hormonal contraceptives affect the menstrual cycle, these have been prescribed for women who have problems with excessive or irregular menstrual bleeding for several decades - even if the women are celibate."''  No one has commented whether "for several decades" applies to the act of prescribing or the act of bleeding.  I've assumed the former and gone ahead and changed the sentence accordingly. --[[User:Catherine Woodgold|Catherine Woodgold]] 20:35, 19 February 2008 (CST)


Medical methods are just that-medical. They are not behavioral, and they are not surgical. They are medical. Is there not another article that is unqualified to be written called Contraception? Could that article not contain whatever you want to put in it? Could it not be a whole slew of workgroups? THIS article, I had hoped, back when I was busy writing it, would contain MEDICAL methods. It has a theme- normal conception would be described, and how medical methods are likely to either stop ovulation, fertilization, or implantation would be described. The hormonal stuff alone is worth paragraphs. [[User:Nancy Sculerati|Nancy Sculerati]] 16:46, 3 May 2007 (CDT)


== lets keep on topic ==
:: I have tried to trim this page down without effecting the meaning too much, or when it seemed in error.
Thus, they reduce pregnancy in women (not couples, single women can get pregnant, but never men), I removed sexually active (thinking about rape victims too).


It seems medical methods are not seen as such by some of the authors. May I remind all participants to keep within track of the meaning of this article, and if needed spin-off to another article (possibly create it) to elaborate on side steps. Thank you. [[User:Robert Tito|Robert Tito]]&nbsp;|&nbsp;<span style="background:grey">&nbsp;<font color="yellow"><b>[[User talk:Robert Tito|Talk]]</b></font>&nbsp;</span> 17:41, 3 May 2007 (CDT)
To me, the article "feels" like it was written by an abstinance advocate and needs some tweaking for neutrality yet.
Ran out of time and patience, and plan to take a fresh look later [[User:David E. Volk|David E. Volk]] 14:52, 14 May 2008 (CDT)


== References: with notes ==
:::In the current draft it says "Pregnancy can result from intercourse after missing progestagen-only pills at any time of the cycle". It's not clear whether this means that the missing of pills is at any time of the cycle, or that the intercourse is at any time of the cycle.  I doubt pregnancy can actually result from intercourse at any time of the cycle; (Normally, advice to avoid unprotected intercourse at all times of the cycle is more because one doesn't know with certainty what part of the cycle one is in, than because pregancy can actually result at any time).  This sentence seems to imply that pregnancy can't result from missing pills after intercourse:  I doubt that, too. [[User:Catherine Woodgold|Catherine Woodgold]] 16:00, 11 July 2009 (UTC)


==Emergency contraception==
::::I agree that the sentence has a problem in that it doesn't make it clear whether it means "missing the pill" or "having intercourse"  at any time can lead to pregnancy. I'm just not sure which the source has said...  or if either statement is accurate!  Let's look into it some more... [[User:D. Matt Innis|D. Matt Innis]] 23:31, 11 July 2009 (UTC)
Mittal S. Introduction of emergency contraception in India. Journal of the Indian Medical Association. 104(9):499-502, 504-5, 2006 Sep.
''Consortium on National Consensus for Emergency Contraception met in New Delhi in January 2001, to reach a consensus on strategies for introduction of emergency contraception in India.''


Petersen R. Albright JB. Garrett JM. Curtis KM. Acceptance and use of emergency contraception with standardized counseling intervention: results of a randomized controlled trial. [Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't. Research Support, U.S. Gov't, P.H.S.] Contraception. 75(2):119-25, 2007 Feb. UI: 17241841
I found the following at [http://familydoctor.org/online/famdocen/home/women/contraceptive/632.html this site]. It seems to support the idea that, if you miss one pill at any time, you have messed up the whole month. This is different than combined hormonal pills. I'm thinking that it's likely because, if you miss your pill, you will start the cascade of ovulation and will not be able to prevent fertilization and, more importantly, implantation. Maybe this happens as soon as the progesterone level drops (it's been a long time since I took endochrinology :)  That would mean that you would at least need to avoid intercourse for the three days after missing just due to the fact that the ovum will still be viable for at least three days. Sperm can stay viable for three days (if I remember correctly), so in theory, if you had intercourse two days before you missed the pill, you could still get pregnant... that's six days total. Do you think we have enought o at least reword this accurately?


Hansen LB. Saseen JJ. Teal SB. Levonorgestrel-only dosing strategies for emergency contraception. [Review] [34 refs] [Journal Article. Review] Pharmacotherapy. 27(2):278-84, 2007 Feb.
<pre>
UI: 17253917 '''ref added'''
Does the progestin-only pill have any disadvantages?


==IUD==
You might have a little bleeding between your periods for several months after
Archer DF. Reversible contraception for the woman over 35 years of age. [Review] [23 refs] [Journal Article. Review] Current Opinion in Obstetrics & Gynecology. 4(6):891-6, 1992 Dec.  
you start taking the progestin-only pill. This can be inconvenient, but it is not a health risk. The bleeding will
UI: 1450355
probably go away on its own after you use the mini-pill for a few months. If the bleeding seems heavy or if it bothers
'''ref added to article, if you wish to move it and need help, let me know'''
you, you can talk to your doctor about it.


==Condoms==
A common side effect of the mini-pill is feeling hungry more often, which may result in weight gain.  
Flannigan J. Promoting sexual health: practical guidance on male condom use. [Review] [30 refs] [Journal Article. Review] Nursing Standard. 21(19):51-7; quiz 58, 60, 2007 Jan 17-23.  
This side effect usually goes away when you stop taking the pill. Tender breasts can also occur.
UI: 17288318


Gallo MF. Grimes DA. Lopez LM. Schulz KF. Non-latex versus latex male condoms for contraception.[update of Cochrane Database Syst Rev. 2003;(2):CD003550; PMID: 12804475]. [Review] [29 refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. (1):CD003550, 2006.
Like regular birth control pills, the progestin-only pill has to be taken for a whole month before it can protect you
UI: 16437459
from pregnancy. So for the first month, you need to use another kind of contraception, such as condoms, along with the
==Hormonal methods==
mini-pill.  
Liu SL. Lebrun CM. Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review. [Review] [104 refs] [Journal Article. Review] British Journal of Sports Medicine. 40(1):11-24, 2006 Jan.  
UI: 16371485


Bradley LD. Abnormal uterine bleeding. [Review] [23 refs] [Journal Article. Review] Nurse Practitioner. 30(10):38-42, 45-9; quiz 50-1, 2005 Oct.  
The mini-pill works best if you take it every day at the same time of day. Timing is much more important for
UI: 16217420
the progestin-only pill than in regular birth control pills. If you are more than three hours late taking the
progestin-only pill, you should take your missed dose right away and use a backup method of contraception
(such as a condom) for 48 hours.


Ehrmann DA. Polycystic ovary syndrome.[see comment]. [Review] [144 refs] [Journal Article. Research Support, Non-U.S. Gov't. Research Support, U.S. Gov't, P.H.S.. Review] New England Journal of Medicine. 352(12):1223-36, 2005 Mar 24.  
If you miss a day completely, you have to use a second method of contraception for the rest of the month
UI: 15788499
(until your next period). You can't take two mini-pills the next day to make up for a missed pill, the way
you can with regular birth control pills.  
</pre>


Khoury-Collado F. Bombard AT. Hereditary breast and ovarian cancer: what the primary care physician should know. [Review] [45 refs] [Journal Article. Review] Obstetrical & Gynecological Survey. 59(7):537-42, 2004 Jul.
Whatcha think? [[User:D. Matt Innis|D. Matt Innis]] 00:16, 12 July 2009 (UTC)
UI: 15199272


Winkel CA. Evaluation and management of women with endometriosis. [Review] [54 refs] [Journal Article. Review] Obstetrics & Gynecology. 102(2):397-408, 2003 Aug.  
:Okay, I found the following as well that seems to support the assumptions I made above from [http://www.aafp.org/afp/20001015/1839.html the American Academy of Family Physician site] (which was used as a source for the last site).
UI: 12907119
<pre>
The progestin-only methods of contraception work by a similar mechanism. Progesterone suppresses gonadotropin-releasing
hormone, thereby inhibiting the release of follicle-stimulating hormone and luteinizing hormone. This action prevents
ovulation. The atrophic endometrium that results from prolonged exposure to progestins minimizes the likelihood of
implantation. By promoting the development of a thick cervical mucus, progestin-only contraceptives also make sperm
penetration less likely.  
</pre>
:[[User:D. Matt Innis|D. Matt Innis]] 00:46, 12 July 2009 (UTC)


Olive DL. Pritts EA. Treatment of endometriosis. [Review] [94 refs] [Journal Article. Review] New England Journal of Medicine. 345(4):266-75, 2001 Jul 26.
::I made a stab at it, but I'm not sure I'm totatlly satisfied I've made it clear. Take a look and feel free to clarify. [[User:D. Matt Innis|D. Matt Innis]] 01:07, 12 July 2009 (UTC)
UI: 11474666


Moore J. Kennedy S. Prentice A. Modern combined oral contraceptives for pain associated with endometriosis. [Review] [1 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (2):CD001019, 2000.  
==Reorganization==
UI: 10796731
I think the organization  can be improved:
*Group all the methods into one section
** Place the orphan section Surgery and natural methods into this schema and divide into a surgery section and a natural section.
** Relocate topics such as latex allergy (currently under effectiveness of condoms) and spermacide (currently under condoms).


DeCherney A. Bone-sparing properties of oral contraceptives. [Review] [25 refs] [Journal Article. Review] American Journal of Obstetrics & Gynecology. 174(1 Pt 1):15-20, 1996 Jan.
Seem ok? Revert or modify if not. [[User:Robert Badgett|Robert Badgett]] 13:34, 2 June 2010 (UTC)
UI: 8571999


Iyer V. Farquhar C. Jepson R. Oral contraceptive pills for heavy menstrual bleeding. [Review] [1 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (2):CD000154, 2000.
==Another reorganization coming==
UI: 10796696
If no one objects, I'm going to break this article into smaller articles.  IUD's, birth control pills/patches, cervical caps, condoms, etc. each have a very different record of effectiveness, and I think the reader ought to be able to see clearly on the disambiguation page which methods are more vs. less effective. It's going to be a lot of work.  And really, I think the top-level article ought to be called "birth control" and not "contraception".  Why use a great big word that only doctors use, when the rest of the planet uses the everyday words?  Maybe when this was all first written, people were trying to avoid controversy, but it can't be avoided.  Let's just tell the facts, then separate out the controversy part into separate articles or at least sections.[[User:Pat Palmer|Pat Palmer]] ([[User talk:Pat Palmer|talk]]) 12:13, 22 January 2023 (CST)


Burkman RT. Collins JA. Shulman LP. Williams JK. Current perspectives on oral contraceptive use. [Review] [72 refs] [Journal Article. Review] American Journal of Obstetrics & Gynecology. 185(2 Suppl):S4-12, 2001 Aug.
:In the process of doing this, it means this article will need to be "unapproved", which in a way is a shame, because the bulk of the information has not changed. But I don't agree with having all these many different medical approaches lumped into one article; it's a disservice to women, who cannot quickly and easily decide which topic they want to read about but are instead exhausted with a deluge of technical information. Thus, I will "unapprove" this article, not because it's out of date per see, but because I don't agree with the structure.[[User:Pat Palmer|Pat Palmer]] ([[User talk:Pat Palmer|talk]]) 12:16, 22 January 2023 (CST)
UI: 11521117


Tyrer LB. Current controversies and future direction of oral contraception. [Review] [42 refs] [Journal Article. Review] Current Opinion in Obstetrics & Gynecology. 5(6):833-8, 1993 Dec. nice older summary of oral contraceptives after 30 years of use: in 1993-main questions of safety had to do with exogenous estrogen and posible increased risk of cervical and breast cancer. Oral contraceptves began being widely prescribed in about 1960. Reduction of doses of both estrogen and progesterin lowered clinical incidence of cardiovascular complications.The cardiovascular complications associated with OCP are specific:thromboembolic events, stroke, MI.As far as Breast cancer- the consensus in 1993 was that the overall incidence waqs not greater in women who used OCP, but the acceleration of the growth of early breast cancers (rather than their initiation) is a risk. The incidence of endometrial and ovarian cancer, however, is lower in women using birth control pills.Higher dose pills have some significant effects on CHO metabolism, especially in women who are "pre-diabetic" but do not cause diabetes.Health benefits of OCP : decreased iron deficiency anemia, less dysmennorhea, menometrorraghia, taken correctly combination pills about 100% effective in preventing pregnancy.
:Also putting an important resource here (and one of the reasons this article is out of date).  Since it was written, both the morning-after and abortion pill have become more widely available to womenThey are drugs and physically non-invasive. They are also controversial (especially the latter).  I don't think this article is up to date about them.  Planned parenthood has this clear disambiguation of the two: [https://www.plannedparenthood.org/blog/do-i-need-emergency-contraception-or-the-abortion-pill Do I need Emergy Contraception or the Abortion Pill?].[[User:Pat Palmer|Pat Palmer]] ([[User talk:Pat Palmer|talk]]) 10:18, 28 January 2023 (CST)
UI: 8286698
 
 
===Risk populations,complications etc===
CARRIE ARMSTRONG:ACOG Releases Guidelines on Hormonal Contraceptives in Women with Coexisting Medical Conditions
American Family Physician - Volume 75, Issue 8 (April 2007)
 
Bushnell, Cheryl D. MD, MHS; Hurn, Patricia PhD; Colton, Carol PhD; Miller, Virginia M. PhD; del Zoppo, Gregory MD, MS; Elkind, Mitchell S.V. MD; Stern, Barney MD; Herrington, David MD; Ford-Lynch, Gwendolyn MD; Gorelick, Philip MD, MPH; James, Andra MD, MPH; Brown, Candice M. PhD; Choi, Emily MD; Bray, Paul MD; Newby, L Kristin MD, MHS; Goldstein, Larry B. MD; Simpkins, James PhD Advancing the Study of Stroke in Women: Summary and Recommendations for Future Research From an NINDS-Sponsored Multidisciplinary Working Group. Stroke. 37(9):2387-2399, September 2006. "Women have poorer outcomes from stroke than men. Women also have risk factors that are unique, including pregnancy and hormone therapy. Hormone therapy for postmenopausal replacement increased the risk of ischemic stroke according to results of the Women’s Health Initiative clinical trials. Based on the current understanding of the mechanisms of action of estrogen, the reasons for this increased risk are uncertain."..."A multidisciplinary workshop was held in August 2005 to summarize the current evidence for estrogen and, more generally, stroke in women, and to provide recommendations for future basic, preclinical, and clinical research studies."
 
Tozer, Beverly S. MD; Boatwright, Elizabeth A. MD; David, Paru S. MD; Verma, Deepa P. MD; Blair, Janis E. MD; Mayer, Anita P. MD; Files, Julia A. MD Prevention of Migraine in Women Throughout the Life Span. Mayo Clinic Proceedings. 81(8):1086-1092, August 2006. "Migraine is a common disorder in women. The 1-year prevalence of migraine is 18% in women compared with 6% in men. Migraine most commonly occurs during the reproductive years, affecting 27% of women 30 to 49 years of age. "
"During the reproductive years, headaches in women are commonly associated with menses, pregnancy, and use of combined oral contraceptives (COCs).".."Oral Contraceptives: Many women with MM also take COCs, which can unpredictably induce, alter, or alleviate migraines. The normal decline in endogenous estradiol concentration in the late luteal phase of the natural menstrual cycle is equivalent to a 20- to 25-µg decline in synthetic ethinyl estradiol (EE).13 Thus, no COC will prevent MM in a woman who has headaches during her natural cycle because even the lowest-dose medication produces a decline equivalent to 20 µg of EE premenstrually. If use of COCs exacerbates migraines throughout the cycle, the initial strategy should be to lower the estrogen content to 20 µg of EE. Persistent headaches despite this intervention may necessitate discontinuing COCs in these patients.20 When a woman experiences prolonged aura, focal neurologic symptoms different from those of her typical aura, or a sudden prolonged headache, use of COCs should be discontinued, and possible secondary causes of headache should be explored.16"
 
==Vaginal ring==
Teal SB. Craven WM. Inadvertent vesicular placement of a vaginal contraceptive ring presenting as persistent cystitis. [Case Reports. Journal Article] Obstetrics & Gynecology. 107(2 Pt 2):470-2, 2006 Feb.
UI: 16449153
 
Miller L. Verhoeven CH. Hout J. Extended regimens of the contraceptive vaginal ring: a randomized trial. [Clinical Trial. Comparative Study. Journal Article. Multicenter Study. Randomized Controlled Trial] Obstetrics & Gynecology. 106(3):473-82, 2005 Sep. UI: 16135576:Objective: To compare the bleeding patterns and tolerability of 3 different extended ring regimens with those of the standard 28-day cycle with 21 days of contraceptive vaginal ring use followed by 7 ring-free days.Methods: Following a run-in 28-day ring cycle, women were randomized to 1 of 4 regimens: monthly (28-day cycle), every other month (49-day cycle), every third month (91-day cycle), or continuous (364-day cycle). Treatment duration was 1 year. Daily bleeding diary, interval visit questionnaire, and examination data were collected.Results: A total of 561 women were enrolled, 429 were subsequently randomized, and 289 (67.4%) women completed the entire year. All schedules were well tolerated and acceptable to women, but study completion rates were higher for the shorter cycles. Bleeding days were reduced with postponement of the withdrawal bleeding (ring-free) week, but spotting days increased. For example, women using the continuous or 364-day ring cycle reported a median of zero bleeding days but 10–12 days of spotting during the first 3 months of extended use. Unscheduled bleeding during ring use was the lowest with the traditional 28-day cycle. Adverse events, blood pressure, body weight, and laboratory findings were comparable over the 4 treatment groups.Conclusion: The combination vaginal contraceptive ring can be used for extended cycles to alter the bleeding schedule. Women willing to tolerate some spotting might choose the longer extensions to have fewer menstrual periods.
 
==New start==
Nancy and Peter, what is the goal of writing this article as opposed to the more general one on [[contraception]]? Where does this new start fit into the big picture? Is abstinance to be a separate article or part of the more general contraception article? [[User:Chris Day|Chris Day]] [[User talk:Chris Day|(talk)]] 15:28, 4 May 2007 (CDT)
 
Just looking in here, I think that there is an important role for an article that essentially aims to explain exactly how different methods of contraception work. Such an article can really avoid the moral/religious issues altogether. I think it is important to get across a clear account of the principles underlying hormonal use, in a way that will lead to an understanding of the limits of effectiveness and the potential hazards too. Hormonal contraception in men is also physiologically a very interesting (and illuminating) story.
 
I guess I see that there are potential problems in having an article that covers both the reproductive cience aspects and the ethical/societal aspects. For the moment it seems a good idea to develop these separately, though perhaps later they can be merged or linked.[[User:Gareth Leng|Gareth Leng]] 11:55, 5 May 2007 (CDT)
 
== disclaimer font ==
 
It may just be my macbook pro, but I can't read the font/type-size/font-color/letter spacing of the disclaimerChanging just one of those variables would make it easier to read.  [[User:Thomas E Kelly|-Tom Kelly]] [[User talk:Thomas E Kelly|(Talk)]] 18:17, 5 May 2007 (CDT)
 
it's your browser settings- make the text bigger. I'll put the font up 1, bit it will probably be too big, It's not a disclaimer- it's a guide. [[User:Nancy Sculerati|Nancy Sculerati]] 19:19, 5 May 2007 (CDT)
 
I think in general it's better to let the user's browser choose the font.  Html tags such as <nowiki><big>, <small> </nowiki> etc. can be used to gently suggest what type of font to use without forcing it on the user.  I would just use italics and not make the font smaller.  Remember that people might have to read this stuff on various types of devices:  devices for blind people;  tiny handheld devices with limited screen size and resolution, etc. --[[User:Catherine Woodgold|Catherine Woodgold]] 19:30, 7 May 2007 (CDT)
 
== Contraception versus birth control ==
 
My understanding of the word "contraception" is that it means methods that prevent conception, and that conception is the joining of egg and spermTherefore methods that prevent implantation are not contraception, except euphemistically.  If such methods are to be discussed, perhaps "birth control" would be a better name for the article.  --[[User:Catherine Woodgold|Catherine Woodgold]] 19:25, 7 May 2007 (CDT)
 
----
 
That understanding is ''not'' a physician's understanding, and one reason that certain articles, including this one have been broken off from the main article [[Contraception]] is exactly to prevent conflicts in approaches and understanding from rendering all the articles useless. For example, for some religious views- contraception does not include prevention of implantation, but only of conception- but that is not a health science view:
 
According to the Medline-Mirriam Webster on line Medical dictionary:Main Entry: con·tra·cep·tion
Pronunciation: kän-tr-sep-shn
Function: noun
: deliberate prevention of conception or impregnation
- con·tra·cep·tive /-sep-tiv/ adjective or noun
 
Contraception includes the deliberate prevention of pregnancy. This is also how the topic is treated in every OB-GYN textbook I have ever read, and all the ones that are referenced here. However, it would be absolutely inaccurate to use this definition for groups who are not health scientists and do not agree with it, and we will strive to make this health science definition clearer in the article.
 
Since it makes a great deal of difference to many patients EXACTLY how contraceptives work, that information ''is'' being provided in this article- to the best of the current health science information.
 
A discussion of contraception from a different perspective than health sciences, as well as health sciences, is the main focus of [[Contraception]], an article that needs authors. The different ways contraception are defined and the implications seem to belong there, as a full an unabbreviated discussion. [[User:Nancy Sculerati|Nancy Sculerati]] 11:16, 8 May 2007 (CDT)
 
== Comments on the introduction ==
 
Re link to natural family planning:  "abstinence methods" is too narrow;  for example, the withdrawal method is also a method of natural family planning (depending on the definition of natural family planning).  How about "natural methods"?
Re "failure rate": I prefer the term "pregnancy rate" for two reasons.  For one thing, "failure rate" can be interpreted to mean a number of things, such as the rate of breakage of condoms, for example, whether or not anyone becomes pregnant as a result.  (When something other than pregnancy rate is actually meant, some other less ambiguous term can be used.)  For another thing, "pregnancy rate" is more polite, in my opinion, especially when the article is read by a person who knows that their own existence resulted even though their parents were using a birth control method.  Re '' of the group of women who were supposedly using it. '' I suggest changing to "group of women" to "couples" to avoid seeming to support the idea that contraception is women's sole responsibility. 
''Other methods have a rate of effectiveness that is independent of compliance.''  They can't be completely independent of compliance, or else the people could be not using the method at all and still achieve the effectiveness.  (Unless possibly you mean something like the lactation amennhorea method.) Oh, wait, it could be getting shots every few monthsStill, one has to comply insofar as getting the shot in the first place. I haven't thought of a better wording yet, though. --[[User:Catherine Woodgold|Catherine Woodgold]] 20:05, 5 May 2007 (CDT)
 
::In this health science article the rate of pregnancy is referred to in the standard manner as in the published medical literature- when discussing any method of contraception, the "failure rate" is ordinarily reported as as the percentage of women in a group that reports using a particular contraceptive method that become pregnant in the course of one year. Because of how the statistics are done for large studies, individuals placed in a group- such as "condoms" are counted in that group's results- EVEN if they are admittedly non-compliant most (or all) of the time. Similarly, if a woman had an IUD placed, and the IUD came out the next day (expelled) her one-year results would be reported in the IUD results, generally speaking. That's where the "supposedly" comes from- and it will have have more development. The "withdrawal method" is NOT a recognized form of medical contraception, nor a recognized "health science" method of effective birth control, but instead is a "traditional" or "alternative medical" method that is sometimes used as a control when reporting health science statistics. In fact, the use of condoms in a medically advised manner (see article here) unequivically states that the condom must be applied before contact such that it contains any pre-ejaculate. Should you wish to discuss traditional or alternative medical methods of reducing or influencing the pregnancy rate , there are other articles to do so [[Natural Family Planning]], and [[Contraception]]- including any new articles that you (or others) might like to start. This article legitimately focuses on medical methods only. [[User:Nancy Sculerati|Nancy Sculerati]] 11:24, 8 May 2007 (CDT)
 
:::The note about the link to the natural family planning article need not use medical terminology.  I see no reason not to change the wording "abstinence methods" to "natural methods" in that note at the top of the page. The withdrawal method is not the only problem with the phrase "abstinence methods".  Another problem is that some people consider "abstinence" to mean abstinence from sexual activity (not just abstinence from vaginal intercourse);  and some people consider "abstinence" to mean abstinence all month, not periodic abstinence.
 
:::Citizendium articles are supposed to be written from a neutral point of view, not divided into one article on contraception written from a medical point of view using medical terminology in a way that is in conflict with common understanding, and another article on the same topic written in common terms in a way that is in conflict with medical understanding.  This article may be about medical methods of contraception, but it must present them with a neutral point of view.  See [[CZ:Neutrality Policy]]--[[User:Catherine Woodgold|Catherine Woodgold]] 15:55, 13 May 2007 (CDT)
 
== minor formatting point ==
 
Editors may wish to paraphrase quotes, unless the particular quote is of such uniqueness that it should be left intact. Just a suggestion.--[[User:Peter A. Lipson|Peter A. Lipson]] 08:38, 10 May 2007 (CDT)
 
:One reason that I like to quote is because it leads readers to the references. But that's short quotes- some of the long ones are sort of placeholders here, that way we can develop the sections, know the references. [[User:Nancy Sculerati|Nancy Sculerati]] 12:04, 10 May 2007 (CDT)
 
==Effectiveness of condoms==
 
We probably should mention the compliance rate, i.e., in what percentage of sexual encounters in which the partners intend to use condoms, do they actually remember to do so before it's "too late"?
 
With 'the pill', the crucial moment is a matter of routine. Every day the girl takes a pill (or recalls that it's a "no pill" day), and probably always at the some time - like after getting up or before going to bed.
 
With condoms, the crucial moment is typically part of a sexual encounter. It requires additional discipline to interrupt foreplay, for example. It's easier for the girl to remember to take a pill in the bathroom by herself every day, than to remember to say, "No glove, no love" at just the right moment. (Not to mention issues of self-esteem, will he/she reject me, etc.) --[[User:Ed Poor|Ed Poor]] 11:36, 10 May 2007 (CDT)
 
:I agree with you. This is really in a rough draft form, and the whole compliance issue has to be well written. It isn't now- I've ben reading the medical literature, and taking notes, and working on the various articles that relate to the references as I can. That's one reason that I started [[Contraception (veterinary)]], oddly enough, because I cam across these papers in the talk page there as I was researching various methods. Anyway- I'm continuing to work, and happy to have help. The hormonal stuff- from a physiological point of view, is another area that is really unfinished, and [[Ovulatory cycle]] is getting written, too. [[User:Nancy Sculerati|Nancy Sculerati]] 12:02, 10 May 2007 (CDT)
 
::The main advantage of latex condoms is not their utility in pregnancy prophylaxis, although the stats could be better, could be worse, but currently they are the only method of having sex while being protected against STDs. A little hard to figure out how to make the point, but I prefer to do it here on the discussion page and see how others integrate it.  I think Ed already knows how I feel about this one : ) [[User:Peter A. Lipson|Peter A. Lipson]] 17:35, 10 May 2007 (CDT)
 
That point is already made in the text, but the other point -not yet made- is that, like for contraception, these devices are NOT 100% effective, even when remembered to be placed before any actual contact. The other point not yet made, is that the very group of people who are most at risk for HIV etc, generally, promiscuous, impulsive younger people- are the very people who have the worst stats in using these effectively for birth control. [[User:Nancy Sculerati|Nancy Sculerati]] 17:41, 10 May 2007 (CDT)
 
::The point almost leads into a point about HPV vaccine, but I'll leave that for later.  Thanks, Nancy.[[User:Peter A. Lipson|Peter A. Lipson]] 17:44, 10 May 2007 (CDT)
 
:Nancy, that's a good point: impulsiveness is a risk factor in itself. It's not just a medical issue, but a social (sociological?) one. --[[User:Ed Poor|Ed Poor]] 18:03, 10 May 2007 (CDT)
 
It's a medical issue in that every OB-GYN article and textbook chapter- when discussing contraception, talks about: a sort of "best match" strategy of patient ("client") and method. So, the obese woman who is hypertensive is likely to do best with something that is not going to further raise her blood pressure, the person at high risk for catching a STD is better off (in one sense) with latex condoms incorporated into the method- and worst off with an IUD. etc. There are several published references discussing the fact that latex condoms are fairly ineffective in preventing pregnancy in young women, and much more effective in older women. That reason- impulsiveness greater in young people,  is implied as one of the underlying issues. Also -female condoms, that I don't know much about- I'm just reading about them now, may offer protection, some protection anyway, against sexually transmitted disease as well as male condoms. I feel strongly that these articles have to be factual, encyclopedic articles that do not push a political or religious view. On the other hand, all health science articles should be "doctorly" in that they are a service to the public that give clear information in a kind and helpful manner. That's sort of an extension of "family friendly", human friendly, in other words, humane. Anyway- there's a long way to go here, yet- but progress is being made. [[User:Nancy Sculerati|Nancy Sculerati]] 18:20, 10 May 2007 (CDT)
 
==Question==
I am still perplexed at why NFP would be barred from inclusion on an article about "medical methods of contraception", especially when condoms are included (''how'' is a condom "medical" and NFP not??). The AMA medical encyclopedias I have make no distinction and consider the topic of NFP as within the purvey of the field of medicine and medical practitioners within a "best match" strategy. [[User:Stephen Ewen|Stephen Ewen]] 20:02, 13 May 2007 (CDT)
 
:Good point! Having one article that talks about almost all the methods and then a different article for the natural methods gives a certain impression -- it gives the impression to doctors and patients, for example, not to expect discussion of natural methods in the doctor's office, which is unfortunate.  --[[User:Catherine Woodgold|Catherine Woodgold]] 21:02, 13 May 2007 (CDT)
 
::Well, IMHO, I do think a unified contraception article should include all methods, including the abysmal success rates of certain methods, like withdrawal, rhythm, etc.  [[User:Peter A. Lipson|Peter A. Lipson]] 21:31, 13 May 2007 (CDT)
 
Why don't you all write one? [[Contraception]] remains blank. [[User:Nancy Sculerati|Nancy Sculerati]] 21:45, 13 May 2007 (CDT)
 
:Nancy, I am not trying to be difficult here, please understand. [[Contraception]], as I understand it, would include a brief history of contraception and coverage of key social issues such as ethics, population control, women's rights, etc.  In [[Contraception (medical methods)]], this article, it seems to me, and in medical encyclopedias, it seems that they all have a "natural methods" section. I cannot understand why condoms would be considered a ''medical method'' while NFP would not be.  Can you, or someone, kindly explain the rationale that would differentiate these two
 
:Also, I have a question. What about [http://www.essure.com/Home/Understanding/WhatisEssure/tabid/55/Default.aspx Essure]? Would that be considered any more surgical than IUD placement?
 
:[[User:Stephen Ewen|Stephen Ewen]] 22:25, 13 May 2007 (CDT)
 
An IUD placement is ''not'' a surgical procedure. An IUD is a medical device, which is why you'll find it in this article. Ths article, by the way, is already fairly robust and yet it does not yet include the different types of IUDs, and does not yet give a proper description of the medical complications of hormonal contraceptives. This is an additional reason why I, personally, have no interest in expanding the topic for this article to include birth control in general. To do even ''minimal'' justice to the medical methods of contraception it's going to be long'' as'' it is. If you have read it and still think an IUD is placed surgically, it may be because I did not describe how IUDs ''are'' placed, and-come to think of it- that really should be in here. I haven't written the fallopian tube obstruction part of [[Sterilization (surgical)]], but glancing quickly at the site you reference, Essure is a non-reversible surgical sterilization procedure which is some variation of that. Thanks for the reference. I'll check it out as I slowly continue doing the library research, and may inc orporate it in the sterilization article. I myself stick to medical textbooks and peer reviewed articles in medical journals, and I'll see what I can find. Give me time, please. [[User:Nancy Sculerati|Nancy Sculerati]] 22:36, 13 May 2007 (CDT)
 
Sorry-this article has simply collected the various medical devices and drugs that are used for contraception as medical methods. NFP does not use drugs or devices, it's strictly behavioral. It is not routinely mentioned as a contraceptive, but it conceivably (sorry for that pun) could be - and for that matter, tube tying and vasectomy might be mentioned as well, even though they are not ordinarily reversible and are not really contraceptives but are sterilization procedures. Still, various "medical" books and articles might mention all these birth control methods in the same breath. That doesn't mean that they are all "medical contraceptives". I don't "own"these articles but I am committed to writing well referenced prose that completely covers all the topics. NFP is missing a lot of stuff- the recent work on temperature, for example, and the explanation for why lactation inhibits ovulation, as well as other things I am aware of. The sterilization article is barely started. I urge you to write or work with someone to write an overall article on Birth Control. I have a very clear idea iof what I am doing and all I can say is that I can demonstrate it better than justify it in advance. I assure you, by all our precedents of acceptable lengths of articles, I cannot cover these topics in proper detail and expand the topics. I would like to continue working, and learning. I'll help you with a general article on Birth Control, but I myself am not interested in starting it at this time. Start it, work on it- I'll fill in where I know something.[[User:Nancy Sculerati|Nancy Sculerati]] 22:54, 13 May 2007 (CDT)
 
Steve, you seem to have your hands on some medical encyclopedias. Maybe you could explain in more detail the title of the article in an encyclopedia (this matters quite a bit), how abstinence is covered, and whether and to what extent this is treated as a "medical method" like others. --[[User:Larry Sanger|Larry Sanger]] 23:30, 13 May 2007 (CDT)
 
By the way, can't this problem above be finessed by having ''strictly'' medical methods in the present article, and other methods (along with medical ones) listed in [[birth control]]?  We ''should'' have an article called "birth control," shouldn't we?  If not, why not? --[[User:Larry Sanger|Larry Sanger]] 23:32, 13 May 2007 (CDT)
 
===Reply===
Here's a synopsis from American Medical Association Home Medical Encyclopedia (in two volumes), Random House, 1989.
 
;Birth control
Just a two paragraph entry. Defines it simply, then says it can refer to what it calls "the narrow area" of both "natural or artificial" means to prevent pregnancy and then the "broader" areas of "family planning" and "population control".  It uses "birth control" as an umbrella term for 1) family planning; 2) contraception (defined as the means for #1); 3) Elective abortion; 4) Sterilization; and, 5) population control. It mentions human rights issues when States pressure citizenries in population control efforts.
 
;Contraception
Total coverage is several pages long. It includes an Intro that briefly discusses ''all'' methods, from "avoidance of intercourse" (a nicely neutral term for the politically charged "abstinence", don't you think?) to surgical sterilization. Discusses effectiveness measuring; risks of usage; and, future possibilities, e.g., vaccines.
 
It then gives detailed separate entries for 1) barrier methods (mechanical and chemical); 2) hormonal; 3) periodic abstinence (temp, mucous, symptothermal); and, 4) postcoital methods.
 
;Sterilization
Has a brief intro article and then separate entries for male and female.
 
This all is, of course, simply how ''they'' chose to do it.
 
But here is what I think would prove ''very'' useful. I think it would be very helpful to have some leadership on an ''overall plan''. That way, everyone who'd like to contribute to these topics can be doing so within the larger, articulated strategy.
 
[[User:Stephen Ewen|Stephen Ewen]] 00:31, 14 May 2007 (CDT)
 
== "Contraception"--what does it mean? ==
 
I was asked to comment here.  I don't want to do so in any greater detail without getting the matter more study and thought, which I don't have time to do.  But I would like to say something.  ''Suppose,'' first, that in fact medical doctors, in conceptualizing what ''they'' call contraception, consider only active methods of preventing impregnation ''after sex.''  '''''IF''''' that is the case, then it is ''not,'' strictly speaking, biased at all to omit discussion of abstinence.  Speaking for myself, and bear in mind that I am very far from being an expert on this, I always thought "contraception" meant "methods of preventing sex from resulting in a pregnancy," and so by definition excludes abstinence, whereas "birth control" was a broader term that could of course include abstinence.  It wouldn't surprise me if this is what doctors understood by the term.  If so, then there is no need to mention abstinence in the article titled "contraception."  Granted, there ''would'' be a systematic professional bias against abstinence as a method of birth control if we only had an article titled "contraception," and it did not mention abstinence; but we should have a broader article, something like [[birth control]], that lays out all the options, including abstinence.  These two articles will have overlapping content, no doubt, but I suppose that's all right.  Besides, the "birth control" article could cover ethical and religious aspects, which it would be strictly inappropriate to include in an article that is focused on ''medical'' practices.  (I hope it is not controversial to say the latter.  Obviously, some people do, on ethical or religious grounds, advocate ''against'' certain medical practices.  But surely it is useful knowledge to such people to have a clear explanation of the exact practices they are advocating against.  That's what the present article is for, as I understand it.)
 
I think it would be worthwhile cataloging the different related concepts here, and deciding explicitly which we want to have articles about:
* Contraception
* Birth control
* Family planning
* Others?
 
I ask the disputants here whether, perhaps, it would be more productive to use [[birth control]] as a locus for all the different methods of preventing pregnancy (which methods may or may not actually involve sex).
 
I don't mean to hand down a decision, here.  I'm just on all points stating my opinion here, and I think that the relevant decisions here belong in the hands of the Health Science Workgroup. --[[User:Larry Sanger|Larry Sanger]] 21:47, 13 May 2007 (CDT)

Latest revision as of 11:19, 28 January 2023

This article is developing and not approved.
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Clean restart

Can I just note that this Draft is open for editing and improvement, without restrictions. There are certainly imperfections in the article, - so just go for it. Get it better. It needs copyediting and enriching; most changes and all minor changes don't need discussion.Gareth Leng 10:04, 13 February 2008 (CST)

Thank you so much for the go-ahead, Gareth, and for archiving the talk page. I really appreciate it.
I'm now starting to implement some of the changes I had suggested on May 19 and 20, 2007. Everyone, please feel free to revert selected changes, with or without explanation since these are minor changes; if I happen to think something is important I might ask you about it. --Catherine Woodgold 18:58, 14 February 2008 (CST)

mechanism/mechanisms

Re a minor change to the approved version:

The approved version said "The mechanism of action for combination pills (estrogen-progestin) and progestin-only pills are different." It was pointed out that "mechanism ...are" is grammatically incorrect, and suggested to add an "s" to the end of "mechanism".

An editor approved the following change: "I'd vote for "The mechanisms are different" and unless there is any further objection, Stephen (or someone else) may kindly fix it. Supten 01:53, 25 September 2007 (CDT)"

However, the change actually implemented by a constable was this: "The mechanism of action for combination pills (estrogen-progestin) is different than the mechanism of action for progestin-only pills." This changes a lot more than one letter. It isn't the change approved by Supten, and it contains the expression "different than," which is considered by many speakers to be grammatically incorrect, or to be accepted in spoken language only but not written language. (See here.)

I suggest that a constable change the sentence to what I understand Supten to have approved, i.e. "The mechanisms of action for combination pills (estrogen-progestin) and progestin-only pills are different." (exactly the same as the original approved version except that a letter "s" has been added to "mechanism".) --Catherine Woodgold 18:59, 15 February 2008 (CST)

Changed in the Approved version per Supten and brought to my attention. D. Matt Innis 19:41, 15 February 2008 (CST)

Comments

I'm not implementing this suggestion now. Would need verification: The section "Pregnancy rates after IUD removal" could also mention the possibility of pregnancy if the IUD is removed within the 2 weeks following intercourse (for those IUDs that act by preventing implantation); perhaps this a reason for removing the IUD during the menstrual period, and that might be worth mentioning as well. --Catherine Woodgold 20:22, 19 February 2008 (CST)

Third paragraph of section "Hormonal medications (systemic): It said, "Since hormonal contraceptives affect the menstrual cycle, these have been prescribed for women who have problems with excessive or irregular menstrual bleeding for several decades - even if the women are celibate." No one has commented whether "for several decades" applies to the act of prescribing or the act of bleeding. I've assumed the former and gone ahead and changed the sentence accordingly. --Catherine Woodgold 20:35, 19 February 2008 (CST)


I have tried to trim this page down without effecting the meaning too much, or when it seemed in error.

Thus, they reduce pregnancy in women (not couples, single women can get pregnant, but never men), I removed sexually active (thinking about rape victims too).

To me, the article "feels" like it was written by an abstinance advocate and needs some tweaking for neutrality yet. Ran out of time and patience, and plan to take a fresh look later David E. Volk 14:52, 14 May 2008 (CDT)

In the current draft it says "Pregnancy can result from intercourse after missing progestagen-only pills at any time of the cycle". It's not clear whether this means that the missing of pills is at any time of the cycle, or that the intercourse is at any time of the cycle. I doubt pregnancy can actually result from intercourse at any time of the cycle; (Normally, advice to avoid unprotected intercourse at all times of the cycle is more because one doesn't know with certainty what part of the cycle one is in, than because pregancy can actually result at any time). This sentence seems to imply that pregnancy can't result from missing pills after intercourse: I doubt that, too. Catherine Woodgold 16:00, 11 July 2009 (UTC)
I agree that the sentence has a problem in that it doesn't make it clear whether it means "missing the pill" or "having intercourse" at any time can lead to pregnancy. I'm just not sure which the source has said... or if either statement is accurate! Let's look into it some more... D. Matt Innis 23:31, 11 July 2009 (UTC)

I found the following at this site. It seems to support the idea that, if you miss one pill at any time, you have messed up the whole month. This is different than combined hormonal pills. I'm thinking that it's likely because, if you miss your pill, you will start the cascade of ovulation and will not be able to prevent fertilization and, more importantly, implantation. Maybe this happens as soon as the progesterone level drops (it's been a long time since I took endochrinology :) That would mean that you would at least need to avoid intercourse for the three days after missing just due to the fact that the ovum will still be viable for at least three days. Sperm can stay viable for three days (if I remember correctly), so in theory, if you had intercourse two days before you missed the pill, you could still get pregnant... that's six days total. Do you think we have enought o at least reword this accurately?

Does the progestin-only pill have any disadvantages?

You might have a little bleeding between your periods for several months after
you start taking the progestin-only pill. This can be inconvenient, but it is not a health risk. The bleeding will 
probably go away on its own after you use the mini-pill for a few months. If the bleeding seems heavy or if it bothers 
you, you can talk to your doctor about it. 

A common side effect of the mini-pill is feeling hungry more often, which may result in weight gain. 
This side effect usually goes away when you stop taking the pill. Tender breasts can also occur. 

Like regular birth control pills, the progestin-only pill has to be taken for a whole month before it can protect you 
from pregnancy. So for the first month, you need to use another kind of contraception, such as condoms, along with the 
mini-pill. 

The mini-pill works best if you take it every day at the same time of day. Timing is much more important for 
the progestin-only pill than in regular birth control pills. If you are more than three hours late taking the 
progestin-only pill, you should take your missed dose right away and use a backup method of contraception 
(such as a condom) for 48 hours.

If you miss a day completely, you have to use a second method of contraception for the rest of the month 
(until your next period). You can't take two mini-pills the next day to make up for a missed pill, the way 
you can with regular birth control pills. 

Whatcha think? D. Matt Innis 00:16, 12 July 2009 (UTC)

Okay, I found the following as well that seems to support the assumptions I made above from the American Academy of Family Physician site (which was used as a source for the last site).
 The progestin-only methods of contraception work by a similar mechanism. Progesterone suppresses gonadotropin-releasing
 hormone, thereby inhibiting the release of follicle-stimulating hormone and luteinizing hormone. This action prevents
 ovulation. The atrophic endometrium that results from prolonged exposure to progestins minimizes the likelihood of
 implantation. By promoting the development of a thick cervical mucus, progestin-only contraceptives also make sperm
 penetration less likely. 
D. Matt Innis 00:46, 12 July 2009 (UTC)
I made a stab at it, but I'm not sure I'm totatlly satisfied I've made it clear. Take a look and feel free to clarify. D. Matt Innis 01:07, 12 July 2009 (UTC)

Reorganization

I think the organization can be improved:

  • Group all the methods into one section
    • Place the orphan section Surgery and natural methods into this schema and divide into a surgery section and a natural section.
    • Relocate topics such as latex allergy (currently under effectiveness of condoms) and spermacide (currently under condoms).

Seem ok? Revert or modify if not. Robert Badgett 13:34, 2 June 2010 (UTC)

Another reorganization coming

If no one objects, I'm going to break this article into smaller articles. IUD's, birth control pills/patches, cervical caps, condoms, etc. each have a very different record of effectiveness, and I think the reader ought to be able to see clearly on the disambiguation page which methods are more vs. less effective. It's going to be a lot of work. And really, I think the top-level article ought to be called "birth control" and not "contraception". Why use a great big word that only doctors use, when the rest of the planet uses the everyday words? Maybe when this was all first written, people were trying to avoid controversy, but it can't be avoided. Let's just tell the facts, then separate out the controversy part into separate articles or at least sections.Pat Palmer (talk) 12:13, 22 January 2023 (CST)

In the process of doing this, it means this article will need to be "unapproved", which in a way is a shame, because the bulk of the information has not changed. But I don't agree with having all these many different medical approaches lumped into one article; it's a disservice to women, who cannot quickly and easily decide which topic they want to read about but are instead exhausted with a deluge of technical information. Thus, I will "unapprove" this article, not because it's out of date per see, but because I don't agree with the structure.Pat Palmer (talk) 12:16, 22 January 2023 (CST)
Also putting an important resource here (and one of the reasons this article is out of date). Since it was written, both the morning-after and abortion pill have become more widely available to women. They are drugs and physically non-invasive. They are also controversial (especially the latter). I don't think this article is up to date about them. Planned parenthood has this clear disambiguation of the two: Do I need Emergy Contraception or the Abortion Pill?.Pat Palmer (talk) 10:18, 28 January 2023 (CST)