A healthy, happily married couple in their early 40s has sought your advice on contraceptive strategies. The woman is concerned about the long-term effects of birth control pills and wants to stop taking them. They have two kids in high school and are certain they do not want more children. They seek your advice on what to do. What do you tell them?

Downstream Causes

Background Information

Upstream Effects

Male Anatomy

Female Anatomy

Uterine/Ovarian Cycles

Contraceptive Methods

Factors important for this couple that might not be in a different couple or individual seeking birth control options?


Contraceptive Options

Vagina

Hymen

Labia Majora

Uterus

Labia Minora

Fallopian Tube

Clitoris

Ovary(ies)

Epididymis

Testis(es)

Vas Deferens

Urethra

Scrotum

Prostate

Bladder

Fundus

Body of Uterus

Endometrium

Myometrium

Infundibulim

Fimbriae

Penis

Corpus Spongiosum

Corpus Cavernosum

Glans Penis

Most Effective

Effective

Least Effective

Menstruation

Ovulation

"Monthly" Cycles that occur about every 28 days and involve the maturation of female gametes (eggs) and preparing the body for fertilization

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Female gonads, two on either side of the uterus

Important functions

Secrete Hormones

Protect the eggs the female is born with already

Release eggs into the uterus through the fallopian tubes for possible fertilization

Two tubes connected to each ovary that let eggs travel from the ovaries to the uterus

Funnel shaped tube that catches the egg and pushes it through the tube

Projections that surround the ovary and release hormones to allow the mature egg into the fallopian tube

Curved upper region where the fallopian tubes connect to the uterus

The main, central part of the uterus

The innermost lining of the uterus

Prevents adhesions between the myometrium

During the menstrual cycle, it thickens and then sheds in the event of no egg fertilization

The middle layer of the uterine wall

Consists of smooth muscle, stromal and vascular tissue

Responsible for uterine contractions

Cervix

The lower portion of the uterus that opens into the vagina

Widens (10 cm) in childbirth to allow the passage of the baby

Female reproductive tract

Responsible for some sexual arousal and intercourse

Canal in which the baby is delivered during childbirth

Membrane of tissue that surrounds or partially covers the vaginal opening

Located where the vulva and labia minora meet at the front

Highly sensitive, containing many nerve endings and aides in sexual arousal

Where the mons pubis separates into two separate skin folds

The two soft folds of skin within the labia majora

Sac that holds urine and excretes it through the urethra which exits through the penis

Works with the seminal vesicles and contracts, forcing semen into the urethra

Gland that rests under the bladder but above the penis and testes

Tube which extends through the penis and releases urine and semen

External organ of the male reproductive system that has reproductive and urinary function

End of the penis that supports the foreskin and retracts to expose the glans

Erectile tissue that ends on the glans

Prevents the urethra from being closed when an erection occurs

Two columns of spongy tissue that run through the penis

Forms most of the penis, and is filled with blood vessels

Forms erections when the blood vessels fill

Sperm ducts

Extends from the epididymis to the spermatic cord

Transports mature sperm to the urethra to be released

Narrow, tightly coiled tube that connects the testes to the vas deferens

Transports and stores sperm cells that are produced in the testes

Brings sperm to maturity and pushes sperm into the vas deferens

Male gonads, primary reproductive organ

Sperm production

Hormone production, primarily testosterone

Loose pouch like skin sac that stores the testes and lies posterior to the penis

Protective function

Climate control system for the testes

AKA Period

Period lasting approximately 5 days and the beginning of the cycle

Endometrium is shed from the uterus due to know fertilization

New egg is maturing in the ovaries as this happens

Egg has been released from the ovary and traveled down the fallopian tube into the uterus

Egg attaches to the uterine wall, ready for fertilization

The peak time of the ovarian cycle for pregnancy to occur

Oestrogen levels are very high at this point in the cycle

Peak ovulation is around day 14 of the cycle

Following Ovulation

The endometrium continues to thicken regardless of fertilization

Corpus Luteum is formed

If not fertilized the egg dies, and the corpus luteum and endometrium shed, beginning menstruation and the cycle again

Progesterone levels are high as the corpus luteum is formed

IUD

Surgical Sterilization

Implant

Pill

Patch

Injection

Ring

Withdrawl

Sponge

Fertility-awareness based methods

Spermicide

Female Condom

Male Condom

Diaphragm

MOST Effective due to having little to remember once they contraception is placed

Male

Female

Vasectomy

Abdominal

Laparoscopic

Hysteroscopic

Emergency Contraception

Best Options

Worst Options

Age

Her concern about the long-term effects of pills

The fact that they already have two children

Mid 40's to 50's are around when menopause can begin for women

As men age erections can become difficult or sparse

Women are born with the number of the amount of eggs they have in their lives, so the older they get the less eggs they have

Birth control pills are often used to help balance hormones in women as well

Birth control pills are often seen as a short term solution or to be used to prevent ovary problems

They made it clear that they don't want any other children

Other couples might only want to temporarily prevent pregnancy

Surgical Sterilization

Implant

IUD

Fertility-based method

Withdrawl

Spermicide

Since both of them are confident in their decision to not have any more children, this is the most logical option

With their age it also makes sense

Wether only one of them or both of them do it, it has a very high success rate and low rate of failure

The most effective form of contraception because there is such a low chance of mistake

99% success rate

Definitely a good alternative if they don't want any kind of procedure done

Another good alternative, a birth control implant for the arm

99% success rate as well

Another good alternative if the couple doesn't want to go through something as invasive as a procedure or IUD

This is only slightly effective, because there is significantly less chance of pregnancy if intercourse happens after or before ovulation

It is definitely not full proof, and there is still a high chance of pregnancy even if it's not peak ovulation time

AKA "Pull-out" Method

Still not full proof, as if there is even slight hesitation fertilization can still occur

Any sperm could work to fertilize an egg

A chemical that works to kill sperm

28% chance of failure

Has to be used before intercourse, which can be difficult for some to remember

Can be difficult to be concious of

Works better with a combination of a condom or another birth control, but still not as effective as an IUD or Implant