Date Archives September 2021

Lets talk about the methods of contraception beyond old school

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Let’s deviate a bit from the classical methods of contraception and talk about some of the new kids on the block .

Some of the newer methods are the contraceptive patches, vaginal rings , implants, injectables and intrauterine system containing hormones.

They may not have taken the Indian woman by the storm but its important she knows about them and takes a calculated choice about using them.

CONTRACEPTIVE PATCH:

The contraceptive patch is a combined estrogen and progesterone patch which can be applied on the skin of the shoulder, upper back, abdomen, buttock or upper arm. They are very similar in composition to oral contraceptive pills but good for women who don’t want to or forget to take the pill every day. These need to be applied every week for 3 weeks are removed after that and a fresh one is applied after a gap of one week. In this 4 th week when the patch is not applied, the user will get her menstrual period. Ideally, this should be started on the first day of the period and if it is started on any other day, additional backup is needed for a week.

Some additional benefits include a lesser menstrual blood flow, lesser iron deficiency anaemia and lesser cramps. They can be used during bathing, swimming, sports etc.

However, some studies have shown a slightly higher chance of clots in the legs, though these are not proven in other trials. People who are obese with a BMI greater than 30 kg/m2 should not use them.

INTRAUTERINE CONTRACEPTIVE DEVICE AND SYSTEM CONTAINING PROGESTERONE

The IUCDS which contain copper have become sleeker, they can now be used even in young girls who have not yet  borne children . Earlier it was contraindicated in this group of girls. It is a method which is low maintenance. These can be inserted by the health care provider for a period of 3-10 years and unlike the oral pills one doesn’t  need to take them everyday. There is a risk of pelvic infection, especially if one has multiple sexual partners, there may be heavier periods and if it fails, a chance of tubal ectopic pregnancy as well.

The hormone containing IUD is the MIRENA which is effective in a number of associated conditions like heavy bleeding, cramping , endometriosis and correction of anemia owing to its property  of reduced blood flow.

The common side effects though ,are irregular bleeding or spotting , which generally get better after 3-4 months of use. They may also cause stoppage of bleeding or amenorrhoea .

They are highly effective and no fuss, and a lot of women are switching over to these as a method of contraception.

 

IMPLANTS

Contraceptive implants contain a rod around 4 cm long which contains the hormone etonogestrel. It is inserted by a doctor certified to carry out a minor procedure ,under local anaesthesia ,in your  non dominant upper arm, under the skin. It is easily felt by the recipient if properly inserted. This method too is a hormonal method, small quantities of the hormone released every day . It is removed after 3 years by another simple procedure. This implant is recommended for women who are breast feeding, in whom oestrogen is contraindicated and in women who prefer a non fussy, get it forget it approach.

Side effects include irregular spotting and occasionally stoppage of menstruation . It can be removed at any time if you wish to become pregnant or if you desire removal due to side effects.It has a quick return to fertility and while it is used it has very good efficacy. It is a preferred method in the west, though not so much in India currently .

INJECTABLE CONTRACEPTIVES

These have been available for many years and consist of the progesterone DMPA which is inserted once in every 3 months. The compliance of this has been poor due to the side effects of irregular spotting and amenorrhoea. Some weight gain has also been reported.

VAGINAL RING

Another method soon to hit the markets is the contraceptive vaginal ring which is a soft ring that contains hormones, inserted high up in the vagina. It is used for 3 weeks and then removed for 1 week in which the user gets her periods. It is easy to insert and remove and is not uncomfortable. It is not felt by her partner either at the time of sexual intercourse.

Remember to talk to your doctor to help you make a choice depending on your personality, lifestyle, goals and objectives. Associated conditions too. Also be assured that if one method doesn’t suit you, there are many others in this bouquet.

CONTRACEPTION – HOW TO CHOOSE WHATS BEST FOR YOU

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There is a whole basket of birth control methods that are available, often so confusing. My aim is to run you through some of these so that you can choose what is appropriate for you. The best person to guide you is your doctor.Choose what is best for you.Also, do not worry, if one does not suit you; there are many alternatives that you can try till you find one that is good for you.

The methods available are :

  • Condoms [male]
  • Condoms [female]
  • Caps
  • Diaphragms
  • Combined pills
  • Progesterone only pills
  • Contraceptive implant
  • Contraceptive injection
  • Contraceptive patch
  • Intrauterine device [ copper containing and hormone containing]
  • Vaginal ring
  • Rhythm method

Permanent methods:

  • Tubectomy
  • Vasectomy

Condoms and other barrier methods like cervical caps and diaphragms prevent sexually transmitted diseases as well.

WHO CAN USE THE COMBINED PILL?

Combined estrogen and progesterone pills help by preventing ovulation [release of the egg], by preventing the egg to be fertilised by the sperm or by making cervical mucous thick. When used correctly, the pill is 99% effective in preventing pregnancy.

Your doctor will take a proper history and rule out contraindications to take the pill. The pill may not be good for you if:

  • You are a smoker and are 35 years or older
  • Stopped smoking less than a year ago and are 35 years of age or more
  • Are extremely overweight
  • Take certain medicines which may interact with these pills
  • Have had blood clots in a vein or a stroke
  • Have a family history of blood clots or stroke
  • Have heart disease or severe hypertension
  • Have severe migraines or depression
  • Have breast cancer or genital cancer
  • Gall bladder disease
  • Diabetes

Immediately post-delivery when you are breastfeeding your baby

You will highly benefit from these pills even if you have heavy bleeding, fibroids, ovarian cysts, endometriosis, PCOS, symptoms of PMS and many other problems like acne and abnormal hair growth.

Remember, though that these pills do not protect against STDs

WHO IS A GOOD CANDIDATE FOR A CONTRACEPTIVE IMPLANT OR HORMONE CONTAINING IUD?

If you forget to take a pill everyday and find doing so very troublesome , a hormone containing implant or IUD is good for you . It can be inserted for a period of 3-5 years . Also, it is indicated where estrogen is not indicated especially for girls who are breast feeding . It reduces heavy bleeding and period pain .

Remember however that it requires insertion by a doctor .

WHO CAN USE THE PROGESTERONE ONLY PILL?

If you’re above 35 years of age, a smoker , are breast feeding your baby and don’t have a problem about taking the pill everyday or with irregular bleeding or spotting or no periods (amenorrhea ) while you use this POP.

WHO NEEDS A PERMANENT METHOD OF BIRTH CONTROL?

A vasectomy or tubectomy is suited for someone who’s completed their family and does not want any more children. These methods are generally irreversible; they have a small chance of reversal depending on many factors. You must be very sure before you opt for these procedures.

There is a method that suits everyone ; just let your doctor find the one which will help you prevent an unwanted pregnancy and unnecessary and occasionally risky terminations