CONTRACEPTION – Avoiding Unwanted Pregnancy

Reproductive health is a basic human right, its awareness can promote safe motherhood by decreasing the medical problems associated with unwanted pregnancies. The various  contraceptive measures can be used successfully with couple education, motivation and cooperation.

It is very important to know the most effective contraceptive measure for you, as it varies for couple to couple. This blog will give you some information about the available contraceptives, their uses and benefits, side effects and success rates. You can easily select any suitable method for yourself, but be very clear about the fact that a right choice can only be made after proper evaluation by a qualified gynecologist.

There are certain medical conditions which need to be treated first. Therefore remember, for all contraceptive measures:

• Always tell your doctor about age, relationship status, menstrual cycle history about any irregularity and unexplained abnormal vaginal bleeding
• History of abortions, alive kids
• pelvic surgeries, caesarean section, history of tubal pregnancy
• pelvic infections and sensitivity to copper
• high blood pressure and heart disease, diabetes, liver disease, eye problem like glaucoma
• Smoking, alcohol consumption or any drug intake
• Medicines like antibiotics, blood thinners, ant acids
• Irreversible contraception or reversible contraception

After a detailed history, complete medical examination, pelvic ultrasound and some essential blood may be done like blood counts, lipid, if needed. Discuss various contraceptive options suitable for you, efficacy, duration of action, side effects and then select the method that suits your life style.

TYPES OF CONTRACEPTIVES

They are reversible and irreversible measures ,which are selected accordingly

A – Reversible Methods: These are for couples who need some spacing for short duration, as they have future plans of extending their family. There are various methods which can be selected after careful discussion. These methods include natural spacing and by using barriers or hormones.

• Natural Method: It is useful in women who have regular menstrual cycle ,those who do not want any intervention. You need to know that first day of period is the first day of a cycle, all calculations are done with day 1 of cycle.
  Safe days are calculated according to cycle length, these are the days in which there are very low chances of conception, they are first three days after periods and last week before periods, remember the most fertile days start from day 10 to day 18 of a cycle. The signs you can easily pick that whether the egg is released in body are rise of body temperature to 1 degree if you record temperature regularly, and thin watery, stretchy vaginal discharge. Now a days, the ovulation kits are available, in which if urine sample is placed two lines appear showing hormone peak due to release of egg in body.
  The success rate of this method varies from 80 to 90 %.The problem with this method is it needs proper recording and calculation of menstrual cycle which may be difficult, resulting in failures.

• Artificial Method: There are two types to artificial method:
  – Barrier method
  – Hormonal method

Barrier Method: Barrier method only prevents the entry of sperms into womb, with 90 to 95% success rate, it is used for couples who don’t want to use hormonal methods due to any reason. The common problem in its use is that it needs couple  motivation and proper use. Women can use barriers of Vaginal rings, diaphragm, cervical caps, whereas condoms and spermicidal cream are also available. These are the only contraceptives that provide safety from sexually transmitted infections.

Intrauterine System (IUS): They are of two type:
– Non-hormonal; Copper T
– Multi-load hormonal; Mirena

They act by changing the lining of uterus, preventing implantation of pregnancy. They are suitable for age more than 40 years, women who have children and want to space for long time, patients with medical problems in which hormones cannot be given. It has 99% success rate.

Mirena is a new progesterone hormone loaded device, used for contraception and treatment of   women with heavy periods, as it really makes lining of uterus thin, periods gradually lighten and then stop temporarily.

You should know few things before you go for insertion of intrauterine device.

Please take appointment during periods, as it is easy to insert right IUS after periods on sixth or seventh day of cycle. After your complete history and examination in a gynae-clinic, IUS is placed in uterus, it is normal to have little discomfort or cramps which will settle down within few days by taking painkillers and then you for a follow up after a month, periods, as maximum chances of expulsion are within first month. The thread should be visible on examination. If it is not visible then ultrasound is done to locate IUS. You should come for a checkup if you have heavy or irregular bleeding or pain, excessive discharge or your periods are overdue. Remember it should be changed before 5 years, earlier, if you are having repeated infections, pain or bleeding. These should be inserted with care if you had pelvic surgeries like fibroid removal or Caesarian deliveries, it should not be used if you have cardiac disease, allergy to copper, history of tubal pregnancy.

Hormonal Method: They are popular, reversible, easy and dose adjustable method for couples. There are preparations of hormones available which interfere with body hormones, interfering with egg release from ovaries, making lining of uterus unfavorable for pregnancy and increase in thickness of cervical secretions, with 99% success rate. They are available in form of pills, injections, implants, skin patches and vaginal rings.

You should not take hormones if age is more than 40, had liver disease, stroke, leg clot or gallbladder stones in past. Moreover, if you are taking medicines for epilepsy, anti-acids, blood thinners and antibiotics; then efficacy of oral contraceptives is decreased.

About Oral Contraceptive Pills
They have low dose of estrogen and progesterone ,started from fifth day of periods. They also make menstrual cycle regular, lighter and painless with 99% success rate. There is improvement in health condition of hair, skin and nails. They also help to treat any ovarian cysts.

REMEMBER!!

• They should be taken at a FIX time, DAILY.
• If you miss a tablet, then take the missed tab as soon as you remember it, BUT you cannot take more than two tablets in a day. If less than ten pills are left in the pack then stop and wait for periods, start  a new pack from day five .

Side Effects: Now a days low dose pills are available with less side effects. You should not take them while breast feeding, as feed will be reduced and they are also excreted in breast milk. Commonest problem is nausea, vomiting, light headedness, weight gain. The risk of having clots, rise  in blood pressure and cholesterol levels, increase in blood clotting, more chances of stroke and leg clots, gall stone formation is also increased. Liver injury can also occur in some cases.

Progesterone Preparations
These are pills injections, implants and vaginal rings, all act by changing uterine environment and make cervical secretions thick with 97% success rate. They are easy to use with no monitoring.
Side Effects: They cause bloating, excessive weight gain, high blood pressure, stopping periods (amenorrhea), irregular menstrual bleeding.

What are Emergency Contraceptives?
There are various options available after unprotected intercourse, first 24 hours are very important as the chances of unwanted pregnancy can be minimized.

• Morning after pill, EC pill are progesterone preparation, 02 tablets are taken and then repeated after 12 hours, it causes withdrawal bleeding within a week in 95% of cases, it has side effects of headaches, weight gain, irregular cycle.
• Take  one tab of any contraceptive pill and second after 12 hours for 2 days, total four tablets are taken, its success rate is 97% but it causes severe nausea, vomiting, headaches and blood pressure changes.
• If in certain selected cases, where pregnancy could be life threatening for women or there is a  risk of genetic defects, after proper consultation, prostaglandins are used.

Contraception After 40 Years & Above
Fertility  declines markedly at 35 years of age and decreases further after 40, and becomes NEARLY zero after menopause, so should you stop all contraceptive measures?

NO! You can’t take any risks of unexpected pregnancy. You can use any method till 40, after that use barrier methods. The problem is after 40, when menstrual cycle has irregular pattern see your  doctor if you have any doubts, if you had IUCD insertion, continue using it till 1 year after menopause, as research studies have shown rare pregnancies.

B – Irreversible Methods: The couples who want permanent contraception, irreversible methods are offered to both. In females both tubes are tied or clipped, laparoscopically or through operation, with 98% success rate, its chances of failure are 2% if done right after delivery. If you ever want to have another pregnancy then either you to have IVF or a tubal operation for reopening of tubes, but  as tubes are damaged, chances of conception are low, and the risk of a tubal pregnancy are high, so think twice before going for sterilization.
Among males tying of sperm carrying duct (vasectomy) is an irreversible method, done under local anesthesia, with 99 % success rate, after few months of operation, but remember its reversal and recanalization has also poor outcome.
Whatever contraceptive measure you select, it should be effective, easily available, affordable and with minimum or no side effects, as your quality of life is priority for all of us. You can only look after your family once you are fit and healthy.

Dr. Ayesha Azam Khan

Disclaimer: This blog provides general information and discussion about medicine, health and related subjects.  The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician or other health care worker. Never disregardful professional medical advice or delay in seeking it because of something you have read on this blog or in any linked materials. If you think you may have a medical emergency, call your doctor immediately.

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