Everything you need to know about Contraception
- mediculous
- Jun 20, 2018
- 6 min read
In the recent years contraception has become a major topic in preventive medicine. It is important for everyone to feel comfortable discussing about contraception with your physician. Even though few years back it was seen as a stigma to be on contraception, it have helped women and families in tremendous ways. Studies have shown that more women were able to get a good education and advance in career, avoiding pregnancy until financial stability is met have increased rates of successful upbringing of children, decreased the rates of unwanted pregnancy and abortions. Contraception is not purely used for avoiding pregnancy, in addition women with menstrual problems, women who should not conceive due to other medical problems can also benefit form contraception. There are so many options of contraception to chose from. It is really important to have a basic idea of what kind of contraception will chose you better. It is highly recommended to discuss with your physician on different options available. However reading this and having a basic understanding can help you with your discussion about contraception.
Oral Contraceptive Pills (Also known as Birth Control Pills)
Oral contraceptive pills used to be the main contraception therapy few years ago. Recently the use of OCPs have decreased due to other newer and more convenient options available in the market. Even though this is not the form of contraception that i would recommend, it is still beneficial when taken as instructed.
There are 2 types of OCPs - Combined oral contraceptives and Progestin only pills.
Combined Oral Contraceptives
Contain estrogen and progestin
They prevent pregnancy primarily by suppressing ovulation. In addition they also contribute to thickening of cervical mucus and reducing tubal motility and thereby preventing the sperm from reaching the egg.
A monthly combination pill pack will include hormone-based pills for 3 weeks and 1 week of placebo pills that’ll bring on your period.
Progestin Only Pills
They contain only Progestin and not Estrogen.
These pills primarily work by thickening the cervical mucus. It can also suppress ovulation, however it is not consistent.
It is usually used in women who cannot use estrogen due to other medical conditions.
When used correctly the OCP failure rate is as low as 0.3%. However, failure rates with typical use are much higher and estimated at 7.2% - 9%. The high failure rate is attributed to the way the pill should be taken. You should take the pill everyday at the same time without missing the dose in order to reduce the failure rate. Taking the pill every day at the same time without forgetting can be really difficult.
Who should be cautious taking Combined Oral Contraceptives?
Women who are 35 years of age and older and smokes cigarettes
Women with history of blood clots or stroke in the past
Women with a history of breast cancer
Women with liver disease
Women with certain heart problems
Women with migraine headaches with aura (vision problems with flashing lights)
<21 days after delivering a baby (It is safe to take progestin only Contraceptives at any time after delivery)
Poorly controlled Hypertension
Are you taking any other medication beside OCP?
Certain medication can affect the effectiveness of the birth control pills and cause pregnancy by decreasing the drug level in the blood. certain anti-seizure medication, certain antibiotics and certain natural herbal supplements can contribute to decrease blood levels of OCP. If you are taking any other medications make sure to discuss with your doctor.
Benefits of OCPs
The main benefit and purpose of OCP is that It reduces unwanted pregnancies. In addition it is widely used to treat menstrual irregularities and menstrual problems. Studies have also showed that use of OCP reduce the risk of ovarian and endometrial cancers. OCPs can also help with acne and hirsutism (unwanted hair growth ).
Intrauterine Devices (IUD)
This is one of the recommended method of contraception in women who is not planning to get pregnant in the next year. The convenient using method and safety profile have made this the preferred method of contraception.
What is an IUD?
IUD is a small, T-shaped device that are made of plastic with a thin string that your doctor places in your uterus by going through your vagina and cervix . There are different types of IUDs available in the market and it is important to chose the one that is best for you. If you decide that you are ready to get pregnant IUD can be removed by your physician and the contraception can be reversed. They are very easy to use (unlike OCPs you do not have to remember to take the medicine) and are very effective (only 1 in 100 women got pregnant in the first year after using an IUD). IUDs do not contain Estrogen and therefore are safe in obese, older women and in smokers. Some studies have shown that IUDs lower your risk of developing cervical cancer.
Types of IUD
Copper containing IUD
Paragard is the only copper releasing IUD that is currently in the market. Once inserted it can stay in your uterus for up to 10 years to prevent pregnancy.
Paragard is also a great emergency contraception and can use up till 5 days after the sexual intercourse to successfully avoid pregnancy.
One of the unfavorable effect of Paraguard is the heavy or long menstrual period in some women.
Paragard is a good choice if you do not want to get pregnant for another 10 years or want to avoid any hormone containing IUD.
Progestin Containing IUD
Unlike copper releasing IUD, there are several types of Progestin releasing IUD in the market (Mirena, Kyleena, Skyla, and Liletta)
Mirena and Kyleena can stay in your uterus for up to 5 years to prevent pregnancy. Liletta can stay in place for up to 4 years and Skyla can stay in place for up to 3 years.
Unlike Paraguard progestin-releasing IUDs have lighter, less painful periods
Image obtained from http://stayteen.org/sex-ed/article/iud
Although it is very rare, there is a possibility of IUD to come out after insertion. This can result in failure of contraception and unwanted pregnancy. You should not get IUD if you recently had untreated Sexually transmitted infections such as Chlamydia or gonorrhea or Pelvic Inflammatory Disease.
Implantable Birth control
This is another most effective form of birth control similar to IUD. Failure rate is <1% in the first year of implanting the device. A single rod containing etonogestrel (nexplanon) is implanted in the subdermal skin i your upper inner arm. It is a simple office procedure and can be performed with only using local anesthetics. It can stay underneath your skin and provide contraception for up to 3 years. It can be taken out early if you desire to get pregnant or are unhappy with the device. Only absolute contraindication for implanting nexplanon is breast cancer. One of the most common side effect reported with the use of this device is abnormal menstrual bleeding. Most women will have fewer lighter bleeding, however some women may experience heavy irregular bleeding. You can get Nexplanon insertion immediately after giving birth and it will not interrupt breast feeding.
Contraceptive Injections
Depot medroxyprogesterone acetate or DMPA (Depo-Provera) is the only form of injectable contraception that is available in USA. It is usually injected deep into a muscle, such as the buttock or upper arm every three months. It prevents ovulation and thickens the cervical mucus, making the cervix impenetrable to sperm.The biggest disadvantage of DMPA are irregular or prolonged bleeding and spotting, particularly during the first few months of use.Weight gain was also reported to be an unfavorable effect of DMPA by patients, however major studies did not find any significant weight gain. Studies have shown long term use of DMPA is associated with decreased bone density. However stopping the medication revereses this effect. Only absoulute contraindication for DMPA is Breast cancer.
Emergency Contraception
Emergency contraception is another way you can keep from getting pregnant if you recently had sex. It is also known as "the morning after pill," or "plan B." There are 3 types of Emergency contraceptive pills available.
Pill containing levonorgestrel (also known as Plan B one step) is available without prescription in USA. This can work up to 72 hrs after intercourse.
Another type of pill called Ulipristal (also known as ella, ella one) is available and you can take it within 120 hrs after intercourse. However this pill needs prescription.
Certain Birth control pills can also be used as emergency contraception. you will need a prescription for these and you will have to discuss with your physician regarding the timing.
Copper IUD (Paragard) can also be used as an emergency contraception within 120hrs after intercourse. This is highly effective and offers 99% protection. This is a great form of emergency contraception if you are >165 lbs, since pills might not be as effective.
Other reliable forms of contraception is sterilization
Men : Vasectomy
Women : Tubal ligation or hysterectomy
Other less favorable methods of contraception
Abstinence
The patch
Condom
Vaginal ring
Diaphragm
Spermicide
Cervical Cap
Withdrawal
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