Contraceptives

Here’s a quick on line quiz on contraceptives to test yourself over a coffee. Here also are a couple of ‘myths’ about oral contraceptives that are FALSE:

MYTH 1. You get lighter periods when on the pill- NO, you do not get a true menstrual period at all while you are taking oral contraceptives, you get a withdrawal ‘bleed’ caused by the sudden drop off of synthetic hormones while you are taking the inactive or 7 day ‘dummy’ pills. Hormonal contraceptives trick the body into believing it is pregnant so, no egg release means no fertilization, means no preparation of the uterus lining to receive a fertilized egg, means no need for a ‘true menstrual period’, which is normally the shedding of a ‘prepared’ but ‘unused’ uterus lining after ovulation. Did you follow all that?

Seven consecutive active pills need to be taken to stop us females from ovulating.

Ovulation may occur if more than 7 days are missed so if in the heat of a passionate night we forget to use protection, an unwanted little surprise may be in store for us! The big ‘P’! The lengthening of the pill free interval is one of the most common causes of pill failure and is often associated with a woman starting her new pill packet late. If you’re not home for dinner, when you usually take your pill and you don’t carry your new packet in your purse, it’s SO easy to forget completely later.

MYTH 2. The most dangerous time to miss a pill is in the middle of the pack- NO, it is at the beginning or at the end of the pack. If you think ovulation occurs in the middle of your cycle when you are taking oral contraceptives, you are wrong. Women on hormonal contraceptives do not ovulate in most cases if they are taking the contraceptive correctly. Oral contraceptives keep your ovaries in a ‘resting state’ so eggs are not released. In fact, you can miss 7 active pills without the risk of ovulating (this is what happens when you take the ‘dummy pills’ for 7 days)

Ok head on over and see how you go with that quiz.

Remember- protect yourself at all times from STds and stock up on condoms from this reliable site.

Following on from the last post on choosing the right doctor for your contraceptive ‘affair’, here are some ’starter’ questions on contraceptive options to take with you to the consult. Don’t be embarrassed, put off or rushed through a short consult when you talk to your doctor about choosing the right contraceptive for you - pay for a long consult if need be but DO empower yourself with knowledge before rushing off to the pharmacy with your script.

Even if you use the convenience of buying your oral contraceptives on line, discussing all aspects of birth control with a medical practitioner is essential when it comes to understanding and taking charge of your body’s health in regard to managing birth control- especially if you take oral contraceptives which affect your body’s hormone levels.

The doctor will know your medical history but maybe not know what type of lifestyle you lead so explain a bit about this first. Remember, this is your body, your future safety and happiness that’s at stake and you are about to make one of the most responsible and important decisions of your life, your partner’s life and the lives of your unborn children.

If you ask these questions and you don’t understand the answer you get back, be a little terrier and keep asking until you do.

1. Given my age and state of health/lifestyle, which method of contraception do you suggest for me?

2. Out of all the hormone based types of contraceptives, which is the most effective and are there any I cannot take due to my medical history or the medications I’m taking?

3. If I don’t opt for a hormone based contraceptive, what other alternatives are most effective?

4. Is an IUD an option for me and can it cause problems if I want to become pregnant later on?

5. How will ‘the pill’ affect my fertility and what do I watch out for re side effects?

6. Which form of contraceptive carries the greatest health risk?

7. If I ever want to get pregnant when should I stop taking the pill?

8. What should I do if I fail to use contraceptives during intercourse?

9. How and where can I get the ‘morning after’ pill?

10. I’m breastfeeding, what do I do about contraception?

11. Do you have information about natural birth control?

12. I don’t want kids for YEARS yet, is an implant a good option for me now?

13. Are there any other resources in my community where I can get help and advice on contraceptives?

14. We have enough children now, I need information on tubal ligation and vasectomy and whether or not these methods are reversible.

Here are a couple of books that I recommend, vastly different in price but both excellent.

The Contraception Sourcebook: From oral contraceptives and intrauterine devices to periodic abstinence and male contraception to the latest developments in the field, every form of birth control is covered in this book. Thought provoking and pragmatic, here at last is a comprehensive, intelligent guide to contraception.

Family Planning SourceBook: Family planning covers a wide range of issues related to pregnancy and contraception as well as how best to plan and prepare for having a family. The basic, straightforward information presented in this Sourcebook can help men and women deal with such concerns as methods of contraception and avoiding unwanted pregnancy. It also provides guidance on factors to consider when planning a family, why you should plan, and how to prepare for pregnancy.

When you ask your doctor for a prescription for your oral contraceptive, is it a quick ‘in and out’ visit? Are you in that clinic because it’s the closest to home or because old doc Brenchley has been the family physician since your mum took you there for your first measles jab? Or maybe you feel really uncomfortable about asking for contraceptives and have no idea where to go?

It’s time to be truthful, girls, the best person to assist you with your sexual health may NOT be the doctor who gave you your last prescription for antibiotics. Let’s face it, you shop around for the best insurance, pair of shoes and car so where your body and your health are concerned why would you not do the same?

It is SO important that you feel comfortable and relaxed with the person with whom you are discussing this most intimate topic. You should trust and have confidence in the person who is ‘partnering’ you in decisions that will affect your reproductive health and sex life. This new ‘relationship’ with your doctor is important- you want to invest in a ‘gold plated’ one as it will affect your personal lifestyle, your future and your ultimate happiness.

Ask yourself honestly- would I feel more at ease with a female doctor? Some clinics have doctors who specialise in reproductive health (gynaecologists) and also childbirth (obstetricians) Nurse practitioners can also write prescriptions and counsel you and many make great ‘confidantes’. YOU have the right to CHOOSE whom to trust this important aspect of your life to.

If you’re not sure where to go, ask a female friend or colleague for help or ring around some family planning clinics till you like the sound of a friendly, efficient voice on the other end of the phone! Do an internet search for your area. Check out health insurance plans and what costs you are liable for. Don’t feel that you are ‘locked in’ for life at one clinic -if you don’t feel comfortable after your first consultation, trust your intuition, go somewhere else! If you are a college student, find out who has a good reputation at the college clinic, what you are covered for and what medications, including oral contraceptives, will cost you.

When you make that first appointment to talk about birth control and oral contraceptives, check to see if you need to book a longer session. It’s a good idea to go between menstrual periods in case you need a pelvic exam. Oral contraceptives do not protect against HIV/STD’s so pick up some condoms on your way home too.
Information that your doctor will need if you ask for oral contraceptives (if you type it up once, it’s easy to update anytime and you’ll always have it handy if you change doctors)

• your medical and family’s medical history- (include all your close relations, your parents and siblings but also grandparents, aunts and uncles.)
• do you or your family members smoke, drink alcohol, or have specific medical conditions?
• do you have allergies?
• are you currently taking any medications (both over the counter and prescribed)?
• what is your menstruation history? (when did you have your first period? How long do they last? Blood flow- is it heavy, irregular? Are you periods painful ?)

If you use a diaphragm or cervical cap take it with you and don’t forget your medical insurance plan if you have one.

It’s YOUR body and your health and you have the right to have all your questions answered. The more information you can get the easier it is for you make a decision. The last thing you need is to feel embarassed, put off or intimidated by a health care provider who is eager to move on to the next patient. BE PREPARED for the consult before you leave home. Nervousness often makes us forget things so write down some ‘headings’ to remind you of the main things you want to find out.

Whether you are a ‘first timer’ about to begin your sexual journey or a seasoned veteran who could tell a few stories, it’s never too late to embrace the magic of your feminine power! Go forth, be safe and be protected.

For detailed information about different types of oral contraceptive pill, just click on each brand name below: Alesse, Desogen, Levlen, Mircette, Ovral and Ortho Tricyclen

This post follows on from an earlier one with more information about contraceptive IUD’s (intra uterine devices). An IUD is highly effective at preventing pregnancy and works by preventing fertilisation. Once inserted you can ‘forget it’ and your fertility status can easily be reversed by removing it.

IUD’s are recommended for cost effective, long term contraception and can be used by most women unless they have a history of cervical infections or genital cancer.

The newest form of IUD or IUS (intra uterine system) releases a progesterone like hormone called Levonorgestrel and is sold under the name Mirena (introduced in 2000 and believed to be more than 99% effective) Protection lasts for 5 years- maybe even longer and, unlike the copper IUD, this type of IUD does not have the potential to cause anaemia. The original copper IUD- known by the names: TCu-380A (most widely used) the Multiload ML375, and Nova-T380- is also highly effective and is preferred by some women as it does not contain hormones and therefore does not interfere with a woman’s natural hormone levels. Protection lasts for 5-10 years depending on type.

You will be thoroughly checked by a doctor to make sure that you are a suitable ‘candidate’ for the insertion of an IUD and you should use this opportunity to ask lots of questions yourself, however silly they may appear. IUD’s do not travel around the body or interfere with your heart. IUD’s do not cause pelvic inflammatory disease (PID) if you don’t already have one.

If you have gonorrhea, chlamydia or purulent cervicitis it is not advisable to have an IUD inserted as you may be at risk of developing a PID within the first 20 days after insertion.

Insertion-takes 5- 10 minutes

Your doctor will insert your IUD into the top of your uterus through your vagina during the first 12 days of your menstrual cycle or at any time when he is certain that you are not pregnant. Some mild cramping may occur after insertion. To see a diagram of where the IUD is placed go here.

Careful insertion reduces the chances of the uterus contracting and expelling the IUD and also avoids perforation of the uterine muscle wall. If perforation does happen (rate fewer than 2 per 1000) it is usually obvious and the IUD is removed at once without serious damage occurring.

Can the IUD come out on its own?

Unlikely if it is inserted correctly -but 2-8 women per 100 expel their IUD’s in the first year and usually within 3 months of insertion. Some studies show that young women, aged 20-25 and women who have not had children account for several cases within this range.

Side effects

There is a slight chance of infection if the IUD is not inserted carefully/correctly. Serious complications with IUD’s are very rare.

Copper IUD -The main reason that stopped some women using the copper IUD was increased bleeding and cramping, in some cases up to 50% above ‘normal’ levels prior to IUD use. The new copper IUD’s only ‘moderately increase’ blood flow. Increased blood loss can lead to a decrease in iron levels and subsequently lead to anaemia in women who are already low in iron.

Hormone IUD -can eventually decrease bleeding due to the thinning of the uterine lining caused by the progestin hormone. After a year of having an IUD inserted 20- 35% of women have no bleeding at all. Side effects of hormone IUD’s occur in fewer than 5% of women, (hormone is released in the uterus and is not processed by the liver) are similar to those experienced with oral contraceptives such as acne or other skin problems, back pain, breast tenderness, headache, mood changes and nausea.

What if I get pregnant when I have an IUD fitted?

The chance of you getting pregnant with an IUD insertion is rare. If you do conceive you risk severe complications such as miscarriage so go to your doctor immediately if you suspect that you may be pregnant and if confirmed, he will remove the IUD.

Are there any cancer risks with IUD’s?

IUDs may reduce the risk of cancer of the uterus but read this report for yourself.

A final reminder: IUD’s do not protect against HIV/STD’s.

Sources: Salem, R. “New Attention
to the IUD:Expanding Women’s Contraceptive
Options To Meet Their Needs.” Population
Reports, Series B, No. 7. Baltimore, Johns
Hopkins Bloomberg School of Public
Health,The INFO Project, February 2006.

This second post on contraceptive implants is packed with information so it’s a bit long but it IS timely, given the decision by the Department of Health in the UK to introduce a national campaign that aims to make young people more aware of contraceptive options. ‘Doctors will be told to advise young women they should not automatically opt for oral contraceptives and instead think about using newer methods that last between three months and five years.’ reports the Daily Telegraph. Women will be told to consider injections and implants instead of the Pill, in an attempt to reduce the number of unwanted pregnancies.

Regardless of country, every women has the right to be offered and counselled on ALL methods of contraception, with no bias implied unless individual medical history prevents some types of contraceptive from being safely prescribed. In Britain, it seems that for 3/4 of women, this does not happen (APPG survey).  Surely, for a public campaign, the focus should be on educating and empowering everyone to make their OWN informed choice according to their own circumstances, not steering them to ‘long term’ contraception with contraceptive implants and injections?

SO, to inform and empower you, here are a few FAQ’s and answers to some common misunderstandings about the ‘new generation’ contraceptive implants :
(read the earlier post on the effectiveness of contraceptive implants and how they work)

If you have a specific question, do a quick scroll down to find the answer.

Do I have to undergo any pelvic or breast exam before I use an implant? NO
Do I need a blood test? NO
How long do the new implants work?
Jadelle is currently labelled for up to 5 years of continuous use
Sino-Implant (11) is labelled for up to 4 years of continuous use
Implanon is labelled for up to 3 years of continuous use

Does it hurt to have a contraceptive implant inserted and removed?  A local anaesthetic is given first and most women say it doesn’t hurt as much as they expected though removal may hurt a bit more than insertion.
Will I have a scar? Possibly a tiny one after some bruising but the implant is inserted with a hollow needle in the doctor’s clinic then bandaged, no major surgery is needed.
Will the implant be visible? NO, not unless you are VERY thin but you can feel it under the skin.

How soon am I protected? After 24 hours but remember that unless you use a condom aswell, you are NOT protected from STD’s.
Do I need a follow up visit to my doctor? NO, not unless you have any concerns.
Will an implant make me infertile? NO, fertility resumes with normal bleeding patterns after removal of the device.
Can the implant move around my body? NO. Very rarely a rod may start to come out because it was not inserted correctly or infection has occurred (in the first 4 months). Go straight to the doctor.
Do implants interrupt a current pregnancy? NO and they will not harm a fetus if you get pregnant during use.
Do contraceptive implants cause cancer? NO, studies have not shown increased risk but if you have or have had breast cancer implants are not for you.
Will an implant make me ‘moody’? Generally NO, some women complain of this side effect but the majority don’t- some even report an improvement in mood changes and sex drive.

Will a contraceptive implant change my sex drive? There is no evidence for this.
I am breastfeeding-will a contraceptive implant affect my baby? Wait for 6 weeks after the birth then an implant will be permitted and is deemed to be safe.

I am overweight - can I use a contraceptive implant? YES but you may need to have it replaced earlier than its recommended ‘life span’, depending on the brand.
I have HIV, can I use a contraceptive implant? YES but use a condom also
I have abnormal vaginal bleeding- does this mean I can’t use implants at all? NO, not necessarily but get a proper diagnosis and treatment first then ask to be re-evaluated for an implant.
I have a liver disease- can I use a contraceptive implants? NO, hormonal contraceptives are not for you.
I’m a heavy smoker and I’m over 35 years old- can I use an implant? YES. Contraceptive implants contain a progestin hormone, not estrogen which increases the risk of blood clots. However, if you suffer from serious clotting in your legs or lungs, contraceptive implants are not suitable for you.
Can I go back to work after having a contraceptive implant inserted? YES, providing you do not bump the insertion site or get it wet.
Can an implant be left in my arm permanently? It will not do you any harm but beyond its effective lifespan it will no longer be releasing its hormone and providing you with protection so this is not recommended. You will be given a reminder card with the type of implant on it and the dateby which it should beremoved.

WARNING: If you are taking ANY medications for seizures, tuberculosis or other illnesses they may reduce the effectiveness of a hormone -delivering, contraceptive implant so make sure you discuss contraceptive alternatives with your doctor.

That was a lot of information to get through but I hope you found it valuable. If you want a brief handout to take with you to the doctor’s GO HERE.

Sources: Ramchandran, D. andUpadhyay, U. D. “Implants: The Next Generation.”Population Reports, Series K, No. 7. Baltimore,INFO Project, Johns Hopkins Bloomberg School of Public Health, October 2007

‘Family Planning- a Global Handbook for Providers’.

A remote controlled contraceptive for guys- could this be the ultimate ‘boy’s toy’?

You can stop holding your breath for the male contraceptive pill or putting out for your man to choose a vasectomy (my ex did bless him, or I may have ended up with 4 to bring up alone!) Living in Melbourne, I have to say “Go the Aussies!” for this radio controlled device that, wait for it, controls the flow of sperm from your lover’s testicles to his penis. All design components have been finished and lab tests with pressurized water are the next step. Live pigs and sheep watch out- you’re next.

New Scientist has just released information about a male contraceptive implant that is being developed at Adelaide University, Australia. The device is an open/close micro valve that is placed inside the vas deferens ( tube leading from the testicles that is the sperm ‘highway’ to the penis) When closed, the valve blocks off the sperm and only allows those little swimmers to resume their merry way again when it is opened by a radio controlled switch. Whatever next!?

Vasectomies are usual permanent and often irreversible  ( a physician can use a needle to remove sperm from the testicles and then perform in vitro fertilization) but this little sweetie looks like being much more user friendly, with high hopes of easier and more successful reversal. The valve will only be offered to men who are considering a vasectomy anyway, as there are still fears that over time, proteins could clog the device closed and cause permanent infertility. After initial insertion there will be a ‘cooling off’ period when the procedure can easily be reversed so this will give peace of mind to those who may later decide they want more children after all.

New Scientist states, ‘The silicone-polymer valve can be flipped between open and closed positions with a pulse of radio waves. A set of conducting “fingers” on the valve act as antennae and convert the signal’s energy into sound waves that travel through the polymer and create stresses inside the device.’ Team leader Said Al-Sarawi explains,”Since it is flexible, the polymer either contracts or expands as a result, and this movement allows the valve to be opened or closed as needed”.

“It will be like turning a TV on and off with a remote control,” added team founder Derek Abbott, “except that the remote will probably be locked away in your local doctor’s office to safeguard against accidental pregnancy or potential misuse of the device.” In case you’re wondering if the device can be turned on accidentally- NO because it works in a similar way to a car’s remote key-fob. Each valve responds only to a radio-frequency signal with its own unique code.

How is the male contraceptive implant inserted? No open surgery is needed but the needle squeamish guys out there will have to look away as the hypodermic snugly ‘push fits’ the little micro valve into position. Is another male contraceptive needed as well? You betcha, unless you are with one ‘clean’ partner- use a condom if you wish to avoid catching an STD.

I do hope they give the implant a nice name, if a dog is currently ‘man’s best friend’ he may soon find himself with a rival.

Contraceptive Implants have had a bad reputation in the past and are not as popular in America as the contraceptive pill. However, this site is about empowering you to make informed decisions about all types of contraceptive options so I’m presenting a 2 part post on contraceptive implants to provide you with the latest facts. Why 2 parts? I recently participated in a worldwide, on line forum on contraceptive implants, where I acquired a wealth of knowledge about this method of birth control. The reading ‘homework’ alone gave me access to a huge amount of the latest information but in order to distil the main facts for you it’s best if I split it up into two posts. In this first post let’s find out exactly what contraceptive implants ARE and how they work in your body.

Contraceptive Implants have come a long way since the earliest clinical trials in 1968.
Although no single contraceptive method is perfect or appealing to all, contraceptive implants fulfill a very important need when it comes to preventing pregnancy- especially for young women who want to put off having children for a few years or women who do not want any more children. The success rate of contraceptive implants is extremely HIGH- with less than one pregnancy per 100 females using implants over the first year. This means that 9,995 of every 10,000 women using implants will not become pregnant. The effectiveness of contraceptive implants is comparable to IUD’s and vasectomy in men and is claimed to be better than female sterilization. Implants are completely reversible upon removal and do not affect fertility.

What are Contraceptive Implants?

The ‘new generation’ implants are small, thin, flexible plastic rods, each about the size of a matchstick, that release a small amount of progestin hormone into the blood, either levonorgestrel (Jadelle, Sino-Implant (II)) or etonogestrel (Implanon) into the body. The implants are inserted into the inside of the upper arm, just under the skin and are invisible unless you are very thin. Progestin prevents pregnancy by thickening cervical mucous to make it really hard for those little spermies to reach the uterus-it can also prevent ovulation. Norplant was the first well known brand of contraceptive implant introduced in the 1980’s but this ‘6 capsule’ form of implant is being discontinued this year in favour of the other mentioned types which are quicker and easier to insert and remove.

Contraceptive Implants do not contain estrogen- so may be an option for women who are intolerant to estrogen and also women who are breastfeeding (starting 6 weeks after birth)

Contraceptive Implants do not protect against STD’s

Contraceptive Implants are not experimental- they have been approved by the FDA.

Why do some women like Contraceptive Implants?

• do not need user to attend to them once they are inserted
• pregnancy is prevented VERY effectively
• are long lasting
• don’t interfere with sex
• have no known health risks

Why do some women not like Contraceptive Implants?

• changes occur in vaginal bleeding pattern (prolonged irregular bleeding during the first year, then lighter, regular or infrequent bleeding. Up to 1/3 of women using contraceptive implants report no bleeding at all after 1 year)
• headaches, abdominal pain and other side effects may occur (not a sign of illness and these usually stop or become less during the first year )

Who can use Contraceptive Implants?

Implants are safe for nearly all women, including adolescents and women over 40, whether or not they have had children, had an abortion, miscarried or had an ectopic pregnancy. Women with HIV, varicose veins, anemia and YES smokers can use contraceptive implants!

If you are considering using contraceptive implants yourself- you need extended appointment time with your doctor to thoroughly discuss all aspects before committing to this method of birth control. You need to weigh up the acceptability and management of any side effects (especially the change in bleeding patterns) when assessing the advantages and effectiveness of contraceptive implants. Family planning groups insist contraceptive implants are almost completely effective at preventing pregnancy and have fewer side-effects than the combined contraceptive pill. Contraceptive implants are now approved in more than 60 countries around the world and have been used by approximately 11 million women worldwide (Bongaarts and Johansson, 2000).

In the next post I shall list some FAQ’s and address some misunderstandings about contraceptive implants that will be an essential guide if you want to discuss this form of contraceptive with your doctor.

Source: Info project, Centre for Communications, Johns Hopkins Bloomburg School of Public Health