Contraceptives

PLAN your ‘contraception career’- learn about LOW DOSE birth control, side effects and contraceptive options

Contraceptives OR Abortifacients? Is There a Difference?

WHEN contraceptives actually work in your body could make all the difference as to how you feel about selecting one- especially where religious tolerances are concerned and ‘abortion’ in the purest sense of the word is a real issue for you.

We use contraceptives mainly to ensure that we don’t get pregnant. “Getting pregnant” means that his sperm has fertilized your egg and a baby is on the way right? Well, that all depends on WHEN you believe a new life has begun. Is it at fertilization or a bit later- before, during or after the fertilized egg has implanted itself into the wall of your uterus?

Selecting a method of contraception may be more confusing and stressful for you if your religion has certain beliefs around when a new human life begins. Seek counseling and accurate information on this issue so that you can be satisfied that the type of contraceptive you eventually choose does not conflict with what you personally believe. I acknowledge that if you are against abortion you may also be against methods of birth control that are not ‘natural’. I list options below for information only.

Family planning professor, John Guillebaud has examined many sources of information on contraceptives and WHEN they work regarding fertilization and implantation and, as this site aims to address all aspects of contraceptives, I thought it wouldn’t hurt to summarise some of his study findings to help those of you who face this dilemma. Professor Guillebaud’s personal view is that implantation is the biological event that separates family planning from abortion. If you are unsure about the physiological changes that oral contraceptives cause within the uterus itself, I strongly recommend that you also read the whole of this post- it may just help you make the final decision.

Let’s look at WHEN Oral Contraceptive Pills Work

The active ingredients in the combined oral contraceptive pill prevent ovulation and therefore prevent fertilization so there is nothing to implant. For this reason they are not classed as ‘abortifacients’. Their capacity to activate their ‘back up mechanism’, that of obstructing implantation of a fertilized egg, is what puts oral contraceptives into the ‘gray’ area of the purist abortion debate.

The progestin only pill sometimes acts after fertilization (with the exception of Cerazette) because in some women it permits ovulation to happen therefore an egg could be fertilized. However, if taken correctly and on time, it is scientifically proved that these pills also act prior to fertilization and do not have to ‘use their back up mechanism’ to block implantation.

Obviously if you regularly forget to take your combined oral contraceptive pill, (particularly a low dose one) you risk ovulating.

It is the lengthening of the pill free period that causes pill failure pregnancies and ‘near misses’- NOT forgetting to take a pill at other times. Even if ovulation does occur without subsequent pregnancy, it does not follow that the pill acts post-fertilization: the hormones in the oral contraceptive thicken the cervical mucus and block the sperm’s journey to the egg.

Professor Guillebaud states “Most experts believe that if sufficient pills were missed to cause the mucus mechanism to fail as well, there still wouldn’t be any interference beyond fertilisation; the anti-implantation effect (being the COCP’s weakest contraceptive effect) would fail also, leading to conception. Of course, one couldn’t be certain of this over many years of forgetful pill-taking. Still, we are talking about a forgetful pill-taker taking one of the weakest available pills.”

Depo-Provera

This type of contraceptive prevents ovulation and is delivered by an injection given ‘on time’ every 3 months. If you are worried about possible fertilization happening (and implantation subsequently being disrupted) you can opt to have the injection every 10 weeks instead of every 12 weeks. This will ensure that ovulation is always blocked and (for you) the unacceptable back-up mechanism is never used.

Please note: According to Alison Edelman, M.D., an assistant professor of obstetrics and gynecology at Oregon Health Sciences University, in Portland, Depo can delay fertility for up to a year and a half (the average is six months) With the other hormonal methods, including the Pill, it’s possible to become pregnant within one to three months.Intrauterine contraceptive devices (IUCs or IUDs)

IUDs contain copper or Levonorgestrel. Copper is toxic to sperm. Devices containing Levonorgestrel act as contraceptives by thickening cervical mucus to block sperm from traveling to the egg. Both types also keep the uterus lining thinner than normal to make implantation difficult. Using this type of contraceptive, which also acts after fertilization, could be a dilemma for you if you believe that life begins at fertilization, not at implantation.

If you believe that blocking implantation is abortion and you are also a hopeless pill taker, here is a list of contraceptive options that you may wish to consider:

  • Male and female sterilization- vasectomy, tubal ligation or Essure insertion
  • shorten the pill free period of your combined oral contraceptive pill to 4 days instead of 7 and/or use a tri cycle regime-in which the pill free interval is eliminated usually for four, three or sometimes two monophasic pill cycles (for better bleeding control) and then also shortened after each run of packets.

Implanon prevents ovulation and is a contraceptive device that is inserted underneath the skin on the inside of a woman’s upper arm. The hormone content and actions are very similar to Cerazette. Implanon should be replaced every three years. Implanon acts prior to fertilisation and does not have to ‘use the mechanism’ to block implantation.

Full breast-feeding - combined with the ‘mini pill (progestin only) or the Depo-Provera injections. During weaning there is a risk of ovulation so back up contraceptives should be used.

Coitus interruptus- also known as ‘withdrawal’ or ‘being careful’, is better than using no manufactured contraceptive but is not the most effective method of birth control. Even those little sperm in that first drop of fluid swim very fast into the uterus and are up into the Fallopian tubes before you know it!

Natural fertility management- charting your temperature and checking the thickness of your cervical mucus helps you to estimate your ‘infertile days’ when there is little risk of pregnancy.

Male and female barrier methods and spermicides- including condoms, the diaphragm and the cervical cap.

The home pregnancy test kit

This kit measures a hormone in a woman’s blood called hCG (human chorionic gonadotrophin) If hCG is present the test shows a positive reading BUT hCG only shows up AFTER IMPLANTATION (which occurs six to twelve days after fertilization) of the fertilized egg into the wall of the uterus. hCG (nor any other embryo-specific substance) does not show up while contraceptives are in use. This means that any method of contraception linked with the presence of serum hCG would be off-limits to someone requiring a contraceptive that only operates BEFORE fertilization.

Source: www.cmf.org.uk

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Contraceptive Implants- FAQ’s and Misunderstandings

Filed under: Contraceptive Implants, Female Contraceptives-types, Hormonal Contraceptives-Types — admin at 2:05 am on Friday, February 8, 2008

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’.

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