Contraceptives

If you use low dose birth control did you consciously PLAN it as part of your ‘CONTRACEPTION CAREER’ (which could last 30 years or more) or are you just living month to month and automatically getting those prescriptions filled? Whether or not to bring another human being into this world is a huge decision for anyone, regardless of age and can often be one that is forced upon you when the timing really couldn’t be worse. If babies are not definitely NOT part your agenda for several years yet, it’s a good plan to consider long term contraception methods now and find out which are the best for you. There are several ‘low dose’ options and some that do not contain hormones at all.

Low dose birth control pills, IUD’s, patches, injections or implants are used for long term contraception. Which should you choose? Several factors will determine if long term contraceptives will be suitable for YOU and other factors may influence IF you wish to use them at all. See my post on patches.

Low Dose birth control pills are also prescribed for the treatment of some medical conditions, apart from preventing pregnancy and if this applies to you it is really important that you give your health care provider (who may not be the doctor who prescribed your ‘pill’) all the details before discussing long term contraceptive alternatives.

Answer the following questions before you talk to your GP (and if you have a long time sexual partner, involve him or her too) then you’ll be armed with the basic information to help you to choose the best long term contraceptive ‘mix’:

• do you have any religious restrictions on the type of birth control you use?
• do you have any serious health problems? Your personal medical history and lifestyle will affect which long term contraceptive options (if any) are suitable for you. Low dose birth control types contain synthetic hormones, including IUDs, may be a ‘No No’
• will expense be a major factor in which contraceptive method you choose? eg. low dose birth control pills will take a bigger chunk out of your budget over a 5 year period than a low dose Mirena IUD
• do you have multiple sexual partners? Protection from STD’s (condoms)may also be needed alongside a ‘no worries’, long term contraceptive. Pelvic inflammatory disease should be explained to you in the same conversation as IUD’s
• how long do you wish to delay having children, one year, 3 years, 5 years or longer? If you already have one child and intend having more, how far apart would you like them to be spaced?
• do you want a reversible or an irreversible method of contraception? Your family may be complete yet you may still have many fertile years ahead of you
• do you want a ‘no care’ /low maintenance contraceptive? Hormone injections need to be given every 3 months. IUD’s and implants do not require this attention by the user and stay in place for years.
• can you tolerate estrogen in a synthetic form? Some long term contraceptives, such as injections, (Depo) implants and the Mirena IUD- do not contain estrogen but release a low dose birth control hormone, levonorgestrel daily (about 12- 20mcg) The recommended dose of depo provera for effective contraception is 150 mg every three months. The contraceptive protection of depo provera starts as soon as you have the first injection.
• is vasectomy an option? Vasectomy is currently a long term contraceptive option for men and definitely a ‘NO dose hormone method of birth control for both of you! Vasectomy is generally irreversible. How does you partner feel about this? It’s a good idea to talk this over as rationally and calmly as you can before you go to the doctor.

Like vasectomy, tubal ligation for women and insertion of the Essure device are two permanent contraceptive methods that should be ‘counselled’ before being selected. Neither of these methods are low dose birth control as no hormones are involved. Essure is a non surgical form of long term contraceptive that comprises a fine coil which is inserted into a woman’s fallopian tube. The coil causes natural scarring to occur and the resulting tissue subsequently blocks the tube. Obviously there are far fewer ‘operative’ risks with this method than with tubal ligation and you can watch the procedure being performed on a monitor. Side effects are associated with long term contraceptives, even low dose birth control types - some women may notice no change at all, others end up trialling several different contraceptives in a quest to find one that suits them. We all respond to medications in different ways, even vitamins, so thorough investigation, education and consultation with a physician about long term contraceptives is a must.

There is no ‘perfect’ contraceptive.

I bet you go to great lengths when it comes to choosing other things that impact on your life, like your house, your job or even a holiday destination, well…this is your one and only living, changing and ageing BODY we are affecting here, not to mention the future of your entire life (and of those you love) so….surely a bit of research (like you’re doing now) and a good chat with a medical professional is a small investment when the pay off is years worth of great sex and ideal family planning? (many experts recommend 21/2- 3 years between each child) Short spacing can take its toll on a mother’s health and adversely affect other siblings.

There is great joy in ‘making babies’ together when both partners are ready to bring up children. While rearing another human being is without doubt the hardest job in the world, nothing else comes close to the rewards it brings. An unplanned, unwanted pregnancy can bring great distress and sadly, children often end up paying a very high price for their ‘parents’ mistake.

Depending on which country you live in and which study you read, unplanned pregnancies are as high as 50-60%, even with the use of contraceptives. Forgetting to take a pill or using contraceptives improperly is common practise and can lead to unwanted pregnancies, strained relationships and emotional anxiety. Long term contraceptives reduce the likelihood of user error, afford peace of mind and relieve anxiety for longer periods - you just have to be sure they are right for you. There’s a video you can watch HERE from an earlier post.

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.