Contraceptives

Do you participate in one of today’s highest risk activities- taking oral contraceptive pills and smoking, especially if you are over 35 years of age, babies are off the agenda but you enjoy a great sex life AND your ciggies?

Why does your heart beat faster and faster? Why do your blood vessels get narrower?

We all know that smoking is bad for your lungs and can cause cancer and it is also a fact that taking contraceptive pills and smoking does place women at a much higher risk of developing heart disease or having a stroke than taking oral contraceptive pills and NOT smoking. So, yes, smoking is the major villain here and in case you didn’t come top of the class in Health Ed. but you’re still a little bit interested in what happens inside your circulatory system (the arteries and veins that carry the blood throughout the body) when you smoke, take a look HERE at this easy to read explanation from JAMA (Journal of the American Medical Assocn). If you do, you’ll feel like a ‘know it all’ and and I’ll feel better that I gave you the option as ‘back up’ to your ‘contraception education’.

I have never smoked so it’s easy for me to recommend which activity to give up if you love your baby free, happy sex life and are up for a challenge - maybe after reading the JAMA page you’ll learn to love your throbbing pink circulatory system more than those deathly white cancer sticks (ouch) Contraceptive pills and smoking just ain’t good bedfellows!

Contraceptives, especially oral pill types, come in hundreds of brand names but what is really important and relevant to YOU is how they are classified. What does this mean and do you care so long as they suit you? Well, I think you’ll find you’ll get much more attention (and gold plated service?) from your health care provider if he/she hears you asking about ‘monophasic’, ‘low dose combined’ and progestin only’ pills when you are considering which contraceptive pill will give you the least side effects.

Oral Pill Types Explained

This is an introductory explanation of the different types of oral contraceptive pills that may help you to select the one that is best for your body and if nothing else will place you in a position of strength during that consultation. 50 years on, we have discovered that the oral contraceptive pill for women still prevents pregnancy if it is made up of much lower doses of estrogen and progestin than in the early days. ‘The Pill’ used to contain 50-100 micrograms of estrogen and today it contains only 20-35 micrograms, with researchers trying to reduce this amount further to reduce side effects. Synthetic hormones (estrogen/ethinyl estradiol and progestin) used in contraceptive pills mimic the natural hormones (oestrogen and progesterone) produced by the ovaries, adrenal gland and liver.

Estrogen’s main job in the contraceptive pill is to prevent ovulation (release of an egg from a woman’s ovary). Progestin in the pill, while it does have some intermittent effect on ovulation (about 50% of the time) is relied on mainly to thicken the mucus around the cervix to stop sperm from getting through to an egg.

Contraceptive Pills come in two basic types: single hormone pills (progestin only) and combination hormone pills (estrogen + progestin) Pills are supplied in two basic packs- 28 day pill packs= 3 weeks of active hormone pills +1 week placebo pills and 21 day pill packs= 3 weeks of active hormone pills with no placebo pills.

PROGESTIN only pills (the ‘mini pill’) do not contain estrogen and only have a small amount of progestin in them. Breastfeeding women are often prescribed these ‘mini pills’ (estrogen may cause a reduction in milk supply) as well as women who cannot take synthetic estrogen for medical reasons. Side effects are less than pills containing estrogen and they are not associated with heart disease, however, irregular bleeding /spotting/mood swings may occur. Progestin only pills MUST be taken at the same time each day and are affected by vomiting or diarrhoea.This type of contraceptive pill is not affected by antibiotics.

COMBINATION PILLS- contain estrogen and progestin and can be further categorized as being Monophasic, Biphasic or Triphasic- so what do these terms mean? Pills are put into these categories according to whether or not the levels of hormones they contain stay the same throughout the first three weeks of a woman’s menstrual cycle (in 28 day pill packs, the pills for the fourth week in the pack are placebo or ‘reminder pills’ that are inactive and do not contain any hormones)

MONOPHASIC Pill- is one that contains the same amount of hormones in every ACTIVE pill so you are less likely to have mood swings as your hormone levels do not vary much throughout the month. Popular monophasic pills include:Alesse,Brevicon,Desogen, Levlen, Levlite, Loestrin, Modicon, Nelova, Nordette, Norinyl,Ortho-Cept, Ortho-Cyclen, Ortho-Novum, Ovcon, Yasmin. In 2003 the FDA approved a new packaging of a monophasic contraceptive pill called Seasonale. This pill is taken for 91 days, during which no periods occur -so in one year, women taking this pill will only have 4 periods (for the first year though, expect the same no. of menstrual days as with a traditional contraceptive pill till your body adjusts)

BIPHASIC Pill- is one that contains different amounts of hormones throughout the pack. These pills alter your hormone levels once during your cycle by increasing the dosage of progestin about halfway through your cycle and are thought to better match your body’s natural production of hormones- they contain smaller doses of hormones in total than monophasic pills. However, insufficient evidence has been gathered to favour these pills over monophasic ones, where much more reliable data is available so monphasic pills are preferred. Breakthrough bleeding has been reported as a side effect with these pills. Popular biphasic pills include : Jenest, Mircette, Necon 10/11, Nelova 10/11, Ortho-Novum 10/11. Attempts to decrease side effects led to the three-phase pill in the 1980s.

TRIPHASE Pill- is one that contains 3 different amounts of hormones in the ACTIVE pills over three weeks, i.e. a change in hormone levels within the body occurs every 7 days for the first 3 weeks.. The dose of estrogen is gradually increased and in some pills, the dose of progestin is also increased. Whether three-phase pills lead to fewer pregnancies than two-phase pills is unknown. Nor is it known if the pills give better cycle control or have fewer side effects. Look for the ‘TRI’ on the label such as:Ortho Tri-Cyclen, Triphasil, Tri-Levlen, Trivora, Tri-Norinyl, Cyclessa, Ortho-Novum 7/7/7.

The Best Pill to Take? All contraceptive pills are effective if taken correctly, with combination pills (containing estrogen and progestin) being more effective than the low dose ‘mini pill’. Monophasic pills may be the best to start with- they are cheaper and those with lower amounts of estrogen may have fewer side effects (but more breakthrough bleeding)

Always use back up (a condom or diaphragm) for the rest of the month if you miss a pill. Trial and error, side effects and talking to your doctor should help you to find a contraceptive pill that suits your body. Pregnancies occur mainly when women forget to take a pill or take them incorrectly, vomit, get diarrhoea or, in the case of the mini pill, do not take pills at the same time each day. It is very easy to start a pill packet late if you just forget or if you don’t have the next new packet on hand. The most dangerous time to miss a pill is at the end or beginning of a packet because it lengthens the pill free interval beyond seven days which means that you may not have absorbed sufficient synthetic hormones to prevent you from ovulating in the next month.

Phew! Well, that was a marathon read but at least you have some reference information and a few brand names to discuss with your doctor- not all of these brand names will be available in each country but there will be some generic brands that will be a ‘match’ for the types of contraceptive pill explained above.  Good luck!

Low Dose Birth Control Pills Minimize Side Effects

Today’s oral contraceptive pills,  called ‘new generation contraceptives’,  contain much lower doses of synthetic hormones than in the 1960’s when ‘The PILL’  (with 50 micrograms of estrogen) first went onto the market. “So how does that benefit me?”, you may be saying to yourself - here’s some information about low dose oral contraceptive pills that may help you to talk to your doctor if you’re not happy with the oral contraceptive that you are currently taking.

Trial and error with different pill types is likely to be ahead of you -bearing in mind that oral contraceptives are still not the perfect method of birth control for everyone. If you are on the ‘right pill’ to suit your body, you should feel exactly the same way as you do normally, if not a little better. Some women cannot tolerate the estrogen in combined oral contraceptive pills so are prescribed progestin only pills.  Estrogen seemed to be the main culprit where side effects were to blame so low dose  birth control pills were developed to minimise these.

Changing hormone levels within your body can result in side effects which vary for every individual. Keeping hormones at  a consistent level in your body is the job of an oral contraceptive so that you do not ovulate, your uterine lining thins and your cervical mucous thickens. These three events work together to prevent pregnancy.

Pills such as ALESSE and MIRCETTE are called ultra low dose birth control pills as they contain only 20mcg of estrogen. These oral contraceptives are effective at preventing pregnancy but some women find that they have more spotting and breakthrough bleeding with them than with pills containing 30 or 35 micrograms (considered the norm today) of estrogen. Spotting and breakthrough bleeding often disappear after a few months on a low dose birth control pill.

Women who prefer ALESSE and MIRCETTE say they reduce headaches, mood swings, breast tenderness and bloating. These two brands also may be better for ‘first timer pill users’ as a ‘low estrogen start’ to introducing synthetic hormones into their bodies.

Progestin only pills or ‘mini pills’

These oral contraceptives are 90-95% effective at preventing pregnancy compared to the 99% efficacy rate of combination pills.  However,  they do not cause the common side effects of estrogen pills such as nausea, breast tenderness and cramps. The risk of developing deep vein thrombosis and cardiovascular disease is lower with progestin only pills. Nursing mothers can use progestin only pills a few weeks after giving birth as progestin does not affect milk supply like estrogen does. ‘Mini pills’ must be taken every day at the same time with no break.  If you miss just one pill or take it more than three hours past the regular time, you need to use a backup method of birth control for 48 hours after taking the late pill.

Disadvantage of the ‘mini pill’ - apart from irregular spotting and breakthrough bleeding, is that it can increase the risk of ovarian cysts and ectopic pregnancy.

Latest Update

Low-dose birth control pills may increase risk for heart attack or stroke, especially in women who suffer from polycystic ovary syndrome (PCOS) or metabolic disorder. However, this risk disappears when you stop taking the pill (according to a Virginia Commonwealth University study published in the July issue of the Journal of Clinical Endocrinology and Metabolism).

PCOS is a condition that can affect a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels and appearance.

“Despite the doubling of risk associated with the pill, the absolute risk for a cardiovascular event in an individual woman taking the pill is low - Women using the pill are not going to automatically have a heart attack,” states John Nestler, M.D., professor and chair of the Division of Endocrinology and Metabolism in the VCU School of Medicine. “However, our findings do raise the issue of whether oral contraceptives are optimal therapy for certain groups of women who are at baseline risk or who are taking the pill for a longer time, such as women with PCOS.”   Source: http://www.medicalnewstoday.com

So if you don’t have PCOS and you think a low dose birth control pill may suit you better, read more about Alesse and Mircette before asking your doctor which brand would ’suit’ your own medical history. Don’t forget to tell him/her which other medications you are also taking. The suppliers I have recommended on line are accredited and also offer the best prices.

Sources: Centers for Disease Control and Prevention, Dr. Elizabeth Silverman,  obstetrician-gynecologist at Scripps Memorial Hospital in La Jolla. Dr. Pamela Deak, obstetrician-gynecologist at the University of California San Diego Medical Center.

It’s a good idea to start your ‘contraception career’ with a hormone check up first so that you and importantly, the person who will write your contraceptive pill prescription, knows exactly what state your body and its hormones are in. I thought I’d pass on this information from a doctor’s newsletter I subscribe to (link to Dr. Pete below) as it is relevant to anyone who is thinking of taking oral contraceptives AND also to those who aren’t.

OK. Let’s say you are NOT on the pill- if you suffer from painful, heavy or irregular periods, irritability and mood changes, (yes, I did say NOT on the pill!) poor memory, fatigue, lack of motivation, craving sugar and chocolate, fluid retention, bloating, night sweats, hot flushes,… it could be that your hormones are out of balance. If you haven’t seen a health professional about these symptoms maybe you should- especially if want to use any type of hormonal contraceptive.

Many of us know first hand the impact that a hormone imbalance can have on every breathing moment of your waking life AND how it is maddeningly and frustratingly underestimated by ‘himself’ and the kids! Taking oral contraceptives and hormonal replacement therapy (HRT) can be beneficial in adjusting hormone levels and reducing symptoms. However, some women find that they then replace one set of side effects with another so getting a hormone check before you start down that path will place you and your doctor in a position to make the most sensible and appropriate choice to trial first.

The ingredients (synthetic hormones) in contraceptive pills are often prescribed to alleviate painful periods and other symptoms rather than to prevent pregnancy. We in the western world are having fewer children on average and experiencing approximately 400 periods during our reproductive life. Even if we only have one painful day each cycle (you wish!) that equates to an average of 400 days, or more than ONE YEAR OF PAIN. According to Dr. Pete, if you accept that 90% of women experience period pain, this has the potential to create a significant health
and socioeconomic issue.

IN SUMMARY Dr.Pete states:

Hormone Imbalance causes:Period Pain, Premenstrual Syndrome, Endometriosis, Fibroids, Poly Cystic Ovarian Syndrome (PCOS) and Menopause.

What Interferes with Hormone Balance?

• “oestrogen dominance”, associate with fertility problems- this is where high or relatively high (compared to progesterone) levels of oestrogen

activity cause increased tissue activity in oestrogen-sensitive tissues, such as the lining of the uterus, ovaries and breasts

• poor liver detoxification, which is often due to allergies, food intolerances or toxins, results in a build up of harmful oestrogen break down

products

• many environmental chemicals such as pesticides

Get to know your hormones and hopefully they’ll behave themselves for many years - Having a check up at the doc’s could save you a few prescription ’swaps’ in the long run and help you to successfully manage those controlling little juices.

If you would like to join Dr. Pete’s newsletter here is the LINK

You’re probably wondering, ‘What on earth can a cup of cottage cheese have to do with me taking oral contraceptives? If moodiness is a side effect you suffer from- you need to read this. Personally, I am not a pill popper and much prefer to use ‘natural’ products whenever possible, including good quality, non synthetic supplements that have not been tested on animals. At the end of this post I have provided some links to an on line, direct supplier for this type of supplement, this source also has natural skin care products, shampoos, weight loss products and yes, even a ‘natural libido booster’ if life is a little ‘quiet’ for you right now!

Did your doctor tell you that oral contraceptives can increase your hunger (so you eat more and gain weight!) and also that they can deplete your body of certain essential nutrients? As though refined foods and sugary treats weren’t enough!

Have you been taking an oral contraceptive for more than 7 years? If so, it is likely that you are deficient in some nutrients and should be taking a supplement. Research has shown that the B group of vitamins are the most commonly depleted nutrients when taking oral contraceptives. Vitamin B is critical to keeping your nerves healthy (hence they are often sold as executive ’stress’ vitamins)

A high-potency, B-complex vitamin (with at least 50 -100mg of B6, 1,000 meg of B12, and 800 meg of folate) should be taken alongside contraceptive pills. An increased need for vitamins C (1-3g, yes, not mg), E,(400-600 IU’s) and K may also result from the use of birth control pills- Vit C especially can help to reduce the chance of vaginal infections.

Cells that are replaced frequently, like those in the mouth and gut can become ulcerated if folate is depleted.
Folic acid is a relative of Vit B and is important for brain health as well as cell repair and development.

You may never have heard of Tyrosine but you’ve probably heard of amino acids. Tyrosine is an amino acid which has many ‘jobs’ in your body but one is to keep your thyroid healthy. Low tyrosine can also contribute to depression. Depletion of tyrosine is one of the reasons ‘the pill’ is often associated with weight gain and moodiness. AH! Is that a penny dropping? OK , next time you pop out to collect your prescription for Alesse or other oral contraceptive pill, grab a tub of cottage cheese from the supermarket as this is the highest food source of tyrosine: 1 cup provides 1.5 g. (or you can take a supplement -1.5 g daily), particularly during the second half of your menstrual cycle.

It is likely that we are all slightly short of magnesium anyway so women who take oral contraceptives can become even more depleted. deficiency often shows itself as muscle cramps, weakness, insomnia, kidney stones, bone loss, depression, nervousness, anxiety and high blood pressure. Take 500 mg at bedtime in a liquid or powdered form for easy absorption.

Copper levels in the blood may be increased by the use of oral contraceptives which can lead to depression and
emotional problems. Limit supplement to 1mg. Whole grains, nuts, seeds, and vegetables will ensure that copper requirements are met.

If you normally take an iron supplement you may not need it if you take oral contraceptives. Iron levels may increase when you are on the pill as there is often less blood loss. Iron needs are probably reduced from the usual 18 mg. to around 12-15 mg per day. However, if your periods are heavy or you have anemia then you may need a different dose of iron. Check with your doctor first.

Zinc is another essential mineral depleted by oral contraceptives and is important for wound healing and combatting depression; supplement with 20 to 50 mg daily, which will also help to reduce copper levels.
“As if I don’t have enough side effects to worry about!”- well, at least a quick blood test will show you exactly where you stand with your body’s nutrients and you never know- that tub of cottage cheese may be just the thing to banish those monthly moods!

Source: Nutrition and Vitamin Therapy, Michael Lesser, M.D

Elson M. Haas M.D. Staying Healthy with Nutrition
Better Nutrition

Here are the links to the natural products I mentioned. Be kind to your body, be kind to earth, Vegetarian, chemical free, addictive free and All Natural- what more could you want?

Multi Vitamin Supplements
Get nature’s wholesome goodness of whole food ingredients with a combination of powerful nutrients, with Life Multi Complete a multivitamin and mineral combination.

Natural Skin Care products

Libido Booster

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

• a combined oral contraceptive pill such as Mircette or Ortho Tricyclen (but do not lengthen the pill free period)

• 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

Oral contraceptives and risks-  alarming headlines can often be misleading when it comes to oral
contraceptive research so it pays not to assume anything on first ’skimming’. Rather, investigate a bit more deeply if it’s something that is likely to affect you and your body and your own future management of contraception.  A whisper about ‘new’ evidence on oral contraceptives, either positive or negative,  can generate mass over reaction and exaggeration.  Find out for yourself as much as you can before allowing the results of studies and ‘findings from the latest research’ influence any decision you are about to make about a specific contraceptive you are considering.

One of the agreed benefits of taking combined oral contraceptives that emerged from many global studies over the years,  is that they reduce the risk of ovarian cancer.  It now seems that they may also slightly reduce the risk of colon cancer .  According to lead researcher Dr. Geoffrey C. Kabat, of Albert Einstein College of Medicine in New York it’s too soon to leap ahead and conclude this yet but in a study of nearly 90,000 Canadian women aged 40- 59, it was found that those who had ever used contraceptive pills were 17 percent less likely to develop colon cancer over the next 16 years.  Interestingly, this was NOT the case for women on HRT (hormone replacement therapy)

These results regarding oral contraceptives were published in the International Journal of Cancer after a breast cancer screening study was carried out on 89,835 Canadian women over a period of 16 years. Studies with smaller groups have also been done in Italy between 1985 and 1996 with similar results.

It seems to me that there are so many other factors to be considered such as lifestyle, weight, medical history of family for colon cancer and not least the various doses of hormones in all the different types of oral contraceptives,  so I think it will be quite a while before any firm statement will be made on this one.

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’.

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