Contraceptives

If you are not planning to welcome a new little soul into your arms anytime soon, you may wish to join the growing number of women who are forsaking their low dose birth contol pill in favor of a long acting, reversible contraceptive (LARC ) such as an IUD or an implant. A recent bulletin by the American College of Obstetricians and Gynecologists show that today’s much improved IUDs and implants are the most effective forms of reversible contraception.

IUDs are now considered suitable for the majority of women, including adolescents, women who have had a miscarriage or an abortion, women who have had ectopic pregnancies and also women who have never had any children. HERE is an earlier post with details and a video of a copper IUD insertion.

My earlier post is HERE if you want details of implants but today’s post is just to bring you up to date with the latest increase in popularity of these two low maintenance LARCs.

“IUDs and implants should be considered first-line contraceptives for a majority of women,” says Eve Espey, MD, MPH, an associate professor of obstetrics and gynecology at the University of New Mexico in Albuquerque. Espey also says that available evidence suggests that IUDs do not cause PID (pelvic inflammatory disease) which prevented many doctors recommending them to women who had not had children.

“The majority of unintended pregnancies among contraceptive users occur because of inconsistent or incorrect contraceptive use, and this is where implants and IUDs stand out from the pack. They are maintenance-free, which means there is virtually no margin of error,” she says.

Implanted, contraceptive ’rods’ were approved in 2006. You do need to go to a doctor to have the implant inserted just underneath the skin on the inside of one arm and protection against pregnancy usually lasts for 3 yrs. Yes, you can feel it if you press on the insertion site as seen here http://youtu.be/4TNEtyu1WUU but the idea is to forget about it once it’s in so don’t worry that it’s going to catch on your clothes! These two videos show insertion and removal if you’re interested in the procedure.

INSERTION

REMOVAL- don’t worry about the foreigh language on this video, the procedure is clearly shown.

An IUD can provide 5-10 yrs of protection depending on the type. Paragard is a copper IUD and will protect you for up to10 yrs, while Mirena is a hormonal IUD releasing progestin and will protect you for up to 5 yrs. IUDs also need to be inserted by a doctor.Warning: Neither of these contraceptives will protect you from STIs so condoms come into their own as rescue special ops! Your doctor may or may not offer these two options. Implants and IUDs should not be used if you have been diagnosed with any form of PID, reproductive cancer or Wilson’s disease (too much copper in your body).   If you are a vegetarian did you know that you can buy Vegan/Organic Condoms on this site (search for Sir Richards brand) Undercover Condoms Sales - Click here to view this month’s sale items including Condoms, Lubricants, and more!!Downsides in brief:

• irregular menstrual bleeding, possible acne and weight gain in a few women (no different to other forms of hormonal birth control) and sometimes temporary cramping following an IUD insertion which usually diminishes after a while
• very rarely (1 in 1,000) an IUD pushes through the wall of the uterus and has to be removed
• the contraceptive skin implant may cause a mild insulin resistance in some women 
• initial high cost of several hundred dollars for each type but when averaged out over several years, the monthly cost compares favorably to the cost of a low dose birth control pill

You may be satisfied with the effectiveness of your low dose birth control but there is one thing it DOES NOT do for you and that is give you protection against STIs. You knew this though- didn’t you?

OK, so you also know about the STI called Chlamydia and you’re confident you won’t get it because you always use a barrier method ( cap, femidom, condom, diaphragm)  of birth control right?  ALWAYS used protection- not missed even ONCE?  Yep, it only takes ONE sexual act (notice I did not write ‘intercourse’) for one partner to pass an STI on to another, male or female so this is a plea for you to consider popping in for an STI test, especially if you have had multiple sex partners. No, it’s not a big deal to get tested. Watch the video I mention below.

You may know that an untreated STI can lead to PID in women (pelvic inflammatory disorder) that in turn can lead to sterility but -did you know that Chlamydia in men can affect sperm function and male fertility?

It’s much less stressful and difficult than you think to get yourself tested!

Watch this video and you’ll see that getting tested for Chlamydia requires no more than guys peeing in a pot and gals doing a vaginal swab THEMSELVES in the privacy of the bathroom.  That’s right- no nurse fiddling about ‘down there’ and it’s all over in a few minutes, literally ‘in and out’!

All consults are completely confidential, even the results are delivered to you discreetly in case you are worried about your parents finding out.
Treatment is easy too:  4 antibiotic tablets and no sex for 7 days at least. Of course the smart thing to do is to always  use a condom anyway, it’s becoming ‘uncool’ not to.

Be a HERO though, if the result comes back positive.  Let your partner(s) know so they can get tested too.

Calling anyone who parents or educates young people.

Are you comfortable having a healthy conversation with a teenage girl about flavoured condoms? Would you avoid such a discussion at all costs, after all, it’s a guy thing, right? Do you think someone else should talk to her about ‘these things’ or do you believe the subject of birth control should be taboo until she ‘grows up’?

Like it or not, young people ARE having sex and many of them do not have access to the information THEY NEED that will help them to plan their own futures and the welfare of their future families. Of course, sex education will raise many more discussion topics apart from flavoured condoms but if we are to follow through with  our duty of care towards our young people then  we must be prepared to face topics that may be outside our own ‘comfort’ zone.  The quote from Philip Harvey below is to encourage you to see the ‘ big picture’ and to step forwards rather than backwards with the sexual health education of the young people who may look to you for advice.

In my light hearted post on November 5th I mentioned a non profit organisation called DKL International who supply coffee flavoured condoms to Ethiopia. The philanthropist behind this organisation is Philip Harvey who runs Adam and Eve, the largest on-line store of adult merchandise in the United States. Philip’s company now gives away 25% of its profits to good causes and provides 10% of DKI’s total funding.
Why am I mentioning Philip?

Because he is making a difference- all over the world in the arena of birth control, especially in countries where access to contraception is limited.  We don’t need Philip’s funds to make a difference though, we can do it with our own attitude to educating young people about birth control and protecting themselves from sexually transmitted infections.

This is what Philip has to say about a woman’s right to control her fertility :
“My feeling about birth control is that it has an immediate and enormous humanitarian impact for the people who get access to contraception. It has a dramatic impact on infant mortality, it has a marked impact on maternal mortality and it certainly has an impact on family welfare. The ability to control ones fertility, especially for women, is a form of liberation, that I think in and of itself is very important. And in thirty five years of doing this I have never seen a down side.”
How fortunate are we to live in a country where we have so much contraception assistance ‘on tap’, yet teen pregnancy and STI’s stats are alarming?  How fortunate are we that we have inspired teachers and health care providers working tirelessly to improve sex education programmes yet thousands of teenagers in the Western world are still left ’stranded’  from knowledge, unable to separate myth from fact when it comes to sex?
WE ALL need to do MUCH more to liberate our young people and to provide them with a thorough education in all aspects of sexual health. We owe humanity that.
PS. If you need stocking fillers this Christmas for any sexually active young people you know, there are great condom bargains to be found HERE  …and who knows, you may just find a few fun items for another favourite person in your life too?

PPS. It goes without saying that you talk to young guys about using condoms too. Watch this first video on STIs- Chlamydia is the most common STI among teens.

Today something more lighthearted (and ‘good on you’ Barack Obama, we look forward to your support on the contraception front!)

Most of you know that safer sex involves the use of a male condom, whether or not the female partner uses low dose birth control or not. Condoms act as barrier to sexually transmitted diseases but in many countries are not popular for a variety of reasons.

In trying to encourage the use of the condom, here are a few novel ideas launched by condom companies and non profit organizations that will make you smile. I found these little gems in the CCMC PUSH Journal Source: CNN News, collated by Meghan Holohan.

1. Condom Trees for Australia - Got to start with this one first! On my home patch, here in Oz, I think this is a great idea, I just hope that the literally ‘perishing’ sun factor has been catered for! Western Australia has the highest rate of HIV on the continent. Young people hang out under trees in the countryside and the clever public health nurses, in their efforts to distribute condoms, decided to hang condom filled cannisters in the branches. Grabbing a condom was then made easy and private- each month over 3,000 condoms are taken.

Another initiative saw Aborigine teenagers encouraged to sell condoms and keep 50% of the proceeds. Cases of STDs have been reduced even though the number of sexual partners may not have.

2. National Condom Ringtone for India - Bill and Melinda Gates Foundation have donated money for a ringtone to be composed by Acapella singers singing ‘Condom, condom’ in the vein of the pop song,’Barbara Ann’. More than 60,000 people have downloaded the ring tone since August. Would you be comfortable enough to use it or do you still have issues around condoms? In India, the condom is associated with prostitutes so a stigma is attached to using them.

3. Coffee Condoms for Ethiopia - if you hate the smell of latex maybe coffee flavoured condoms will appeal? DKT International, a United Sates nonprofit, created dark brown condoms that reportedly smell like a macchiato (Ethiopia’s favourite coffee) Since the Ethiopians claim to have invented coffee, the coffee condom bolsters their national identity. Not sure if the other flavoured condoms by DKT International would appeal in Oz though - sweet corn (for China) and Durian (for Indonesia) I’m not a fan of Durian myself so I think I’ll pass.

4. Spray On Condoms - “Having trouble finding a condom to fit sir? Just slide yourself into this cylinder, press the button and The Jolly Joe will fix you up nicely”. The 3 minutes it takes for the latex to dry was definitely NOT a benefit of this German’s solution to the snug and natural look! Poor Jan Vinzenz Krause, he’s still waiting for a latex that dries in 5 secs.

With the party season fast approaching it may be an idea to stock up on your supply of condoms and think about a few ‘novel’ Christmas presents.  I’ll scout around for some ideas and include them in my upcoming posts, in the meantime, below is a link to some bargains on the net for condoms as prices will be going up in 2009 and condoms have a shelf life of 3 years if stored properly. I think you can save up to 70% on this particular site.

Undercover Condoms Sales - Click here to view this month’s sale items including Condoms, Lubricants, and more!!

Female condoms (femidoms) are not quite as effective as male ones but if you are allergic to latex they do offer some protection against STIs- watch this video to the end to see how to use one.

There is not much choice when it comes to short videos about ‘guys bits’ and how they work but I found this one that is pretty clear.

There is also a short video on female reproductive organs on this site too so please check out the Reproductive organs category  or the Videos  in the sidebar.

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.

Easy to understand animation for those of you who treat split condoms or missed pills with a nervous giggle. Emergency contraceptives work within 72 hours of ‘oops!’

If you are using an oral contraceptive pill, hormone injection, implants or an IUD (intra uterine device) for your method of birth control and have found some changes in your menstrual bleeding patterns, this useful patient handout may reassure you. It explains some of the ways in which different contraceptives can affect your menstrual cycle and when you should consult your doctor. Usually no action is needed but being informed often allays unnecessary fears.

Most menstrual bleeding changes while using contraceptives are to be expected and are not harmful.

The handout also explains about breakthrough bleeding or spotting between periods.

If you have concerns about your menstrual changes with your contraceptive, don’t
stop using it without talking to your clinician. Often nothing is needed but your health care provider can assess the situation and provide treatment if necessary. Some clinicians suggest using a menstrual diary or calendar to record menstrual changes so that you can have an objective record. The diary will help you remember what changes have occurred so you can tell your clinician.

If you need a reminder about where the menstrual bleeding comes from each month this video will explain.

People often confuse Emergency Contraception with Plan B. Plan B is a dedicated emergency contraception product and can be purchased over the counter if you are 0ver 18. –watch this video-

however, higher doses of oral contraceptives also act as emergency contraceptives and a copper IUD  will also be effective if inserted within 5 days following intercourse.

Some pharmacies may not carry Plan B, but most carry oral contraceptives and may provide them as emergency contraceptives. In the unlikely situation that you may not be able to get to a pharmacy or your doctor for the ‘morning after pill’ within 72 hours of unprotected intercourse, here is a list of emergency doses for a popular number of oral contraceptive pills available on line through this website.

The Food and Drug Administration has declared the following brands of oral contraceptives to be safe and effective for emergency contraception:

Ovral (1 dose is 2 white pills)

Alesse (1 dose is 5 pink pills)

Levlen or Nordette (1 dose is 2 light-orange pills)

Lo/Ovral (1 dose is 4 white pills)

Tri-Levlen or Triphasil (1 dose is 4 yellow pills)

Check with your doctor at once if you need emergency contraception and you are breastfeeding- even though there are no actual studies to prove that hormonal contraceptives damage a baby, please be cautious with ALL medications you take. Whatever you swallow is absorbed by your body and eventually passes through your milk and reaches your baby- do you really want your baby to have to cope with huge doses of hormones, alcohol or drugs? Your baby has no ’say’ in the matter so even though you find yourself stressed in this emergency situation please do not panic if you have to include bottle feeds for a while.

Your doctor will reassure you as to what to do next with your birth control regime and your baby will not die of malnourishment.
Precautions to take with the ‘morning after pill’

Just to be sure, it is wise to use an additional method of contraception to prevent pregnancy such as a condom and/or spermicide, especially when your period starts again. Some women find that when they take Plan B (emergency contraceptive) they get their period earlier or later than usual- this means that you are not quite certain when, during that particular cycle, you are at risk of getting pregnant! For the morning after pill to be effective it contains higher doses of hormones than the regular contraceptive pill and may cause noticeable side effects so it should NOT be used routinely.

Do not rely on breastfeeding for emergency contraception unless you fully understand all the criteria required (see separate article on breastfeeding and contraceptives)

Depending on how frequently and for how long you breastfeed a baby determines when your periods return and assume their ‘normal’ cycle. Your hormones swing around all over the place when you have a baby (”don’t I know it!” I hear you say?) so if you wish to continue with birth control after giving birth, take these precautions:

If your breast fed baby is now 6 months old, if you have recently reduced the number of feeds or the length of time you breastfeed your baby or have just introduced some bottle feeds, please take extra caution by using another, non hormonal type of contraceptive.

If you have multiple sexual partners don’t let them give you the gift of syphilis for Christmas! Unless you are absolutely certain of your partner’s medical history in this area , you should always insist on the use of condoms, even though an oral contraceptive or other method of birth control may be used as well.

A condom is the safest way of protecting yourself against sexually transmitted diseases so….. watch the little ‘cucumber’ video below( especially if sex is relatively new to you)

“Oh, Come on!” ” I can hear you say but please indulge me, better safe than sorry and it will give you a giggle (AND ease my conscience that I have left no rubber ‘unrolled’ in simplifying the useful information I promised to deliver on this site).

By the way, if you had any ‘accidents’ or unfortunate experiences with condoms that could serve as a warning to others, please feel free to leave a comment- but keep it ‘clean’. I think the best and most reliable (pardon the pun) site for buying condoms and other ‘goodies’ on line is this one.