Contraception

Contraceptive methods are necessary for family planning.

There are various forms of contraception either reversible or permanent.

Practical failure rates vary greatly.

They are either hormonal or involve contraceptive devices.

Certain contraceptive choices may carry special risks and side effects.

Selection should be tailored to the specific needs of every patient to reduce risks and to maximize efficacy and safety.

There are various forms of contraception:

• Natural methods
• Barrier method,
• Hormonal methods
• Use of contraceptive devices or implants
• Permanent contraception (tubal ligation or vasectomy)

I do not perform the ESSURE method of sterilization.

If your husband would request a vasectomy he would be referred to a urologist.

Natural Methods

Some women may choose to use natural methods of contraception such as the Billings method and may choose to have intercourse only in the non-fertile time of their cycle. This may not be effective if they have irregular menstrual bleeding and this method may consequently have a have a high failure rate (25%).

Barrier Methods

Some women may be averse to the option of having any hormonal contraception or they may be concerned about the risk of contracting a sexually transmitted illness. They may therefore prefer to use barrier methods (failure rate 14%).

Oral Contraceptives

The contraceptive pill can be a combined pill or a progesterone only pill.

If used correctly the pill is 99.7% effective in preventing a pregnancy.

The problem is that the pill is often forgotten, or the patient may have diarrhoea or vomiting. Some patients may be on some other medication that prevents adequate absorption of the pill. As a result the pill has a failure rate of 3.8%.

Combined contraceptive pill comes in different forms:

• High, average, or low dose pills (20, 30 or 50micro gram)
• Pills in which doses of oestrogen and progesterone remain fixed
• Others where the hormone doses vary through the cycle.

If patients experience side effects or if they have break through bleeding they will need to change their contraceptive pill. The oestrogen dose may need to be changed or an alternative progesterone may be required.

There are two types of estrogen (Mestranol and oestradiol) and many synthetic progestogens in different contraceptive pills. Some new progestogens such as Drospirenone have recently attracted some adverse attention because of side effects.

Some hormone combinations in the pill can be associated with side effects such as:

• Neurologic (migraines),
• Emotional (depression and anxiety),
• Somatic side effects (premenstrual symptoms and libido).

Some women may have specific contra indications to use the combined oral contraceptive pill. Such women may have a previous history of venous thrombosis, migraines, oestrogen dependent tumours and vaginal bleeding of uncertain cause.

There are many other advantages in using the pill above the benefits of contraception.

The pill may improve:

• Control cycle regularity, menorrhagia and dysmenorrhoea.
• Decrease premenstrual syndrome.
• Improve skin problems

Long Acting Contraceptives

Long acting contraceptives have low practical failure rates and may reduce the amount of menstrual bleeding.

They are very effective contraceptives with very low practical failure rates.

They are convenient because they do not require the effort of remembering to take a pill.

They are absorbed topically and do not expose the liver to higher doses of hormones.

Long acting contraceptives include:

• Depot Provera, is not commonly used (3 monthly injections)
• Implanon (Progesterone implant lasting 3 years)
• Mirena IUCD (Progesterone medicated IUCD lasting 5 years)

Depot Provera uses higher doses of progestogen and is administered 3 monthly.

Implanon is very effective as a contraceptive but often has poor cycle control rates.

Mirena is very effective and is often used for the control of heavy menstrual bleeding.

Mirena IUCD is my preferred long-term contraceptive method.

Permanent Contraception

Permanent contraception may be the preferred method that women may choose.

If some women have high risk factors for hormonal contraception they may elect to have a sterilization procedure (tubal ligation). Alternatively their partners may have a vasectomy, which is a less invasive procedure.

Women must be sure that they will not have any more pregnancies. They must not have menstrual abnormalities such as menorrhagia, irregular cycles or dysmenorrhoea. These women should be in a regular relationship and have no fear of any STD. The decision is one that needs to be reached by the couple after consideration of risks.

Overview

There are various forms of contraception. The choice needs to be determined by the:

• Practical failure rate.
• Convenience factors (forgetfulness).
• The presence of transient sexual relationships (risk of STD).
• The potential health risks of the woman related to her medical history.
• Menstrual abnormalities which may dictate the type of contraception.

Contraception is patient specific.

Some contraceptives may not be appropriate for everyone.

Contraceptives can carry special risks for some women.

Your contraception needs to be carefully selected for you to minimize risks.

A contraceptive choice, which satisfies your needs and is safe should be selected.