How to get access to birth control has been problem from early days. Until U.S. Supreme Courts withdrew it in 1965, the Comstock law banned the circulation of contraception information . In 2005, college health clinics and many other health care institutes were prevented from providing contraceptive methods at a lower price by the Deficit Reduction act. Even with all the sex education at schools, the practical application of the knowledge is poor.
Birth control methods may be natural or artificial. Natural methods have a relatively higher failure rate compared to conventional methods. Breast feeding amenorrhoea, withdrawal method and safe period method are the most commonly used natural methods. Even though the natural methods have poor success rates, there are no adverse effects.
Modern methods include barrier methods, hormonal methods and intra uterine devices. Barrier methods are the male and female condom. Hormonal methods range from hormonal oral contraceptive pills, hormonal sub-dermal implants and hormone impregnated IUCDs.
Male condom is for one time use and is the cheapest. It gives the best protection against STDs. Failure rate is 14% in typical use and 4% in perfect use. Incorrect placement, incorrect lubricant use, failure to use throughout and in every intercourse are the main reasons for failure. There’s a chance of it reducing the enjoyment of sex. Breaking, slipping and oily lubricants can cause failure. Allergy to latex can be a problem.
Female condom is also for one time use. It has two rings; one on the closed end holds it in place inside the vagina. It can be inserted 8 hours before intercourse. It contains no spermicidal agents. It can be cumbersome and cause urinary tract infections. Some can have allergies to latex.
Diaphragm is a cup shaped device made of latex inserted in anticipation of sex. It covers the cervix and prevents entry of sperm into the uterine cavity. The doctor will examine your vagina before deciding on the correct size. Spermicidal agents will be applied on the inside of it before insertion. It is effective up to 6 hours. After sex it has to be left inside for 6 hours. Main advantages are that the woman controls it and it’s non hormonal. Insertion takes a professional and it can cause urinary tract infections. It can fail 20% of the time. Experience of use, spermicides, continuous use increases effectiveness.
Cervical cap is made out of latex. Spermicidal agents must be applied until the cup is one thirds full before insertion. It covers the cervix acting as a mechanical barrier stopping sperm entry in to the uterine cavity as well as a chemical barrier. It can be inserted 8 hours before in anticipation of sex and can be left inside for 48 hours. Its effectiveness depends on the shape of the cervix. In a woman who has not delivered a baby the cervix is round shaped and the failure rate is 9% in perfect use. In a woman who has previously delivered a baby the cervix is oval shaped. In them the failure rate is 20% in perfect use. One of the main advantages is it provides contraception during its time inside the vagina regardless of the number of intercourses. Obesity makes insertion difficult and means a higher failure rate. You need to have a normal Pap smear result to use this method. It takes a professional to insert it .
Intra uterine devices (IUD)
There are three devices currently available in the U.S., namely, Progestasert (2% failure rate), Copper T380 (0.6% failure rate) and Mirena (0.1% failure rate). They are T shaped devices with a piece of string attached to the longer limb. They are highly effective, long term, convenient methods that do not interfere with sex.
Progestasert contains progesterone and it can provide contraception for 400 days. Copper T380 has 380mg of copper on various parts of it. It is effective up to 10 years. Mirena is a levonogestrel (a type of progesterone) based contraceptive which is effective up to 5 years.
There have been no reported systemic adverse effects after IUD insertion. Amount of blood lost in menstruation is reduced and menstrual pain is less with Progestasert. Mirena causes temporary cessation of menstruation in 20% of users.
In some occasions there have be perforation of uterus during insertion, but it can be avoided by proper uterine sounding. Copper T380 can increase menstrual pain, while during the first few cycles following insertion Copper T380 and Mirena can increase bleeding. IUD do not protect against sexually transmitted diseases (STD). Pregnancies implanted in site other than the normal uterine cavity (ectopic pregnancies) are 50% less than in women not using IUD. But compared to the other two Copper T380 can cause more ectopics. Pelvic infections and IUD have an uncertain relationship.
In some conditions IUD should NOT be used.
Vaginal bleeding of uncertain origin
- Past ectopics
- More prone to get infections (AIDS, diabetes, heart valve diseases, leukemia etc)
- Abnormal structure of uterus
Oral contraceptive pills
There are two types of oral contraceptive pills. They are combined oral contraceptive pill and the progesterone only pill. Combined oral contraceptive pill is the most commonly used method.
Combined oral contraceptive pills are extremely safe with a failure rate of just 0.3% with correct use. It takes about 4-7 days till the onset of action. The effect is reversible and fertility returns quickly after stopping. Combined oral contraceptive pills should be taken daily. There are some preparations to be taken for 21 days, and some have extra tablets for 7 more days containing iron to compensate for the menstrual loss. Oral contraceptive pills do not provide any protection against sexually transmitted diseases. It regulate periods so that they are lighter and less painful than usual. Some say that there is a weight gain but there is actually no proven effect on weight. It also reduces the risk of ovarian and endometrial cancers. Statistically it has been shown to increase the risk of breast cancer and blood clotting in deep veins.
Contraceptive dermal implants
These are slender cylinders impregnated with hormones. They provide a sustained release over a long period of time, so that they are much more convenient than pills. Usual site of insertion is the under-side of the upper arm. There are many brands and the cost varies accordingly. Usually the periods stop entirely but there are cases where women bleed heavily as a result of the implant. Implants can be used while breast feeding and it may even reduce pre-menstrual syndrome.
By: Dr T.M.S. B. Madugalle
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