Wed | Mar 29, 2017

Dr Rhonda Reeves | Effective contraceptives to ring in the New Year

Published:Wednesday | December 28, 2016 | 12:00 AM
Dr Rhonda Reeves
Happy New Year
An intrauterine device
The pills
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The holidays are a time for food, family, friends, and celebration, but it is no secret that it is also a time for love ... a love that sometimes, you will be forced to remember nine months later. It is a known fact in our practice that deliveries increase in number significantly in September, nine months after the Christmas holidays, so much so that it has been called "peak season".

A child is a great responsibility, one that a couple should be prepared for, so as you prepare to ring in the New Year in style, it is best to ensure that you are using effective contraception (birth control), and I can help you make a choice that's suitable for you.

A patient's choice of contraceptive method takes into consideration factors such as how effective it is, how safe it is, if there are any non-contraceptive benefits, the cost, as well as personal considerations such as how well suited it is to the individual's lifestyle. I will give an overview of the methods currently available and their pros and cons to make the choice a bit easier.

 

BARRIER METHODS

 

These methods include male and female condoms. Male condoms are one of the most popular barrier methods among all of the barrier methods and the one that provides the most effective protection of the genital tract from sexually transmitted infections (STIs). They are very easily accessible, low cost, hormone free, and are single use and so are suitable for non-long-term situations.

It does, however, interrupt sex, and as such, can be considered to be inconvenient for persons in stable relationships or who are married. Other options are discussed below. Read on.

Other barrier methods include diaphragms and cervical caps, but these are not available in Jamaica.

 

HORMONAL CONTRACEPTIVES

 

Hormonal contraceptives can be short-acting or long acting. The short acting methods are routine and need to be remembered to be taken either once a day, once a month, or once every three months. These methods are best suited for short-term use and include:

1. The contraceptive Pill

This is a highly effective, widely available contraceptive method that is easy to use and is also easily reversible. The contraceptive Pill is a combined hormonal contraceptive method, meaning that it contains two hormones: estrogen and progestin.

The pills help to prevent pregnancy by preventing ovulation (the release of an egg from one of the ovaries) as its main mode of action. They also have other means of preventing pregnancy such as thickening the cervical mucus, making it difficult for sperm to enter the uterus. They also cause thinning of the lining of the uterus (the endometrium), making it less likely for a fertilised egg to attach to it (implantation).

The main setback with this contraceptive method is having to take it every day, which then requires you to remember to take it every day. The main cause of failure with this method is patients forgetting to take the Pill. So if you are not going to be able to remember to take it every day, this is not the method for you.

2. The injection

If you know that you won't be good at remembering to take the Pill everyday, then an injectable method may be more suitable for you. Like the contraceptive Pill, it is highly effective, widely available, and easy to use. There are two types available: a monthly preparation, which, like the contraceptive Pill, is a combined contraceptive method, and works at preventing pregnancy in a similar manner. The injection is given every 28-30 days (once a month), and when taken within this time window, is as effective as the contraceptive Pill (or more since missed pills are the main reason for failure and this method eliminates that).

The other type of injectable contraceptive is the three-monthly injections, which contains only one hormone: a progestin. It works in various ways to prevent pregnancy such as suppressing ovulation; increasing the thickness of cervical mucus, making it difficult for the sperm to enter the uterus; as well as thinning the lining of the womb (the endometrium), making it unfavourable for implantation.

This one provides a longer interval between doses, requiring only four doses for the year, and is also very effective. Since there are three months between doses, it doesn't rely heavily on memory to remain effective. It also has the added benefit of light to absent menses.

The setbacks with this method are that it is injectable and so causes pain with administration and may be a source of anxiety for patients who fear needles, (both very minor disadvantages), as well as there may be a delay in return to the patient's previous state of fertility.

Other short-term methods include the Patch and the Ring. However, these are also not readily available in Jamaica.

3. The implant

This is a long-acting, reversible hormonal contraceptive that can last between three to five years, depending on the type, which is supereffective. This method consists of a rod that contains a progestin. The implant releases small amounts of the hormone into the blood stream on a daily basis and reaches its peak within the first few weeks. Contraceptive protection begins within 24 hours of insertion if it is inserted during the first week of the menstrual cycle. The rod is inserted subcutaneously (under the skin), usually in the woman's upper arm, where it is visible under the skin and can also be easily felt to confirm its location.

It works to prevent pregnancy by suppressing ovulation; thickening the cervical mucus to deter sperm penetration; and thinning the endometrial lining (lining of the womb), making it unfavourable for implantation.

It is very effective, with pregnancy rates less than one per cent, and other advantages include its long duration of effectiveness of three to five years. It is not reliant on patient memory for its effectiveness and needs no upkeep or monitoring. There is also prompt return to the previous state of fertility upon its removal.

Disadvantages associated with this method are that it requires a minor surgical procedure for its removal, and menstrual irregularities are common (irregular periods).

 

INTRAUTERINE DEVICES

 

The intrauterine device is one of the most effective contraceptive devices available, with pregnancy rates less than one per cent.

It comes in the shape of a T and is inserted into the endometrial cavity, where it remains until you are ready to have a baby. Then it is removed with immediate reversal of its contraceptive effect. It is very reliable and doesn't require any upkeep, nor does it rely on memory to remain effective.

There are two major types available: the copper intrauterine device, commonly called the 'Copper-T'; and the hormonal intrauterine system, which is also a long-acting hormonal contraceptive method.

The Copper-T is a T-shaped piece of plastic with fine copper wire wrapped around it. It prevents pregnancy by mimicking a foreign-body reaction, creating a toxic intrauterine environment, which will cause damage to the sperm and the egg before they meet (preventing fertilisation). Its contraceptive effectiveness continues for 10 years, but it can be removed before the 10 years if within that time, pregnancy is desired. It can also be used for emergency contraception (Read on, details below.)

The only setback with this method is that it may cause heavier menses or cramping.

The hormonal intrauterine system is similar in shape to the Copper-T in that it also consists of a small T-shaped plastic frame; however, it has a reservoir that contains the hormone levonorgestrel, a progestin. The intrauterine system releases small amounts of levonorgestrel per day into the uterine cavity for as long as three or five years, depending on the type. It works to prevent pregnancy by thickening the cervical mucus, which helps prevent the sperm from entering the womb. It also inhibits the movement and function of any sperm that may enter the womb, and it also thins the lining of the womb (the endometrium), making it unfit for implantation of any fertilised egg.

It also has the added benefit of causing very light to absent menses, with the five-year device now being FDA approved for treating menorrhagia (heavy menses) as well.

 

EMERGENCY CONTRACEPTIVES

 

In the event that you completely missed the boat with all the above contraceptive methods, all hope is not lost. There are still emergency contraceptives available.

I previously wrote a detailed article in October last year on emergency contraceptive options, so you can refer to it for more detailed information.

There are the emergency contraceptive pills that are more effective the sooner they are taken, so take them as soon as possible after having unprotected sexual intercourse. They prevent a pregnancy by preventing or delaying the release of the egg from the ovary (by preventing ovulation). They may also work by preventing fertilisation of an egg (the joining of the sperm with the egg) by affecting the cervical mucus or the ability of sperm to bind to the egg.

They are most effective when taken within 72 hours of unprotected intercourse.

They are not effective once the process of implantation has begun, and they will not cause abortion.

The emergency pill only protects against one incident of unprotected sex or birth control failure and is not to be repeated for the same menstrual cycle, as it is likely that it will not work. You can become pregnant later in the same menstrual cycle if you have used emergency contraception pills earlier in the cycle. To prevent pregnancy, you should use a barrier contraception method such as a condom until your next menstrual period occurs.

If you have again missed the boat and 72 hours have passed since unprotected intercourse, or if you are desirous of an ongoing, highly effective contraceptive method and find yourself in need of emergency contraception, the copper intrauterine contraceptive device (IUCD) is an ideal emergency contraceptive in such a case.

The copper IUCD must, however, be inserted within five days of having unprotected sex for it to be effective.

So, with so many options and back-up plans, it is now easy to prevent having to remember a love-filled holiday season nine months later. Visit your gynaecologist to start your chosen method. And remember, it is always better to use two options, a condom and any other one to protect against both pregnancies and STI's.

I do wish you all best wishes for the New Year.

- Dr Rhonda Reeves is the obstetrician/gynaecologist at Southdale Medical & Gynae Centre, Shop 6, Southdale Plaza. Email: yourhealth@gleanerjm.com.