Birth control: Make a smart choice
View(s):You know there are many different kinds of birth control but which one is right for you? This month in MediScene, Consultant Gynaecologist and Obstetrician, Dr. Nalinda Rodrigo, explains how you should plan with your child’s best interests at heart, and what to watch out for.
A health worker inserts a contraceptive implant into an housewife's arm during a Family Planning fair conducted by the United Nations Population Fund in Manila. (File pic REUTER)
Birth control is not just about prevention – it can be about planning too: Research has shown that women should ideally allow for 2 – 5 years between having children. This gap not only allows a woman’s body to recover from pregnancy and birth, but also ensures that the first child gets his or her parents’ full attention during this critical, early phase in his or her development.Studies have shown that women who become pregnant again within 12 months of giving birth are at an increased risk of developing plancenta related abnormalities as well as the child being born pre-term or with low birth weight. Waiting a few years also allows for a more significant age gap between siblings and often reduces competition between them.
Knowing how what you want in terms of ‘pregnancy spacing’ can also allow you and your partner to select the appropriate contraceptive method — such as birth control pills, contraceptive injections or implants, or an intrauterine device (IUD). When should you begin birth control? Women who are sexually active or in the reproductive age should consider being on birth control says Dr Rodrigo.However, which stage of your life you are in and your circumstances will help your doctor recommend the most appropriate form. Doctors need to understand not just a patient’s history but also their attitudes and schedules to make a good recommendation. Among the factors your doctor will consider are your overall health, how often you have sex and the number of your partners. Your doctor will need to know whether you want to have children someday as well. In turn, you should understand possible side effects and be honest about whether you are comfortable with the suggested method and think it will work for you. There is no single ‘best’ method of birth control.
Calendar method:This method requires you to be particularly watchful and has a high risk of failing. To understand the basis of this method, you should know that a woman who has a regular menstrual cycle has about 9 or more days each month when she is able to get pregnant. As a rule of thumb, these fertile days are about 5 days before and 3 days after ovulation, as well as the day of ovulation. To know which days these are, you must carefully track your cycle. You’ll need to keep a record of when you get your period, how heavy or light your flow was and how you feel. You should also be willing to check your vaginal discharge every day – you are most fertile when it is clear and slippery. Using a basal thermometer will also allow you to pinpoint the first day of your ovulation because your temperature will rise by 0.4 to 0.8° F. However, Dr. Rodrigo cautions that the cycle can change from month to month and this method is far from foolproof.
Hormonal methods: Falling into this category are one of the most popular forms of birth control – the pill. Hormonal methods prevent pregnancy by interfering with ovulation, fertilization, or implantation of the fertilized egg. Some of the things that can make the pill unsuitable for you is if you’re over the age of 35 and are a smoker or have a history of breast, endometrial or liver cancer. A history of blood clots is considered another warning sign. The pill works by delivering a combination of the hormones oestrogen and progestin into your system. Taken daily, these prevent the ovaries from releasing the egg and also cause changes to the lining of the uterus and your cervical mucus. Remember certain antibiotics might reduce the efficacy of the pill, so talk to your doctor before you begin a course.
A woman holding a birth control pill (File pic, REUTERS).
Doctors may also prescribe pills to help women cope with medical issues such as excessive bleeding or cramping. (Contraceptive pills also offer the added bonus of reducing your risk of certain cancers.) But if you’re forgetful, the pill is not for you. (Missing your dose for two days or more will render it ineffective.)Some women find the birth control shot works best for them. In this method, you get a hormone progestin injection every 3 months. It is affordable and very effective says Dr. Rodrigo, explaining though that a small percentage of women put on weight. Doctors can be reluctant to encourage younger women to take this option because it can take between 3 – 6 months or more for fertility to return. However, women should not opt to take this more than 2 years in a row because it can cause a temporary loss of bone density. The longer you rely on the method, the greater the risk of fracture and osteoporosis.
Barrier Methods: The male condom is among the best known barrier methods. What many people are unaware of is that condoms need to be worn right at the beginning of sexual intercourse and not just near to climax. Pre-ejaculate may contain sperm and result in pregnancy, cautions Dr. Rodrigo. This is also what makes the withdrawal method risky. Condoms are a good choice particularly if you are not with a single, long-term partner as they reduce the risk of catching STDs.
Remember that you need to use a new condom each time you have sex and that condoms need to be stored in a cool, dry place. If left in a wallet for instance, the latex breaks down and the condom could then tear or break.
Implantable devices: Women who would like a discreet form of birth control that they do not then have to think about on a daily basis, often opt for implantable devices. One of the most common in Sri Lanka is the copper IUD. An IUD is a small ‘T’ shaped device that is placed inside your uterus, explains Dr. Rodrigo. A copper IUD releases a small amount of copper into the uterus, which first interferes with the sperm reaching and fertilizing the egg. But if this does happen, it then prevents the fertilized egg from implanting in the lining of the uterus. You will need a doctor to implant it, but it can then stay in your uterus for 5 to 10 years. An alternate is hormone impregnated loops, says Dr. Rodrigo, which offer similar results. These can reduce blood loss and the pain associated with menses, he adds, but cautions that other more serious illnesses have to be ruled out as the underlying cause first.
While IUDs are convenient, they do not protect against STDs. So a woman with more than one partner may still want to consider using a condom. IUDs are not always suitable for young women who still want to have children in the future, says Dr. Rodrigo, explaining that it makes them more vulnerable to contracting bacterial infections in the pelvis which can jeopardise their fertility.
Permanent birth control methods:
Women can opt to have surgical sterilization during which their fallopian tubes are cut, tied, or sealed, though Dr. Rodrigo says this is often only considered in the case of a mature women. This way the eggs are unable to travel down to the uterus and cannot be fertilised. Some women opt to combine this surgery with a caesarean birth, so that they do not have to go in for surgery again.
In general, it’s easier for men to undergo permanent sterilisation, says Dr. Rodrigo, explaining that it is a cheaper and simpler process. However, he notes that there is a strong cultural resistance to the idea. By undergoing a vasectomy, a man ensures that his ejaculate never has any sperm in it because the sperm has been blocked. There is a risk for up to 3 months after this surgery that sperm remains so during that time, other birth control methods should be used.
Emergency contraception: Best known as the morning after pill, this form of contraception should only be used rarely. Women who suspect that their contraceptive method failed or were not on any form of contraception and wish to prevent a pregnancy can take this pill up to 72 hours after having sex. Some women experience side effects such as nausea and vomiting. However, the reason not to make a habit of taking emergency contraceptive pills is because there is a risk they will not work. If taken within the first 24 hours, the efficacy is about 85% says Dr. Rodrigo.
This brings us to the end of our comprehensive list of different forms of birth control. It’s clear that the most suitable one for you may change over the course of your lifetime, but staying aware and making smart choices will allow you to make the most of your options.