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CONTRACEPTION

CONTRACEPTION

Condoms

They are a form of barrier contraception. They are sheaths that are worn on the penis after erection, before ejaculation so that they can trap the sperms and prevent them from entering into the vagina/women’s body. They have an additional advantage that they protect both partners from sexually transmitted infections (STIs), including HIV.

The condom is usually very effective. If 100 women used it over a period of one year then only two women would get pregnant. Success of the condom depends on the man using it. The commonest cause of failure is that either he forgot to wear it or else he wore it too late or too roughly such that it tore. It can also tear in case the couple uses oil based lubricants / creams / oils that can make holes in the condom.

The female condom is made of polyurethane, and has two rings: first – round the opening and another one at the closed end – which is the end that goes into the top of the vagina. The woman needs to wear the condom before sex. The closed end has to be inserted inside the vagina and the ring on the open end fits on the vaginal opening covering the clitoris. Thus the vagina is lined completely by the condom. After sex it is important to remove and discard the condom.One advantage of the female condom over the male condom is that the use of the method is under the control of the woman.

Contraceptive Pills

The combined oral contraceptive pills are commonly referred to as “the pill”. The Pill contains two hormones – an oestrogen and a progestogen. Various types of pills are available depending on the dose of the estrogen and the type of progesterone that they contain. All pills work on the same principle. They prevent a pregnancy by different mechanisms, the most important being by preventing the formation of the egg. In addition they also thicken the cervical mucus thereby preventing the sperm from reaching the egg. It also makes the lining of the uterus unreceptive to the pregnancy. The pill is extremely effective and the failure rate is less than 0.2. This is provided it is taken properly.

The pill not only provides birth control but also has other advantages. It makes the periods lighter, shorter and usually there will not be any period pains whilst on the pill. The pill is used widely in treatment of certain problems such as acne, excessive hair growth, management of endometriosis and management of PCOS.

When one starts the pill it is possible that in the first 1-2 cycles one may have common side effects such as nausea, vomiting, breast pain, leg cramps, and may be spotting just before the period begins.

Most of these side effects settle down. If they persist then they can be easily managed by switching to another brand.

There are certain situations wherein women should avoid the pill completely. There are certain medicines which will interfere with the action of the pill. Therefore it is essential that before you start the pill you should have a complete evaluation and discussion with the doctor. Once you are on the pill then it is advisable to see the doctor for a routine check once in a year.

Intra Uterine Devices

The Intrauterine device – IUD is a small T shaped plastic device, which is placed inside the womb, to prevent a pregnancy.It is a form of reversible contraception.It is also commonly referred to as the coil / loop/ copper T/ or IUCD – intrauterine contraceptive device/ intrauterine copper device IUDs are about 98 per cent effective. The IUCD’s have a life of three to five years after insertion. The silver containing IUD has a life of 10 years once inserted. They have to be inserted by a qualified / trained doctor.

It is a good method for spacing and therefore is a great option for those women who have one child and want to space the other. It is also ideal for women who have completed child bearing but do not want permanent contraception. It is best avoided in women who have pelvic infection/ STD / unexplained vaginal bleeding / heart valve problems / an allergy to copper/ are at high risk of ectopic pregnancy or have had one.

It is best inserted when the period is just finishing, but it can be inserted all through the first half of the menstrual cycle and up to 5 days post ovulation. The procedure for insertion requires about 5 minutes and is easily done in the consulting room. The contraceptive action starts immediately.

After insertion one will need check up once after the next period and then once a year till the it is time for the IUD to be changed or the woman wants an another pregnancy. When an IUD is inserted after the age of 40 years then it can remain inside till menopause irrespective of its life. The IUD has to be removed by the doctor and it is a two minute procedure easily done in the clinic. If the IUD needs to be changed then it can be done at the same time. If you want to switch to nanother method then that should be started 7 days before removing the IUD.

Injectables

Depo-Provera (medroxyprogesterone acetate) is a form of birth control. It is an injection, or shot, that contains progestin. This is a natural hormone that your ovaries produce each month as part of your menstrual cycle. You must get it from your primary care or women’s doctor. They give you the injection in either your upper arm or buttock. It can go into a muscle (intramuscular) or under your skin (subcutaneous).

Depo-Provera prevents pregnancy by stopping ovulation (the release of an egg by your ovaries). It thickens your cervical mucus, which makes it hard for sperm to reach and fertilize an egg. It also thins your uterine lining, which makes it hard for a fertilized egg to implant, or attach, to your uterus.

Depo-Provera works for about 3 months at a time. To prevent pregnancy, you have to get 1 shot from your doctor 4 times a year, about 12 to 14 weeks apart. If you get it in the first 7 days of your cycle, it works right away. If you don’t, you’ll need to use another form of birth control for 1 week. Your doctor will confirm you are not pregnant before giving you the injection.

Most women who use Depo-Provera have changes in their menstrual periods. These may include:
• bleeding or spotting between menstrual periods
• an increase or decrease in menstrual bleeding
• no menstrual bleeding at all.

About half of women who use Depo-Provera stop having periods after 1 year. This is not harmful. Menstrual bleeding usually returns to normal when you stop using Depo-Provera. It may take about 9 to 10 months to get pregnant after your last shot.

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