Dr Suman Bijlani, Gynaecologist, Sonologist, Infertility Specialist, Obstetrician and Laparoscopic Surgeon, Mumbai.

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Birth Control

Planning our families is absolutely essential in today's day. With abortion laws becoming more stringent, women have fewer choices after getting pregnant.

It is obvious that there is no perfect or best method for anyone. In order to be able to select the best option for contraception for us, we need to know a few facts about each method.

We list out to you the options available and a few details of each method so you can find your pick.

The Condom:

 

  • Easily available, does not need doctor's assistanceCondom
  • Has to be used with every act of intercourse
  • Have to rely on male partner
  • Failure possible due to user errors
  • Protects from sexually transmitted diseases
  • No side-effects except occasional allergy
  • Failure rate (about 15%)

Every man must know the technique of using condoms correctly. Incorrect usage is the commonest reason for an unintended pregnancy.

Make sure you apply the condom BEFORE the first penetration and NOT just before you ejaculate. Also, take care that you hold the condom tightly all around at the base while removing it, so that there is no spillage at the time of removal.

Please use the condom  for EVERY act of intercourse. Many couples use it only during the 'fertile period' and that is the commonest reason for an unwanted pregnancy.

Intrauterine contraceptive device (IUD) also known as Copper T:

A small plastic device containing copper which can be inserted into the uterine cavity where it prevents implantation of the forming embryo.

  • Time tested, but associated with menstrual irregularities, heavy periods and pain in many cases
  • Effective for 3, 5 or 10 years depending on brand
  • Not suitable for women who have yet to have a baby or those who have pelvic infectionsIUD
  • Needs medical assistance to insert, insertion mildly painful
  • Failures rare (0.8%)
  • Needs to be checked every month by the user (a simple task)
  • Does not protect from ectopic pregnancy

This method is very useful for women who cannot remember to take the pill or whose partners would not want to use the condom. It certainly gives you a sense of freedom from having to remember to use protection always.

The Mirena is a special type of IUD which releases the hormone progesterone within the uterus. Mirena users experience less flow during their periods compared to other IUD users and it is therefore more acceptable than the routine copper devices. It is also used to treat heavy periods. It is, however, much more expensive (about 7500 Indian rupees) and it reduces the flow during periods over time. In fact, most women stop getting periiods about 6 months after Mirena insertion. It is not harmful though,in fact, a welcome side-effect for many women. Periods resume after a while once the Mirena is removed.

In fact, the Mirena is used to treat certain conditions which cause heavy periods such as endometriosis, adenomyosis and uterine hyperplasia.

The Contraceptive Pill:

With the market being flooded with newer contraceptive pills, there is a lot of confusion in the minds of women today about which pill to take for which situation.

Whereas the doctor is the best judge of which pill is best for you, every woman must know the basics.

Broadly, one may categorize pills as :

  • Birth control pills ( e.g. Maladi or any of the 21 tab or 24 tab packet tablets)
    which contain two hormones, Estrogen and Progesterone or Progesterone alone.
  • The emergency contraceptive pill ( e.g. I pill , Unwanted 72, Pill 72 among others )
  • The Abortion pill

 The birth control pill is the true contraceptive pills as it prevents pregnancy. It needs to be taken daily as per instructions and is more than 99% effective if taken correctly. Today various pills are available in the market and women need to consult their gynaecologist to find out which works best for them. In olden days, the pill was not considered safe as the dosage of hormones used was high and hence the risk of stroke and breast cancer was high, especially in older women and smokers. Today's pills use better hormones in lower quantity which makes the pill a safe option for long term birth control as well.

There are different ways of taking the pill:

1. For 21 tablet strip. Start a new pack within 5 days of onset  of menses. Take it daily at around the same time till the  pack is over. If the pack shows arrows, follow the arrows in taking the tablets. Once the pack is over, wait for your period. Start a new pack in the same manner (as above).

OR

Once the pack is over, wait for 7 days. Start a new pack on the 8th day irrespective of the day of menses.

2. For 24 tablet strip - Start a new pack within 3 days of onset of menses. Take one tablet daily at around the same time. After 24 days, wait for the period. Restart a new strip as above.

OR

Once the strip is over, wait for 4 days and restart new pack on the 5th day irrespective of the day of menses. This method works very well for women with premenstrual syndrome, premenstrual breast pain and depression.

Forgot a pill?

Take the pill as soon as you remember and take the next dose at the regular scheduled time. If you remember the next day at the scheduled next dose, you may take two pills together.

Forgot two pills?

Use the condom for the next 7 days.

Be prepared to bleed or spot in the next few days. If you have just a few tablets left in your pack (you are nearing the end of your cycle), stop the tablet and await menses (withdrawal). If you have many tablets left, take 2 tablets immediately today and tomorrow and resume the pack as before. If the bleeding persists or becomes heavy, you may have to give a break and start a new cycle.

 

A special progesterone only pill (Tab Cerazette/Zerogen) is available for use by breastfeeding mothers. It does not harm the milk and does not cause any significant side-effects.

It has to be taken daily continuously at around the same time, without break during menses also. Please do not forget to take a single tablet. If you forget to take a single tablet, you might get spotting or bleeding and pregnancy might become possible.

The emergency pill (I pill/ Unwanted 72/ Option7/ Pill 72/ Norlevo) is to be used only in case of an emergency i.e. rape or when an unexpected unprotected act of intercourse has taken place. It needs to be taken within 72 hours, preferably 12 hours of intercourse... the sooner the better. It is about 90% effective within the first 48 hours and more you delay, less effective it becomes.

The abortion pill is to be taken after you become pregnant. It is most effective for pregnancies less than 7 weeks. The success rate is about 90%. In case of failure, a surgical abortion must be carried out. Medical abortion is a legal matter and comes under the purview of the MTP Act, 1971. It must be carried out under the guidance of a registered medical practitioner as per the guidelines of the Act.

Pls refer to my article on Abortion Pill and Surgical Abortion for more details.

Contraceptive injections:

These injections are to be given every 2 months (60 days) or 3 months (90 days) and they release the hormone progesterone within the body which prevents pregnancy.

There are two formulations available

  • DMPA or Depot Provera Contraceptive (3 monthly injections) and
  • NET - EN (2 monthly injections)

These injections have the following features:

  • Highly effective if taken correctly
  • Can cause some weight gain esp. in the first year of use
  • Menstrual irregularities are very common and the main reason for discontinuation in most cases
  • Return of fertility is delayed (you may take some time before you can conceive again after stopping injections)
  • Some metabolic problems are possible making you more prone to developing diabetes mellitus or high blood pressure
  • Bone loss may occur with Inj DMPA and you need to take calcium and vitamin D supplements and also consult your gynaecologist about it.

They are not very popular mainly because of the disturbance caused to the menstrual cycle.

Vaginal spermicidal:

These are chemicals applied locally in the vagina to destroy the sperms or to make them immotile thereby preventing pregnancy.

The most popular of the spermicides used is TODAY. TODAY is a vaginal tablet which has to be inserted into the vagina by the woman before intercourse. It is effective from 10 min to 1 hour and a new tablet has to be used with each act. It is not as effective as the other options and failures are relatively common, however it is an option for women who find other methods unsuitable.

NuvaRing:

This is one of the latest advances in the world of contraception. It is a vaginal ring which releases the hormones estrogen and progesterone and works just like the birth control pill. NuvaRing

The ring has to be inserted into the vagina by the woman within the first five days of her period (she need not wait for the period to get over) and left in place for three weeks and reinserted after an interval of one week, during which she would get her next monthly cycle.

The side effects and mode of action are the same as that of the birth control pill, except that a few women may experience problems of expulsion or vaginal irritation or discharge.

The main advantages the ring would offer would be:

  • Freedom from having to remember to pop the pill everyday
  • Regular menstrual cycles
  • Highly effective (failure rate very low)

contraceptive ring in place

Since Nuvaring is new in the market, it is yet to become more popular.

 

For contraceptive choices and insertion of IUD, do contact us. For further clarification/ free online consultation, click here.

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