Top 10 Methods of Contraception – Part 2

By on May 6, 2013
contraception

6.     INTRAUTERINE CONTRACEPTIVE DEVICES (IUCD)

What is an intrauterine contraceptive device?

An Intrauterine Contraceptive Device is a device inserted into the uterine cavity and left for varying periods of time for the purpose of contraception.

They are usually made up of polypropylene impregnated with barium sulphate, for visualizing them on x-rays. There are many devices of different designs. The commonly used devices are “T” shaped with a horizontal and a vertical arm. The vertical arm has a copper wire wrapped around it and two colored threads at the lower end. These nylon threads (tail) which protrude through the cervix into the vagina allows you to check your IUCD whether in place or not. There are hormone-releasing IUCDs available in the market which are suitable for women with special needs.

How does it work? 

The presence of the IUD in the endometrial cavity stimulates an inflammatory reaction causing release of large microscopic cells called “macrophages”, which are capable of destroying sperm before they can get in to the tube to fertilize the egg. Copper IUD’s are also commonly used as an emergency contraceptive method. It also prevents the fertilized egg from getting hold on to the inner uterine surface, i.e., implantation.

Failure rate 
The IUD is 98% to over 99% reliable in preventing pregnancy. The newer ones, like multiloads ML-Cu-250, ML-Cu-375, Cu 7 – 380 A, are highly effective, i.e. greater than 99% reliable.

What are the advantages?

  • The IUD doesn’t require regular supply nor does have any problem of disposal affecting privacy.
  • It does not interfere with sex.
  • It doesn’t have any systemic side effects.
  • It works as soon as it is inserted. The return of fertility following removal is immediate.
  • Life risk is at minimum and doesn’t increase with age as in oral contraceptives.
  • You only have to check the strings of the Cu T once a month (post-menstrually to know if it’s still in place).

What are the disadvantages and common side effects?

  • Some women report that their periods become heavier, longer or more painful. They usually settle down after a couple of months.
  • If you are not in a monogamous relationship (i.e., if you or your partner has other sexual partners) you are at risk of developing Pelvic Inflammatory Disease (P.I.D).
  • It does not protect you from sexually transmitted diseases (STD’s).
  • It is possible that your womb could push out the IUCD. This is more likely in the first 2- 3 months so it is important to remember to check if the IUD is still in place.
  • The pain following insertion of IUD is due to uterine cramps, which usually subsides within a week and is mostly relived by analgesics. If the pain is persistent, you may need to consult the health care professional.
  • Some women do get rise in vaginal discharge following insertion, which usually subsides after 1 month. It is associated with pain and fever, consult your health care professional.

7.     HORMONE RELEASING IUD

Progesterone IUD (progestasert )
The vertical shaft of IUD is fitted with a capsule containing hormone progesterone, which is released in sustained fashion, giving the desired contraceptive effect. Life span is one year.

Levonorgestrol IUD 20 (LNG20, Lernova) (Mirena)
The hormone Levonorgestrel is released gradually from the capsule. Life span is 5 – 7 years.

Advantages

  • Hormonal IUD’s are more effective than other IUD’s in relieving cramps.
  • Pregnancy and expulsion rates are lower than other IUD’s .
  • Amount of bleeding reduces significantly so more suitable for women with heavy periods.

Disadvantages

  • Insertion is relatively painful for the patient as the device is a little bulky.
  • Relative increase in number of extra-uterine pregnancies is reported for.
  • Some women have reported complaints of breast tenderness and ache which usually settles down within 3 months.
  • Irregular bleeding and absence of menses are common with users.
  • Infection due to the adhesions inside the uterus that blocks the tubal openings.

8.     STERILIZATION

Male Sterilization

What is male sterilization? 

Male sterilization is also known as a Vasectomy or “The Snip”. It is a permanent method of contraception and requires a small operation under local anesthesia. The doctor or surgeon will make a small incision in the scrotum and pull out the vas deferens (a tube that connects the testicles to the penis). The doctor or surgeon will then cut the tube and the cut ends are then either tied off or heat-sealed. It is very important to view this method as irreversible. Vasectomies can be reversed for a small number of men but don’t count on one of them being you as you may be very disappointed.

How does it work? 

Because the tubes (carrying the sperm) are cut, no sperm are present in the semen when a man ejaculates. It takes some time for the sperm still left in your system (above the cut ends of the tubes) to clear, so you will have to use additional contraception until being the “all clear”. You will be required to produce two semen samples to test the sperm content, the first will be around 12 – 15 weeks after the operation and the second a couple of months after the first. Two successive clear sperm counts that are not containing any sperm are needed before you will be given the “all clear.’’

What are the advantages?

  • It is permanent.
  • It is a very minor operation with almost no surgical risks.

What are the disadvantages?

  • It doesn’t work immediately.
  • You will need to use additional contraception (until given the all clear) usually for 3-5 months after the operation.
  • Sometimes (but very rarely) the man’s tubes rejoin and he can become fertile again.
  • Bruising and/or discomfort for a couple of days following the operation maybe there, therefore it is advisable not to do anything strenuous for the first week (including intercourse or lift any heavy objects).
  • Some men change their mind and wish for the operation to be reversed, which isn’t always possible.

Failure rate: 
After being given the all-clear, male sterilization is over 99% effective; the failure rate is 1 in 1000. It is obviously less effective if relied upon before supplying two successive clear sperm counts. It is very important to use additional contraception until this time.

How do I get sterilized? 

Speak to your Doctor, Gynecologist or Family Planning Clinic about sterilization. They will ask you some questions about why you think this is a relevant option. They will discuss the implications of sterilization and answer any questions you may have and describe the operation procedure. Male sterilization is available free in Family Planning Centers / Government hospitals. Many doctors provide this privately.

9.    FEMALE STERILIZATION

What is female sterilization? 

Female sterilization is a permanent method of contraception and requires a small operation under local/ spinal/ general anesthesia.

It is very important to view this method as an irreversible method and only have it, if you are absolutely sure that you no longer wish to conceive in the future.

How does it work? 

After the doctor/surgeon has made their cut, they then cut, seal or block the fallopian tubes. This will stop any eggs released from traveling down the fallopian tube to the womb. Once the fallopian tube is cut, there are several options to stop them from rejoining.

What are the advantages?

  • It is a permanent method of contraception.
  • It works immediately (unlike male sterilization, which takes around 6 months).
  • Use barrier method of contraception to protect STD’s and HIV.

What are the disadvantages and common side effects?

  • A majority of women who have this operation under general anesthesia may feel drowsy or sick following the operation.
  • It requires a couple of days’ rest following the procedure.
  • It may involve an overnight stay, but this is becoming less so.
  • Sometimes the tubes can rejoin, but this is rare.
  • Some women change their minds and want the operation reversed, which isn’t always possible.
  • Some women find their periods heavier and more painful following sterilization.

Failure rate: 
Female sterilization is over 99% effective, the failure rate being 1 to 3 in 1000.

How do I get sterilized? 

If you think that this is the right option for you, speak to your Doctor, Gynecologist or Family Planning Clinic about sterilization. They will ask you some questions to know if this is the right method for you, and can help you to make up your mind. After routine investigation of blood and urine, the health care professional can take a decision of operation and go ahead with it.

10.    EMERGENCY CONTRACEPTION

This is a method of contraception used as an emergency procedure to prevent pregnancy following:

  • Unprotected inter course.
  • Expected failure of contraceptive method like slippage of condom, bursting of condom, forgotten to take two or more contraceptive pills, premature ejaculation in couples practicing coitus interrupts Link to Natural Family Planning methods regularly.
  • When unprotected isolated intercourse happens at some odd moments in couples otherwise using conventional contraceptives.
  • In cases of rapes and incest.
  • Following a single act of sexual exposure in young girls, as happens sometimes among college and university girls.

The method should be reserved for emergency situations and should not be used as an ongoing method of contraception on regular basis. This is so because of relatively high failure rate and higher incidences of irregular bleeding.

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