Adaptera
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Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)
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Contraceptive Injection

  • Contraceptive Injection

Effectiveness:

Over 99%effective. Less than I women in 100 will get pregnant in a year.

How it works:

Releases the hormone Progestogen slowly into the body. This stops ovulation, thickness cervical mucus to prevent sperm meeting an egg thins the lining of the womb to prevent an egg implanting.

Advantages:

Lasts for 12 weeks (Depo- provera) .  May protect against cancer of the womb and offers some protection from pelvic inflammatory disease. You don’t have to think about contraception for as long as the injection works.

Disadvantages:

Periods may stop, be irregular or longer. Periods and fertility may take time to return after stopping the injections. Some women gain weight. Other possible side- effects include headaches, spotty skin, mood changes and breast tenderness.

Comments:

The injection cannot be removed from the body so any side- effects may continue for long as it works and for some time afterwards. Not affected by other medicines.

 

  • Implant

Effectiveness:

Over 99% effective. Less than 1 woman in 100 will get pregnant in a year.

How it works:

Flexible tube put under the skin of the arm. Releases the hormone Progestogen. It stops ovulation, thickens cervical mucus to prevent sperm meeting an egg and this thins the lining of the womb to prevent an egg implanting.

Advantages:

Works for three years but can be taken out any time. You don’t have to think about contraception for as long as the implant works. When the implant is removed your normal level of fertility will return.

Disadvantages:

Periods are often irregular, much longer or stop for at least the first year. Some woman gain weight. Other possible side- effects include headaches, spotty skin, mood changes and breast tenderness.

Comments:

Put in using a local anaesthetic and no stitches are needed. Tenderness, brusing and some swelling may occur. You may feel the implant with your fingers, but it can’t be seen. Some medicines may stop the implant from working.

 

  • Intrauterine system (IUS).

Effectiveness:

Over 99% effective. Less than 1 woman in 100 will get pregnant in a year.

How it works:

A small plastic device which releases the hormone Progestogen is put into the womb. This thickens cervical mucus to prevent sperm meeting an egg, thins the lining of the womb to prevent an egg implanting and may stop ovulation.

Advantages:

Works for 5 years but can be taken out at any time. Periods will be much lighter, shorter and usually less painful. You don’t have to think about contraception for as long as the IUS is in place. When the IUS is removed your normal level of fertility will return.

Disadvantages:

Irregular light bleeding between periods is common for the first three months and sometimes longer. May be temporary side- effects such as headaches, spotty skin and breast tenderness. Very small chance of getting an infection during the first three weeks after insertion.

Comments:

Women are taught to check the IUS is in place by feeling the threads high in their vagina. Very useful for women with very heavy and/ or painful periods. A check for any existing infection is usually advised before an IUS is put in. 

 

  • Intrauterine device (IUD):

Effectiveness:

Around 99% effective. Less than 1 to2 women in 100 will get pregnant in a year.

How it works:

A small plastic and copper device is put into the womb. It stops sperm meeting an egg or may stop an egg implanting in the womb.

Advantages:

Works as soon as it s put in. can stay in 3 to 10 years depending on type, but can be taken out any time. You don’t have to think about contraception for as long as the IUD is in place. When normal level of infertility will return.

Disadvantages:

May not be suitable for women at risk of getting a sexually transmitted infection. Periods may be heavier or longer or more painful. Very small chance of getting an infection during the first three weeks of intercourse. A small increased risk of ectopic pregnancy if the IUD fails.

Comments:

If fitted after the age of 40 it can stay in until the menopause. Women are taught to check the IUD is in place by feeling the threads high in their vagina. A check for any existing infection is usually advised before an IUD is put in.

 

  • Female and male sterilization.

Effectiveness:

Female sterilization- lifetime failure rate is 1 in 200. Male sterilization (also known as vasectomy)- lifetime failure rate is 1 in 2000.

How it works:

The fallopian tubes in women or the tubes carrying the sperm (vas deferens) in men are cut or blocked to prevent sperm reaching an egg. Female sterilization usually involves a general anaesthetic.

Advantages:

Vasectomy is a simple and quick operation. Sterilization is permanent with no longer or short- term serious side effects. Once the operation has worked, you don’t have to think about contraception.

Disadvantages:

After vasectomy, it takes a few months for the sperm to disappear from the tubes. Contraception must be used until a semen test shows that no sperm can be seen. A small increased risk of ectopic pregnancy if female sterilization fails.

Comments:

Should not be chosen if in any doubt and counseling is important. You may experience discomfort or some pain for a short time after sterilization. It is important to rest and avoid strenuous activity for a while after the procedure. 

 

  • Contraceptive patch.

Effectiveness:

Over 99% effective if used according to instructions. Less than 1 women in 100 will get pregnant in a year.

How it works:

A small patch stuck on the skin, releases two hormones. Oestrogen and Progestogen. It stops ovulation, thickens cervical mucus to prevent sperm meeting an egg and this thins the lining of the womb to prevent an egg implanting.

Advantages:

Easy to use. Can help to reduce bleeding and period pain. May protect against cancer of the ovary and womb. Can be used by healthy non- smokers up to the menopause. When you stop using the patch your normal level of fertility will return.

Disadvantages:

Not suitable for smokers over 35 and some other women. Very low risk but serious side-effects may include blood clots (thrombosis), breast cancer and cervical cancer. Can be temporary minor side-effects. Possible skin reaction where the patch is stuck on the skin.

Comments:

May be seen. New patch has to be used each week for three weeks out of four. Some medicines can make it less effective. Less effective in women who weight 90kg or over. Not affected by diarrhea or vomiting.

 

  • Combined pill.

Effectiveness:

Over 99% effective if taken according to instructions. Less than 1 women in 100 will get pregnant in a year.

How it works:

Contains two hormones- oestrogen and Progestogen. It stops ovulation, thickens cervical mucus to prevent sperm meeting an egg and thins the lining of the womb to prevent an egg implanting.

Advantages:

Often reduces bleeding, period pain and pre- menstrual tension. Protects against cancer of the ovary and womb and some pelvic infections. Suitable for healthy non- smokers up to the menopause. When you stop using the combined pill your normal level of fertility will return.

Disadvantages:

Not suitable for smokers over 35 and some other women. Very low risk but serious side- effects may include blood clots (thrombosis), breast cancer and cervical cancer. Can be temporary minor side- effects.

Comments:

May not be as effective if taken late or after vomiting or severe diarrhea. Some medicines can make it less effective. Pill users increase their risk of heart disease if they smoke.

 

  • Progestogen- only pill.

Effectiveness:

99% effective if taken according to instructions. 1 woman in 100 will get pregnant in a year.

How it works:

Contains the hormone Progestogen, which thickens cervical mucus to prevent sperm meeting an egg and thins the lining of the womb to prevent an egg implanting. In some women it stops ovulation.

Advantages:

Few serious side- effects. Can be used by women who cannot use oestrogen. Can be used by women over 35 who smoke. When you stop using the progestogen- only pill your normal level of fertility will return.

Disadvantages:

May be temporary minor side- effects. Periods may be irregular, with some bleeding in between, or be missed. A small increased risk of ectopic pregnancy if it fails. May be less effective in women who weigh over 70kg.

Comments:

It needs to be taken at the same time each day. Not effective if taken over three hours late or after vomiting or severe diarrhea. Some medicines may make it less effective but most antibodies do not affect POPs.

 

  • Male condoms.

Effectiveness:

98% effective if used according to instructions. 2 women in 100 will get pregnant in a year.

How it works:

Made of very thin latex (rubber) or polyurethane (plastic) it is put over the erect penis and stops sperm from entering the women’s vagina.

Advantages:

Widely available and a variety of types to choose from. May protect both partners from some sexually transmitted infections, including HIV. Men can take responsibility for contraception. No major side effects.

Disadvantages:

Putting it on can interrupt sex. May slip off or split if not used correctly. Man needs to withdraw as soon as he has ejaculated and be careful not to spill any sperm.

Comments:

Free from family planning and sexual health clinics. Must be put on before the penis touches the women’s genital area. Spermicide is not needed. Oil based products such as body lotions damage latex condoms, but can be used with polyurethane condoms.

 

  • Female condoms.

Effectiveness:

95% effective if used according to instructions. 5 women in 100 will get pregnant in a year. 

How it works:

A soft polyurethane sheath lines the vagina and the area just outside, and stops sperm from entering the vagina.

Advantages:

Can be put in any time before sex. May protect both partners from some sexually transmitted infections, including HIV. L based products can be used with female condoms. No major side- effect.

Disadvantages:

Putting it in can interrupt sex. Need to make sure the man’s penis enters the condom and between the vagina and the condom. May get pushed too far into the vagina. Expensive to buy.

Comments:

Use a new condom each time and follow the instructions carefully. Sold widely and is free at some family planning and sexual health clinics.

 

  • Diaphragm/ cap with Spermicide.

Effectiveness:

Latex types are 92% to 96% effective if used correctly. Between 4 to 8 women in 100 will get pregnant in a year. Silicone caps are less effective.

How it works:

A flexible latex (rubber) or silicone device used with Spermicide, is put into the vagina to cover the cervix. This stops sperm from entering the womb and meeting an egg.

Advantages:

Can be put up any time before the sex. May protect against some sexually transmitted infections and cancer of the cervix. A variety of types to choose from. No major side- effects.

Disadvantages:

Putting it in can interrupt sex. With some types, extra Spermicide is needed if you have sex again. Cystitis can be a problem for some diaphragm users. Can take time to learn how to use correctly.

Comments:

Correct size needs to be known and fitting should be checked every 12 months and if you gain or lose more than 3kg, or have a baby, miscarriage or abortion. Silicon caps come in disposable and reusable types.

 

  • Natural family planning.

Effectiveness:

Using several fertility indicators is 98% effective if instructions and teaching are followed. 2 women in 100 will get pregnant in a year.

How it works:

The fertile and infertile times of the menstrual cycle are identified by noting the different fertility indicators. This shows when you can have sex without rising pregnancy.

Advantages:

No side- effects. No hormones are used. Gives a woman a greater awareness of her body. Can also be used to plan a pregnancy.

Disadvantages:

Need to avoid sex or use a condom at fertile times of the cycle. The method needs to be learned from a trained natural family planning teacher and takes time to learn.

Comments:

Persona is a small handheld computerized monitor with urine test sticks, which measure hormonal changes. Persona predicts the fertile and infertile times of the menstrual cycle. It is claimed to be 94% effective.