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Contraception options vary with age, body and individual

Natalya Anderson gives an overview of contraception options available to women in Ireland and the advantages and disadvantages of using particualr methods

Not all women are created equally when it comes to sexual activity and birth control needs, but they may not even know it.

While statistics published as recently as 2008 indicate that a combined oral contraceptive pill (‘the pill’) is still the most popular form of contraception (25 per cent of Irish women between the ages of 15 and 45 use it), other birth control devices are worth reviewing for women who might want to consider options better suited to them, depending on their age, body type, and medical requirements.

Combined Oral Contraceptive Pill
A combination of oestrogen and progestogen, the combined oral contraceptive pill comes in several forms in Ireland. Different brands of ‘the pill’ contain varying levels of oestrogen and different types of progestogen, but each combination currently available is more than 99 per cent effective at birth control.

The pill acts as a fertilization block by preventing ovulation each month. The pill pack should contain 21 birth control pills, which should be taken once daily, commencing on the first day of menstruation. After 21 days, a seven-day break should be taken from the pills (some packs may contain placebo pills for these days).

Following the seven-day break, (during which menstruation should occur), the birth control pills should be taken again daily. Women who are forgetful about taking a daily pill may not like this option.

Women who have a history of blood clots, serious migraine headaches, who are overweight, who have high blood pressure, or who are smokers aged 35 or over are advised not to take this form of contraception. Experts at Well Woman Centres further stress that women with a history of breast cancer in their family might be advised to avoid pills containing oestrogen.

Side effects in women who take this pill may include bloating, nausea, headaches, tender breasts, and mood swings. In some cases skin problems like acne, and a change in sex drive can also occur. The pill’s effectiveness is reduced if a woman is sick (vomiting or diarrhea, for example, may inhibit absorption).

Well Woman Centres offer further information on late or missed pills.

Emergency Contraception (‘The Morning After Pill’)
In the event that a woman is not taking birth control and finds herself in an emergency situation (a condom breaks, an unwanted act of sexual intercourse or sexual assault occurs), emergency contraception (EC) can be taken in the form of a pill up to 72 hours after unprotected sex. IMT reported in 2008 that approximately 90,000 pills are prescribed annually in Ireland.

NuvaRing
A relatively new form of contraception which also contains a combination of oestrogen and progesterone, Nuvaring is a flexible, vaginal ring. It is suitable for women who can tolerate the combined contraceptive pill. By pinching the middle of the flexible ring together, the ring is inserted into the vagina and left in place for three weeks.

Throughout this time, the ring slowly releases the hormone combination to prevent fertilization. The ring should then be removed for one full week and then replaced with a new ring. If accidental expulsion of the ring occurs, rinsing the device in warm water and reinserting it should not change efficacy. This option might be suitable for women who have a tendency to forget taking the pill.

Possible side effects with NuvaRing include vaginal infections and irritation, vaginal secretion, headache, weight gain, and nausea.

Clinical trial results published around 2002 indicated that 1 per cent to 2.5 per cent of 2,500 women discontinued using NuvaRing in relation to side effects. The most frequent of these were device-related events, discomfort, vaginitis, vaginal secretion, headache, mood swings, and weight gain.

Intrauterine Contraceptive Devices
There are two common forms of intrauterine devices (IUDs): Mirena (containing progesterone), the Flexi – T 300 (containing copper), and the Copper T 380 (also containing copper). These T – shaped devices must be inserted into the womb by a specialist physician.

Mirena:
Reportedly effective for at least five years, Mirena prevents sperm from reaching an egg by thickening the mucus in a woman’s cervix and thinning the wall of the womb to prevent implantation. In some cases it can prevent ovulation entirely, but the majority of women who use Mirena continue to ovulate. It has been reported that less than one in 100 women become pregnant while using Mirena.

Although Mirena may be advantageous for the duration of its efficacy and for its reportedly reducing length of cycle and heaviness of menstruation, it can cause spotting between periods, infection in the womb from the implantation procedure, headaches, acne, breast tenderness, and expulsion.

Flexi – T 300 and the Copper T 380 (Copper Coils):
Similar to Mirena, these prevent sperm from fertilizing an egg by forming a barrier with thickened mucus in the cervix and thinning the womb wall.

Copper coils are reportedly less effective than Mirena, (the Flexi – T 300 only last up to three years), with up to 5 per cent of women getting pregnant on the Flexi – T 300.

With slightly more copper on it and lasting five to eight years, the Copper T 380 is reportedly more effective. Some experts argue that – even with the 5 per cent risk rate – the Flexi – T 300 is just as effective as the oral contraceptive pill, and can’t be forgotten or poorly absorbed during illness like the pill. Heavier periods and infection in the womb can occur with use of these devices. Check-ups several weeks after implantation are necessary.

The Patch
The contraceptive patch is like a plaster that needs to be changed weekly. It releases hormones (progestogen and oestrogen respectively) into the body slowly. The patch may be beneficial for women who are uncomfortable with the thought of having a coil or implant surgically placed. Side effects include nausea and/or vomiting, skin reaction where the patch is placed, breast tenderness, headaches and emotional changes.

Women who are 35 or over who smoke are at increased risk of cardiovascular events with the patch. If it is unlikely that she will quit smoking, she should not use the patch.

Progestogen only pill (the ‘Mini Pill’)
Sometimes referred to as the ‘mini – pill’, the progestogen only pill only contains the hormone norethisterone (a type of progestogen). Efficacy can be 95 - 99 per cent, especially in women 30 years old and over and in women who are breastfeeding (both considered to be less fertile than younger women who are not breastfeeding).

Like IUDs, the mini pill thickens mucus at the cervix and changes the lining of the womb. It can sometimes prevent ovulation all together. This pill is suitable for women who cannot or should not take oestrogen for health reasons.

Possible side effects are congruent with those associated with the pill.

Usage is slightly different than with the pill, as there is no ‘break’ after 21 days, and the mini pill must be taken at the same time every day to be effective. It can be essential to begin taking this pill on the fist day of menstruation as well.

Well Woman Centres offer further information on late or missed pills, as well as on what can interfere with efficacy. Check-ups during use of this pill are also necessary.

Injectable Contraception and Implants
Each containing progestogen, injectable contraception (Depo-Provera) and implants (Implanon) slowly release the hormone over time.

Depo-Provera
Depo-Provera is the one injectable contraception available in Ireland; it contains medroxyprogesterone acetate (a type of progestogen).

Administered as a single injection in the bum muscle every 12 weeks, the first injection is given sometime during the first 5 days of a normally-occurring menstrual cycle. A woman’s physician should give her the date of her next injection. A woman is safe to have sexual intercourse immediately if she is given the injection on the first day of her period. If it’s administered any later than day one a woman should abstain from sex for seven days to be safe.

This form of contraception is beneficial as its slow release of progestogen means little can interfere with its efficacy. Women who are taking medication for epilepsy may need an injection every 10 weeks for improved efficacy. Additionally, this injection has an advantage over oral contraception in that antibiotics or illness (vomiting, for example) will not alter its efficacy.

One concern reported in studies indicates that bone density levels might be effected in women who are administered this injection in their late teens and early 20s (leaving them more susceptible to osteoporosis). Women in their late teens and 20s (when bone density is still developing), and women with a family history of osteoporosis, should consult their physician with any concerns.

Check-ups should take place at each 12 week injection.

Implanon
Inserted just above the elbow under the skin, Implanon is a rod-shaped device containing etonorgestrel (a type of progestogen). Local anaesthetic is administered to numb the area before insertion, and stitches or a plaster will be applied after insertion. This should be fitted during the first five days of a woman’s normal menstrual cycle.

Again, if implanted on day one of the menstrual cycle, protection from pregnancy is immediate. If implanted later in the menstruation cycle, a woman should abstain form sex for seven days to ensure effective contraception. The rod is reportedly effective for three years unless a woman is very overweight (implant change after two years might be necessary in some cases).

Like the Depo-Provera injection, little can interfere with this form of birth control due to its slow release of progestogen into the system, and antibiotics or an upset stomach shouldn’t alter efficacy either. Again, antiepileptic medication may interfere, however, and alternative contraception might be necessary in such cases.

Check-ups will be recommended six weeks after implantation, and then annual check-ups should be scheduled.

Injections and implants are over 99 per cent effective and can be used by most women. Because they do not contain oestrogen, women over the age of 35 who smoke, and women who suffer from severe migraines, may chose this form of contraception.

Women with irregular menstrual cycles, however, should consult their GP before use of progestogen. Women with a history of depression can be vulnerable to worsening mental health conditions with use of progestogen. Other side effects typically associated with birth control might occur, including spotting between periods, mood swings, bloating, nausea, headaches, and breast tenderness.

Some women may experience a complete stop to their menstrual cycle with use of injections or implants. Any concern should always be expressed to one’s physician, without hesitation. Normal menstrual cycles should recur within a few months if a woman chooses to cease treatment.

Posted in Women's Health on 01 October 2009
Tags:

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abortion, accupuncture, ACE inhibitors, acne, ADHD, alcohol, allergies, Alzheimer's, anaemia, anaethesia, anorexia, antibiotics, antidepressants, antihistamine, anxiety, appetite control, arthritis, ASCOT, aspirin, asthma, atherosclerosis, autism, autoantibodies, back pain, beta carotene, beta-blockers, bipolar disorder, birth, bleeding, blindness, blood pressure, body dysmorphic disorder, body mass, breast cancer, breast feeding, bronchitis, Caesarean section, calcium, cancer, carcinogens, carcinoma, cardiac syncope, cardiolgy, cataracts, cervical cancer, chemotherapy, child psychiatry, children, cholesterol, clinical trial, clopidogrel, Clostridium difficile, cognitive behavioural therapy, colectomy, colic, colorectal cancer, complementary and alternative therapies, contraception, COPD, coronary care, coronary stents, Crohn's, cystic fibrosis, defibrillator, dementia, depression, dermatology, diabetes management, diet, disability, DNA, Down's syndrome, eating disorders, echinacea, ECT, eczema, elderly people, endoscopy, epilepsy, erectile dysfunction, euthanasia, exercise, fat, fertility, fitness, flu pandemic, fluoxetine, folic acid, food labelling, fracture, fragile X syndrome, general surgery, genetics, gerontology, GIK infusion therapy, GORD, gout, haemodialysis, hearing, heart attack, heart disease, heart failure, heart health, hepatitis, HIV, hospital care, HPV, HRT, hyperglycaemia, hypertension, hypoglycaemia, IBD, ICU, incontinence, infant, infant mortality, infection, inflammatory bowel disease, influenza, invasive candidiasis, IQ, Irish Heart Foundation, irritable bowel syndrome, keyhole surgery, kidney disease, laser, learning difficulties, leukaemia, liver disease, lumbar disk herniation, lung cancer, lung disease, lymph nodes, macular degeneration, macular oedema, magnetic resonance imaging (MRI), malaria, malnutrition, Marfan syndrome, media, medical ethics, medical research, medication, meningitis, mental illness, metabolic syndrome, migraine, miscarriage, mortality rate, MRSA, multiple sclerosis (MS), NCHDs, nephrology, neurology, OAB, obesity, obstetrics, occupational health, ocular medicine, omega-3, opthalmology, oral cancer, organ transplantation, orthopaedics, osteoporosis, otolaryngology, ovarian cancer, paediatrics, pain management, pancreatic cancer, panic, Parkinson’s disease, patient safety, patient-physician communication, personality disorders, physiotherapy, plastic surgery, polio, practice, pre-eclampsia, pregnancy, preventative health care, probiotics, prostate cancer, psoriasis, psychiatric admission, psychiatry, psychotherapy, PTSD, public health, quality of life, radiology, radiotherapy, rectal cancer, reproductive health, research, resuscitation, rheumatoid arthritis, rheumatology, rhinitis, salt, SARS, schizophrenia, screening, seizures, self harm, sexual abuse, sexual health, sexually transmitted infections, SGA, sinusitis, skin cancer, sleep disorders, smoking, smoking ban, spinal injury, sports medicine, statins, stress, stroke, substance abuse, suicide, supplement, surgery, syncope, technology, teenagers, testosterone, thoracic surgery, thrombosis, thyroid cancer, tonsillectomy, tonsillitis, Tourette's syndrome, toxicology, travel medicine, tuberculosis, tumour angiogenesis, type 1 diabetes, type 2 diabetes, ulcer, ulcerative colitis, urinary incontinence, vaccine, vitamins, weight, WHO, women's health, World Health Assembly

«Previous article | Next article»

Contraception options vary with age, body and individual

Natalya Anderson gives an overview of contraception options available to women in Ireland and the advantages and disadvantages of using particualr methods

Not all women are created equally when it comes to sexual activity and birth control needs, but they may not even know it.

While statistics published as recently as 2008 indicate that a combined oral contraceptive pill (‘the pill’) is still the most popular form of contraception (25 per cent of Irish women between the ages of 15 and 45 use it), other birth control devices are worth reviewing for women who might want to consider options better suited to them, depending on their age, body type, and medical requirements.

Combined Oral Contraceptive Pill
A combination of oestrogen and progestogen, the combined oral contraceptive pill comes in several forms in Ireland. Different brands of ‘the pill’ contain varying levels of oestrogen and different types of progestogen, but each combination currently available is more than 99 per cent effective at birth control.

The pill acts as a fertilization block by preventing ovulation each month. The pill pack should contain 21 birth control pills, which should be taken once daily, commencing on the first day of menstruation. After 21 days, a seven-day break should be taken from the pills (some packs may contain placebo pills for these days).

Following the seven-day break, (during which menstruation should occur), the birth control pills should be taken again daily. Women who are forgetful about taking a daily pill may not like this option.

Women who have a history of blood clots, serious migraine headaches, who are overweight, who have high blood pressure, or who are smokers aged 35 or over are advised not to take this form of contraception. Experts at Well Woman Centres further stress that women with a history of breast cancer in their family might be advised to avoid pills containing oestrogen.

Side effects in women who take this pill may include bloating, nausea, headaches, tender breasts, and mood swings. In some cases skin problems like acne, and a change in sex drive can also occur. The pill’s effectiveness is reduced if a woman is sick (vomiting or diarrhea, for example, may inhibit absorption).

Well Woman Centres offer further information on late or missed pills.

Emergency Contraception (‘The Morning After Pill’)
In the event that a woman is not taking birth control and finds herself in an emergency situation (a condom breaks, an unwanted act of sexual intercourse or sexual assault occurs), emergency contraception (EC) can be taken in the form of a pill up to 72 hours after unprotected sex. IMT reported in 2008 that approximately 90,000 pills are prescribed annually in Ireland.

NuvaRing
A relatively new form of contraception which also contains a combination of oestrogen and progesterone, Nuvaring is a flexible, vaginal ring. It is suitable for women who can tolerate the combined contraceptive pill. By pinching the middle of the flexible ring together, the ring is inserted into the vagina and left in place for three weeks.

Throughout this time, the ring slowly releases the hormone combination to prevent fertilization. The ring should then be removed for one full week and then replaced with a new ring. If accidental expulsion of the ring occurs, rinsing the device in warm water and reinserting it should not change efficacy. This option might be suitable for women who have a tendency to forget taking the pill.

Possible side effects with NuvaRing include vaginal infections and irritation, vaginal secretion, headache, weight gain, and nausea.

Clinical trial results published around 2002 indicated that 1 per cent to 2.5 per cent of 2,500 women discontinued using NuvaRing in relation to side effects. The most frequent of these were device-related events, discomfort, vaginitis, vaginal secretion, headache, mood swings, and weight gain.

Intrauterine Contraceptive Devices
There are two common forms of intrauterine devices (IUDs): Mirena (containing progesterone), the Flexi – T 300 (containing copper), and the Copper T 380 (also containing copper). These T – shaped devices must be inserted into the womb by a specialist physician.

Mirena:
Reportedly effective for at least five years, Mirena prevents sperm from reaching an egg by thickening the mucus in a woman’s cervix and thinning the wall of the womb to prevent implantation. In some cases it can prevent ovulation entirely, but the majority of women who use Mirena continue to ovulate. It has been reported that less than one in 100 women become pregnant while using Mirena.

Although Mirena may be advantageous for the duration of its efficacy and for its reportedly reducing length of cycle and heaviness of menstruation, it can cause spotting between periods, infection in the womb from the implantation procedure, headaches, acne, breast tenderness, and expulsion.

Flexi – T 300 and the Copper T 380 (Copper Coils):
Similar to Mirena, these prevent sperm from fertilizing an egg by forming a barrier with thickened mucus in the cervix and thinning the womb wall.

Copper coils are reportedly less effective than Mirena, (the Flexi – T 300 only last up to three years), with up to 5 per cent of women getting pregnant on the Flexi – T 300.

With slightly more copper on it and lasting five to eight years, the Copper T 380 is reportedly more effective. Some experts argue that – even with the 5 per cent risk rate – the Flexi – T 300 is just as effective as the oral contraceptive pill, and can’t be forgotten or poorly absorbed during illness like the pill. Heavier periods and infection in the womb can occur with use of these devices. Check-ups several weeks after implantation are necessary.

The Patch
The contraceptive patch is like a plaster that needs to be changed weekly. It releases hormones (progestogen and oestrogen respectively) into the body slowly. The patch may be beneficial for women who are uncomfortable with the thought of having a coil or implant surgically placed. Side effects include nausea and/or vomiting, skin reaction where the patch is placed, breast tenderness, headaches and emotional changes.

Women who are 35 or over who smoke are at increased risk of cardiovascular events with the patch. If it is unlikely that she will quit smoking, she should not use the patch.

Progestogen only pill (the ‘Mini Pill’)
Sometimes referred to as the ‘mini – pill’, the progestogen only pill only contains the hormone norethisterone (a type of progestogen). Efficacy can be 95 - 99 per cent, especially in women 30 years old and over and in women who are breastfeeding (both considered to be less fertile than younger women who are not breastfeeding).

Like IUDs, the mini pill thickens mucus at the cervix and changes the lining of the womb. It can sometimes prevent ovulation all together. This pill is suitable for women who cannot or should not take oestrogen for health reasons.

Possible side effects are congruent with those associated with the pill.

Usage is slightly different than with the pill, as there is no ‘break’ after 21 days, and the mini pill must be taken at the same time every day to be effective. It can be essential to begin taking this pill on the fist day of menstruation as well.

Well Woman Centres offer further information on late or missed pills, as well as on what can interfere with efficacy. Check-ups during use of this pill are also necessary.

Injectable Contraception and Implants
Each containing progestogen, injectable contraception (Depo-Provera) and implants (Implanon) slowly release the hormone over time.

Depo-Provera
Depo-Provera is the one injectable contraception available in Ireland; it contains medroxyprogesterone acetate (a type of progestogen).

Administered as a single injection in the bum muscle every 12 weeks, the first injection is given sometime during the first 5 days of a normally-occurring menstrual cycle. A woman’s physician should give her the date of her next injection. A woman is safe to have sexual intercourse immediately if she is given the injection on the first day of her period. If it’s administered any later than day one a woman should abstain from sex for seven days to be safe.

This form of contraception is beneficial as its slow release of progestogen means little can interfere with its efficacy. Women who are taking medication for epilepsy may need an injection every 10 weeks for improved efficacy. Additionally, this injection has an advantage over oral contraception in that antibiotics or illness (vomiting, for example) will not alter its efficacy.

One concern reported in studies indicates that bone density levels might be effected in women who are administered this injection in their late teens and early 20s (leaving them more susceptible to osteoporosis). Women in their late teens and 20s (when bone density is still developing), and women with a family history of osteoporosis, should consult their physician with any concerns.

Check-ups should take place at each 12 week injection.

Implanon
Inserted just above the elbow under the skin, Implanon is a rod-shaped device containing etonorgestrel (a type of progestogen). Local anaesthetic is administered to numb the area before insertion, and stitches or a plaster will be applied after insertion. This should be fitted during the first five days of a woman’s normal menstrual cycle.

Again, if implanted on day one of the menstrual cycle, protection from pregnancy is immediate. If implanted later in the menstruation cycle, a woman should abstain form sex for seven days to ensure effective contraception. The rod is reportedly effective for three years unless a woman is very overweight (implant change after two years might be necessary in some cases).

Like the Depo-Provera injection, little can interfere with this form of birth control due to its slow release of progestogen into the system, and antibiotics or an upset stomach shouldn’t alter efficacy either. Again, antiepileptic medication may interfere, however, and alternative contraception might be necessary in such cases.

Check-ups will be recommended six weeks after implantation, and then annual check-ups should be scheduled.

Injections and implants are over 99 per cent effective and can be used by most women. Because they do not contain oestrogen, women over the age of 35 who smoke, and women who suffer from severe migraines, may chose this form of contraception.

Women with irregular menstrual cycles, however, should consult their GP before use of progestogen. Women with a history of depression can be vulnerable to worsening mental health conditions with use of progestogen. Other side effects typically associated with birth control might occur, including spotting between periods, mood swings, bloating, nausea, headaches, and breast tenderness.

Some women may experience a complete stop to their menstrual cycle with use of injections or implants. Any concern should always be expressed to one’s physician, without hesitation. Normal menstrual cycles should recur within a few months if a woman chooses to cease treatment.

Posted in Women's Health on 01 October 2009
Tags: