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Birth Control – Everything You Need to Know

All women in today’s world need to know about contraception. Having an accurate knowledge of contraception helps a woman to remain in control of whether she becomes pregnant or not. Couples who wish to delay or space pregnancy or who do not wish to have children at all often seek counselling together on the best methods of contraception. Your gynaecologist will help you to choose the method of birth control that suits your needs the best.

Natural methods

  • Withdrawal: Also known as coitus interruptus, this method involves withdrawing the penis from the vagina before the ejaculation of sperm. It is not very reliable, as failure to withdraw the penis at the correct time can result in pregnancy.
  • Rhythm method: This is also not a failsafe method. It involves abstaining from sex during the fertile period in a woman’s menstrual cycle. The fertile phase begins at the beginning of follicular development and ends 48 hours after ovulation. Sperm retains the capacity to fertilise the egg for up to 5 days in the cervical mucus. Thus the combined unsafe phase for sex is about 6 to 8 days of every cycle. Owing to individual variations and irregularities in the date of ovulation, it is unwise to depend on the rhythm method for effective contraception.

Condoms (to be used by the man)

Condoms are one of the oldest and most reliable methods of contraception. A condom is a thin, lubricated rubber sheath that is worn over the penis in a state of erection. It acts as a barrier, trapping the sperm within, and not allowing it to enter the cervical canal. A fresh condom has to be used every time a couple has sex. As condoms are not very expensive, this does not pose a problem. One complaint against condoms is the reduced sensitivity experienced during sex. Tearing of the condom during sex is also a rare risk. Condoms are almost always successful in preventing pregnancy. They are also useful for guarding against sexually transmitted diseases, the HIV virus and carcinoma of the cervix.

Cervical diaphragm (to be worn by the woman)

This is a dome-shaped rubber device, which has to be inserted into the vagina, until it covers the anterior vaginal wall and the cervix. A diaphragm acts as a barrier to sperm. It is even more effective when used in combination with a spermicidal cream or jelly. The effectiveness of a diaphragm depends on leaving it in place for 6 six hours after sex and introducing more spermicide if sex occurs again. The only side effect associated with this method is greater frequency of urinary tract infections. However, a diaphragm may also protect against pelvic inflammatory disease.

Spermicidal substances (to be used by the woman)

Spermicidal substances include creams and jellies that contain spermicides. They are normally used along with other methods of contraception such as diaphragms or condoms, to increase their effectiveness. Very few women rely on spermicides alone to prevent pregnancy. Spermicides work by spreading themselves across the vagina and cervix and killing sperm, decreasing their motility or inactivating the enzymes required for penetration of sperm into the egg. There are no serious side effects of spermicide use.

Intra-uterine contraceptive devices (IUCD)

These are highly effective devices that are inserted into the uterus to prevent implantation of the fertilised egg. Implantation of the fertilised egg is prevented by a local sterile inflammatory reaction caused by the presence of the foreign body in the uterus. IUCDs must be inserted by a medical worker only.

Types of IUCD

Advantages of IUCD

  • They do not have any associated systemic metabolic effects.
  • A one-time insertion is required for protection over a long (but limited) period of time.
  • They are highly effective in preventing pregnancy.

Disadvantages of IUCD

  • Uterine bleeding: Women who discontinue the use of IUCD mostly do so because of heavy periods or intermenstrual bleeding. In most cases the bleeding stops after the uterus gets used to having a foreign body within it. If it does not stop, the IUCD should be removed.
  • Perforation of the uterus: This can occur rarely, due to careless insertion of the IUCD.
  • Infections: For 24 hours after an IUCD has been inserted, there is an infection of the uterus (which is normally sterile) with bacteria. In most cases, the bacteria are destroyed naturally, but in some, infections develop. IUCD use is associated with a greater risk of salpingitis. The risk of infection is also higher in women under 25 who have not had children, in those with a history of pelvic infection and in those with multiple sexual partners.

Birth control pills (to be taken by the woman)

Birth control pills are also known as oral contraceptives. They are commonly referred to as “the pill” and are highly effective. These pills, which have to be taken every day by the woman, contain oestrogen and progestogen in combination, or progestogen alone. These substances prevent pregnancy by suppressing gonadotropin and inhibiting ovulation. The cervical mucus becomes thick and does not allow sperm to penetrate beyond it. The endometrium becomes flat and inactive and is not prepared for implantation of a fertilised egg.

Minor side effects of birth control pills: Headaches, nausea and vomiting.

Serious complications associated with birth control pills

  • Thromboembolic complications: Oestrogen (which is contained in oral contraceptives) causes an increase of certain blood clotting factors. Users Women who take birth control pills are at higher risk of both superficial thrombosis (coagulation of blood) and deep vein thrombosis. They are also at a 4 four times greater risk of dying of vascular diseases than women who do not take the pills.
  • Hypertension: Hypertension can occur in a small number of users women as a result of taking the pill. About 5% of users women in the USA have been reported to develop hypertension after 5 years of use. Almost all women who have developed hypertension return to normal after discontinuing the pill.
  • Amenorrhea after stopping the pill: Some women develop amenorrhea (absence of periods) for a while after stopping the pill.
  • Rare liver tumour: There is an association between the use of birth control pills and a rare liver tumour called the hepatocellular adenoma. The risk of this tumour increases with more than 5 years of oral contraceptive use.

Long acting injectables

Birth control injections consisting of 250 mg of depomedroxyprogesterone acetate (DMPA) are now used widely all over the world. These injections prevent conception over a period of three months by inhibiting ovulation. This method of contraception has been tried and tested by the World Health Organisation. DMPA injections are particularly recommended for women who run high obstetrical risks, suffer from iron-deficiency or anaemia, have diabetes or live in remote areas where medical attention is not easily available. However, some women stop taking these injections because of menstrual irregularities such as frequent, irregular or heavy periods, and even amenorrhoea (absence of periods). There is also a delay in returning to the fertile state after stopping the injections.

Steroid- releasing implants

This is another long-term method of contraception for women. The implant is inserted under the skin. It slowly releases the steroid, which prevents conception. One implant is effective for about 8 eight months, and is easy to insert or remove. Because the steroid is released in a controlled manner, side effects are minimised. The implant can be removed if the woman has menstrual disturbances following insertion.

Steroid- releasing vaginal rings

This is a convenient method of contraception as the steroid-releasing vaginal ring can be inserted and removed by the woman. The ring has to be inserted on day 5 of the menstrual cycle and removed on day 25. There is no real harm done even if the woman forgets to remove it at the right time and retains it for a few days more. The insertion of a vaginal ring does not interfere with sex.

The “morning after” pill (post-coital contraception)

This course of pills can be taken within 72 hours of unprotected sex. However, it is better to take it within 24 hours. The pills (diethylstilbesterol 25 mg, twice daily for 5 five days) release a high dose of steroids. Just after ovulation, a high dose of steroids can disrupt the endometrium enough to prevent implantation of the fertilised egg. Anti-emetic tablets need to be prescribed to stop nausea and vomiting. In some cases, post-coital contraception does not work. Then it becomes necessary to have an abortion, as the pills taken could have a teratogenic (easier word?) effect on the foetus. It goes without saying that preventive contraception (back to links at the top) is much more advisable than post-coital contraception.

Permanent methods of contraception (sterilisation)

Permanent methods of contraception are those which cannot be reversed. Couples usually go in for these methods after they have completed their family. However, these methods are also recommended in those people who are mentally retarded, schizophrenic or epileptic, in women with severe diabetes mellitus, chronic leukemia or breast cancer. In men, permanent contraception involves a surgical procedure called vasectomy. In India, there are a lot of misconceptions about vasectomy, including that it will reduce the strength or sexual vigour of the man. None of this isthese are true, and vasectomy is really one of the best methods of permanent birth control for couples. In women, there are a number of methods including ligation of fallopian tubes, minilaparotomy and colpotomy.

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