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Your guide to contraceptives
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Dr. Aniruddha Malpani
Renowned infertility specialist. He runs an infertility clinic in Mumbai and has written many books.
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Since all of us need to plan our families, we all need to be aware of how to use birth control (contraception). There are many "Methods of Family Planning" as taught in medical college and these include: tubal ligation; vasectomy; oral contraception (OC); intrauterine contraceptive devices (IUCDs). However, you do not go to the doctor asking for an OC or IUCD - instead, you need to select a method, which is appropriate for your needs.
1. The newly married couple
Oral contraception (birth control pills) is the best method, provided you are reliable and are willing to take the tablets regularly. A major problem with OCs is that many women have heard many myths about the effect of "hormones" on their weight. While it is true that side effects with OCs are fairly common especially bloating, fluid retention and nausea, most of these are temporary, and will subside on their own in a few days. The best way to take OCs is to take one daily; from the first day the period starts, at a fixed time (for example, when brushing teeth). If you forget one, you simply need to take two the next day. However, if you forget two, then you need to use an additional form of contraception for the rest of the month.
While there are many brands of OCs available, select a low-dose OC, which has a low-dose OC, which has a low-dose of estrogen and progesterone. Triphasics are more expensive, because they are newer and are being marketed more aggressively, but have little benefit as compared to the traditional monophasics (which are much less expensive).
OCs also have many beneficial effects - they can help to regularize your periods, improve your complexion and reduce your acne! Women on oral contraceptives usually have regular, painless menstrual cycles with a reduced blood loss. Thus, if you have heavy irregular menstrual periods, and also need contraception, then using OCs will allow you to kill two birds with one stone! Long-term use will not affect your future fertility, so you can take them for as long as you like, till you are ready to start your family.
The intrauterine contraceptive device (IUCD) has the advantage that it can be fixed and forgotten. But IUCDs may cause more problems when fitted in women who have never been pregnant, because the uterus is smaller.
Condoms are still the most popular form of contraception, but can easily be forgotten in the "heat" of the moment, especially in a newly married couple.
2. The young woman who has had unprotected sex
This is a medical emergency - at least for the patient! The good news is that post-coital contraception is now very effective and safe - and should be more widely used. The most popular regime is the Yutzpe regime. This consists simply of 4 tablets of Ovral (which consists of 50 ug of ethinyl estradiol and 500 ug of dl-Norgestrel); 2 tablets taken immediately, followed by another 2 tablets after 12 hours. Post-coital contraception can be started as late as 48 hours after the act of intercourse, without affecting its efficacy. Another alternative, especially for the patient who wants an ongoing form of contraception, is to fit an IUCD. This can be done upto 5 days of the act of intercourse, and is equally effective in preventing a pregnancy.
Other options which may be suitable for selected women include:
Natural family planning, which is an excellent alternative-especially for patients who are uncomfortable with the idea of using contraception- for example, on religious grounds. However, it requires a highly motivated couple, who are intelligent enough to be able to follow the woman's menstrual cycle, and synchronise their sex life accordingly. It is very effective, especially for the woman's awareness of her own ovulation, as determined by her tracking the pattern of her cervical mucus.
Newer options, which are still not easily available, include depot preparations, such as Depo-Provera.
The risk-benefit of contraception
Please remember that contraception should be used to help you to meet your personal reproductive needs. Using any contraception carries a certain risk- for example, the small risk of stroke in patients using oral contraception. Unfortunately, the adverse effects of contraceptives have been overemphasised - especially in the lay press, leading to many myths amongst women. The risk of an unwanted unplanned pregnancy is usually far greater than the risk of using any contraceptive.
Indisputably, the availability of reliable contraception has been one of the major medical advances of this century - and has allowed the modern young woman to plan her family the way she wants!
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