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Wide choices abound in contraception Despite the many available contraception choices, approximately 50% of all pregnancies in the United States are still unintended. Ideally, every child should be wanted and every baby should be conceived when the mother-to-be is in optimal health. Losing weight and getting chronic medical conditions under good control are best done prior to conception so that the baby grows within the best possible environment – for the health of both baby and mother. Preventing “surprises” is one course of action – not only financially and emotionally, but also physically. Let’s review the latest in choices for contraception. The pill Introduced to the public in the early 1960s, the birth control pill has undergone several improvements in the past few years. The most recent update of the pill – Seasonale – still prevents ovulation and works in the same manner as typical oral contraception, but the hormones are administered for 11 rather than three consecutive weeks. This allows the user to only have four periods a year, instead of 12. Research is now focused on a pill that would limit menstruation to once a year. The main concern with such infrequent periods is that a woman might be accidentally pregnant for a long time before she’d realize it, thinking that going three months or longer without a period is normal, while on the pill. Not realizing that she is pregnant, she may then continue smoking, drinking or abusing other substances that would harm the fetus. The patch For women who have difficulty remembering to take a pill once a day for three weeks and then not take it for a week, there’s Ortho Evra, better known as “the patch.” It is left in place on the skin for a week, then removed and replaced with a new patch. If you forget to change the patch after seven days, there are sufficient hormones in the patch for eight days of coverage. The fourth week is the “withdrawal week” during which you menstruate. The patch is just as effective as the pill with ideal use, but is slightly more effective with typical use (occasional forgetfulness), since you only have to remember contraception once a week with the patch, rather than once a day with the pill. The patch is less effective in women who weigh more than 200 pounds. As with oral contraceptive pills, the patch, too, can be less effective in women who are taking anti-seizure medications or certain antibiotics. Nausea and breast tenderness may be experienced with either the pill or the patch – with the added complication of skin irritation with the patch. This is usually prevented by rotating the patch’s site. Any form of contraception containing estrogen can increase the risk of blood clots – an infrequent but potentially life-threatening condition if left untreated. Symptoms of blood clots in the leg include pain or swelling of the leg, which is aggravated while walking. Heavy smokers (15 or more cigarettes a day) and women with uncontrolled diabetes or high blood pressure are more prone to blood clots, but in general, most women tolerate the pill and patch well and do not experience side effects. The ring For women who only want to think about contraception once a month, there’s NuvaRing, a gel bracelet that is inserted into the vagina and kept in place for three weeks. Estrogen and progestin are released from the ring and absorbed vaginally. Unlike a diaphragm, it does not have to be individually fitted. In about 2% of women, the ring has caused vaginitis, an irritation or infection of the vagina. The shot For women who don’t mind shots, there’s still Depo-Provera, administered intramuscularly four times a year in a doctor’s office. There are some side effects, including weight gain, headaches, or irregular spotting or irregular bleeding in the first few months of use. Women who are prone to depression may experience exacerbation of their depressive symptoms and should speak to their physician about this form of contraception prior to use. However, there are secondary benefits including lighter periods or even amenorrhea, which is the cessation of periods altogether. Male contraception Though researchers continue the search for a contraceptive for men, male physiology makes this difficult. Men produce sperm on a 72-hour cycle, which means that their hormones would have to be suppressed constantly. Long-term consequences are unknown; irreversible sterility, once the hormone suppression is stopped, is one concern. For now, with the exception of condoms, male contraception is still on the drawing board. For women, comfort and convenience remain the main factors in determining what contraceptive choice is right for them. It is important for each woman to choose a contraceptive that suits her individual preferences so that she uses it consistently and, ideally, becomes pregnant only when she is ready to welcome a baby into her life. Dr. Bich-Van Tran is a board-certified OB/GYN at UCI Medical Center, Orange County’s only university hospital, which has been named one of the nation’s best hospitals for gynecology by U.S. News & World Report. Information: ucihealth.com or 714.456.2911. |
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