Which Contraceptives Are Best for Preventing Pregnancy?
Preventing Pregnancy
Several factors come into play when deciding which method of birth control is best for you. Your overall health, age, frequency of sexual intercourse, the number of partners you have, and whether you desire to have children in the future must all be considered before deciding upon a birth control method.
The Pill
The pill is the first contraceptive that most women think of when considering birth control. Today the pill is available as combined oral contraceptives (COC) which contain both estrogen and progestin, or in progestin only pills (POP) which contain only progestin.
COC's work by suppressing ovulation and may make periods more regular. According to an FDA Consumer report, they also offer a protective effect against pelvic inflammatory disease (PID), as well as ovarian and endometrial cancers. These pills are considered safe for most women, however women who smoke and are over 35 or who have a significant family history of cardiovascular disease should not use oral contraceptives due to an increased risk of cardiovascular diseases. Women with a medical history of blood clots, or breast or endometrial cancers also should not use combined oral contraceptives. Possibleside effects which may subside after a few months include nausea, headache, breast tenderness, weight gain, irregular bleeding, and depression.
POP's work by reducing and thickening the cervical mucus to prevent sperm from reaching the egg, and by keeping the uterine lining from thickening to prevent implantation of a fertilized egg. Because these pills contain no estrogen the risk of blood clots is not present as with the combined oral contraceptives. This type of birth control pill is a good option for women who cannot take estrogen because they are breast feeding or because of headaches or high blood pressure problems associated with estrogen. The progestin only pill may cause menstrual changes, weight gain, and breast tenderness.
Injectable Progestins
Pregnancy can be prevented up to three months by injection of Depo-Provera. Depo-Provera prevents pregnancy by inhibiting ovulation, changing the cervical mucus to prevent sperm from reaching an egg, and by changing the uterine lining so that a fertilized egg will be unable to implant. This method is extremely effective since all that's required of a woman is to return to her health care provider for a shot every three months. Benefits and side effects of Depo-Provera are similar to those of progestin only pills.
Interuterine Devices (IUD)
The IUD has experienced some bad publicity in the past when the Dalkon Shield was associated with a high incidence of pelvic infections, infertility, and some deaths. However, today's IUDs have one of the lowest failure rates of any contraceptive method. An IUD is a T-shaped device that is inserted into the uterus by a health care professional. There are two types of IUD available, the Paragard CopperT 380A which protects against pregnancy for 10 years, and the Progestasert Progesterone T which must be replaced every year. The IUD is an appropriate choice for those in long term monogamous relationships who are not at high risk for sexually transmitted diseases or infections.
The Sponge
Allendale Pharmaceuticals was recently given approval by the FDA to manufacture the Today Sponge again in the US. The sponge works by releasing spermicidal gel over the vaginal mucus while the sponge forms a barrier to kill or immobilize sperm before it can reach the cervix and enter the uterus. The sponge can be inserted several hours before intercourse and can be left in place up to 12 hours after sex. It does not need to be replaced if sexual intercourse is repeated. Women who are allergic to nonoxyl-9 or who have had toxic shock syndrome should not use the sponge. Protectaid® is currently available in Canada, and US residents can expect to find the Today Sponge on pharmacy shelves in the fall.
Diaphragm
The diaphragm is available by prescription and is sized by a health care professional to ensure a proper fit. The diaphragm works by covering the cervix with a dome-shaped rubber disk with a flexible rim to prevent sperm from entering the uterus. A spermicidal is applied to the diaphragm before insertion to kill sperm. The diaphragm may be left in place for 6 hours, however for repeated sexual intercourse or intercourse after 6 hours spermicide should be inserted into the vagina while the diaphragm is still in place. Diaphragms should never be left in for more than 24 hours due to risk of toxic shock syndrome (TSS).
Cervical Cap
The cervical capis similar to the diaphragm. It is a soft rubber cup with a roundedrim and is sized to fit, by a health car professional, tightly around the cervix. Like the diaphragm, spermicide is required with the cervical cap. It protects against pregnancy for 48 hours and for multiple acts of sexual intercourse during this time. Prolonged use (over 48 hours) may increase the risk of TSS and can produce a foul odor or discharge.
Benefits of Oral Contraceptives
Most of us think of oral contraceptives as a means of preventing unplanned pregnancies. Oral contraceptives contain progestin and may also contain a synthetic estrogen. With consistent and proper use oral contraceptives are a highly effective method of contraception.
But did you know there are several other reproductive health conditions that can be improved or prevented with the use of these hormones? According to American Family Physician's update on oral contraceptives, "The non contraceptive benefits (and favorable side effect profiles) of oral contraceptive pills are so important that some patients use the pills exclusively for those reasons.
The conditions which the American Academy of Family Physicians endorses the use of oral contraceptives are:
Excessive androgens:
Implicated in the development of acne, oral contraceptives reduce the amount of androgen that is available. Just how this works depends on the specific hormone combination in a particular oral contraceptive. In a study reported in American Family Physician, 83 percent of participants who received norgestimate and ethinyl estradiol rated their acne improved after six months. Sales of Ortho Tri-Cyclen have tripled since the results of this study were published, and the FDA gave Johnson & Johnson the right to sell Ortho Tri-Cyclen for the treatment of acne.
Benign Breast Cysts:
Oral contraceptives are considered first line treatment for this condition. Seventy to ninety percent of patients see improvement in the symptoms of fibrocystic breast conditions with use of oral contraceptives.
Dysmenorrhea:
While the FDA does not approve of oral contraceptives prescribed primarily for the relief of cramps, women who use The Pill rarely experience menstrual cramps.
Ectopic Pregnancy:
According to the Centers for Disease Control (CDC) there is clearly controversy about whether oral contraceptives prevent ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg fails to implant itself in the uterus, most often remaining in the fallopian tubes.
Endometriosis:
Progestin only oral contraceptives are an effective treatment for endometriosis. Unfortunately the side effects of this treatment which includes irregular bleeding, fluid retention, and depression have made this option unbearable for many women.
Functional Ovarian Cysts:
These are the most common type of ovarian cyst and usually dissolve within two menstrual cycles without treatment. Oral contraceptives may help prevent this type of ovarian cyst by helping to regulate the menstrual cycle.
Hirsutism:
Polycystic ovarian syndrome (PCOS) is the most common cause of excessive hair growth in women. Oral contraceptives can improve or stabilize up to 50 percent of cases caused by PCOS.
Metrorrhagia:
Women who experience abnormal uterine bleeding can often regulate their menstrual cycle with oral contraceptives, if after close medical investigation the abnormal bleeding is not found to be a symptom of a more serious condition.
Mittelschmerz:
Oral contraceptives block the surge of hormones that occurs before ovulation, and are often effective for relieving mid-cycle or ovulation pain.
Ovarian and Endometrial Cancer:
Women who use oral contraceptives experience these types of cancer at about half the rate of nonusers. However it's important to note that there may be an increased risk of breast cancer and cervical cancer in women who use oral contraceptives for more than five years.
Premenstrual Syndrome:
Many women experience less symptoms of PMS while using oral contraceptives. However, there are other treatments and lifestyle modifications which may also provide relief and which should be considered.
Uterine Fibroid Tumors:
According to the National Library of Medicine, oral contraceptives may be an effective treatment for uterine fibroid tumors.
Oral contraceptives may not be the right choice for everyone. For some women the side effects of oral contraceptives may be worse than the original symptom. There is controversy among some health care professionals about using synthetic hormones for these purposes when more natural options for many of these conditions exist.
If you think oral contraceptives might be right for treating your reproductive health problems discuss your personal medical history with your physician.
