About our Book: A Gynecologist's Second Opinion

Contraception

Edited excerpts from our book
A Gynecologist's Second Opinion
by William H. Parker, M.D.

WHAT CONTRACEPTIVE METHODS ARE NOW AVAILABLE?

No method of contraception is perfect, and each has its own set of advantages and disadvantages. The currently available means of contraception are:

Birth control pills
Emergency contraception - pills
Intrauterine devices (IUDs)
Barrier methods such as condoms, the diaphragm, sponge or cervical cap
Spermicides in the form of foam, films or creams,
Rhythm (periodic abstinence)
Abstinence
Withdrawal
Hormonal injections (depo-provera, Lunelle)
Hormonal implants (Implanon) beneath the skin
Hormonal vaginal ring
Hormonal patch
Female and male surgical sterilization
Male hormonal injections

One of these methods may be very reasonable for one woman but unsuitable for others. The goal for you and your doctor is to find out what will work best for you.

Here are the factors to consider when choosing a contraceptive method: Effectiveness of the method
Frequency of intercourse - more often increases your risk of pregnancy
Relative importance to you of not becoming pregnant
How careful you are likely to be using the method (Will you remember to take a pill every day? Will you insert a diaphragm every time?)
Availability and cost of the method
Your age and general medical condition (some methods may have increased risk with age or medical diseases)

HOW DO BIRTH CONTROL PILLS WORK?

In order for an egg to develop in the ovary and then be released, a complicated symphony of hormonal events must take place. An area of the brain, called the hypothalamus, is responsible for regulating the hormonal signals that start this process. The hormones in the pill shut off these signals from the brain that tell the ovary to develop and release an egg. Without these signals, the egg does not develop and is not available to be released (ovulated) and pregnancy can not occur. In addition, the pill has a few other effects on your body that decreases the likelihood of pregnancy. One of the hormones in the pill, the progestin, makes the mucous thicker in the cervix and tubes so that it is more difficult for sperm to pass into the uterus and more difficult for the egg to move down the tube. Also, the pill causes changes in the uterine lining that hinders implantation of the fertilized egg.

Birth control pills contain synthetic hormones, somewhat different from their natural forms so that they can be taken orally and not be destroyed by the digestive juices in the stomach and intestines. All the pills now contain the same estrogen, ethinyl estradiol, but slightly different types of progesterones called progestins. Different brands of pills contain various doses of both estrogen and progestins in order to meet the needs of a range of women. While you may find one birth control pill suits you perfectly, another woman may have undesirable side effects from that same pill.

The pills originally made in the 1960s contained about 80-150 micrograms of estrogen. Today’s pills contain either 50 micrograms (mcg) of estrogen, called high-dose, or 35 mcg, called low-dose, or 20 mcg, called very low-dose. Very-low dose pills are just as effective as high-dose pills for prevention of pregnancy. It is best to take the lowest dose pill, so that side effects are less likely. However, some women notice bothersome breakthrough bleeding on the lowest dose pills. Switching to a slightly higher dose pill often resolves this bleeding. Women’s bodies are different, so you may need to try a few types of oral contraceptives in order to find the one that is right.

WHAT IS EMERGENCY CONTRACEPTION?

We all make mistakes sometimes, but making a mistake regarding contraception can have major consequences. Some women have unprotected intercourse, or a condom breaks, or they take the diaphragm out too soon. In these situations, emergency contraceptive pills, taken within 72 hours following this unprotected intercourse are fairly reliable in preventing pregnancy. Emergency contraception works by preventing or delaying ovulation. Two new pill packages, called Preven and Plan B, are now available specifically for this purpose. In some states emergency contraception is available over-the-counter without a prescription from a doctor. It is a good idea for all women who use barrier contraception to have a supply of, or prescription for, emergency contraception on hand.

Preven contains a higher dose of the same hormones that are present in the regular birth control pills. Plan B contains only the progesterone hormone (progestin). For each of these brands, one pill is taken as soon as possible following unprotected intercourse, and another pill is taken 12 hours after the first. Both of these brands have a success rate of 75% so are not as effective as most standard methods of contraception (hence the name Plan B). If 100 women have unprotected intercourse during the middle two weeks of their cycle, about 8 women will get pregnant. If emergency contraception is used, only 2 women will get pregnant. Emergency contraception is excellent for back-up contraception, when needed.

Unfortunately, many women do not know about emergency contraception, and many unwanted pregnancies may occur as a result. If you are using a barrier method of contraception that you may occasionally forget to use, you should have a package of emergency contraception in your medicine cabinet to be safe.

WHAT IS THE BEST WAY TO PREVENT BOTH PREGNANCY AND SEXUALLY TRANSMITTED INFECTIONS?

Choosing the best method of birth control depends on which method will be safe for you, which method you will be able to use consistently and which method has the least side effects. However, only one method helps prevent STI’s – condoms. Sexually transmitted infections can cause fever, pelvic pain or nausea and vomiting. Some infections are milder and can be treated with antibiotics at home, but more severe infections often require hospitalization for intravenous antibiotics. Other infections may be subtle, causing not much more than an upset stomach that will not lead to a doctor’s visit. However, any of these infections can lead to scarring around the tubes or ovaries and may cause infertility. Therefore, prevention of STI’s should be of great importance to women.

Condoms will prevent contact with both the skin of the penis and semen, both of which can carry infections. As a result, it is a good idea to use condoms in addition to other contraception. Once you are sure the relationship is mutually monogamous and both of you have been tested free of STI’s, you may consider omitting condoms.

WHAT IS BEST FOR YOU?

As with most medical decisions, a lot has to do with what method of contraception suits you best. The one statement that applies to almost everyone is this: if you are in a new sexual relationship or a non-monogamous relationship, you should use a condom in addition to another method of contraception. The male or female condom is the most effective means of avoiding sexually transmitted infections.

However, since the condom is not the best means of preventing pregnancy, an additional method for contraception is also advised. The diaphragm is a great method, but it won’t work if you dislike using it so much that you often leave it in the drawer. Sterilization, either male or female, is very effective, but should be viewed as permanent so is not appropriate until you have completed your family. Hopefully, this chapter has provided enough information to help you make a reasonable choice. Ask your doctor or health-care provider for further information about your particular situation. It is important that you feel comfortable with your decision. After years of limited choices, recent advances have led to a number of new contraceptive methods now available. Other methods of contraception are in development and may be suited for you when they become available. New information about risks and benefits of current methods is regularly published and may influence your decision. This is an important decision and you should explore all your options.

The following questions and answers can be found in our book

How Does Pregnancy Occur?
How Likely Are You To Get Pregnant?
What Contraceptive Methods Are Now Available?
Birth Control Pills
- What Are Birth Control Pills?
- How Do Birth Control Pills Work?
- How Effective Are Birth Control Pills?
- What Are Mistaken Beliefs About Birth Control Pills?
- What Are The Benefits Of Taking The Pill?
- Can The Pill Help Relieve Acne?
- What Are The Side Effects Of Birth Control Pills?
- Does The Pill Cause Weight Gain?
- What Are The Uncommon Side Effects Of The Pill?
- What Are The Long-Term Risks Of Taking The Pill?
- Can The Pill Decrease Your Fertility?
- Who Should Not Take The Pill?
- Does The Pill Increase Your Risk Of Getting Cancer?
- How Should You Take The Pill?
- What Should You Do If You Miss A Pill?
- Can You Postpone Bleeding For An Event – Like A Wedding Or Vacation?
- Should You Stop The Pill Every Few Years “To Give Your Body A Rest”?
- How Long Can You Take The Pill?
- Are There Benefits To Taking The Pill In The Perimenopause?
- What If You Have Irregular Bleeding On The Pill?
- What If You Don’t Have Any Bleeding At The End Of The Month?
- What If You Take The Pill Inadvertently When You Are Pregnant?
Emergency Contraception
- What Is Emergency Contraception?
- What Are The Side Effects Of Emergency Contraception?
- What Is The Contraceptive Patch?
- What Is The Contraceptive Ring?
- What Is Implanon?
- What Are The Benefits Of Implanon?
- What Are The Side Effects Of Implanon?
- What Is Depo-Provera?
- What Are The Benefits Of Depo-Provera?
- What Are The Side Effects Of Depo-Provera?
- What Is Lunelle?
IUD
- What Is An Intrauterine Device?
- How Does The Iud Prevent Pregnancy?
- How Effective Is The Iud?
- Are There Any Benefits To Using An Iud?
- Does The Iud Increase The Risk Of Uterine Infection?
- What Is The Best Way To Prevent Both Pregnancy And Sexually Transmitted Infections?
- Who Should Not Use An Iud?
- What Are The Side Effects Of The Iud?
- What If You Get Pregnant With An Iud?
Barrier Methods
- What Are The Barrier Methods?
- What Is A Male Condom?
- What Is The Effectiveness Rate Of The Male Condom?
- What Are The Advantages Of Using A Male Condom?
- What Are The Disadvantages Of Using A Male Condom?
- How Does The Female Condom Work?
- How Does The Diaphragm Work?
- How Effective Is The Diaphragm?
- What Are The Advantages To The Diaphragm?
- What Are The Side Effects Of The Diaphragm?
- What Is The Cervical Cap?
- What Are Spermicides?
- What Are The Advantages To Using Spermicides?
- What Are The Side-Effects Of Spermicides?
Natural Family Planning
- What Is Natural Family Planning?
- What Is The Rhythm Method?
- What Is The Ovulation Method?
- What Is The Basal Body Temperature Method?
- What Is The Symptothermal Method?
- What Are Home Ovulation Predictor Kits?
Female And Male Sterilization
- What Is Female Surgical Sterilization?
- How Is Female Sterilization Performed?
- What Are The Advantages Of Female Sterilization?
- What Are The Disadvantages Of Female Sterilization?
- What Is Male Surgical Sterilization?
- What Are The Advantages Of Male Sterilization?
- What Are The Disadvantages Of Male Sterilization?
- How Is Male Sterilization Performed?
- What About Male Hormonal Contraception?
What Is Best For You?

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Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.