Health Guide

Birth Control Complications

Although the contraceptive pill is very safe, there are some women who should not use it. Those who have had blood clots, severe liver disease, strokes or bad migraines must not take the pill. Heavy smokers, obese women and those with diabetes must be observed closely, and probably should not use the pill after 35 years of age. Medroxyprogesterone injections are generally very safe, and by far the most reliable of the reversible forms of contraception, but problems can include headaches, abnormal vaginal bleeding, and the contraceptive effect lasting far longer than desired.

The complications of a tubal ligation are few, the main ones being bleeding and infection. The operation is safe and effective, and it is extremely rare for pregnancy to occur afterwards. The woman's menstrual cycle is not affected in any way, but if the contraceptive pill is ceased after the operation, her periods may become heavier and uncomfortable due to the loss of control offered by the pill. This sometimes leads to the misconception that hysterectomies are needed after a tube tie. After a vasectomy there may be some bruising and discomfort of the scrotum for a few days after the operation, but other complications are rare. Not all women are suited to the use of IUDs. Only about 40% of women still have them in place a year after insertion. Sometimes they can fall out, they may cause heavy and painful periods, or rarely they can cause infections of the uterus resulting in permanent infertility. During insertion, it very rarely may penetrate the uterus to cause serious peritonitis. The devices seem to have fewer side effects in women who have had a pregnancy, but there are smaller devices available for women who have had no children.

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The Intrauterine Device - Birth Control

The intrauterine device -
The intrauterine device is a piece of plastic shaped like a7, T or S, that may be covered by a thin coil of copper wire. It is inserted by a doctor through the vagina and cervix to sit inside the uterus (womb). The intrauterine device acts by irritating the lining of the womb (uterus), and preventing the development of the pregnancy. The insertion of the device is done very simply by your own doctor, and takes only a few minutes. It is usually quite pain free. Through a speculum (a collapsible metal tube) a doctor will examine the entrance to the womb (the cervix) and check the shape and size of the uterus. Then, while holding the cervix carefully with a special pair of forceps, the IUD is slowly pushed through the cervix canal into the uterus. It is only 3mm. in diameter when inserted, but once inside the uterus it springs open to its "7", "T" or "S" shape and is held in position by the arms of the device pushing on the uterine walls. It is normal to insert the intrauterine device immediately after a menstrual period, but may be inserted at other times if the woman wants immediate protection Once in place, the woman is not aware of its presence. After each period she should feel for the fine thread which will normally hang into the vagina. This is used to remove the intrauterine device at a later time. The device can remain in place for two or three years before its needs to be changed, but a doctor should check it every year, when you should also have a routine Pap smear test. The intrauterine device has one great advantage - you cannot forget to take it or use it. Once in place it can be relied upon to give 97% protection against pregnancy. When you want to become pregnant, or no longer require contraception, the device is easily removed. Your doctor will merely pull on the short thread left outside the uterus (but inside the vagina), and the intrauterine device will fold up on itself, enabling it to be gently withdrawn.

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Contraceptive pill - Birth Control

Contraceptive pill -
The oral contraceptive pill is the safest and most effective form of reversible contraception. There are many different dosage forms and strengths, so that most women can find one that meets their needs. The main types are the constant dose two hormone pill, the two or three phase two hormone pill (hormone doses vary during month), and the one hormone mini-pill (see Medication Table). The pill has several positive benefits besides almost perfect prevention of pregnancy. It regulates irregular periods, reduces menstrual pain and premenstrual tension, may increase the size of the breasts, reduces the severity of acne in some women, and libido (the desire for sex) is often increased. It even reduces the incidence of some types of cancer.

Two different hormones control the menstrual cycle. At the time of ovulation, the levels of one hormone drops, and the other rises, triggering the egg's release from the ovary. When the hormones revert to their previous level two weeks later, the lining of the womb is no longer able to survive and breaks away, giving the woman a period. The pill maintains a more constant hormone level, and thus prevents the release of the egg. With the triphasic pills, the level of both hormones rises at the normal time of ovulation, and then drops slightly thereafter to give a more natural hormonal cycle to the woman, while still preventing the release of an egg. When the pill is stopped (or the sugar pills started) at the end of the month, the sudden drop in hormone levels cause a period to start.If taken correctly, the pill is very effective as a contraceptive. But missing a pill, or suffering from diarrhoea or vomiting can have a very pregnant result. Some antibiotics can also interfere with the pil. A few women do have unwanted side effects from the contraceptive pill. These can include headaches, break through bleeding, nausea, breast tenderness, increased appetite and mood changes. If these problems occur, they can be assessed by a doctor, and a pill containing a different balance of hormones can be prescribed.

There is no need these days to take a break from the pill every year or so. This may have been the case in earlier years, but is no longer necessary. The effects of the pill are readily reversible. If you decide to become pregnant, you could find yourself in that state in as little as two weeks after ceasing it, with no adverse effects on the mother or child.

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Vasectomy - Birth Control

Vasectomy
Most men are very anxious about a vasectomy, as they are not sure what happens and are concerned that it may affect their libido or masculinity. This is not so. Sperm are produced by the testes throughout adult life at a relatively constant rate. The sperm enter a complex network of small tubules which unite to form the sperm tube (vas deferens). The sperm pass along this tube to a storage sac (the seminal vescicle) in the groin where they await the next ejaculation. The walls of the sperm storage sac secrete a fluid which nourishes the sperm, and along with an exudate from the prostate gland, forms 95% of the semen passed by the man during intercourse. When he ejaculates, the sperm and supporting fluid (called semen when combined) pass down the sperm tube to its junction with the urethra, and then along this tube to the outside of the penis. In the operation, a local anaesthetic numbs the side of the scrotum, and through a small incision, the doctor cuts, burns and ties the sperm tube (vas deferens) so no further sperm can pass along it from the testes. This may be done in the doctor's rooms, or as a day patient in a private hospital.

The procedure is very simple and brief, and no pain is felt.The man is not immediately sterile after the operation. Because sperm are stored in the sac above where the tube is tied, this must be emptied by about a dozen ejaculations over the next few weeks. It is normal to have a test done about six weeks after the operation to check that no sperm are getting through or remaining in storage. The couple can stop their other contraceptive measures after this test is confirmed. The male hormones which establish and maintain masculinity are also produced in the testicles. These are no affected in any way by the operation as they enter the blood stream directly from the testes and continue to function normally. The man's ejaculation is not affected either, as the fluid from the sperm storage sac is passed as normal.

2. Preventing the release of the egg (ovum) from the ovary.

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Tubal ligation - Birth Control

Tubal ligation

A tubal ligation can be done by an open procedure or laparoscopy. In the open operation the surgeon (usually a gynaecologist) makes a horizontal cut about 7cm. long just above the pubic bone to gain access to the fallopian tubes and then ties or clamps them. The scar should be below the line of all but the briefest of bikinis. The commoner and simpler operation is a laparoscopy. Two small cuts are made in the abdomen, one in the belly button and one low down on one side. Each is 1cm. long. Through these small cuts, long stainless-steel tubes are placed. The surgeon looks through one, and operates with very long, fine instruments through the other.

The Fallopian tubes are closed with metal clips and electrically burnt in this procedure, which takes only 15 minutes under a general or local anaesthetic in a hospital or clinic. Laparoscopy can also be done through a cut in the top of the vagina, which avoids any scars, but is technically more difficult and sex must be avoided for several weeks. Only an overnight stay is required in hospital with these procedures. With laparoscopy there is only minor lower abdominal discomfort for a few days, and normal work can be resumed after a week. Recovery is a little slower with the open operation.If the circumstances are appropriate, and if arranged with theobstetrician beforehand, tubal ligation can be performed at the same time as a Caesarean section.

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Sterilisation - Birth Control

Sterilisation

Tying the fallopian tubes in a woman or the vas deferens in a man to give permanent infertility. A couple may decide that their family is complete, and that under no circumstances do they want more children. This must be a decision of the couple, and not the individual woman, as the ability to have children is a joint property, not an individual one. Once the decision has been made, a further decision to choose between a male vasectomy or female tubal ligation (tube tie) is necessary. Because both these operations are designed to be permanent, even the most extenuating circumstances, including the death of a child or marriage break-up, must be taken into consideration. Some individuals do succeed in having micro-surgical repair of their vas deferens or fallopian tube, but the success rate is only about 65%, and it is not a factor that should be considered when contemplating sterilisation.

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Periodic Abstinence - Birth Control

Periodic abstinence


Natural family planning is really a form of periodic abstinence from sex, or not having sex at those times of the month when a woman is fertile. The trick is knowing just what are the safe and not so safe times. Obviously, it is essential for both sexual partners in this situation to cooperate fully in the contraceptive process. The man must be as aware of the woman's cycle as she is herself. For this reason alone, this method of contraception does not suit all couples. There are many different ways of calculating the fertile time of the month. The most common is a simple mathematical calculation, as a woman usually ovulates 14 days before her next period starts. If the woman has a regular cycle, there is no problem, but if her cycle varies significantly, other clues to ovulation must be observed. Changes in body temperature can give a guide to ovulation, as the temperature first dips, then rises about half a degree centigrade at the time of ovulation. Changes in vaginal secretions also occur just before ovulation, and these can be noted on a glass slide. Breast tenderness and lower abdominal pain may be other relevant signs in some women.

The Billing's method of contraception is a combination of the above factors. Because sperm can live for a number of days in the woman after ejaculation, and because the woman is fertile for two or three days after ovulation every month, sex must be avoided for six to eight days during every cycle. The failure rate of this method can vary widely, and depends a great deal on the couple's commitment to follow the rules strictly, and the woman's own ability to note her own bodily changes. The percentage of women falling pregnant in one year while using natural family planning as varied from 5% to 25% in different clinical studies. Natural family planning can be used in combination with other forms of contraception, such as condoms, spermicidal foam or diaphragms, which are used at the time of the month when pregnancy may occur. No couple should undertake this form of contraception without consulting a doctor who understands, and is prepared to teach, natural family planning.

Contraception: Periodic Abstinence

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