In my last article, I wrote about the importance of spacing pregnancies. When women have pregnancies that are too close together, their bodies do not have time to recover and are not strong enough to support the next pregnancy. Furthermore, poor family planning can also put a strain on family resources. With prices of petrol and basic goods increasing, a family has to plan carefully for the future, especially for the children’s education.
I have described the various methods of contraceptives that do not require the use of hormones, such as condoms and diaphragms, intrauterine devices, natural methods (breastfeeding and keeping track of the cycle), and sterilisation.
In this article, I will describe the hormonal methods.
There are four types of hormonal contraceptives that can be used in family planning.
This method uses the injection of a hormone called depot medroxyprogesterone acetate, which can be given at six weeks after she has given birth. The hormone prevents pregnancy by preventing ovulation (the release of eggs by your ovaries every month).
The injection, given in the upper arm or buttock, lasts for three months, so you have to get another shot every three months. It is a highly-reliable (96.9-99.7% success rates), non-oestrogenic method of contraception that is suitable for women who cannot remember to take a pill every day.
This injection is also reversible, but it may take between six and 12 months to get pregnant again after stopping the injections.
Here is another method that doesn’t require you to keep track of something or remember to take a pill every day. Hormonal implants are small plastic capsules inserted under the skin of a woman’s upper arm, starting from six weeks after she delivers her baby. The capsule delivers small, continuous doses of the hormone progestin that blocks ovulation and thickens the mucous of the cervix, making it impossible for sperm to reach the egg. The effects can last for up to three years, and are reversible soon after the capsule is removed.
However, hormonal implants can cause side effects, such as spotting between menstrual periods, longer or heavier periods, or even no periods at all.
Combined oral contraceptive pills
Birth control pills (sometimes generally called “the Pill”) are a common form of contraception used by women. There are several types of contraceptive pills, depending on what kinds of hormones they contain. The combined pills contain oestrogen and progestin, which prevent pregnancy by inhibiting ovulation, thickening the cervical mucous and changing the endometrium so that the fertilised egg is less likely to be implanted.
Women who have just had a baby should only begin taking these pills six months after childbirth. These pills are not safe for women who smoke, particularly if they are over 35. The success rate of the combined pill is 92.4% in the first year, and 99.9% for compliant users (women who take the pill regularly).
Progestin-only pills are also known as “mini pills”. They work in the same way as the combined pills. This pill is also recommended for breastfeeding mothers as it does not reduce the breast milk.
The difference is that progestin-only pills can be taken as early as two to three weeks after delivery. The success rates are similarly high for women who can keep to the routine of taking the pill every day. However because it is a low dose pill, it has to be taken at almost the same time everyday in order for it to be effective.
Emergency contraceptive pills or ‘the morning after pill’ or the day after pill’
You can use emergency contraception right away – or up to 72 hours after intercourse – if you think your birth control failed, you didn’t use contraception, or you were forced to have sex.
Emergency contraception makes it much less likely you will get pregnant. But emergency contraceptives are not as effective as birth control that’s used before or during sex, like the pill or condoms. So if you are sexually active or planning to be, don’t use emergency contraception as your only protection against pregnancy.
One of the most recent developments is the emergency contraceptive pill, although this is not strictly a family planning method. This pill contains the hormones levonogestrel. The brand names currently on the market for progesterone only emergency contraception is Postinor. Emergency contraception mostly works to prevent or delay ovulation. It may also prevent a fertilised egg from sticking to the wall of the uterus.
How effective is the emergency pill
It is very effective and is more effective the sooner it is taken after sex. However, it is not as effective as using other methods of contraception regularly .
Of the pregnancies that could be expected to have occurred if no emergency contraception had been used the emergency pill will prevent:
- up to 95 per cent if taken within 24 hours
- up to 85 per cent if taken between 25-48 hours
- up to 58 per cent if taken between 49-72 hours.
If the emergency pill is taken after 72 hours its ability to prevent a pregnancy decreases over time
- Side effects include nausea and vomiting in up to one-fifth of women. It can disrupt your periods. You may have some irregular bleeding between taking the emergency pill and your next period. This can range from spotting to being quite heavy.
Which method suits you best?
As you can see, there are so many methods to choose for family planning. However, you cannot just pick any method at whim – this is a decision that has to be made carefully after considering your needs, and discussing with your partner and doctor. The method must also be suitable to your body’s needs and your current state of health.
Here are some questions you should ask yourself:
- Which will work best with my schedule and habits? If I have an irregular schedule or am forgetful, will the oral contraceptives be suitable for me?
- Are there extra health benefits from a particular method?
- Which method has possible unwanted side effects or complications?
- Am I protected against sexually transmitted diseases?
- Which kind is the most appropriate for my current state of health?
- How effective is it?
- Will it suit my current lifestyle or relationship between me and my partner?
With these answers and a thorough medical check-up, you will be ready to practise responsible family planning, to ensure good health for yourself and your children.
The Star Newspaper, August 27, 2007
By Dr Nor Ashikin Mokhtar