THERE are many modern contraceptives that are safe and effective.
However, with so much misinformation regarding contraception among women, many opt for unreliable methods or use contraceptives incorrectly, resulting in unplanned pregnancies.
Figures from the Malaysian Maternal Mortality review show that 70 per cent of the women who died from pregnancy-related causes in Malaysia have never used contraception.
Women should consult their healthcare providers to choose an appropriate contraceptive that is effective, safe and suitable for their individual lifestyles.
These are the options available:
ORAL CONTRACEPTIVE
The pill is 99 per cent effective when used correctly.
Certain medications like antibiotics and anti-epileptic drugs can reduce the efficacy of the pill. The pill does not protect against sexually transmitted infection.
The most common concern is weight gain, but less than 10 per cent of patients experience this. Fertility returns within one to two months of stopping the pill.
The latest research indicates that it does not increase the risk of getting breast cancer. It also protects against endometrial (womb) and ovarian cancer.
But it does increase the risk of blood clots in the veins, strokes and heart attack in some women.
THE PATCH
The hormones are delivered by a skin patch applied to the skin on the buttocks, stomach, back or upper arms. Each patch is used for seven days, and a patch is used each week for three weeks, followed by a week with no patch, during which period will occur. The patch is less effective in women who are over 90kg.
VAGINAL RING
The vaginal ring is a soft plastic ring (5.4cm in diameter), inserted into the vagina by the woman herself.
It can be removed for up to three hours at a time per day and still maintain effectiveness as a contraceptive. The ring is placed in the vagina for three weeks, and then removed for a week when periods will occur.
Side effects are uncommon. In addition to those generally associated with the pill, vaginal irritation, discharge and discomfort can occur.
PROGESTERONE-ONLY HORMONAL CONTRACEPTION
In addition to a progesterone-only pill, it is possible to use progesterone as a contraceptive in other forms, namely progesterone injections and progesterone implants. This method of contraception will not protect against sexually transmitted diseases.
INJECTABLE CONTRACEPTION
This is administered via injections in the upper arm or buttock every 12 to 13 weeks. The method works by preventing ovulation. The woman will only need approximately four injections during the year and does not need to worry about taking pills. Irregular bleeding is common during the first few months.
One of the side effects of this method is decreased bone density, reversible once it is stopped. Weight gain is also seen in some.
IMPLANT
This is a hormonal method similar to the injection. A small rod about the size of a matchstick is inserted into the upper arm in the clinic, using a special applicator.
After insertion, the implant cannot be seen, but it can be felt if the skin over it is pressed.
The implant will last three years, after which it should be removed (again under local anaesthetic in the clinic), and a new implant inserted, if further contraception is desired.
The most common side effect is irregular bleeding in the first few months after insertion. Periods can become scanty in many women and may stop completely. Other side effects are weight gain, mood changes, headache, acne, and depression.
INTRAUTERINE DEVICE
This is a small plastic device inserted into the uterus in the clinic. It's done by a healthcare professional.
There are two types of IUDs, the copper-containing IUD, and the progesterone-releasing intrauterine system.
IUDs are reversible and very effective methods of contraception. They can be inserted during the time of the menstrual period, six weeks after delivery, or even after an abortion.
This method is not recommended for women who have not had children and will also not protect against sexually transmitted diseases.
EMERGENCY CONTRACEPTION
This is the use of contraception after a woman has had sexual intercourse without birth control, or if the method has failed (such as a breakage of condom or missed birth control pills).
These methods are not as effective as the methods described earlier, and should not be used as routine contraception. Side effects include menstrual irregularity, transient abdominal pain and nausea.
CONDOM
It has the very important additional benefit of helping to prevent sexually transmitted diseases. It is widely available "over the counter" but correct use is important. With perfect use, it is 98 per cent effective; and with typical use, it is 85 per cent effective.
Other methods include tubal ligation for the female, and vasectomy in males. Although reversal is possible, these operations are not always successful, so the couple must be very sure that they do not want any more children.
*The writer is consultant gynaecologist/gynaecological oncologist at Gleneagles Hospital Penang.
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