Injectable contraceptives

Depo-Provera (medroxyprogesterone acetate or DMPA) is a form of birth control. It is an injection, or shot, that contains progestin. This is a natural hormone that your ovaries produce each month as part of your menstrual cycle.

How does it work?

Depo-Provera prevents pregnancy by stopping ovulation (the release of an egg by your ovaries). It thickens your cervical mucus, which makes it hard for sperm to reach and fertilize an egg. It also thins your uterine lining, which makes it hard for a fertilized egg to implant, or attach, to your uterus.

How is it administered?

Your doctor will give you the injection in either in your upper arm or buttock. It is given into  your muscle (intramuscular).

Depo-Provera works for about 3 months at a time. To prevent pregnancy, you have to get 1 shot from your doctor 4 times a year, about 12 to 14 weeks apart. If you get it in the first 7 days of your cycle, it works right away. If you don’t, you’ll need to use another form of birth control for 1 week. Your doctor will confirm you are not pregnant before giving you the injection.

What is the effect of DMPA on periods?

Most women who use Depo-Provera have changes in their menstrual periods. These may include:

  • bleeding or spotting between menstrual periods
  • an increase or decrease in menstrual bleeding or no menstrual bleeding at all

About half of women who use Depo-Provera stop having periods after 1 year. This is not harmful. Menstrual bleeding usually returns to normal when you stop using Depo-Provera. It may take about 9 to 10 months to get pregnant after your last shot.

What are the advantages?

  • Convenient, requires only four shots per year
  • Discreet
  • Very effective
  • Reversible
  • Very light or no periods beneficial in conditions like iron deficiency anemia,excessive bleeding,cramping during periods. May be a desired lifestyle change; can also decrease the risk of dysfunctional menstrual bleeding in women who are overweight.
  • Lack of estrogen in DMPA makes it appropriate for smokers older than age 35, postpartum, breastfeeding women, and others who have contraindications to estrogen.

What are the disadvantages?

  • Requires visit to clinician for quarterly injection.
  • Initial irregular bleeding
  • Weight gain may occur in some women due to increased appetite, particularly those who are sedentary or overweight when they begin DMPA.
  • Short term reversible bone mineral density loss.
  • Delayed return to fertility: the median time to conception for those who do conceive is 10 months after the last injection, much longer than with other hormonal methods.
  • No protection against STIs.

 What are the possible side effects?

  • weight gain
  • headaches
  • nervousness
  • abdominal pain
  • dizziness
  • weakness or fatigue
  • osteoporosis (loss of bone density)
  • blood clots

Contact your doctor right away if you have abnormally heavy or nonstop bleeding.

Also To renew your DMPA prescription you will need to see a doctor for review once a year. A review of risks for loss of bone density (osteoporosis) will take place at this visit.

Injectable contraceptive is a good option for you if you choose to use contraception methods at a leisure and to avoid daily usage of pills or insertion of IUDs.Discuss with your doctor if DMPA is a good choice for you keeping in mind the risks and benefits.

Acknowledgements

https://www.ncbi.nlm.nih.gov/books/NBK51044/

https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/injectables.html

https://www.uptodate.com/contents/depot-medroxyprogesterone-acetate-for-contraception

-Dr Prerna Gaur

Barrier Contraceptives

Barrier methods work by stopping sperm from entering the vagina and provide a physical barrier between the sperm and the egg.                                            

(Fun Fact-A pretty simple concept and one that has been used for millennia – cave paintings in France show a man using a condom during sexual intercourse date from 12-15,000 years ago)

Spermicides, a form of chemical contraceptive that work by killing sperm, are often combined with barrier methods of contraception for greater effectiveness.

There are three main barrier methods of contraception.

These methods include:·         

  • Male condoms Male condoms are a fine rubber covering that is rolled on to the penis before sex. Polyurethane condoms are available for people who are allergic to rubber.
  • Female condoms Female condoms are a polyurethane cylinder with one open        end. It is held in place by a ring on either side. The closed end of the female condom covers the cervix and the open end is positioned at the entrance of the vagina. When female condoms are used correctly and every time, they are 90% effective in preventing pregnancy and also protect against STDs.         
  • Diaphragms A diaphragm is a dome-shaped device made of silicone that is put into the woman’s vagina. It must be put in place before sex and left in for at least six hours afterwards.

Unlike other methods of birth control, barrier methods are used only when you have sexual intercourse.

Be sure to read the instructions before using a barrier method. It is very important that you use a barrier method correctly every time you have sex.

Sexually transmitted infection protection.

Male or female condoms are the only birth control methods that protect against sexually transmitted infections (STIs), including infection with the human immunodeficiency virus (HIV). To help protect yourself and your partner from  Sexually transmitted infection, be sure to use a condom every time you have sex.

Barrier Is a good choice if-

  • You want an option that does not require hormones or insertion of an intrauterine device.
  • You want an option that does not restrict when you have sexual intercourse, such as natural family planning.
  • You are planning to become pregnant soon and prefer a method you can stop using anytime you want.
  • You are breastfeeding.
  • You have heavy menstrual periods. A diaphragm may be used for birth control during a menstrual period and can contain the menstrual blood as long as it is not left in for longer than 6 hours at a time.
  • You and your partner find it easy to use the method every time you have sex.

Risks

Condoms

A condom can tear when it is too tight or fall off when it is too loose. If this should happen while you are having intercourse, use emergency contraception. If you are worried about exposure to a sexually transmitted infection (STI), get tested.

Diaphragm or cervical cap

Using a diaphragm with spermicide may increase your risk of urinary tract infections.

Leaving a diaphragm or cervical cap in for longer than 24 hours increases your chances of getting toxic shock syndrome.

Advantages of all barrier methods

Barrier methods of birth control:

  • Do not affect a woman’s or man’s future fertility.
  • Are only used at the time of sexual intercourse.
  • Are safe for a woman to use while she is breastfeeding.
  • Do not affect other health conditions, such as high blood pressure or diabetes.
  • Are less expensive than hormonal methods of birth control, and some are available without a prescription.

Condoms and diaphragms may reduce the risk of cervical cancer, which is caused by a sexually transmitted human papillomavirus. Condoms also are the best method for reducing the risk of sexually transmitted infections, including HIV.

Disadvantages of all barrier methods

Failure rates for barrier methods are higher than for most other methods of birth control. If you are considering using a barrier method for birth control, think through what the emotional and financial costs of an unintended pregnancy would be if the method fails.

To prevent pregnancy with a barrier method, you and your partner must be comfortable with using it and be prepared to use it every time you have sex. For some couples, barrier methods are not a good choice because one or both partners:

  • Find it embarrassing to use.
  • Do not want a barrier method to interrupt foreplay or intercourse.

Additionally

If you have a possible risk of giving or getting a sexually transmitted infection (STI) and you want to effectively prevent pregnancy, combine condoms with a more reliable method of birth control, such as the hormone pills, ring, patch or shot or an intrauterine device (IUD).

If you think that your barrier method has failed or has been used incorrectly, you can use emergency contraception to help prevent pregnancy. Douching after intercourse does not prevent sperm from reaching the fallopian tubes, where fertilization takes place. It may also increase your chance of getting a pelvic infection.

We will discuss details about other methods of contraception in upcoming articles.

-Dr Prerna Gaur

References

https://www.webmd.com/sex/birth-control/barrier-methods-of-birth-control-19059

https://patient.info/health/contraception-barrier-methods

https://www.medicinenet.com/barrier_methods_of_birth_control/article.htm

http://www.aiims.edu/aiims/events/Gynaewebsite/ec_site/manual/3_barrier_method.htm

 

Introduction to Contraception

Birth control (contraception) is any method, medicine, or device used to prevent pregnancy. Women can choose from many different types of birth control. Some work better than others at preventing pregnancy. The type of birth control you use depends on your health, how soon your desire to have children in the future, and your need to prevent sexually transmitted infections.

What is the best method of birth control?

There is no “best” method of birth control and is different for every woman. The birth control method that is right for you and your partner depends on many things, and may change over time.

Before choosing a birth control method, talk to your doctor about:

  •         Whether you want to get pregnant soon, in a few years
  •         How well each method works to prevent pregnancy
  •         Possible side effects
  •         How often you have intercourse
  •         The number of sex partners you have
  •         Your overall health
  •         How comfortable you are with using the method

  Purpose of contraception

Every month, a woman’s body begins the process that can potentially lead to pregnancy.

Birth control (contraception) is designed to interfere with the normal process and prevent the pregnancy that could result.There are different kinds of birth control that act at different points in the process, from ovulation, through fertilization, to implantation. Each method has its own side effects and risks. Some methods are more reliable than others.

There are more different types of birth control available today than ever. They can be divided into a few groups based on how they work. These groups include:

Methods of contraception

1.Natural method- Natural birth control methods include:

  •         Ovulation test kits
  •         Cervical mucus examination
  •         Tracking menstrual cycles (rhythm method)
  1. Barrier method- Barrier birth control methods include:
  •         Diaphragms
  •         Condoms
  •         Cervical caps
  •         Spermicides

3.Hormonal methods- Hormonal birth control methods include:

  •         Birth control pills
  •         Patches
  •         Implants
  •         Vaginal ring

         4.The Intrauterine Device (IUD)
                       There are two types of IUDs: hormonal or copper-based devices.     

        Copper based IUD

  •        Permanent methods (surgical sterilization) are also available for those who no longer desire to have children.
  •         This includes-
  •         Tubectomy-Blocking of fallopian tube of woman surgically.
  •         vasectomy-Blocking of tubes of scrotum that carry sperm.

There is no form of birth control that is 100% effective, so it is possible to get pregnant while using most types of birth control. However, many types of birth control, when used correctly, are highly effective in preventing pregnancy. For example, the birth control pill is over 99% effective in preventing pregnancy when taken correctly. For all forms of birth control it is important to have a basic understanding how they work and how to use them correctly.

Unfortunately, there is no perfect form of birth control. Only abstinence (not having sexual intercourse) can protect against unwanted pregnancy with 100% reliability. The failure rates, which means the rates of pregnancy, for most forms of birth control are quite low. However, some forms of birth control are more difficult or inconvenient to use than others and  have different side effects and risk profiles.

. In actual practice, the birth control methods that are more difficult or inconvenient have much higher failure rates because they are not used regularly or as prescribed.

  •     The decision about what kind of birth control option to use is extremely   personal, and there is no single choice that is safest or best for all women or couples.

   The choice of birth control method depends on many factors, such as the desire for reversible birth control (preserving future fertility) or permanent birth control methods (surgical sterilization). Some birth control methods, such as barrier methods, may offer some protection against sexually-transmitted diseases (STDs), while most methods do not.

A woman should carefully weigh the risks and benefits, along with the effectiveness of each method before choosing a birth control method. A thorough and open discussion with a healthcare-professional can help in this decision process.

      We will discuss each method of contraception in detail in subsequent articles.
Dr Prerna Gaur

Acknowledgements-

https://medlineplus.gov/birthcontrol.html

https://www.webmd.com/sex/birth-control/ss/slideshow-birth-control-options