Article on Contraception (Family Planning)

1. Do you need a short breathing time to think of pregnancy?
2. Do you think it is too early to have a first child?
3. Do you need a suggestion to tide over Breast Feeding period?
4. Do you want to postpone the next pregnancy?
5. Do you think it is time to call it a day? No more pregnancies?

For infrequent and short period of contraception I can think of two methods:
Condoms, Morning after pill

CONDOMS: 
Advantages:
Safe and effective in preventing pregnancy.
It has an additional advantage of preventing sexually transmitted diseases.
Economically priced and easily available.
Disadvantages:
They may interrupt sex
They can break.
Improper use may cause leaks, resulting in failure.
Some men may complain of reduction in sexual pleasure.

MORNING AFTER PILLS:
Taking regular birth control pills within 72 hours of unprotected sexual intercourse can be effective in preventing pregnancy.
You can greatly reduce the chance of unplanned pregnancy.
These tablets can cause nausea and vomiting and sometimes dizziness.
Rarely an ectopic pregnancy (conception in the Fallopian tube) can be a disturbing side effect.
You can get the exact dose and the timing from the gynecologist.
The sooner you take any of these after unprotected intercourse, the more likely they are to work.
An intrauterine contraceptive device may be inserted anytime within one of unprotected intercourse.

PLANNING THE FIRST PREGNANCY:

Adequate premarital counseling regarding the contraception is valuable. You need to know the basic facts. Women produce an egg (oocyte) around 14th day of a normal cycle (i.e. 28 days cycle). If the sexual contact is established around that time the chances of conceptions are very high. The date of ovulation may differ according to the menstrual cycle. Mid part of the menstrual cycle around the time of ovulation, in short is unsafe. Rhythm method of contraception is based on this principle.

After the intercourse the sperms travel across the cervix, uterus & the fallopian tube. Here conception takes place. The conceptus gradually gets back in to the uterine cavity and grows further.

Now that we have some knowledge regarding the physiology of conception lets talk to you about BIRTH CONTROL PILLS: an ideal method immediately after the marriage. You can use them at a stretch, references quote up to 10 years if you are a non-smoker, but up to 3 years is acceptable. Birth control pills are the number one choice of young women. They are very effective because they prevent pregnancy in several different ways:
They prevent the ovaries from releasing an egg.
They make the cervical mucous thick so the sperm can't swim inside.
They make the lining of the uterus thin so the egg can't stick.
They are very effective, Failure rate is 0.3%.
It's easy for most women to take one pill a day.

Additional benefits of the OC pills are:
Menstrual periods are more regular, lighter, shorter and less painful.
Blood loss is reduced, so the chance of iron deficiency anemia is much less.
They reduce the probability of developing endometriosis.
The chance of ectopic pregnancy (which can require major surgery) is reduced.
They are reasonably priced.
The effects are reversible and you can conceive later.

However the OC pills do have some side effects:
Nausea, vomiting at the beginning but wanes off gradually. Dizziness, light heartedness.
Needs to be taken everyday. Some small solace here- if you miss one probably you can take two on next day without bringing down the efficacy.

You probably can not take pills if you are suffering from heart ailment, have had jaundice in the last six months or so, deep vein thrombosis (pain in the calf muscles- one of the signs), diabetes mellitus(optional).

You better be away from the pills if you happen to have family history of uterine or ovarian cancer.
If you are above 35 years of age. The age bracket reduces further if are a smoker.
If you are using contact lenses- the chances are they fall off because these pills cause corneal edema.
Some of the trade names available in market are TRIQUILAR, OVRAL-L, OVRAL, DUOLUTON, LOETTE, NOVELON, MALA-D, MALA-N, CHOICE----- the list is by no means complete.
During breast feeding, Oral contraceptives may not be the best of choices.

Here-in the INJECTABLE CONTRACEPTIVES do come in the picture. Depo-Provera is a hormonal contraceptive given by injection once every three months.

Advantages include:
It is very effective, 99.7%.
You only have to think about birth control four times a year.
Your menstrual periods usually go away completely, no bleeding.

Disadvantages include:
Some women have a lot of spotting. This usually gets less with time. It can usually be controlled by taking low dose hormone pills.
Weight gain is common. It may be avoided by diet and exercise.
The ability to get pregnant is sometimes delayed for up to one year after the last shot.
It gives no protection against sexually transmitted diseases.

IUCD: after the breast feeding days are over, one can resort to temporary, reversible method of contraception. Intra-Uterine Contraceptive Device is the option.

Mode of action: Commonly used among many brands available in market, Cu-T 200,and Multiload cu 250, work by releasing the Cu content wound round them. Current explanation is that the IUCD causes the endometrium (the inner layer of the uterus wherein the conceptus lodges itself) unreceptive and hence the implantation doesn't take place. 

ADVANTAGES: 

 
One time reversible method.
Can discontinue any time.
Highly effective.
Quite safe.
Inexpensive.
Acceptability is reasonably good.

DISADVANTAGES: Often needs a trained personel for insertion.
Follow-up is nessessary.
Side effects: excessive bleeding during periods, pain, spotting are few of the side effects one can come across.
Complications: uterine perforation, infection and expulsion are few of the rare complications. 

PERMANENT CONTRACEPTION

 
Vasectomy and Tubal ligation are the methods adopted for permanent contraception. Vasectomy is a surgical procedure performed on the husband.

ADVANTAGES:
Simple operation in trained hands.
General health and hormone levels are unaffected.
Testicular function and spermatogenesis is not affected (since the duct carrying the sperms is cut no sperms can be seen in ejaculate).
Lower cost.
Low failure rates: 0.15 per 100 persons. 

DISADVANTAGES:
Side effects and complications: infection, antispem antibody, hematoma are few of the complications encountered.

TUBECTOMY
Female sterilization is an alternative to vasectomy. There are number of methods by which the operation is performed. To name a few, Minilap, laparoscopic sterilization and tubectomy during the caesarian section. 

Safe. 

No change in the hormone function.
Highly effective; though marginal failure rates still persist.
Highly acceptable.

DISADVANTAGES:
Almost irreversible (though tubal microsurgery for reversal is POSSIBLE).
Scar hernia.
Scar endometriosis.

TIMING: The operation can be performed after delivery, after the termination of pregnancy, post menstrual and with the removal of IUCD. The choice of the type of operation, either open or laparoscopic, depends on the timing and patient's preference.