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Contraceptives: All you need to know

By Arathi Menon for Marie Claire magazine
Last updated on: June 25, 2009 17:55 IST
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When the oral contraceptive pill (OCP) arrived in the markets about 50 years ago, it gave women a power they did not possess before. It opened their minds to a life with possibilities beyond just having kids and being a housewife and offered them an opportunity to pursue a career.

Today, the options for birth control have increased. Their roles too have grown from birth control to protection from sexually transmitted diseases (STDs). Barrier methods where a physical barrier prevents the sperms from reaching the eggs, or stops the fertilised ovum from implanting itself in the uterine lining, are ideal for women who may be at risk of contracting a disease or may have multiple sexual partners.

Chemical barriers like spermicides, or hormonal intra-uterine devices (IUDs) render sperms inactive when they enter the vagina. Then, there are hormonal methods, like pills and injectables, which alter the hormonal balance and prevent ovulation and pregnancy. The most recent entrant, the emergency contraceptive pill (ECP) is growing increasingly popular with younger women. It provides high doses of the regular pill in a single burst. Generally it is administered in two doses within a gap of 12 hours.

Doctors, however, warn against excessive use of ECPs. "These cannot replace the daily pills, and if used repeatedly, their failure rate increases," says Dr Gayatri Kamat, consultant obstetrics and gynaecologist at Wockhardt Hospital, Bengaluru. Before you choose your contraceptive, it is also important to talk to your doctor about your family history to know what suits you best.

  • Do not take the pill if you have high blood pressure, deranged lipid profiles, have suffered from jaundice in the past, or have a history of liver diseases or breast cancer (the latter is, however, debated by the experts).
  • Do not use the IUDs if you are pregnant, are allergic to copper, have an abnormal uterus, or a recent history of pelvic inflammatory disease or STDs.
  • Do not use a spermicide if you suffer from vaginal irritation or yeast infections, or have lacerations of any kind.

Traditionally in India, OCPs, IUDs and condoms have been the preferred modes of contraception, according to Dr Shirish Patwardhan, senior vice-president of The Federation of Obstetric and Gynaecological Societies of India, Mumbai.

An expert gynaecologist can tailor-make contraception for couples depending on their health and lifestyle. It is important to know what may not suit you. "If the woman has migraine or some hormonal problem or is obese, then she should avoid pills. In this case, a condom can be used. A new mother can go for an IUD but she has to wait at least six weeks for the uterus to get back to its original size. But the best option for her are injectables, as she may forget to take pills every day," says Dr Kamat. An injectable is an injection taken on the buttocks once in three months that releases hormones into a woman's body that prevent her from conceiving. The GP may ask you to switch to a different method later.

Tubectomy or vasectomy is the safest option once you have achieved the desired family size. But the procedure is largely irreversible. In rare cases, even after a tubectomy, the sperm can find its way inside and lead to a complicated pregnancy. That makes vasectomy a better method of contraception.

Here is a breakdown of different methods and mediums of contraception:

Barrier methods

These prevent pregnancy by physically stopping sperm from entering the uterus.

Male condoms: A male condom is a thin sheath made of latex (rubber), polyurethane (plastic) or animal membrane. Worn by a man over an erect penis, it acts as a physical barrier to keep the sperm from entering the cervix and getting to the egg. It protects both partners from STDs. Condoms come in different sizes, colours and even flavours, and should be stored away from heat and light. Always check the expiry date before use.

Diaphragm: This is not very popular in India yet, and requires the intervention of a medical practitioner to insert it into the vagina. It is a small, round, rubber dome with a firm, flexible rim that covers the woman's cervix, and is used with a spermicide. Diaphragms come in a range of sizes. However, since it has to be held in place by the vagina, you will need to be refitted if you gain or lose weight, if you have a pelvic surgery and in the event of a birth or urinary tract infection. It may slip out of place, so be sure to check its placement before and after sex. If the diaphragm is dislodged during sex, spermicide should be reapplied. It protects against STDs and reduces risk of cervical cancer.

Spermicides: Spermicides are chemical barriers in the form of foams, creams, gels or suppositories, to be inserted into the vagina a few minutes before sex. They have a 70 to 90 percent effectiveness that works best when coupled with other barrier methods like male condoms or diaphragms. they contain a chemical that kills sperm or makes them inactive. Frequent use may irritate vaginal tissue and increase the risk of STDs. The most popular spermicide available in the Indian market is a suppository called Today.

Female condoms: These are a relatively new entrant, with just two brands -- Velvet (Rs 100 for a pack of three) and Confidom (Rs 250 for a pack of two) -- both manufactured by Hindustan Latex Ltd. The female condom targets the urban woman who is informed about sexual health issues and wants to take charge of her health. Its size may seem intimidating -- the condom is kept in place by the inner ring at the cervix and an outer ring at the opening of the vagina. It is made of a material called nitrile, which allows body heat transfer, making sex more pleasurable. It is also tougher and drastically reduces risk of breakage. You can use them in combination with a spermicide, but never with a male condom.

Intra-uterine devices (IUDs): An IUD is a copper coil fitted in the woman's womb that does not allow the sperm to meet the egg. Popularly called Copper T, it is a good alternative to hormone pills. The chemicals in the device change the uterine lining to prevent implantation of eggs. It can be effective for three to 10 years, depending on the kind of device used. The body may resent the foreign body initially, causing some pains. However, a wrongly inserted IUD could cause pelvic inflammation or puncture the uterus. Maintain good hygiene and medical care if you're using one. They are cost-effective and cost as little as Rs 400 to Rs 1,000.

Hormonal methods

These stop your ovaries from producing eggs and cause your cervical mucus to become thicker, inhibiting sperm movement

Oral contraceptive pills (OCPs): They are ideal for women who want to be sexually active but want a worry-free method of birth control. When taken as directed by a doctor, they offer nearly 100 percent protection against pregnancy.

Injectables: Depo-Provera is a popular injectable which costs around Rs 200. Injectables prevent pregnancy by suppressing ovulation. The first shot should be given within five days after the beginning of a normal menstrual period, and the shots should be repeated every three months.

Emergency contraceptive pills (ECPs): As the name suggests, they should be taken only in times of emergency and cannot replace OCPs. Even though no chronic side-effects are known from prolonged use of ECPs, they are best avoided. They have a high failure rate and can lead to irregular periods and menstruation-related problems.

Natural methods of contraception

Withdrawal method: It requires the man to pull out his penis from a woman's vagina just before he ejaculates. This method may not be very effective as it is very stressful for the male partner. Men also have what is known as 'pre-ejaculatory fluid' which seeps out during erection. While this is mainly lubricating fluid, it might contain a few sperms along with certain STDs. So a pregnancy or an infection cannot be ruled out.

Rhythm method: The couple either does not have sexual intercourse during the time when the woman is likely to get pregnant or uses a barrier method. Here, a good idea about the female partner's menstrual cycle is necessary. In a typical 28-day menstrual cycle, the fertile period is from the eighth day of the cycle to the 20th day of the cycle. The safe days are the five days of bleeding, three days from the end of bleeding and again eight days from the beginning of the next cycle. Safe period cannot be calculated in women with erratic menstrual cycles.

Mucus Method: It can be followed by observing the consistency of the cervical mucus or discharge after the monthly period. For example, directly after menstruation, the vagina is dry. This is the safest period to have sex. Just before ovulation the mucus gets sticky. During ovulation the cervical mucus is thick and bright. This is the most unsafe period to have sex. Again, after ovulation, the mucus decreases and before the next bleeding, the vagina gets dry again and intercourse becomes safe.

Despite the various options listed above, female sterilisation or the tubectomy is the most common choice of contraception in India. According to a recent survey by the National Family Health, of the 48 percent of married couples using contraception in India, tubectomy accounts for 71 percent.

Make an informed choice

Frequency of sex: If frequency of sex is low, condoms are the best option. You would not want to be on OCPs if you're having sex only once in a few months.

Number of partners: If you have multiple partners, use a method that protects against STDs. This means that an IUD, spermicides or injectables are not enough for you. You need condoms.

Mutual assent: The choice of contraception should be discussed mutually and responsibility should be shared.

Health and family history: Inform your gynaecologist about family medical history, especially your mother's, as there may be contra-indications with some types of contraceptives. This is vital in case there is a history of smoking, breast cancer, diabetes or heart disease, which can be aggravated by OCPs or injectables.

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Arathi Menon for Marie Claire magazine