IMPLANTS

I guess by now some people would be making up their minds or reconsidering their choice of contraceptive.

IMPLANTS
An implant is a small rod that is placed under the skin in your upper arm. It releases progestogen into the bloodstream. It works for up to 3 years.

It works mainly by stopping ovulation. It thickens the mucus at the neck of the cervix thereby preventing sperm from entering the womb. It makes the lining of the womb thinner. This means that if an egg were to fertilize, it would not be likely to be able to attach to the womb.

It should be fitted during the first five days of your period. It can be put in 3 weeks after childbirth.

Do not use an implant if:

• you have arterial disease or history of stroke 
• you have breast cancer 
• you have unexplained vagina bleeding 

ADVANTAGES

• You don't have to remember to take a pill daily.
• It can be used when breastfeeding. 
• It does not interfere with sex.
• May reduce period pain. 
• It may help protect against pelvic infection.
• Fertility will return to normal as soon as implant is taken out.

DISADVANTAGES

• Irregular bleeding. 
• Periods may be heavier and longer. 

SIDE EFFECTS

• Headache 
• Fluid retention 
• Breast tenderness 
• Mood changes 
• Weight gain.

It is over 99 percent effective.

INTRAUTERINE DEVICES

MIRENA
This is a small T-shaped device containing the hormone Levonorgestrel. It is placed in the womb where it slowly releases the hormone to prevent pregnancy for up to 5 years.

It prevents pregnancy by thickening the mucus at the neck of the cervix, making it difficult for sperm to cross into the womb. It may also stop ovulation. Your doctor will have to check the position and size of your womb before Mirena can be inserted and also confirm that you are not pregnant or have infections. The procedure cab be a bit uncomfortable and a little painful. You may need to take a painkiller such as Paracetamol or Ibuprofen. It can also cause bleeding for a short while.

Mirena should be inserted within the first seven days of your cycle. If it is inserted at other times in your cycle, you will need to use extra protection such as Condoms for the first seven days after it is inserted. If you have had a baby, Mirena should not be inserted until 6 weeks after the birth.

Do not use Mirena if:

• you have breast cancer
• you have abnormalities of the womb
• you have cervical cancer
• you have uterine fibroids
• you have current or recurrent pelvic inflammatory disease
• you have ovarian cancer

SIDE EFFECTS
These are uncommon e.g mood swings, reduced sex drive, pelvic inflammatory disease, breast tenderness, fluid retention.

ADVANTAGES

• Periods usually get lighter, less painful and may even cease.
• Fertility returns as soon as it is removed.

DISADVANTAGES

• You may have irregular bleeding for the first few months which usually settles down.
• The Mirena may come out of your womb without you noticing it.
• Very rarely, there may be perforation to the wall of the womb.

IUD (INTRA-UTERINE DEVICE)
This is an intrauterine device made of plastic, which is wrapped in copper.

It works by preventing the fertilization of an egg by damaging or killing sperm. It encourages the production of fluid by the uterus and fallopian tubes. This fluid contains copper ions which are toxic to sperm.

The IUD should be inserted right after the menstrual cycle.

Do not use a copper IUD if:

• you are pregnant
• you have uterine cancer
• you have an STI
• you have unexplained vaginal bleeding
• you have some structural abnormality of the womb or cervix

SIDE EFFECTS

• Pelvic inflammatory disease
• Cramps
• Heavier periods
• Painful periods
• Perforation to the wall of the womb
• Expulsion of the IUD

ADVANTAGES

• It can be used while breastfeeding
• Fertility returns quickly upon removal
• It works immediately after insertion
• It is long-lasting
• It does not require the daily maintenance like other contraceptives such as the pills.
• It is 98 percent effective.

CONTRACEPTIVE INJECTION

Still on our journey of contraceptive choice, we discuss the contraceptive injection.

The contraceptive injection contains a progestogen hormone. Medroxyprogesterone acetate is given by intramuscular injection every 12 weeks and Norethisterone enantate is given every 8 weeks.

It works mainly by stopping ovulation. It also thickens the mucus made by the cervix, forming a mucus plug. This prevents sperm from getting into the womb to fertilize an egg.

ADVANTAGES

• You don't have to take it everyday like the pills.
• It can be used when breast-feeding.
• It does not interfere with intercourse.
• It can be used by some women who cannot take the combined pill.
• It may help some of the problems of periods such as premenstrual tension,heavy periods and pain.
• It may help protect against pelvic infection. 

SIDE EFFECTS 

• Headache
• Irregular periods 
• Cessation of periods 
• Weight gain 
• Breast tenderness 
• Stomach discomfort 
• Dizziness

It is over 99 percent effective if injections are received according to correct schedule.

ORAL PILLS

As we continue on our journey of contraceptive choice,we would be looking at the oral pills:the mini-pill and the pill.

THE MINI-PILL
This is an oral progestogen-only preparation. It is a suitable alternative when oestrogens are contra-indicated (including patients with venous thrombosis or a past history to venous thrombosis). They are suitable for older women, breastfeeding women, heavy smokers, and for those with hypertension, diabetes mellitus and migraine.

You have to remember to take the mini-pill same time every single day of the year even when you are on your period. If you miss a pill, take it as soon as you remember and carry on with the next pill at the right time. If the pill was more than 3 hours overdue you are not protected. Continue normal pill taking but you must also use a back-up method such as the condom, for the next two days.

SIDE EFFECTS

• Headache
• Nausea
• Mood swings
• Weight gain
• Periods may be irregular
• Periods may stop 
• If you become pregnant while taking the mini-pill, there is a chance that the pregnancy may be ectopic (outside the womb).
• May cause breast tenderness 
• There's a risk of cysts. 

THE PILL
This is a combination of an oestrogen and a progestogen. It contains 21 active and 7 inactive pills. The pills should be taken same time each day. If one or more tablets are missed for more than 12 hours, contraceptive protection may be reduced. If you vomit within 2-3 hours of taking the pill, the pill would not have been absorbed. Take another pill as soon as possible.

Do not take the pill if:

• you think you are pregnant.
• you are very overweight.
• you are 35 years or over and you smoke.  
• you have history of blood clots 
• you have diabetes with complications. 
• you have breast cancer or breast cancer within the last 5 years. 

ADVANTAGES

• Doesn't interfere with intercourse. 
• It relieves premenstrual tension for some women. 
• It makes bleeding regular, lighter and less painful. 
• It reduces the risk of pelvic infection, fibroids, ovarian cysts and non-cancerous breast disease.

DISADVANTAGES

• Headache
• Nausea
• Breast tenderness
• Mood swings
• May increase blood pressure, so people taking it should have their blood pressure checked every 3 months. Does not protect against sexually transmitted infections.
• Vagina bleeding may occur during the first few months in addition to the usual bleeding between packs.

The pill should be started on the first day of your period or upto and including the fifth day of your period. If you start the pill at any other time in your menstrual cycle you will need to use additional contraception, such as condoms, for the first seven days of taking the pill. Taking the combined pill when breastfeeding may reduce your flow of milk. It is better you use a different method of contraception.

The pill is about 99 percent effective if taken according to instructions