Contraception

We all know that prevention is better than cure.  But in practice this principle is followed by few, particularly when it comes to avoiding unwanted pregnancy.  Except the highly educated and living in metros very few couple opt for contraception in the early days of their married life.  The first pregnancy if occurs within a month or two, there will be unending discussions whether to continue pregnancy or undergo abortion.  The girl simply has to oblige wishes of husband/in-law’s family.  This will be quite unpleasant in the early days of marriage. 

Even after abortion and delivery very few couple chooses any contraceptive method.  This is due to lack of awareness and unnecessary apprehensions.

There are many simple methods of avoiding pregnancy – using contraception.  Depending on the couple’s choice, the duration of contraception requirement gynecologists will suggest appropriate method.  As of now except the male condoms all methods are for use by women.  The only contraceptive that can be used by male is ‘condom’. 

The various methods of contraception are -

Natural methods:  The fertile period of woman, strictly speaking, is only 5 days in a menstrual cycle.  In a 28day menstrual cycle ovum is released on the 14^th day or otherwise it can also be said to occur 14 days before the onset of bleeding – first day of periods.  The life of ovum is 48 hours and that of sperm is 72 hours.  So the possibility of conception is from 12^th to 16^th day is high.  A woman having 30days+/-2days cycle should abstain from sexual activity from 12^th to 18^th day of the menstrual cycle (first day of bleeding is considered as first day of menstrual cycle).  This one week is unsafe and any couple wants to avoid pregnancy should either avoid sexual activity (abstinence) or male should withdraw and allow the ejaculation outside the vagina (coitus interruptus).  The failure rate in this method is high.

Barrier method:  This is the method which prevents live sperm meeting the ovum.  Condoms come in this category.  Male condoms are most widely used.  Condoms not only prevent pregnancy but also prevent sexually transmitted diseases.  Male condoms are easily available, can be carried easily, inexpensive and simple to use by males and when properly used the failure rate is 2-3/100 women years (100x12).  Failure could be due to improper usage or tears in the condom. 

Female condoms are costly and bulky to carry.  Failure rate is 5/100 women years.

The chemical barrier is the use of spermicidal jellies or douches.  The common spermicidal agent nonoxynol-9 is available as ‘Today’, to be inserted in the vagina before the act.  This can prevent pregnancy but not infections.

Hormonal methods:  Hormonal contraceptives are the best means of avoiding pregnancy as their effectiveness is 100% when used correctly.  Hormonal pills or OC pills are available in different formulations using estrogen and progesterone.  When both the hormones are used, it is combined pill.  Combined pill can be available as single or biphasic and triphasic depending on amount of hormones used to mimic normal menstrual cyclic changes in the hormones.  Usually fixed dose pills are used.  Combined pills are generally available in pack of 20 or 21.  These are started on first or second day of periods and not later than 5^th day or as advised by manufacturer.  Once started, pills should be taken regularly at the same time – preferably bed time, till the pack is over.  After stopping the pills bleeding starts within a week.  The pills can be used as long the contraceptive protection is needed. 

There are also pills with progesterone only.  These are in particular useful in breast feeding woman. 

The pill which is presently misused by the young generation is post-coital pill.  This is also called as morning after pill and used as emergency contraception. The pills contain large doses of hormones and effective when used within 72 hours of coitus.  But this is only an emergency pill, and the large dose of hormones in these pills may cause more side effects.

Injectable contraceptives that are estrogen free are also available.  These injections can be taken once in 60-90 days depending on the type of injection.

The important side effect of hormones is thrombo-embolism affecting cardiovascular system.  But the low dose of estrogen in the OC pills, estrogen free pills and injections has reduced this troublesome side effect.  The use of injections is supposed to cause some amount of demineralization of bones which reverts to normal once the usage is stopped.  The other common side effects like spotting can be overcome by using appropriate dose pill. 

There are definitely some beneficial effects of OC pills.  The cycles become regular, pain during periods lessens, bleeding is reduced and helps in reducing anemia.  Also studies have shown that pill use may give protection against benign breast disorders and ovarian cancer. 

Non-hormonal pills:  Centchroman 30mg per day twice weekly for 3 months followed by once weekly is a good non-hormonal contraceptive pill.  The only side effect is delayed periods.  This is somehow not easily availble in the medical stores.

Intra-uterine devices (IUD):  These are the small devices placed in the uterus to prevent pregnancy.  These are made of polyethylene or other polymers.  They are usually ‘T’ shaped. These can be medicated and non- medicated.  The commonly used devices have thin copper wires wound around the stem of the device.  Copper has strong anti-fertility effect.  The medicated device is with progesterone in time release form – Progestasert and Mirena. 

The common side effects with IUD is occasional spotting, increased menstrual flow with cramps.  This will subside within a month or two.  There is chance of infection in women with multiple partners.  The failure rate is 3% in the first year. The progesterone medicated IUD, is more beneficial as it protects women against excessive bleeding and reduces anemia.  The advantage of IUD is once inserted and tolerated it can be left in situ depending on prescribed duration of effectiveness(3-5 years) or removed earlier when woman decides to conceive.

In general use of contraception protects women against unwanted pregnancy and abortion with it attendant complications.  Abortion subjects women to more physical, mental, social trauma and financial liabilities.  Any woman who wants to use contraception other than barrier or natural methods should consult a gynecologist and use appropriate method as per her health and requirements. 

There are other forms of contraceptives like diaphragms, vaginal rings which are not commonly used and hormonal implants that need implanting tiny rods with hormones subdermally and removed after the scheduled period or as required.

This is simplified information about contraceptives.  This is to encourage women to protect them from unwanted pregnancy and abortion with its attendant complications.  Abortion contributes to 13% of maternal mortality.  Most of it occurs in the developing world.  Contraception will prevent 218 millions of unwanted pregnancies, averts 138 millions abortions with its morbidity and mortality in a year.

All the contraceptive methods have their effect only when they are used.  They do not affect future prospects of pregnancy or have effect on the progeny. 

For a healthy, happy family life the couple should adopt convenient contraceptive method early in the marital life and later for spacing childbirth.  The permanent method of contraception is ‘tubectomy’ in women and ‘vasectomy’ in men.