Empowered Wise Women – Choose What’s Right For You
The contraceptives listed here are some of the most common but are not the only types available.
Let’s start with one for the guys.
VASECTOMY (FOR MEN)
This is a simple operation which prevents the release of sperm so that fertilisation of the female egg cannot occur. Sperm is made in the testes and travel through a series of tubes (the vas deferens and the urethra) to the penis. In the vas deferens, fluid from the seminal vesicles and prostate gland mix with sperm to make semen. During intercourse, the semen is ejacuated. Vasectomy will prevent the sperm from being released and the fluid that is ejaculated contains only fluids and not sperm.
This common operation has minimal side effects. It is usually performed in a day proceedure unit at a hospital or in a clinic. The scrotum is cleansed with an antiseptic and a local anaesthetic is used to numb the site of the operation. To prevent the release of sperm, two small cuts are made into the scrotum where each vas deferens tube is clamped and a small section is removed, then the ends are tied off.
After the vasectomy, there may be some pain, slight swelling and discomfort for a couple of days. Only a couple of days will be required off work. Vasectomy does not affect a mans ability to have sex or enjoy sex, the only difference will be that the ejaculate fluid will not contain sperm wo it will be clear rather than white and he will not be able to father a child. Sperm only makes up 5% of semen so there will be minimal difference in the amount of fluid ejaculated. Normal sexual activity can be resumed as soon as comfortable.
Alternative methods of contraception will need to be used for about two months after the proceedure, as there may still be sperm present in the vas deferens tubes above where they have been clamped and cut or in the seminal vesicles. Three months after vasectomy, a sperm count will be cone where the number of sperm in the semen is measured. If the sperm count is very low, or sperm are not deteccted, then other forms of contraception can be ceased. However it is important to confirm this with your doctor first.
Vasectomy is a very highly effective method of contraception. Only 2-3 per every 1000 vasectomies fail to prevent a pregnancy. Serious complications are rare, but no surgery is without risk. Bleeding and infection can occur after a vasectomy. A vasectomy should be considered a permanent form of contraception. However it may be able to be reversed if not too much time has passed since the proceedure. Do keep in mind though that even if a reversal is performed, a pregnancy is not guaranteed.
THE PILL (ORAL CONTRACEPTIVE PILL -OCP)
The Pill turned 50 on May 11, 2010. It was first made available in the United States in 1960. The combined contraceptive pill is made up of two hormones oestrogen and progeserone, similar to those normally produced by the body. These pills are called the “active pills”. Almost all the brands of contraceptive pills sold here in Australia also have seven sugar/placebo pills. These pills are included only to keep the woman in the habit of taking a pill every day.
HOW DOES THE PILL WORK?
The pill works in threee ways:
* It stops the body from releasing an egg (ovum) every month
* It changes the lining of the uterus so a fertilised egg is unlikely to grow
* It makes the mucus in the cervix (the entrance of the uterus) thicker, so sperm would have difficulty getting through
HOW DO YOU TAKE THE PILL?
Always check with your health professional on how to correctly take your contraceptive pill. Generally the following points should apply:
* Start taking the pill when you have a period
* Take your pill at about the same time each day
* Take one pill every day until your pack is finished
* If you have a 21 day pack (no sugar/placebo pills), you have a 7 day break before starting the next pack
* If you have a 28 day pack (with sugar/placebo pills), you start the next pack the day after you finish your current pack
* You will still get a period (a withdrawal bleed) usuall at the same time each month
WHEN ARE YOU PROTECTED FROM BECOMING PREGNANT?
* As long as you take the pill at about the same time every day as instructed, the pill is 98-99% effective against becoming pregnant.
* When first starting the pill, you will need to take one hormone (active) pil each day for seven days before you are protected against pregnancy.
ARE THERE TIMES WHEN YOU MAY NOT BE PROTECTED AGAINST BECOMING PREGNANT?
* If you forget to take a pill, take it as soon as you remember and take the next pill at the normal time.
* If you take the forgotten pill more than 12 hours after your normal time, the pill may not work as a contraceptive for you until you have taken one hormone pill each day for seven days.
* If you have vomiting or diarrhoea or are taking antibiotics, check with your doctor for more information.
ARE THERE ANY OTHER BENEFITS FROM TAKING THE PILL?
* Your periods will be regular every 28 days
* Your periods should be shorter and lighter
* If you usually suffer from period pain, you should have less pain
* Decreased risk of contracting cancer of the uterus and ovaries
ARE THERE ANY PROBLEMS WITH TAKING THE PILL?
* Within the first 2-3 months of taking the pill you may get:
* bleeding or spotting between periods
* a nauseous feeling
* breast tenderness
* Women who have uncontrolled high blood pressure or who smoke, should discuss taking the pill with their doctor, due to possible health risks.
* More serious problems are rare. The most serious is blood clotting, so if you get severe headaches or chest pain after starting the pill, see your doctor for a check up straight away.
* The pill will not protect you from sexually transmitted infections (STI’s).
WHO SHOULD NOT TAKE THE PILL?
* Some women who have had deep vein thrombosis (blood clots), stroke, heart attack or focal migraine should not take the pill.
* Always get advice from your doctor or family planning clinic to help you decide if you are suitable to be taking the pil. To obrain the pill, you will need a doctors prescription.
WHAT ABOUT BECOMING PREGNANT AFTER BEING ON THE PILL?
* Most women who want to have a baby, usually become pregnant within six months after they stop taking the pill.
Source: Family Planning Victoria
Depo-Provera is the trade name for a long acting synthetic hormonal contraception called medroxyprogesterone acetate. It is similar to the female hormone progesterone which is made by a woman’s ovaries during each menstrual cycle and during pregnancy. Depo-Provera is given by intramuscular injection and each dose lasts for three months as a contraceptive. It can also be used in the treatment of endometriosis.
HOW DOES IT WORK
When used as a contraceptive, Depo-Provera works by:
* Stopping ovulation (the release of an egg each month)
* Thickening the mucus at the entrance to the uterus, so that sperm cannot get through to fertilise an egg
* Changing the lining of the uterus so that a fertilised egg won’t grow
HOW EFFECTIVE IS IT?
Depo-Provera is one of the most effective methods of contraception. If used for one year by 1,000 women, only one or two out of the 1,000 women would become pregnant.
ADVANTAGES OF USING DEPO-PROVERA
Apart from being a contraceptive, Depo-Provera can reduce endometriosis, cancer of the womb, thrush and pelvic inflammatory disease. Depo-Provera can be safely used in most women who are unabe to take contraception containing the hormone oestrogen.
WHAT ARE THE MAIN CONCERNS ABOUT DEPO-PROVERA?
As with any drug, there are anxieties expressed about immediate and long term effects and risks. Before deciding to use Depo-Provera you should be well informed and give your consent. Statistics have not shown any increase of developing cancers. In fact, Depo-Provera will decrease your liklihood of contracting uterine cancer.
Pregnancy should be excluded before commencing Depo-Provera. There has been concern expressed about the possible risks to the foetus by accidentally giving Depo-Provera to a woman with an undetected pregnancy. To date, no serious abnormalities have been demonstrated it this has occured.
WHAT ARE THE POSSIBLE SIDE EFFECTS?
The main concern with Depo-Provers is that one injection lasts for 12 weeks, so if any side effects do occur, the may last for the entire 12 weeks or possibly longer. Soreness at the injection site for a couple of days
All women given Depo-Provera will experience a change in their menstral bleeding pattern. Some women will cease having periods completely and others may have irregular bleeding. Some women may have persistent bleeding or spotting that may be daily.
Some women may gain or lose weight whilst on Depo-Provera. On average, women can expect to gain around 2 kilos (approx. 4lb) in the first year of use. Unfortunately, a small percentage of women gain quite a large amount of weight, but it is impossible to predict who will or won’t gain weight before commencing treatment.
DELAY IN FERTILITY RETURNING
There may be a delay in the return of normal periiods after using Depo-Provera, however there is no long term permanent effect on fertility. Greater than 60% of former Depo-Provera users who wished to become pregnant, would be pregnant within 12 months. More than 90% would be pregnant within 2 years.
Source: Family Planning Victoria.
TUBAL LIGATION (FOR WOMEN)
Tubal Ligation is an operation where the fallopian tubes are blocked either by cutting, burning or with clips or rings. Women should be fully aware of what is involved in the surgery and what the expected outcome will be. Tubal Ligation is considered to be a permanent (non reversable) form of contraception. All available information should be considered so the woman can make an informed decision.
* Tubal ligation should be considered permanent. A reversal procedure can be done but the success depends upon the type of procedure originally performed. Reversal of tubal ligation is considered to be major surgery and is often unsuccessful.
* A woman must be sure she does not want more children before deciding on a tubal ligation.
* The operation should not be performed at a time of stress.
* Younger women in their 20’s should consider the possibility of regret at some stage in the future if having this operation.
* Decisions about tubal ligation should be avoided during and immediately after pregnancy when a hasty decision may result.
* If you have doubts, postpone your decision and use another form of contraception in the meantime.
TUBAL LIGATION AT THE TIME OF A CAESAREAN SECTION
A tubal ligation could be performed at the time of a caesarean section. However, a decision to have this operation at this time should have been made prior to or very early in pregnancy.
HOW IS THE OPERATION PERFORMED?
A laparoscopic procedure: This is the most common method. A 1cm incision is made just below the umbilicus (belly button). Carbon dioxide gas is introduced into the abdomen through a fine needle so that the organs in the abdomen can be easily seen when the laparoscope is inserted into the abdomen, and to reduce the risk of injury to the bowel when the laparoscope is inserted. The laparascope is an instrument like a telescope, which is used to view the fallopian tubes. A second instrument is inserted through another small incision at the top of the pubic line. The second instrument, which is an applicator is used to place a clip or a ring onto each fallopian tube. A third method, less frequently used, involves picking up and burning the fallopian tubes with a diathermy applicator inserted through the lower incision. Once the instruments are removed, the carbon dioxide gas is released and a stitch is usually placed in each incision.
There may be nausea from the anaesthetic and some pain at the incision sites. There could be pain in the right shoulder and under the rib cage caused by a small amount of carbon dioxide gas settling under the diaphragm and its duration will vary. Complications such as abdominal bleeding or damage to the bowel or adjacent organs occurs rarely.
Tubal ligation does not interfere with monthly ovulation but the egg cannot be fertilised by sperm and therefore is absorbed into the lining of the abdominal cavity and is destroyed. Risk of the operation failing is small with 1 in 500 women who have had the operation becoming pregnant.
IMPLANON (HORMONAL IMPLANTS) – 68mg etonogestrel
Implanon is a reliable sub dermal contraceptive implanted under the skin on the inner side of the non dominant upper arm which lasts for three years, but can also be removed at any time. Implanon proveds contraceptive cover immeiately after insertion, provided it is inserted at the correct time of the womans menstrual cycle. Implanon can be easily felt but not easily seen.
WHO IS IMPLANON SUITABLE FOR?
* Implanon is great for women who don’t want to think about using contraception on a daily basis
* Find other methods of contraception unsuitable or unreliable
* Unable to take oestrogen
* Want an alternative to tubal ligation
* Effective contraception for up to 3 years
* Nothing to remember on a daily basis
* Rapid return of fertility once removed
* Low cost
* All women will experience a change in their menstrual cycle
* Side effects may occur such as headache, acne, weight gain, breast tenderness and mood changes.
* Does not offer protection from sexually transmitted infections or HIV
HOW IS IMPLANON INSERTED?
Implanon is inserted with a sterile applicator by a doctor trained in the technique. Before the Implanon is inserted, a local anaesthetic is given to numb the area. The insertion will take about one minute. A pressure bandage should be used to minimise the risk of bruising.
HOW IS IMPLANON REMOVED?
Implanon is removed by a doctor trained in the technique. A local anaesthetic is given after which a very small incision is made in the skin and the implant is then removed, the proceedure takes about three minutes. Implanon can be removed at any time but must be removed at the end of three years. Women usually start to ovulate within one month of having the implant removed. A small scar may remain.
CAN I BREASTFEED AND USE IMPLANON?
There is no effect to the quality or quantity of breast milk produced. As with all hormonal contraceptives, a very small amount of hormone is excreted in breast milk.
Whilst no contraceptive can claim a 100% success rate, Implanon comes very close. The failure rate in trials over a 12 month period was only 0 – 0.07%.
Source: Patient Counselling Guide – Organon (Australia) Pty. Limited
Condoms are an effective form of barrier contraception as they collect the male semen thereby preventing pregnancy as the semen does not enter the female vagina. Condoms are also an excellent protection against sexually transmitted infections. Condoms, when used as instructed by the manufacturer, will be 95% – 99% effective against a pregnancy occuring. Each condom is strictly single use and remember to only use condoms which meet Australian and international standards. Remember that novelty condoms are not intended for pregnancy or sexually transmitted infection prevention, and should never be used for penetrative sex.
* Cheap and widely available from many retail outlets
* No doctors visit or prescription is required
* Only used when required
* Decreased risk of contracting a sexually transmitted infection
CHOOSING AND CARING FOR CONDOMS
Condoms do come in different sizes, so ensure the correct size is purchased. Only purchase condoms that meet the Australian and international standards. Ensure the use by date on the packet is current. As condoms can be affected by the heat, store them is a cool dry place. When stored correctly, they will last for about five years. If either partner is allergic to latex, purchase latex free condoms.
Remember to always use a lubricated condom and if extra lubricant is required, only ever use a water based lubricant. Water based lubricants help to reduce friction. Friction can lead to condom breakage. Oil based lubricants can weaken the latex and cause the condom to break. Condoms an water based lubricants are widely available from supermarkets and pharmacies.