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There are four highly effective methods
of reversiblebirth control: birth
control pills, Depo-Proverainjectable
contraceptives,the
ParaGard intrauterine device (IUD),
and the Norplant surgicalimplant
(currently off the market). Barrier
methods such as condoms and the diaphragm are popular alternatives,but have a higher
failure rate. Sterilization with either tubal ligation or vasectomy is
an alternativefor permanent contraception.
BIRTH CONTROL
PILLS
Oral contraceptives are made of estrogen
and progesterone. The Pill is taken daily to prevent ovulation.
It is important that birth control pills be taken every day,
preferably at the same time each day. The fourth week of the
pack consists of inactive, placebo pills. It is during this week
that a woman will experience bleeding similar to a normal menstrual
period. When birth control pills are used correctly, they are
more than 99% effective. This is the most popular method of contraception
in our country. Birth control pills do not protect against sexually
transmitted infections. Common side effects are nausea, headache,
and irregular spotting. These side effects, if they occur, often
resolve after the first few months of use.
Combination estrogen and progesterone
birth control pills are not recommended for a nursing mom. However,
there is a progesterone-only birth control pill which is safe
for nursing. It is also known as the minipill. The minipill also
prevents ovulation. The minipill is about 95% effective. Since
combination birth control pills are more effective than the minipill,
once a nursing mom has decided to wean, we prefer that she switch
to combination birth control pills.
INTRAUTERINE
DEVICES
The ParaGard IUD is becoming increasingly
popular. It is a small, soft, plastic device which also contains
copper. It is placed into the uterus by a physician as an office
procedure. It begins working as soon as it is inserted, and it
may be used for up to ten years. However, it can be removed at
any time. It is 99% effective. It works by reducing the sperm's
ability to swim and by preventing fertilization. There are no
hormonal side effects.
There were some IUDs on the market in
the past which were associated with complications. The new IUDs
do not increase your risk of pelvic inflammatory disease. They
are designed for women who have had at least one baby and are
in a mutually faithful, monogamous relationship.
The advantage of the IUD is that you
don't have to think about it every day the way you do with the
birth control pill or with barrier methods. Patient satisfaction
with IUDs is among the highest of any reversible method. This
is because it does not require daily attention and has a high
degree of effectiveness as well as convenience.
DEPO-PROVERA
Depo-Provera is given as a shot in your upper arm or hip.
It consists of progesterone which is released into your system
over a period of three months. It prevents ovulation. It provides
highly effective contraception for three months. It is a popular
method of contraception among nursing moms since it is safe for
breast feeding and does not decrease the milk supply. The most
common side effects are irregular spotting, a small weight gain,
or a delay in return of fertility beyond the three months of
use. Click here for more information on Depo-Provera.
NORPLANT
(Currently off the market)
The Norplant consists of six toothpick
size flexible capsules that are placed in a fan-like pattern
just beneath the skin of a woman's upper arm. A steady low dose
of progesterone is delivered into the system. This prevents ovulation.
It is effective for up to five years. It can be removed earlier
if the patient does not like it. Insertion and removal is a simple
office procedure under local anesthetic. The Norplant is more
than 99% effective. Common side effects include menstrual irregularities
and mood changes.
DIAPHRAGM
A diaphragm is a soft rubber, latex,
or silicone cup that is filled with contraceptive jelly or cream
and inserted into the vagina to cover the cervix. It provides
a physical barrier to semen and holds the contraceptive jelly
which kills the sperm before they can enter the uterus and fertilize
an egg. The diaphragm should remain in place for six hours after
intercourse, and should be removed as soon as possible thereafter.
Diaphragms should be replaced every two years. Use of the diaphragm
may increase a woman's risk of urinary tract infections. The
diaphragm is about 80% effective.
CONDOMS
The male condom is worn on the penis.
It collects semen and prevents sperm from entering the uterus.
It is 88% effective. The female condom is a lubricated plastic
sheath with the rings on each end. The ring on one end is open
and remains outside the vagina, covering part of the labia. The
ring on the other end is closed with the plastic and looks like
a diaphragm. It is placed in the vagina so that it covers the
cervix, preventing sperm from entering the uterus. The sheath
between the two rings forms a pouch to line the entire vaginal
area.
The use of the male condom and the female
condom can help prevent the transmission of sexually transmitted
diseases. Both are available without a prescription. The female
condom can be inserted up to eight hours before intercourse.
STERILIZATION
Tubal ligation is performed with an
instrument called a laparoscope as an outpatient surgery. The
surgery takes about a half an hour. Recovery is within a few
days. There is about a 1 in 300 failure rate. It is considered
permanent. You should not consider tubal ligation unless you
are sure that you do not want to have anymore children. It is
very difficult to have the tubes put back together. Tubal reversal
is not always effective. It is often not covered by insurance.
Vasectomy is done by a urologist as an office procedure. Female
sterilization is immediately effective. Vasectomy is only effective
after multiple ejaculations when the existing sperm are cleared
out of the vas deferens.
POST PARTUM
CONTRACEPTION
We recommend Depo-Provera, the ParaGard
IUD, and Micronor (the "minipill") for post partum
contraception. Breast feeding is not a reliable birth control
option. Although nursing can in some cases delay or even prevent
the return of your period, it does not necessarily prevent you
from becoming pregnant.
Whether or not this is your first baby,
it is not too soon to consider when or if you would like your
next, and what you are going to do about family planning. Going
through another pregnancy may be the last thing on your mind
at this time, but it is best to think it over now so that you
are prepared for the future.
Other options for post partum birth
control include combined oral
contraceptives for women who are not
breast feeding, the diaphragm, condoms, and sterilization.
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