Dra. Leila Catherine Onbargi,

The distinguishing factor of these birth control pills is that while combined pills contain both progesterone and estrogen, the mini-pill contains only the hormone progesterone.

The contraceptive action is derived from the fact that these pills impede the monthly liberation of an ovule (though some ovules do get to be released). They also thicken the vaginal mucus, which hinders the passage of sperm towards the ovule.

Advantages

• They have minimal side-effects. As the mini-pill does not contain estrogen, they can be taken by women who are not candidates to take combined pills, for example those who have a history of arterial thrombosis, hypertension or smokers over 35 years of age.
• They can be taken while breastfeeding. There is no risk for the baby.
• Correctly used, they have a similar contraceptive efficiency as traditional combined pills.

Disadvantages

• For these pills to function correctly it is very important to take them at the same time each day. Just a few hours delay affects their contraceptive effect, and in this case temporary use of condoms is advisable.
• Changes in the menstrual cycle may be observed: periods may become irregular, with either shorter or longer intervals between cycles.
• Spotting between periods may occur, which is inconvenient, but is not considered a complication.
• In very rare cases they can cause headaches, nausea, dizziness or painful breasts.

A contraceptive method that has been in use for over 40 years.

It is a device that measures 3 cms. that is placed in the interior of the uterus through the vagina.

It functions by creating a hostile environment for sperm and impeding them from reaching the ovule.

It is fitted 6 weeks after childbirth (it is not at all painful) or during a patient's menstruation. The IUD model used in this office is considered one of the most effective and safest available.

Advantages

It does not contain hormones so it does not cause weight gain, breast tenderness, nor does it affect libido or cause some of the other side effects of hormones.

The IUD is effective for 5 years, but if you wish to become pregnant it can be removed earlier.

Disadvantages

It can cause changes in menstruation: periods can be heavier, last longer and be more painful, especially in the beginning.

The failure rate (unwanted pregnancies) is between 0.5 and 1% depending on the device model.

There can be an intolerance of the IUD in less than 10% of women, requiring a change in birth control method. Other complications, such as expulsion from the uterus are extremely rare. Women who have already had children are considered better candidates with better tolerance.

There can sometimes be spotting between periods. This is not considered a complication.

Use of the IUD is not recommended for women who have frequent vaginal infections.

If you decide to have an IUD placed

Arrange an appointment to coincide with your period. This is when placement is easier and more comfortable.

An anti-inflammatory is prescribed in the hours prior to insertion.

An antibiotic for prevention of infection is prescribed for three days after insertion.

Sexual relations can be resumed 3 days after insertion.

This progesterone-liberating reversible contraceptive method has been in use for over 10 years, and is considered one of the most effective.

The device measures about 3cms. and is placed inside the uterus through the vagina like any other IUD. It slowly liberates a synthetic female hormone called levonorgestrel in the uterus. This hormone acts exactly like natural progesterone, and is commonly used in other contraceptive implants and pills. It works by creating a hostile environment for sperm, impeding its journey to the ovule. It also affects ovulation and can inhibit it.

It can be placed from 6 weeks after delivery of a child, or ideally when a patient has her period.

Advantages

It rarely affects body weight or blood pressure. It doesn't affect libido and has minimal adverse affects on the organism and the bone structure. If the patient loses weight by dieting, the Mirena remains in place.

The Mirena lasts at least 5 years, but if pregnancy is desired, it can be easily removed at any time before that.

After a few months adaptation, during which menstrual bleeding may increase, a reduction of the menstrual flow occurs, even in patients with long, heavy periods. Some patients will not have a period at all. Apart from its contraceptive action, Mirena is used as an effective treatment for metrorrhagia (heavy periods).

It increases hemoglobin and ferritin (iron) levels. It improves anemia, unlike the copper IUD.

Lower risk of pelvic inflammatory disease than with other IUDs.

Lower risk of ectopic pregnancy than with other IUDs.

Reduces the incidence of uterine fibroids.

Possible Adverse Side Effects

Patients may experience irregular bleeding during the first few months after insertion.

The incidence of undesired pregnancies is 0.1% Intolerance of the Mirena occurs in less than 10% of patients, requiring a change to another method of contraception. Other complications, such as the expulsion of the device are very rare. Women who have had children usually tolerate IUD placement well, and are considered better candidates for this method.

Occasionally one or more of the following symptoms may be observed during the first months of Mirena use: headache, breast tenderness, nausea, acne, hirsutism, mood swings. These problems rarely last beyond the first three months of use.

Ovarian cysts may develop. These usually produce no symptoms and are resolved in time without need for medical intervention.

IUDs are not recommended for women with a history of recurring pelvic infections or who are at risk for the same.

If you wish the Mirena to be placed

Ask for an appointment to coincide with your period, or call the office when your period starts if they are irregular. Placement is easier and more comfortable at this stage of your menstrual cycle.

An anti-inflammatory is prescribed in the hours before the appointment time.

An antibiotic is prescribed to be taken after Mirena placement to prevent infection.

Sexual intercourse may be resumed after 3 days post-placement.

Nuvaring is a new contraceptive that has been available in Spain since 2003. It consists of a small ring made of a transparent, soft and flexible material that is inserted into the vagina, where it liberates a controlled daily dosage of hormones. It is used for three weeks, with one week of rest, during which the patient has her menstrual period.

Advantages

• The hormonal action is similar to the contraceptive pill.
• Easy compliance. As it is worn inside the vagina and is changed only once a month. It does not require a daily reminder.
• It does not affect metabolism.
• Easy insertion and removal.
• Regulates menstrual bleeding.

Disadvantages

• Vaginal discharge may increase. Very occasionally, localized irritation or ulceration may occur.
• It can cause the same side effects as the contraceptive pill.
• Some couples can feel it during intercourse.
• Some patients are uncomfortable with the vaginal manipulation required for the insertion of the ring.

Implanon is a long-term reversible contraceptive method. It consists of a thin flexible rounded strip about the size of a matchstick, which is inserted just below the skin on the inside of the upper arm. The insertion lasts about 1 minute, is not painful, and the contraceptive action lasts for three years. It is appropriate for women who require a long-term contraceptive method, for example those who plan to put off starting a family or having another child for a few years, or for those who do not wish to have more children, but do not want permanent sterilization performed as yet.

After three years the action starts to wear off, and the implant must be removed. A new one can replace it if contraception is still required, or a substitute method can be initiated. It works by slowly releasing a single hormone into the body that impedes monthly ovulation and makes it difficult for the spermatozoids to reach the uterus. If there is no ovule present to be fertilized, there is no possibility of a pregnancy. The implants contraceptive action starts from the first day onwards.

When the implant is removed, ovulation is usually reinstated the following month, and the patient's menstruation returns to its normal rhythm. If the implant is not replaced after extraction, nor is substituted by another method, pregnancy can occur shortly after the implant is removed.

Only a specialist familiar with the technique should insert or extract the implant. As with other methods, the best time for Implanon insertion is at the time of the period.

Advantages

• The contraceptive action is very reliable.
• As it is implanted in the arm, no reminder is required, as is the case with the contraceptive pill that must be taken daily. It lasts three years.
• Both the insertion and the extraction are quick, safe, almost painless, and are performed in the doctor's office.
• The implant is invisible, even with sleeveless clothing.
• After extraction, the patient's former fertility level is rapidly restored.
• 88% of patients with painful periods notice an improvement while using Implanon

Disadvantages

• A change in the patients periods may occur after implantation of the device. They may become more irregular, with intervals that may become shorter or longer between periods. In most cases the amount of menstrual flow is reduced. Up to 20% of women have no periods at all while using Implanon.
• Some spotting may occur, which is somewhat uncomfortable, but is not important otherwise.
• The possible side effects of Implanon are very mild. In some patients, a slight rise in blood pressure is observed.
• In a small proportion of patients it can cause headaches, nausea, vertigo or breast tenderness.
• The insertion and/or extraction can cause some localized pain once the effect of the local anesthetic that is used wears off. Some patients present some short-term irritation of the area.
• Implanon can be incompatible with certain medications.

The Evra birth control patch is a new contraceptive system in which hormones are released into the skin from an adhesive patch. Transdermic systems have been in use for many years as a means of administering various types of treatment (nitro-glycerine patches for heart disease, nicotine patches for smoking cessation etc.)

One patch is placed each week for three weeks, and then one week of rest, during which the patient menstruates. The patches are water and sun-resistant, and can be replaced if one should come off without affecting the contraceptive action.

Advantages

• The effect is similar to contraceptive pills, without requiring a daily reminder
• Low dosage of hormones
• Continuous transmission to the bloodstream
• No effect on the digestive system
• Easy to place and remove

Disadvantages

• Evra can produce the following side effects in some patients:
• Headaches
• Nausea
• Skin eruption
• Breast tension
• Dysmenorrhea (heavy menstrual bleeding)
• Abdominal pain

An unwanted pregnancy can be the result of unprotected intercourse at any stage of the menstrual cycle, and if this should, occur emergency contraception is available. The morning-after pill should not be used systematically as a birth control method, but it can be necessary to use it for the following reasons:

• If no birth control method is used at all
• Condom rupture or displacement
• Incorrect use of contraceptive method (e.g. forgetting one or more pills)
• Rape

In any of these cases, the patient should call the office, where these pills are administered, or present to the ER. Although it is best that a doctor prescribes this medication, it is now available without a prescription in most pharmacies.

For this treatment to be effective it must be used within 72 hours. The earlier it is taken, the less risk of pregnancy.

These pills contain a higher dose than normal of the same hormones used in ordinary contraceptive pills. They upset the menstrual cycle so that pregnancy does not take place.

The pills can cause nausea and vomiting. Medication to relieve these side effects can be prescribed at the same time. If vomiting occurs within the first hour, the dose may need to be repeated.

The next menstrual cycle may be affected; it can be irregular, with lighter or heavier bleeding than normal. If a patient does not get her period, a pregnancy test should be performed, as on rare occasions, this method can fail.

Essure

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