Monday, January 19, 2015

Contra(miscon)ception Part II/II

Part of my job entails contraceptive/sterilization counseling. I usually format my class based the length of duration of the contraceptive method.

1. Permanent:

a. Intrauterine tubal occlusion: Placement of tiny coils in the fallopian tubes through the cervix and uterus.
Pros: No incisions. Cons: There is a 3 month delay in achieving sterilization as the coils occlude the fallopian tube. Look up Essure procedure

b. Extrauterine tubal occlusion: Placement of either clips or bands on the tube via a laparascopic approach.

Pros: Immediate sterilization Cons: 2 tiny abdominal incisions. Look up Filshie clips and Fallope Ring

c. Salpingectomy: Performed usually in the postpartum period. Performed by making a 3cm incision near your belly button.

Pros: Immediate sterilization Cons: Abdominal Incision. Look up Parkland and Pomeroy methods

2. Long Acting Reversible Contraceptives (LARC):

a. Intrauterine Device ( IUD) : They don't suppress ovulation. They work by locally altering the environment in the uterus so as to make it less feasible for sperm to migrate and an embryo to implant.

    i. Progesterone based: Works by thinning the lining of the uterus and thickening cervical mucus.      Look up Mirena ( 5 year ) and Skyla ( 3 year )
       Pros: Can make periods lighter. Locally acting. Quickly reversible when removed.
       Cons:  Placement can be a tad uncomfortable.

    ii. Non-Hormonal: Works by causing inflammation in the lining of the uterus. Look up Paraguard ( 10 year )

       Pros: Can be used as an emergency contraceptive; longest form of single use contraceptive
       Cons: Can cause heavier periods.

b. Subdermal implants: Works by suppressing ovulation and thinning the lining of the uterus. Look up Nexplannon ( 3 year )

     Pros: Progesterone only
     Cons: Can cause erratic and heavy bleeding

3. Mid Acting:

a. DepoProvera : Intramuscular shot that lasts for 3 months. Con: Weight gain
b. Nuva-Ring: Vaginal Ring that lasts for 3 weeks. Con: Has been associated with increased yeast infection.
c. Ortho-Evra: Transdermal patch that lasts for 1 week

4. Daily use:

a. Oral contraceptive pills ( OCP) : Can be combination estrogen + progesterone or progesterone only. Typically work by suppressing ovulation. Come in mono phasic ( same dose the entire month) or triphasic ( three different doses to "mimic" the natural cycle).  My personal go to- Monophasic options such as : Loesterin Fe or Yaz.
b. Condoms
c. Diaphram
d. Spermacide
e. Rhythm Method: Abstinence during fertility window
f. Coitus Interuptus aka " pulling out: : FAIL!

Picking the right form of family planning, as important as it is, can seem a little mind boggling given the plethora of options available. When I have a patient come to me for the discussion, I usually start out with a few basic questions to ascertain what might be the best option(s) for them.

1. Are you a good pill taker or would you rather have something you don't have to worry about every day?

Going back to the previous post, inconsistent use of contraception decreases its efficacy. If you find yourself having to use three alarm clocks, your google calendar, and your best friend as reminder to take your pill every day ( and relatively at the same time) than taking oral contraceptives might not be the best option for you.
2. Other then prevention of ovulation ( and subsequent pregnancy) is there anything else you were hoping to accomplish with your method of contraception?
Perhaps your periods a wicked painful. Perhaps you aren't doubled over in pain every month but the heaviness is crimping your social calendar. Or maybe you don't find the hair on your chinny chin too charming. One pill definitely does not fit all.
3. Are there any medical conditions that I should know about that might make some options better than others?
Specifically- Raging vascular disease such as diabetes, uncontrolled hypertension, lupus, history of blood clots, estrogen sensitive cancer, progesterone sensitive cancer, smoking.
4. How close or far in the future are you planning on pregnancy?
Some birth control forms can sustain ovulatory suppression for a while after they are discontinued. Where as others are as easily reversible as the next cycle.

In the end, the right option for you should be a combination of which will be the easiest to comply with in addition to the one that addresses the most goals.

I welcome and encourage all questions and feedback!

Also, if there is a certain topic you would like for me to discuss, please feel free to let me know!!

Till next time, be happy! be healthy!

ObGynKanobi OUT!

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