Contraceptive Jungle Part III Which Contraception Should I Use?

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Intrauterine contraceptive device, sterilization and emergency contraception.


I will discuss the intrauterine contraceptive device as there are many myths surrounding its use. I will go through sterilization which is a permanent method of contraception. It is not commonly offered or used in Egypt. But it may be the only method in women where other contraceptives are contraindication.


What is an intrauterine contraceptive device?


An Intrauterine Contraceptive Devices is a device inserted into the uterine cavity and left for varying periods of time for the purpose of contraception. They are usually made up of polypropylene impregnated with barium sulphate, for visualizing them on x-rays. They are many devices of different design. The commonly used devices are “T” shaped with a horizontal and a vertical arm. The vertical arm has a copper wire wrapped around it and two colored threads at the lower end .These nylon threads (tail) which protrudes through the cervix into the vagina, allows you to check your IUCD whether in place or not .There are hormone-releasing IUCDs available in the market which are suitable for women with special needs.


How does it work?


The presence of the IUD in the endometrial cavity stimulates an inflammatory reaction causing release of large microscopic cells called “macrophages”, which are capable of destroying sperm before they can get in to the tube to fertilize the egg. Copper IUD’s are also commonly used as an emergency contraceptive method.It also prevents the fertilized egg from getting hold on to the inner uterine surface i.e. implantation.


Failure rate

The IUD is 98% to over 99% reliable in preventing pregnancy. The newer one, like multiloads ML-Cu-250, ML-Cu-375, Cu 7 – 380 A, are highly effective i.e. >99%


What are the advantages?


The IUD doesn’t require regular supply nor there is any problem of disposal affecting privacy. It does not interfere with sex. It doesn’t have any systemic side effects. It works as soon as it is inserted. The return of fertility following removal is immediate. Life risk is minimal and doesn’t increase with age as in oral contraceptives. You only have to check the strings of the Cu T once a month. After menstruation to know if it’s still in place.


What are the disadvantages and common side effects?


Some women report that their periods become heavier, longer or more painful. They usually settle down after a couple of months. It does not protect you from sexually transmitted diseases. (STD’s) It is possible that your womb could push out the IUCD. This is more likely in the first 2- 3 months so it is important to remember to check the IUD, is still in place. The pain following insertion of IUD is due to uterine cramps, which usually subsides within a week and is mostly relived by analgesics. If the pain is persistent, you may need to consult your gynecologist. Some women complain from increased vaginal discharge following insertion, which usually subsides after 1 month. It is associated with pain and fever; consult your doctor as you may be developing a serious infection.


Hormone releasing IUD’s


These are IUD’s fitted with progesterone hormone. The hormone is released daily in equal amounts. The IUD lasts up to 5 years. This is called Mirena, and is now available in Egypt. The Mirena is inserted in a similar way to non medicated IUD’s.




Mirena is more effective than other IUD’s in relieving cramps. Pregnancy and expulsion rates are lower than other IUD’s. Amount of bleeding reduces significantly so more suitable for women with heavy periods. It can be used as an alternative to hysterectomy in woman complaining of heavy or irregular periods. It is very effective as contraceptive with a failure rate below 1 in every 200 women using it.




Insertion is relatively painful for the patient, as the device is a little bulky. Some women have reported complaints of breast tenderness, ache which, usually settles down within 3 months. Irregular bleeding which usually settles within 3 months of insertion. Absence of menses are common with users, which can be considered as an advantage.






What is male sterilization?


Male sterilization is also known as a Vasectomy or “The Snip”. It is a permanent method of contraception and requires a small operation under local anesthesia. The doctor or surgeon will make a small incision in the scrotum and pull out the vas deferens (tube that connects the testicles to the penis). The doctor or surgeon will then cut the tube and the cut ends are then either tied off or heat-sealed. It is very important to view this method as irreversible. Vasectomies can be reversed for a small number of men but don’t count on one of them being you as you may be very disappointed.


How does it work?


Because the tubes (carrying the sperm) are cut, no sperm are present in the semen when a man ejaculates. It takes some time for the sperm still left in your system (above the cut ends of the tubes) to clear, so you will have to use additional contraception until being the “all clear”. You will be required to produce two semen samples to test the sperm content, the first will be around 12 – 15 weeks after the operation and the second a couple of months after the first. Two successive clear sperm counts that are not containing any sperm are needed before you will be given the “all clear’’.


What are the advantages?


It is a permanent method of contraception. It is a very minor operation with almost no surgical risks. Use barrier method of contraception once the “all clear” is given to protect from STD’s and HIV.


What are the disadvantages?


It doesn’t work immediately. You will need to use additional contraception (until given the all clear) usually for 3-5 months after the operation. Sometimes (but very rarely) the man’s tubes rejoin and he can become fertile again. Bruising and/or discomfort for a couple of days following the operation maybe there, therefore it is advisable not to do anything strenuous for the first week including intercourse or lift any heavy objects. Some men change their mind and wish for the operation to be reversed, which isn’t always possible.


Failure rate:


After being given the all clear, male sterilization is over 99% effective; the failure rate is 1 in 1000.It is obviously less effective if relied upon before supplying two successive clear sperm counts. It is very important to use additional contraception until this time.




What is female sterilization?


Female sterilization is a permanent method of contraception and requires a small operation under local/spinal/general anesthesia. You can undergo this operation by various techniques:


Laprorscopy, the most modern method in which a small telescope like instrument is inserted into the abdomen through a small cut under or through navel. The tubes are either tied with a clip or cut and the ends burned. The procedure is done under general anesthetic but as a day case. The patient is discharged on the same day within 2-3 hours from the operation. Sterilization can be done as well during other procedure, commonly during caesarean section. Both tubes are usually accessible; they can be picked up, tied and cut. This usually adds 2-3 minutes to the caesarean section.


It is very important to view this method as an irreversible method and only have it, if you are absolutely sure that you no longer wish to conceive in the future.


How does it work?

Cutting and sealing the tubes stops any eggs released from traveling down the fallopian tube to the womb. Once the fallopian tube is cut, there are several options to stop them from rejoining. They can be tied at the ends and are left in separate tissue area, giving the least possible chance of the tubes to rejoin. In other methods, the fallopian tubes are blocked by the use of clips or rings.


What are the advantages?


It is a permanent method of contraception. It works immediately (unlike male sterilization, which takes around 6 months).Use barrier method of contraception to protect STD’s and HIV.


What are the disadvantages and common side effects?


The majority of women have this operation under general anesthesia may feel drowsy or sick following the operation. It requires a couple of day’s rest following the procedure. It may involve an overnight stay, but this is becoming less so. Sometimes the tubes can rejoin, but this is rare. Some women change their minds and want the operation reversed, which isn’t always possible. Some women find their periods heavier and more painful following sterilization. This may be due to discontinuing hormonal contraception used previously. As hormonal contraception may have been masking menstrual irregularities.


Failure rate: Female sterilization is over 99% effective, the failure rate being 1 to 3 in 1000.




This is a method of contraception used before menstruation is missed as an emergency procedure to prevent pregnancy following unprotected intercourse.

It can be used when expecting failure of contraceptive method like slippage of condom, bursting of condom, forgotten to take two or more contraceptive pills, premature ejaculation in couples practicing coitus interrupts. When unprotected intercourse happens at some odd moments in couples otherwise using conventional contraceptives it is useful. It can be used as well in cases of rape.


The method should be reserved for emergency situations and should not be used as an ongoing method of contraception on regular basis. This is so because of relatively high failure rate and high incidences of irregular bleeding.


How effective is the Morning after Pill?


When you have sex without birth control, your risk of becoming pregnant depends on where you are in your menstrual cycle. During your most fertile days – midway between two menstrual periods – the risk of becoming pregnant could be as high as 30%.


What are the side effects of the Morning after Pill?

Common side effects during MAP treatment are nausea or vomiting. Less common are headache, breast tenderness, dizziness, and fluid retention. For most women the MAP is a simple and safe option for reducing the chance of pregnancy after unprotected intercourse. However, you need to consult your doctor if you should experience any of the following symptoms; severe abdominal pain, severe chest pain cough, or shortness of breath, severeheadache, dizziness, weakness, or numbness, vision loss or blurring, speech problems and severe leg pain (calf or thigh).


How soon will I get my period?

About 50% of women will have a period within a week of taking the MAP. Most of the remaining 50% will menstruate within 21 days. Remember that your next menstrual period may be irregular, heavy. If you do not get your period after three weeks, it will be important to a pregnancy test.


When should I start using birth control?

Start using an effective ongoing method of birth control immediately. The morning after pill is meant only for one time protection. Also protect yourself from HIV and other sexually transmitted diseases by using a condom every time you have sex.



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