Birth Control

Well, we know how  babies happenImage result for oops a baby—I just get a chuckle when women say, “How did that happen???”   Weeeelll, you weren’t using anything for birth control, and you were enjoying yourselves……it’s an old story.

So–you don’t want a baby—or a sibling, to follow just yet!   What to do??

So many options–although not as many as other countries (speak to your government rep on that)!

Here is a good link that shows your options:

http://www.ashasexualhealth.org/pdfs/ContraceptiveOptions.pdf

NON HORMONAL

Some women don’t want –or they CAN’T use hormones–and relying on a man–well—LOL on that !    Hats off to those few MEN who step up and use a condom at least, or get vasectomy when it’s time to shut down the DNA transmission.

CONDOM

Better that nothing!  Not great.  GOT to be put on at the get go–none of this–‘I’ll put it on when I’m “close” stuff!’

Here  is how to put one on!!http://www.avert.org/sex-stis/safer-sex-hiv/condoms

Don’t use your teeth to bite the package open–or scissors, or a knife–look for the arrow!   If it’s your only one,  you need to be careful!  Oh , and watch those fingernails too!

NEVER “double -up”  that increases the chances of condom breaking.

Don’t use any vaseline as a lubricant.  Petroleum products can break down the condom.

Don’t listen to any rubbish about them being too small for his “little man”–see link  CONDOM FITS OVER HEAD!

 

FEMALE CONDOM

Yes–really –they do exist–and for some couples who are, say HIV positive, or have some other condition, this is the safest option. Here is a picture of a female condom

COPPER IUCD/ MIRENA IUD

These are nifty little devices.  Did you know we know about IUCDs because in ancient times, rocks were put into the wombs of camels so that pregnancies, and births of baby camels didn’t happen while crossing the deserts!

Anyway, this is VERY VERY effective at preventing pregnancy—99%+.  There’s a one time cost, and you can get copper ones that last for TEN years for less than 130 bucks–so it ends up being the cheapest effective, and REVERSIBLE, contraception you can probably get.

Now, I hear the concerns of women who come in and say they hear “horror stories”–but truly, in our practice we put in about 700 a year—and I haven’t heard of any real “HORROR” stories.  I know of one (a friend of mine), who had to have a laparoscopy done to remove hers (I put it in, and it was a straight forward insertion) -a day surgery procedure–in and out same day, and no lasting effects.  I feel badly that she had to have a surgical procedure, but things can happen despite doctor’s best efforts!  I think a “horror story” would be ending up with a colostomy, or serious lasting effects, but I hear that “cramping” is a horror story.  Well, you might want it out if you can’t get cramps under control with meds, and if unable to stop the bleeding but–not a ‘horror’ story!   We have to remember we are trying to prevent pregnancy—a really life altering consequence of sex–and you think birth control has complications???  try pregnancy!!!!  WAY more dangerous!

I’m from Canada–but anyone who is in the snow belt can relate to this.   It is a snowy morning–you have to get to work/school.  There’s ice caked on your windows, and you just spent 20 minutes getting enough snow out of the way so you can drive.  You chisel a circle of ice out of your windshield on the driver’s side,

http://f.tqn.com/y/chemistry/1/W/-/X/2/73984965.jpg

you hope your windows aren’t frozen shut–because you have to put them down to see left or right—and you drive down an icy road with 20 ton snow plows coming at you,

https://www.rt.com/files/news/35/43/70/00/france-3.jpg

as you peer through your tiny circle, waiting for the defrost button to do it’s job!  If you’re a Canadian (except in British Columbia)–you’ve all done this!   TALK ABOUT RISK!!!

I don’t personally know (30 years of practice), anyone who has died from having an IUD.  I know of less than 5 girls who developed blood clots on the pill, and way more women who ended up in ICU near death, had limbs amputated, or died as a result of pregnancy!  It is not a perfect world yet–even though we want it all, and we want it all side effect free, and guaranteed!

Here is how an IUD is put in.

This is what you find if it perforates.

Now, the omentum is an apron of fat that drapes across the transverse part of colon, and is like a watch dog.  In cases where surgery not possible, your only hope of surviving appendicitis, or a perforated ulcer is if your omentum walls it off.  It sees a problem, and goes there and tries to wall off the problem—wrap up your appendix, so the rupture doesn’t kill you etc.  It sees an IUD it may go to wrap itself around it, and keep it contained.   There are thousands of IUDs put in across the country every day–yet in our province we see just a handful of perforations a year–only two here in last 3 years!  Typically we can resolve by laparoscopy–two tiny incisions, and a few minutes.  Thankfully, VERY VERY few in North America end up with terrible complications like colostomy or organ perforation.  I don’t personally know of any that were more than a day surgery removal in my practice, or in any of my colleagues–and I’ve been at this for 30 years.  Yet, I hear women come in and say they have heard “all kinds of horror stories”–which usually ends up being one person who had cramps, or one person who had bleeding….sigh!  A bag to poop in on your belly, scarred up–THAT is a horror story!

For insertion, we like to have you on your period (No–it’s NOT “gross”  it’s just blood!)–the “barn door”-entrance to your womb- is a little open!  We also then know you are not pregnant.  Insertion usually takes less than 5 minutes–and I’d say 90% are straightforward insertions.  You do get “difficult insertions”  It is harder to do it if you are overweight–as it can be difficult to get a clear view of the cervix.  If you have not had children, or have had C. Sections, it can be harder as your cervix has never opened up.  Some women have a “supersensitive” cervix.  For these women, you can spray on a topical anesthetic, and even do a cervical block to ease pain of insertion.  It is good to take some Ibuprofen before you get this procedure done!

The Mirena IUD has a hormone (NOT ESTROGEN–so OK for smokers!)in it—a form of progesterone.  It can make your periods MUCH lighter, so it is also approved for heavy periods too.  If you have pretty bad periods, then I would NOT recommend a COPPER IUD–the Mirena may be better choice.  Studies show Mirena is MORE effective than a tubal ligation!

I cannot promise no more periods–but they are typically MUCH lighter!   We use the Mirena is help control heavy periods!

You DO need the check the fishing line that is attached to the IUD once in a while–it is up inside the vagina–you use a finger and reach in to feel the thread against the cervix.

See the threads?cervix

BIRTH CONTROL PILLS

So many to choose from–and all about the same.  We now have doses that drop all the way to 10 mcg estrogen –and all are considered “low dose” if 35 mcg or less.

There are three types of “birth control pill”:

monophasic pills—the same dose all the time (my favorite type).  Contains estrogen and progesterone

triphasic—a different dose of pill each week                                Contains estrogen and progesterone

progesterone only pill–no estrogen –also known as “mini-pill”

You could have more spotting with this, but it is nice option if you have a contraindication to estrogen containing pills, or if you smoke and over 35.

Birth control pills can be used until age 50 if you do not smoke!

Downside is remembering to take the pill every day–and we know that, after a couple of months, about 40% of women forget!

You may experience side effects such as breast tenderness(usually gone after a month), sensitivity to tanning.  There is a risk of blood clots in your legs or lungs–so let your doctor or NP know if there is a family history of those types of blood clots.  Some women have headaches, nausea.   There is no weight gain!!   There is no sugar in the “sugar pills”.   If you are gaining weight—eat less–exercise more!   I wish it was that easy though eh?

You also don’t have to have a period every month!!!—yeah yeah I know, your grandmother will tell you that you have to flush out that toxic blood!   NO YOU DON’T!!—the pill will stop you from building up a period–so many women can use the active pills (the “real” pills) continuously, and you can go for 3 months, 4 months, or even a year at at time!

Of course, I can’t GUARANTEE you won’t have bleeding issues, but you can build up to a year gradually—say go every second month for 6 months, then every 3 months, then every 6 months then try a year!  You can arrange to NOT have your period during your wedding, honeymoon, vacations, exam week, athletic events!  Talk to your doctor/NP about this is you think you want to try!

Let’s see–so many……

Nuvaring (click here for pic)

This is a pretty nifty option—you only have to remember to change the ring once a month.   If you can use a tampon–you can use this –it’s EASY!!  It doesn’t “get lost”, and it won’t fall out.

It is more effective than the pill becasue it doesn’t require you to remember EVERY DAY to do something.  Put a reminder in your smart phone, or a note on your mirror to remind you when to change it to a new one.

Some women even use a tampon applicator to insert it–most just push it in with a finger.

You can leave this ring in for sex–it won’t hurt your partner.  If he doesn’t want it left in , you can take it out for a max of 2 hours—don’t fall asleep in each others arms without putting the ring back in–then cuddle up for the night!

When the ring is in–you won’t feel it.  you don’t feel a tampon if it is in.   The odd time, when you put a tampon in , you realize you don’t put it in far enough because you DO feel it–but all you do is give it an extra shove, right?  Same thing for the ring.  To remove it, you just put a finger into your vagina, and hook it around the ring and pull–it will fold up, and come out quite easily.

As with the pill, you can talk to your doctor about using the ring continuously, and avoid periods!

THE PATCH—click here to see pic

Another option that does not require daily remembering.  You change the patches once a week.  All the same side effects as the pill.  You can also try to use the patch to miss periods–talk to your doctor.

DEPOPROVERA–the 3 month shot

It certainly has a place, and is good form of birth control.  For women who cannot take the pill because of estrogen, it is a nice option.  If you don’t think you can remember the pill every day, it’s a good option.

The thing with the shot –it’s going to be you LOVE it, or you HATE it!  You will LOVE it if your periods are light, or go away, but you might not like it if you are one of the few who bleeds all during the month–and there is no way to predict who does what.

There are medications we can give if the bleeding is a problem, but the shot is in for 3 months.  MOST people settle down within 6 weeks, and LOVE this contraception.

If you decide to use this, you also need to make sure you get plenty of calcium in your diet—a couple of glasses of milk a day –a couple of yogurts etc.  A calcium pilll such as aTUMS a day is better than no calcium at all. Use beyond three years may cause bone loss–so do your best to prevent that.

IMPLANTS

NOT AVAILABLE—very unfortunately–in Canada—I have put in hundreds of these when working in the USA–they are really a great form of contraception!!!

I’ll have to take a look back, and see if I forgot anything.  Tubal ligation will be covered under surgical procedures.

 

 

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