Contraceptives: Choose them wisely

Contraceptives are to be chosen as per your age and health condition

woman with pillMarried but don’t want to be a mother? Mother but don’t want another child? Contraceptives today easily solve most of these issues that women face. However, you need to think and choose wisely before you start taking them.

Choosing a method of contraception is a personal and individual decision. But, in order to make the right and safe choice, it is important to consult a doctor.

The side-effects

Taking contraceptives involves various issues and side-effects, which need to be addressed and known as they can seriously affect a woman’s health. The time period of when to start taking a pill is important as every woman’s menstrual cycle is different.

Also, some women may be allergic to certain kinds of drugs. Issues such as weight gain, weight loss, acne increase or decrease, and nausea are common with many types of contraception.

Irregular bleeding or spotting may occur while you are taking birth control pills. However, it does not indicate any serious problems. Hormonal changes like acne, nausea, depression and dizziness may also occur.

Blood clots are one of the most serious side-effects when taking contraceptives and may cause stroke or death. The risk of stroke and blood clots may be higher with prolonged use. If you experience sharp chest pain, calf pain, heaviness in the chest, sudden severe headache, sudden partial or complete vision loss, this may indicate that you have a blood clot or are experiencing a stroke, in which case, contact your doctor immediately.

Along with this, what method of contraceptive to use and when to use are other issues which need essential examination by the doctor to avoid its effect on your health.

Contraception prevents pregnancy by interfering with the normal process of ovulation, fertilisation and implantation. There are different kinds of birth control that act at different points in the process. The ideal contraceptive should be safe and harmless.

With the present wide choice of methods available, it is of paramount importance that the chosen method should be acceptable and applicable to the needs of the woman. The correct choice of contraceptives is different for different age groups and also differs according to one’s body type or health condition.

For the middle-aged

Intrauterine devices [IUD] are an excellent method of contraception in older women as they long-lasting and effective. Specific contraindications include abnormal menstrual bleeding and the presence of fibroids distorting the uterine cavity.

Condoms and spermicidal creams can also be considered as an alternative. Spermicidal creams help lubricate the dry vagina in older women; whereas condoms provide the advantage of protecting against STDs and HIV infection.

Oestrogen-progesterone combined low-dose or triphasic pills [type of oral contraceptive pills that increase the level of oestrogen] have been found to be safe for the middle aged and pre-menopausal, non-smoking women who do not have other risk factors such as obesity, hypertension, diabetes and familial history of cardiovascular diseases.

For women with medical disorders

For women suffering with various kinds of medical disorders the choice of contraception differs.

  • For cardiovascular patients, IUD is an excellent and safe method. However, particular hygiene and preventive antibiotics at the insertion time are needed.
  • Combined pills are contraindicated in women with cerebrovascular [brain dysfunctions] or coronary disease, thromboembolism [blood clots] and severe hypertension. However, low-dose OCs including the triphasic pill can be used in mild hypertension, with no other additional risk factors such as smoking, obesity and diabetes.
  • The modern copper IUDs are ideal for diabetics. However, special care must be taken to prevent infections at the time of insertion. Combined OCs [COCs] should not be taken by diabetics with vascular diseases, nephropathy and neuropathy. However, low dose OCs and triphasic pills can be prescribed safely in uncomplicated diabetics, if proper supervision is provided. Progesterone-only contraceptives such as pills, implants and injectable are not advised.
  • IUDs and barrier contraceptives suit women with active liver disease or cirrhosis. COCs are contraindicated in those with active liver disease, severe cirrhosis or liver tumour. In epilepsy, most anticonvulsant drugs reduce the efficacy of OCs and perhaps of hormonal non-oral contraceptives.
  • Combined oral contraceptives are contraindicated in focal migraine; IUDs and barrier methods should be used. Low-dose COCs can be given to women with simple migraine.

For lactating mothers

For such women, continued breastfeeding is a natural method of contraception. Introduction of supplementary milk or food to the infant increases the risk of pregnancy and hence some form of contraception, although less effective, should be used from six weeks postpartum to prevent pregnancy.

Also, IUDs are one of the best methods of contraception during lactation because of their high efficacy and lack of effect on breast milk or infant growth. They are best used 6 – 8 weeks after delivery; or at the time of weaning or the first postpartum period.

Pills should be avoided in the first six months or until the first period. Low-dose pills or triphasic pills should be used as they contain smaller amounts of steroids. They can also opt for injectible contraceptives.

Therefore, consulting a doctor before planning the method of contraception helps avoid any unwanted pregnancy and health complications.

Kanika Gupta
Dr Kanika Gupta is the director of gynaeconcology at Galaxy Cancer Institute and Pushpanjali Crosslay Hospital, New Delhi.


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