What is emergency contraception?
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Emergency contraception, also known as "the morning-after pill," is a type of hormonal birth control that's used to help prevent pregnancy when no method was used at
the time of sexual intercourse, or when the method that was used failed (such as if the condom broke). As the term "emergency" implies, this method should not be used routinely as a means of birth control; its effectiveness at preventing pregnancy only ranges between 75%-89%. However, you have to admit that those odds are far better than merely keeping your fingers crossed.
Emergency contraception can consist of a combination pill or a progestin-only pill. For those women 17 years or over, it's now available behind the counter in the form of a progestin-only pill known as "Plan B." For teens under 17 years old, getting it requires a prescription. Plan B consists of taking 2 progestin pills 12 hours apart and the newer Plan B One-Step combines the two doses into one pill.
Although it's called the morning-after pill, it is actually most effective when it's taken as soon as possible after unprotected intercourse. However, it can be taken up to 120 hours later. It works by preventing the release of an egg from the ovary, thereby preventing fertilization of the egg by the sperm. It's important to note that it will not interrupt an already developed pregnancy.
What are the different types of intrauterine devices (IUDs) available?
Intrauterine devices, commonly referred to as IUDs, have a long history of use. However, their popularity suffered in the 1970s because of the problems related to a particular kind of IUD known as the Dalkon Shield.
Due to a flawed design, the Dalkon Shield caused serious infections in some women, and it ultimately was removed from the market. Interestingly, within the United States all other types of IUDs suffered from the bad publicity related to this incident. Consequently, although many types of IUDs are commonly used in Europe, there are only two that are approved for use in the United States.
Today's IUDs are very safe when used appropriately, and they carry only a very small risk of pelvic infection. The IUDs come in various forms and are inserted directly into the woman's uterus to prevent the man's sperm from fertilizing the woman's egg. Insertion of an IUD is usually performed during the woman's menstrual cycle to ensure that the patient isn't pregnant at the time. There are strings attached to the IUD for easy removal.
Intrauterine devices are very effective. The pregnancy rate for women who use them is less than 1%. The two IUDs currently available in the United States are ParaGard and Mirena.
The ParaGard IUD contains a coil of copper and is inserted into the woman's uterus. It works by both deactivating sperm as they swim by, and by damaging or destroying the egg before it can be fertilized. ParaGard is effective for 10 years. I tell my patients that they may see some changes in their menstrual cycles if they use the ParaGard IUD as their birth control method, such as an increased menstrual flow and more cramps. Nevertheless, these symptoms usually aren't bad enough to cause patients to have the IUD removed. On a technical note, patients who have Wilson's Disease, which is a genetic inability to process copper, or if they have a copper allergy, can't use the ParaGard IUD.
The Mirena IUD contains progestin and works similarly to the progestin-only birth control pill. Specifically, it thins out the lining of the uterus making periods
much lighter or even absent in women who use this device, and it thickens the cervical mucus so that sperm can't migrate from the vagina up into the uterus. The Mirena IUD is effective for 5 years. During that time it can have the beneficial effect of making a woman's periods lighter if she previously had very heavy ones. In fact, a common result of this IUD is that a woman's cycles may stop altogether due to the suppressive effect of progestin on the uterine lining. This effect isn't harmful and is completely reversible. However, I also tell all my patients receiving the Mirena IUD that some irregular bleeding can happen during the first 3 to 6 months.
Because of the progestin, certain possible side effects are listed in the instruction pamphlet for the Mirena IUD. These include headaches, bloating, depression, and moodiness. However, because the progestin is mostly confined to the uterus, I rarely have patients report that they notice these problems.
Regardless of which type of IUD is inserted, there are certain risks associated with their use. First, there is a very small risk that when the IUD is inserted, it will go through the wall of the uterus and into the abdominal cavity. If that happens, the IUD would need to be removed by a surgical procedure.
Second, although the risk of pelvic infection is very low, it is not zero, and pelvic infections have the potential to cause infertility. If I am counseling a young woman who desires an IUD, I emphasize that it is important to be in a mutually monogamous relationship to limit her exposure to STDs. The riskiest time for an infection is the month after insertion of the IUD because the procedure can transport bacteria from the vagina into the uterus. After that time, infection is unlikely in those patients who are at a low risk of contracting STDs.
What are the permanent methods of contraception?
Permanent methods of birth control typically are not appropriate for adolescents and young adults, except in highly unusual circumstances. Patients undergoing one of these procedures must fully realize that it takes away forever their ability to have children. And as the old saying goes, forever is a long, long time.
One type of permanent birth control is tubal ligation. This is a surgical procedure that needs to be performed in the hospital under general anesthesia. The purpose of tubal ligation is to block the fallopian tubes and prevent the sperm from reaching the egg. The effectiveness of this procedure is approximately 98%-99%.
Another type of permanent birth control is a vasectomy— and thankfully, the responsibility rests on the man with this one! The purpose of a vasectomy is to block the tubes that carry sperm to the semen. This is a surgical procedure just like tubal ligation, and the effectiveness is the same, but there are a few key differences. First, a vasectomy can be performed with less risk to the patient. Second, the procedure can be performed with just local anesthesia. And third, it can be performed in a doctor's office. What's not to like?
Just so you'll know, after the vasectomy is performed it's still necessary to use an alternative method of birth control for a few months to make sure the vasectomy was successful in blocking the tubes, and even if it was, to permit all the lurking sperm to completely disappear from the man's semen.
The final form of permanent birth control is Essure. Perhaps you've never heard of it because it is relatively new.
With Essure, small coils are snaked up through the vagina, into the uterus, and then into the fallopian tubes in order to cause permanent blockage. The effectiveness is greater than 99%. Advantages include fewer surgical risks, no general anesthesia, and the ability to have it performed in either a hospital or an office setting. Disadvantages include the 3-month wait time required after the procedure to ensure that it was effective and the radiological test required to confirm that the tubes are blocked.