Hormonal contraceptives and you
Hormonal contraception is a method of preventing pregnancy by using substances that act on the female special system called the endocrine system. This is the system that controls both the monthly menstrual period and the monthly egg release called ovulation, which leads to fertilisation and conception.
These substances are the major hormones that control conception. They are oestrogen and progesterone. So, hormonal contraception could either be a combination of oestrogen and progesterone, or it could be progesterone only. The combination may be oral combined daily pill, injectables, skin patch or trans-dermal patch.
Progesterone only may be in form of daily pills called mini-pill injectables (two-monthly or three-monthly injectables) and it may also be in form of implants.
Implants are rod-like, long-acting progesterone that is applied under the skin of the forearm. The rods are inserted under the skin of the forearm and slowly release the progesterone substance for a period of three years or more, depending on the active ingredients.
Hormonal contraceptives include oral pills, sub-dermal implants, injectables, hormonal intra-uterine devices and vagina ring. Hormonal contraceptives work by inhibiting ovulation (preventing the release of egg) and may also inhibit fertilisation.
Combined contraceptives are very effective form of birth control, but they are associated with some risks of the cardiovascular system which include poor blood circulation or risk of blood clot. So, women with underlying factors for cardiovascular disease or those who are active smokers may not be advised to take combined contraceptives.
These types of contraceptives also increase the risk of breast cancer, though they may lower the risk of both the ovarian and endometrial cancers.
Progesterone-only pills may not be as effective as combined pills, but they are deemed safe for breastfeeding mothers.
Implants that are available at most family planning clinics include Norplan, Implanon and Jadelle. These are long-acting progesterone-only implants. Implanon consists of a single rod, and it is commonly prescribed in most centres in Nigeria.
Implanon is a sub-dermal contraceptive implant that is usually inserted under the skin of the upper arm. Though it is long-acting and effective for three years, it is reversible once it is removed.
Most common complaint among users is that of weight gain, which is due to increase in appetite. So, regular exercise and good dietary control will reduce the weight gain that is commonly associated with these hormonal contraceptives.
Skin patch is a trans-dermal patch applied to the skin. It releases oestrogen and progesterone slowly to prevent pregnancy. It is a very effective birth control.
Intra-uterine contraceptive is a device that is inserted into the womb to prevent pregnancy. It may contain copper or progesterone. It is a form of long-acting contraceptive and it is also very reversible.
Apart from the Copper-T intra-uterine device, we also have gold-containing intra-uterine device such as the Gold T IUD from Spain and Germany. Various varieties and shapes of intra-uterine devices are available, but the most popular in use is Copper-T, which may also serve the purpose of emergency contraception within the first five days of unprotected sexual exposure.
It can be used during breastfeeding, as it does not affect the woman’s hormonal system and fertility resumes immediately after removal. Some women may complain of increased menstrual pain or increased menstrual flow, though.
Intra-uterine device acts by preventing fertilisation. It may possibly prevent implantation as it is used as emergency contraception.
When hormonal contraceptives are to be prescribed, a detailed medical history of the woman is necessary, while comprehensive clinical assessment and laboratory investigations may also be necessary.
Emergency contraceptives or ‘morning after,’ also known as post-coital contraception, are control measures taken after an unprotected sexual exposure to prevent pregnancy. It may be in form of combined pills or progesterone-only tablet, such as Postnor.
The earlier the medication is taken, the lower the failure rate. In fact, it is better not to wait till the morning after.
Intra-uterine Copper-T device may also be inserted within the first five days of unprotected sexual intercourse, up till the first seven days to serve as an emergency contraception.
Sterilisation is any medical procedure that makes a man or a woman unable to reproduce. It may be surgical or non-surgical and may be for male or female. Sterilisation is a form of permanent contraception because reversal is usually difficult or even impossible. Example of sterilisation includes tuba ligation in female, whereby the fallopian tubes are tied and cut, making the transport of egg and sperm impossible.
A woman’s womb can also be removed surgically (hysterectomy) to prevent her from getting pregnant again.
Sterilisation for men could be in form of vasectomy, whereby the spermatic cords are cut; hence, preventing sperm from the testicles to be released to the female reproductive system for fertilisation. It could also be in form of castration, whereby the testicles are removed surgically.
Generally, African men are afraid of sterilisation because they believe it may be associated with impotence or childlessness when they reincarnate (i.e. when they are reborn in another life), which is not true.
Dr. Samuel Adebayo
culled from Punch
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