Sunday, November 7, 2010
JULIE, 33, is a senior manager at an accounting firm. She has been married for five years and recently gave birth to her second child, Jayden, 10 months ago. Her first child, Caitlin, is two years old.
Although Julie and her husband are very happy to have a son, they did not plan on adding to the family so soon as they are both still focused on building their careers. Julie’s unplanned pregnancy happened when she forgot to take her oral contraceptive pills, and she does not want to run the risk of being surprised with another child in the next few years.
For couples such as Julie and her husband, deciding whether to expand your family by one more – whether this would be your second child or your fourth – is one of the most significant decisions you will make in your lifetime. Assuming that you have struck a happy balance with your present family size, it is understandable that mothers can be pulled between the joys of having another child and a reluctance to upset the balance that currently exists.
While you and your husband are still deciding on whether you wish to have more children, it is essential to have effective and reversible contraception.
Non-daily contraceptive options available today include the levonorgestrel intrauterine system, copper intrauterine device, progestogen implants, and sterilisation.
The advantages of these methods are that they require less action by the user, and for levonorgestrel and progestogen implants, create steady blood hormone levels due to continuous release of a low dose of hormones.
A ‘fit and forget contraception’
The levonorgestrel intrauterine system or LNG-IUS is one of the most effective contraceptive options available when compared with other methods such as condoms, oral contraceptive pills, and hormone injections. Most importantly, this method does not require daily patient compliance as it provides continuous and effective contraception for up to five years.
The LNG-IUS is a small, T-shaped device made of impregnated plastic that is placed inside the uterus (womb) to provide continuous contraceptive protection. The LNG-IUS releases a progestogen called levonorgestrel (LNG), which acts directly on the lining of the uterus to make it thin and unreceptive to implantation of a fertilised egg, and changes the lining of the fallopian tubes and the mucous produced by the cervix to make it difficult for sperm to swim.
In some women, it also stops ovulation from occurring.
The insertion of LNG-IUS can be carried out in your doctor’s clinic within minutes. Once inserted, you should not be aware of the system. The device is removed by your doctor after five years, or earlier if contraception is no longer required. If further contraception is needed, a new system is inserted at the same time as removal of the previous system.
The most common side effect of the LNG-IUS is a change in the pattern of your periods. This can include an increased time between periods or longer periods, but the longer the LNG-IUS is in place, the more likely that periods will become fewer (further apart) or, for some women, absent altogether.
The LNG-IUS is useful for women who need effective long-term contraception, have just had a baby, who need a reversible alternative to sterilisation, and those who are dissatisfied with other methods of contraception. Compliance is good as it is a “fit and forget” method, which makes it convenient to use. The LNG-IUS is also becoming an increasingly preferred alternative to the irreversibility of sterilisation among women in developed nations.
An advantage of the LNG-IUS is that it can provide effective contraception for a mother who is breastfeeding as the hormone effect is contained within the womb and will not affect the composition or volume of breast milk produced. Other benefits of the LNG-IUS include reduced menstrual flow and pain, a shorter duration of menstrual bleeding, as well as increased haemoglobin and serum ferritin (iron) levels.
Normal menstruation generally returns within 30 days after removal of the LNG-IUS, and a woman’s usual level of fertility returns quickly after removal, with conception rates becoming equal to before IUS use (90% within the first year). Pregnancies progress as normal with no increased risk of foetal abnormalities.
The Copper IUD (Cu-IUD)
A Cu-IUD is also inserted into the uterus and may be left in the uterus for up to 10 years. However, it is different from the LNG-IUS in that it does not release hormones, but copper, into the uterus. Copper is toxic to sperm. The presence of an IUD interferes with the movement of sperm, fertilisation of eggs, and implantation. Cu-IUDs may sometimes cause increased menstrual flow, cramps, or backaches.
A Cu-IUD is a small plastic device that has a stem wound with fine copper wire. It looks like a small anchor with two side branches. Attached to the base of the stem is a nylon string. The string hangs out from the uterus through the cervix and can be felt with the fingers high in the vagina.
The insertion procedure for the copper IUD is similar to the LNG-IUS. Fertility will also return with the removal of the copper IUD.
The contraceptive hormonal implant is inserted under the skin of the inner, upper arm to provide three years of contraceptive protection. The implant is made of plastic containing a progestogen, and is 2mm wide and 4cm long – similar in shape and size to a match stick.
Your doctor will remove the implant after it has been in place for three years, or at any time prior to this if the contraceptive effect is no longer required. Normal fertility returns soon after removal of the implant. To continue contraception, a new implant must be inserted at the time of removal of the previous one.
The contraceptive hormonal implant will continuously release a progestogen hormone called etonogestrel, which prevents ovulation from occurring each month. This means that no egg is available for fertilisation, so pregnancy is avoided. The contraceptive hormonal implant also changes the mucous produced by the cervix, which makes it difficult for sperm to enter the uterus.
Even though the contraceptive hormonal implant is inserted and removed with just a local anaesthetic, you need to be comfortable with the idea of having an implant placed under your skin if you plan to use this contraceptive option. Prolonged, irregular or absent periods, acne, weight gain, headache, and breast tenderness are among the side-effects that have been reported in some women using the contraceptive hormonal implant.
This is an irreversible method of contraception which can be performed on either the male or female. In tubal ligation for the female, the Fallopian tubes are cut and stitched to prevent the ovum (egg) from reaching the uterus. It is a surgical procedure requiring a general anaesthetic.
In the male, a vasectomy is a minor surgical procedure that interrupts the vas deferens (tube that connects the testes to the urinary tract), preventing the sperm from entering the urinary tract, so that semen is ejaculated without sperm. A vasectomy is usually done under local anaesthetic. Sterilisation results in permanent infertility in the female or male in which the procedure is done and cannot be reversed.
Deciding on whether your family is complete or not is a personal decision and one that needs to be discussed thoroughly with your partner and other family members. Family members bond through the process of being considered in the decision making process. Discussing and gathering input will help you and your children prepare for the challenges and the joys of adding a new member to the family.
Nevertheless, until you and your husband decide that the family is ready, effective contraception is a vital consideration in avoiding an unplanned pregnancy.
By Dr S.Y. CHONG
> This article is contributed by Dr S.Y. Chong, medical advisor with Bayer Schering Pharma. This information is provided for educational purposes only and should not be taken in place of a consultation with your doctor. Bayer Schering Pharma disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.