health and wellness · life of a medic

Unmasking Contraception

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A young woman, 23 years of age, goes to an obsgyn and a simple question is asked. How many children do you have? The answer, shockingly, ten!

Married at the age of 11 she has done nothing but to pop children with only the space of about a month. Her husband misses no shot and at 23 she may end up with a parity of more than 20 if something is not done.

Another, a girl, 18years, actively involved in sex but with strict parents who would kill her if they found out. She comes to you, she doesn’t want to become pregnant and her best friend already is. Her boyfriend is not comfortable with using condoms. She doesn’t like it, but she loves him. What do you do?

In yet another scenario, a futuristic lady, business oriented has had her two children, and wants no more, she comes to you for help? What do you do?

As a medical student, not even a doctor yet,many girls approach and ask me this huge mountain of a question, what exactly is contraception, how does it work and which one is the best for me?

Having this in mind, I have seen it right to demystify this in the best way that I can and hope to help you in the little way I know how.

So simple, what is contraception?

Contraception is the deliberate use of devices, medicine or traditional methods to prevent pregnancy after sexual intercourse.

why use contraception?

Well, any woman, after attaining puberty had the God given capability of becoming pregnant and getting a child.

Most of us ladies, well, we would like to plan this. And we have a right to. After all, the only difference,fertility wise,  between rabbits and us, is that capability to prevent unplanned or unwanted pregnancies and have children that we can be able to comfortably raise.

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Methods of contraception

Ain’t this the mother of all questions? I will serve to give possible options which I’m sure any Google search would give you but with a more human touch’s and perhaps share a bit of what I have heard.

Let’s start with the age old ways of contraception. The very ones that our forefathers came with after seeing the need themselves.

The first and the best one known to date is…. Drum rolls!! Abstinence!

I can not belabor this point enough. Abstinence is the only sure way of not getting pregnant especially for young unmarried girls. And it also preserves your sexual purity so that when you stand at that altar before that Priest or Imam you are pure and untouched.

Abstain, abstain, abstain

b) Coitus interruptus

This Is also another traditional method, demographically still used in my population by 8-10% of the population and a method which to my opinion is not really trustworthy. Cause how easy is it to pull out when you are just to cum as a man anyway…or even as a woman. You were just getting there..He is just about to cum and the glory of potentially cumming together and then he just withdraws?! I mean really? Wouldn’t you be tempted to hold him right there …or in that moment go like screw it! There are P2’s anyway!

All the same, if correctly used, 4 out of 100 women get pregnant and if the man does not always use it correctly.. then 27 per 100 women get pregnant annualy.

It is a good method for a method for a couple that has great self control.

Couples who have great self-control, experience, and trust may use the pull out method more effectively. Men who use the pull out method must be able to know when they are reaching the point in sexual excitement when ejaculation can no longer be stopped or postponed. If you cannot predict this moment accurately, withdrawal will not be as effective.

Even if a man pulls out in time, pregnancy can still happen. Some experts believe that pre-ejaculate, or pre-cum, can pick up enough sperm left in the urethra from a previous ejaculation to cause pregnancy. If a man urinates between ejaculations before having sex again, it will help clear the urethra of sperm and may increase the effectiveness of withdrawal.  

– See more at: http://www.plannedparenthood.org/learn/birth-control/withdrawal-pull-out-method#sthash.WhY4x1sp.dpuf

Away from traditional methods, other methods include barrier,  hormonal and intrauterine methods.

Barrier methods.

The most known barrier method is that of using a male condom. That and the use a female condom are the only ways known that also act to protect against sexually transmitted diseases eg  HIV/AIDS.

Where I come from, there’s a certain stigma associated with purchase of a condom or use of a condom. In that before marriage you shouldn’t be having sex and after marriage why are using one unless you are cheating hmm?

Well here’s the sad news most people start sexual activity waaaaay before marriage, in the years of college when every nut that’s unhinged either gets lose or get tied up in our little minds and people Lego (let go) and many married individuals have multiple partners.  Governments have tried and they distribute the condoms freely. In Kenya almost all public toilets are stocked monthly with this commodity. Of course by about a week they are over but at least they help a few individuals.

Well a condom has a very high effective rate, with a 98% pregnancy protection rate IF Used correctly and every time.

The female condom I honestly find if cumbersome, just reading about it makes you tired. But it’s an available method that one can use. You just have to wear it forehand ..like an hour before sexual encounter and it has two rings one that attaches itself on the pelvis and the other hangs on the vagina.

I don’t recommend it much but if you have more thoughts and I have judged it harshly it kindly comment and perhaps shed some light for us.

Hormonal methods.

I will just brush over this. But allow room for questions hehe

So Uhm…there’s progesterone only and the  combined hormones. This are delivered orally as pills, intramuscularly as injection only and as implants.

Pills

Estrogen on its own inhibits milk production, can predispose one to benign cancer and either alleviate or increase menstrual pain hence it’s combined with progestin-only to kind of balance out it’s side effects (being such a powerful hormone) and therefore give better mimicry of the normal hormone cycle in the woman.

Combined pill mostly have multiphasic formulation meaning in each pill, the constitution is the same but the quantity is different and therefore it is mandatory that one takes the pills on the prescribed day. Eg if written day one, don’t skip to day 15pill, cause it’s for its not entirely the same. Remember it’s to mimic the menstrual cycle and hormones have different surges at different points.

Also start on day one of your cycle and not of the month. Which means when day one becomes the day when you start your period.

The combined pill has 21pills and a 7day break within which you receive the monthly period. Or the breakthrough. If you have irregular bleeding cycles btw this might be your best path.

The progestin-only pill is advised for mothers who are lactating, as estrogen reduces milk production and quality. Unlike the combined pill, it has no break and one takes it daily. It has about 35pills in one sachet. It should be taken at approximately the same time. As flactuations prevent maximum efficacy. However if you miss the 8hour window period. ..worry not. Take the pill missed and use protection(read condoms) for the next two days. If you miss a day completely, you have to use a second method of contraception for the rest of the month (until your next period). You can’t take two mini-pills the next day to make up for a missed pill, the way you can with regular(combined) birth control pills.

They may have bleeding problems at first, headaches, and some people can experience weight gain but this normally recede within the first few months of use.

For the first month of use with any pill it’s important to ensure that you use secondary protection as the body adjusts to the “new, artificial” hormones.

Have a baseline though. Baseline weight, acne level and such. To study how your body responds to the new agent.

Injection

The injection contraception is one of the most commonly used contraception in Kenya. I feel like women choose it because it’s a balance between pills ..Which if you don’t take daily don’t work and the implant which they  tend to shy away from (or used to)

It is given on the buttock, right upper quadrant by a qualified practitioner. One can get it at a local health centre and it should be free if I am not wrong. One has to go back every three months for the next phase.

The one thing ladies must know about it is that the return to fertility ..ie after you stop the injections how long does it take for you to conceive is quite long. In some women almost close to two years. So if  you’re trying to get pregnant and you were on DMPP do not worry…The effects may still be wearing off. Don’t think yourself infertile. But do consult your doctor.

Implant.

Implants normally have progestin. There are many kinds, commonly used at least in my set up is Jadelle with two rods and implanon with one. Jadelle protects for five years and implanon for three years.

It’s put on the left underarm transdermally. No it’s not painful. Unless i don’t know who has what anger issues.  The hand is sterilized. A local anaesthetic is applied. Enough to ensure that no pain or sensation is felt over the area. The incision made and the rods inserted and then voila, it heals as a scar. Some people may form a hyperpigmented (darker) area over the wound site. But it’s only about 2cm at most. And then one is good for five years or three.

It’s major issue is the bleeding irregularities for the first year. Many people tend to not have periods altogether. Others bleed continously for close to a month.

It depends on how your body is and how it reacts to it. My success story may not necessarily be yours. But in Kenya it is steadily becoming the second most used hormonal contraception used.

My suggestion would be to use the mini pill (progestin only) for a month or two before switching to implant. I find that it gives you a predictive measure of how you would react.

Intra-Uterine Device

Both the copper and hormonal IUDs work mainly by affecting the way sperm move so they can’t join with an egg. If sperm cannot join with an egg, pregnancy cannot happen.

The hormonal one also increases the cervical mucus making sure sperm  cannot pass through.

The IUD lasts up to 12years and has very high effective rates. However it can slip especially in the young women who have never given birth and has to be reinserted or removed. If it slips the lady may become pregnant. Pregnancy while using IUDs have the risk of becoming ectopic (attach at other places other than the uterine wall) with pelvic inflammatory Disease.

There’s also very high risk of infection especially soon after the insertion of the coil. This can predispose one to ascending infection and needs tobe promptly identified and treated.

Benefits of the IUDs however is freedom to have sex without worrying of pregnancy and it can be used during lactation and some like the copper do not change the hormonal cycle.

Safety begins immediately with a copper coil but within seven days with a hormonal type.

I really do feel like I have spoken a lot but I do hope that I have helped in some type of way.

Regards

Your fellow sister

Jasmine

💋

With

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8 thoughts on “Unmasking Contraception

  1. NFP – Natural family planning – only one that has worked for me without undue hormonal issues and allows me to uphold my beliefs about when life begins. It is such freedom to learn about how your body actually works and to use that knowledge within your marriage.

    Like

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