Reproductive well being is a sensitive topic as a result of it’s so private, intimate and susceptible. Politics and faith are additionally concerned. This publish just isn’t meant to be a sociopolitical or non secular dialog, or a place on girls’s rights or feminism, nor am I attempting to let you know what to do with your personal reproductive well being. My objective is to easily educate. It’s your proper to know all of your choices so you may make a choice that’s proper for YOU. I hope this publish is useful for you, the place ever you might be <3
Contraception is prescribed for quite a lot of causes, however hardly ever are girls totally knowledgeable on all their choices and the professionals and cons of every possibility. I’m unsure why. Maybe it’s the restricted period of time well being care suppliers (HCPs) have with sufferers, HCP bias (all of us carry bias), laziness….I’m unsure. However we must be extra knowledgeable than we truly are.
Contraception is prescribed for contraceptive functions, which is what it’s meant for. However it’s additionally typically prescribed for symptom administration – from PMS to zits to heavy durations to PCOS and rather more. Ladies aren’t given options so it appears contraception is the one possibility to assist them handle these very uncomfortable and generally embarrassing signs. If that was my solely possibility and I used to be informed the professionals and never the cons, you higher imagine I’d be saying sure to the prescription too!
The factor is although, as soon as contraception is stopped these signs emerge once more. I used to be informed to take contraception to “regulate my interval” when in actuality, my physique didn’t know methods to menstruate by itself for 10 years, however the contraception was masking this drawback. Once I wasn’t on contraception, I didn’t get a interval. I additionally didn’t know the “interval” I used to be getting on contraception was truly a withdrawal bleed, not a physiological interval. That’s my story. I get messages and emails from girls every single day sharing their signs are unmanageable when not taking contraception. In case you have zits, this publish and this publish might be useful to learn. In case you have PCOS, this sequence of weblog posts might be useful. Should you’re not getting a interval, learn right here. In case you have irregular durations, learn right here. In case you have lengthy cycles, learn right here. In case you have quick cycles, learn right here. I want to put in writing a PMS publish (I’ve, however have to replace it so it’s archived for now) and a publish on endometriosis and fibroids so keep tuned for that.
This publish is about your choices for contraception. I’m not professional or anti contraception. I prescribe contraception. I’m merely professional knowledgeable consent so you may make a choice that’s finest for you. Your HCP could be a help and useful resource for you as you navigate well being care selections that influence your reproductive well being. These decisions are necessary. It’s best to really feel supported, revered and cared for by your supplier. However even in case you don’t and you are feeling swayed a method or one other, know you’ve full autonomy over your well being.
This publish could possibly be 1000’s and 1000’s of phrases lengthy (and I’m over 3000) so this may on no account be a complete publish protecting all of the ins and outs of contraception – uncomfortable side effects, price, and so on. However I hope this publish serves as a fast reference information to many choices on the market for contraception and speaks to the key execs and cons of every that you would be able to’t simply perceive with a fast google.
There are SO MANY BIRTH CONTROL OPTIONS. It’s unbelievable there are such a lot of to select from! However it could actually turn out to be shortly complicated with regards to making a alternative.
To simplify, consider your choices in three completely different tiers. I like to interrupt it down like this:
- Fingers Off & No Consumer Error
- Fingers On & Some Consumer Error
- On Demand & Most Consumer Error
Fingers off choices you don’t have to consider and haven’t any person error (that means you’ll be able to’t “mess it up”) and subsequently these choices might be best. IUDs, the implant and sterilization (vasectomy/tubes tied) fall into this class. You get these inserted or the process finished and also you don’t have to consider contraception for years. These are greater than 99% efficient.
Fingers on choices you do have to consider, subsequently they are going to be rather less efficient since there’s room for extra person error. These choices embody the contraception capsule, the patch, the ring and the shot. You both have to do one thing each day, weekly, month-to-month or each few months. These are nonetheless fairly efficient at 91-94% however not as efficient because the palms off choices.
On demand choices are these you need to use anytime and don’t want a prescription for. I’m together with on this class withdrawal, condoms*, fertility consciousness strategies, and lactational amenorrhea. These choices CAN be extremely efficient if used diligently. So it’s not that they aren’t efficient, it’s simply there there may be lots of room for person error. Along with one hormone free IUD possibility, these choices are additionally hormone free.
Beneath are a number of the main execs and cons – significantly the quantity of hormone going into your physique, the impact in your interval and the impact in your fertility. To get knowledgeable in regards to the uncomfortable side effects, price, methods to use the strategy, and different particulars of every possibility go try bedsider.org. It’s a great and extremely person pleasant useful resource in case you’re wanting into contraception choices. Use what information resonates together with your perception methods and depart what doesn’t. The web site additionally has details about much less often used choices just like the diaphragm, cervical cap, and so on. together with numerous articles and movies from actual life folks sharing about their expertise with numerous strategies. Enjoyable truth: I acknowledged a pair folks from my nursing program at Columbia within the movies!
Okay, let’s bounce into all these decisions.
You’ve obtained two classes right here: hormonal and non-hormonal.
Hormonal choices within the US embody Skyla, Kyleena, Liletta and Mirena.
The Hormone Scenario –> These all comprise an artificial progesterone (aka progestin) known as levonorgesterel. Skyla has the bottom dose and Liletta and Mirena have the best doses. Kyleena is within the center. General although, in any of them, it’s nonetheless a really small dose of hormone. The progestin is launched domestically in your uterus the place the system is inserted, so little or no truly will get into your bloodstream which is a big plus. There is no such thing as a artificial estrogen in IUDs.
The Impact on Your Interval Scenario –> These IUDs can, however typically don’t, suppress ovulation – subsequently many ladies nonetheless ovulate with IUDs in place which is one other constructive. The cascade of hormones that causes you to ovulate every month isn’t utterly disrupted like it’s with different methodology. The most important facet impact together with your interval is lighter or lacking durations and irregular recognizing.
The Return to Fertility Scenario –> Most ladies resume ovulating quickly after the IUD is eliminated assuming there wasn’t an underlying situation together with your interval earlier than the IUD was inserted. You may get an IUD eliminated anytime.
The non hormonal possibility is Paragard.
The Hormone Scenario –> There aren’t any hormones in Paragard, as an alternative it’s a copper containing IUD. Since there aren’t any hormones, your personal hormones aren’t affected.
The Impact on Your Interval Scenario –> No hormones means you proceed ovulating as common. The most important impact in your interval is heavier, longer durations – the alternative of hormonal IUDs. In most girls this resolves in just a few months and durations lighten again as much as regular. However for some girls, heavier & longer durations proceed for your complete time Paragard is inserted.
The Return to Fertility Scenario –> Since hormones weren’t affected within the first place, you must proceed ovulating as you often would when the IUD is eliminated.
You’ve obtained one possibility right here within the US, Nexplanon.
The Hormone Scenario –> This implant which is in regards to the dimension of a match and inserted beneath the pores and skin in your arm accommodates solely an artificial progesterone just like the IUD, however this one known as etonogestrel. It has the next dose of hormone than the IUDs and the hormone is launched into your bloodstream. Once more, no estrogen within the implant.
The Impact on Your Interval Scenario –> You gained’t ovulate with the implant. The progestin within the implant prevents ovulation by making your physique suppose it’s already launched an egg so that you don’t launch one other egg. For the primary 6-12 months most girls expertise a good quantity of irregular bleeding – for some girls it resolves inside a 12 months and for others it continues the entire time the implant is in place.
The Return to Fertility Scenario –> In comparison with IUDs, return to fertility could be barely slower, however nonetheless quite fast. Most ladies resume ovulating inside a month or two after the implant is eliminated assuming there wasn’t an underlying situation together with your interval earlier than the implant was inserted. You may get Nexplanon eliminated at anytime.
There’s a progestin solely capsule (known as the mini-pill) that doesn’t comprise estrogen. Since that’s not as generally used, we’re going to speak about mixed oral contraceptive pills that comprise progestin and estrogen since these are extra extensively utilized by girls.
The Hormone Scenario –>There are a jillion choices to select from these days. They differ by the quantity of estrogen and the kind of progestin. So if one capsule doesn’t be just right for you, one other would possibly. Some provide the identical dose of hormones every single day (monophasic) and a few differ within the dose all through the month (multiphasic) – with monophasic you get a gentle stream of hormone so that you’re much less more likely to have uncomfortable side effects over time. Since you’re taking the capsule orally, the hormones are launched into your bloodstream vs domestically with the IUD. When on the capsule, your physique makes much less of its personal progesterone and estrogen.
The Impact on Your Interval Scenario –> You gained’t ovulate with the contraception capsule. Basically, the capsule makes your physique suppose it’s continuously within the luteal section of your cycle so your hypothalamus doesn’t launch a hormones known as gonadotropin releasing hormone (GnRH) which is the beginning of the hormonal cascade required for ovulation. So the capsule shuts down this hormone axis. Should you’re on a low dose estrogen capsule, you would possibly expertise breakthrough bleeding. Ladies expertise a withdrawal bleed (not a precise interval) once they take the placebo pills on the finish of their pack. For some girls, their durations are lighter, shorter and fewer painful when on the capsule.
The Return to Fertility Scenario –> There’s not conclusive knowledge to help fertility points when coming off the capsule. Most ladies (~80%) resume ovulating inside just a few months. As a result of the capsule accommodates each artificial estrogen and progesterone and has systemic results, it does a great job of masking underlying points. So it’s not a lot the capsule itself that’s inflicting points coming off the capsule, quite it’s protecting up signs that have been there all alongside or signs that emerged whereas on the capsule. As a result of a great chunk of girls are on the capsule for non-contraceptive causes, you have a tendency to listen to about and examine extra girls having hormone points once they come off the capsule.
There’s one patch possibility out there known as Xulane, the generic type of Ortho-Evra which is not produced.
The Hormone Scenario –>Just like the capsule, the patch accommodates each artificial estrogen (ethinyl estradiol) and progestin (norelgestromin) that will get absorbed via your pores and skin and launched into your bloodstream. The dose absorbed via the pores and skin leads to much less highs and lows of estrogen supply, however the dose is about 60% increased than the excessive estrogen contraception pills. This increased dose doubles the chance of growing blood clots in comparison with the capsule, however the absolute threat of a blood clot, whereas nonetheless a threat, is low. You apply a brand new patch every week for Three weeks after which the 4th week you go patch free and that’s while you get a withdrawal bleed.
The Impact on Your Interval Scenario –> Just like the capsule, you gained’t ovulate with the contraception patch. It really works equally to the capsule. For some girls, their durations are lighter, shorter and fewer painful when on the patch. It’s widespread to expertise irregular bleeding and recognizing when on the patch. For most girls it resolves inside just a few months, however for others it continues whereas on the patch.
The Return to Fertility Scenario –> Just like that of the contraception capsule.
You’ve obtained one possibility known as the NuvaRing.
The Hormone Scenario –> Just like the capsule and patch, the ring accommodates each artificial estrogen (ethinyl estradiol) and progestin (etonogesterel) that will get absorbed and launched into your bloodstream. The dose of hormone is on the low finish. You insert a brand new ring at the start of every month and depart it in for Three weeks, eradicating it throughout the 4th week while you get a withdrawal bleed.
The Impact on Your Interval Scenario –> Just like the capsule and patch, you gained’t ovulate with the ring. It really works equally to the capsule and patch. For some girls, their durations are lighter, shorter and fewer painful when on the ring. It’s widespread to expertise irregular bleeding and recognizing when on the ring. For most girls it resolves inside just a few months, however for others it continues whereas on the ring.
The Return to Fertility Scenario –> Just like that of the contraception capsule and patch.
Once more, one possibility referred to as the Depo-Provera shot. Known as “Depo” for brief.
The Hormone Scenario –> Not like the capsule, patch or ring, the Depo shot accommodates solely artificial progesterone within the type of medroxyprogesterone. This hormone is injected into your muscle and is efficient for Three months. It’s a must to return to your HCP and get a brand new shot each 13 weeks. Every time you get a shot, a excessive dose of the hormone is launched into your physique – it’s an unnaturally excessive stage which stops your physique’s personal manufacturing of progesterone and estrogen.
The Impact on Your Interval Scenario –> The excessive stage of medroxyprogesterone injected into your physique stops your physique from making estrogen and progesterone itself and subsequently you don’t ovulate and the liner of your uterus doesn’t thicken in preparation for a fertilized egg. Most ladies expertise irregular bleeding (longer, heavier durations and random recognizing) for the primary 6-12 months. You could possibly additionally ultimately have shorter, lighter durations or skip your interval all collectively.
The Return to Fertility Scenario –> Depo has a big influence in your fertility. When you get a shot, the hormone stays in your physique for Three months, defending in opposition to being pregnant. So it’s not like all of the above choices the place you’ll be able to cease taking the capsule, take off your patch or out your ring or get your IUD or implant eliminated and fertility returns quite shortly. Even after the three months of effectiveness wears off, it could actually take as much as 10 months for fertility to return.
Medical time period: coitus interruptus. Layman’s phrases: when the man pulls out earlier than he ejaculates.
The Hormone Scenario –> Zero influence in your hormones as a result of as a feminine, you’re probably not concerned with this methodology.
The Impact on Your Interval Scenario –> Nada. Except you get pregnant after which your interval goes away.
The Return to Fertility Scenario –> Your fertility was by no means hampered with. This methodology isn’t that efficient with a failure fee round 22% and that’s if the man could be very conscious of his physique and excellent at this methodology. Except you’re okay getting pregnant, choose a special methodology 🙂
Fertility Consciousness Strategies
This includes you monitoring your cycle and observing and paying attention to your physique’s completely different indicators – physique temperature, cervical fluid and cervical place. If used appropriately and persistently all through your cycle, it’s fairly efficient at stopping being pregnant (95 to 99%) which is up there with the opposite hormonal strategies. However most individuals aren’t that correct and constant so while you account for some inaccuracies and inconsistencies it’s extra like 76 to 88% efficient. This methodology does contain you paying attention to indicators every day and deciphering them to find out if you’re fertile or not (after which not having intercourse or utilizing a condom while you’re fertile) so it’s extra concerned than all of the above strategies. However, it may be very empowering and offer you unimaginable perception into your physique and reproductive well being – whether or not you’re utilizing it to stop being pregnant, get pregnant or simply be taught your physique.
FAMs aren’t for each one. However they’re for some girls. If you wish to learn extra about this methodology, I wrote this publish and this publish that provides you all the small print.
The Hormone Scenario –> Zero influence in your hormones. You’re not placing something into your physique.
The Impact on Your Interval Scenario –> None. Though it can provide you a ton of details about what’s happening in your physique throughout your cycle.
The Return to Fertility Scenario –> Since no hormones are concerned, your fertility isn’t affected. For ladies utilizing this methodology, they turn out to be extra conscious of their fertility.
**that is the way you shield in opposition to STIs – all the opposite choices on this publish don’t decrease your threat of getting an STI. Additionally be mindful you need to retailer condoms correctly for them to be as efficient as attainable – improper storage decreases their effectiveness. Should you use condoms completely (which most individuals don’t) they’re 98% efficient, however realistically with extra typical use they’re round 85% efficient.
The Hormone Scenario –> Zero influence in your hormones. You’re not placing something into your physique.
The Impact on Your Interval Scenario –> None as a result of….no hormones.
The Return to Fertility Scenario –> Since no hormones are concerned, your fertility isn’t affected.
It is a extremely efficient methodology of contraception (98%) if you might be breastfeeding and meet the next situations:
1) your child is below 6 months previous
2) your interval has not returned but
3) you might be completely breastfeeding on demand each day and evening – which implies no strong meals or different liquids and nursing at the least each four hours throughout the day and each 6 hours throughout the evening.
As a result of this methodology depends on the depth and frequency of child suckling, pumping (and subsequently bottle feeding) sadly doesn’t present the identical impact as nursing. Though all you pumping mamas are whole rockstars! Simply be sure you aren’t counting on this methodology.
The Hormone Scenario –> Suckling by the infant stimulates prolactin manufacturing. This prolactin manufacturing disrupts the discharge of a hormone (GnRH) that will get launched out of your hypothalamus and subsequently all the things downstream in your HPG axis is disrupted, stopping ovulation. In brief….the hormone prolactin prevents ovulation.
The Impact on Your Interval Scenario –> You don’t get a interval whereas utilizing this methodology.
The Return to Fertility Scenario –> One any of the above variables (age of child, frequency of nursing, absence of interval) are not met, there’s an elevated chance of ovulation resuming. Though not as widespread, some girls don’t resume ovulating till they’re not breastfeeding. Take into account you may get pregnant earlier than your first interval since you ovulate earlier than you get a interval. Monitoring your cervical fluid could be useful in figuring out if you’re fertile or not earlier than your interval returns.
Okay! That’s a whole lot of information, however I hope it’s informative and straightforward to know and most of all empowering for you as making a decision that’s finest for YOU. Contraception just isn’t a one dimension matches all factor. Depart your feedback and questions under – I’d love to listen to from you! This dialog is so, so necessary.
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Girum, T., & Wasie, A. (2018). Return of fertility after discontinuation of contraception: a scientific assessment and meta-analysis. Contraception and reproductive drugs, 3, 9. doi:10.1186/s40834-018-0064-y
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