More Methods of Birth Control

We continue our treatment of birth-control methods with the intrauterine device (IUD) and others.

Intrauterine Device (IUD)

The intrauterine device (IUD) is a small plastic device inserted into the woman's uterus by a physician. The IUD has a string attached to it that hangs into the cervix, so that the woman can check to be sure that the IUD is still in place. Most researchers believe that the IUD prevents pregnancy by causing changes in the uterine lining that disrupt the normal environment of an egg. For the woman who can use an IUD, the advantages are great, because she does not have to worry about contraception each day. The effectiveness rate is high, with less than a 1 percent chance of pregnancy.

However, there are several disadvantages to the use of an IUD. Severe menstrual cramps and increased menstrual bleeding may follow the insertion of an IUD. Sometimes these side effects lessen after a month or two. In other cases, severe cramps and prolonged bleeding continue, and the physician may advise removal of the IUD. The IUD is also thought to increase the probability of pelvic infections within the first few months following insertion.

Sterilization

A woman may be sterilized by an operation that blocks the fallopian tubes (the structures through which eggs travel from the ovaries to the uterus). A man may be sterilized by a procedure called a vasectomy, in which each vas deferens (one of the two ducts through which the sperm travel from the testes to the urethra) is cut. These procedures may be reversed but only by complicated surgery, which is not always successful. Therefore, physicians recommend sterilization only when a couple has decided, without reservation, that they desire no further pregnancies.

Oral Contraceptives

Oral contraceptives, or birth control pills, are one of the most effective reversible methods of contraception. A woman taking the pill properly has less than a 1 percent chance of getting pregnant.

The pill -- which is available by prescription only -- uses synthetic female hormones (estrogen and progestin) to override the natural hormonal regulation that results in the release of an egg. The pill signals the pituitary gland, which directs hormonal activity in the body, not to release the hormones that would normally stimulate the ovary to release an egg.

Each day the woman takes one pill, at about the same time of day, removing it from a container that has the required number of pills for one cycle (usually 21). One to three days after she takes the last pill for that cycle, her menstrual period begins. Menstrual periods may be lighter in flow, and cramps may be reduced or absent.

If she forgets to take one pill or more, menstrual bleeding may begin. In that case, she should continue taking the pills daily, but she should also use another contraceptive method, such as a condom, until after her next regular period.

Birth control pills are not recommended for women with a history of high blood pressure, blood-clotting problems, hepatitis, or cancer of the uterus or breast. A woman over age 35 who smokes is advised to stop smoking if she wants to take the pill. Birth control pills should not be taken by a woman who suspects she may be pregnant. In addition, women with diabetes, epilepsy, heart disease, or thyroid disease may be advised not to take birth control pills, depending on the nature and severity of the disease.

It is important for a woman taking birth control pills to report to her doctor if any of the following symptoms occur: blurred vision; severe chest pain; sudden shortness of breath; abdominal pain; unusual bleeding or bruising; breakthrough vaginal bleeding (spotting); changes in menstrual flow; pain in the calves; depression; difficult or painful urination; enlarged or tender breasts; hearing changes; increase or decrease in hair growth; migraine headaches; numbness or tingling; rash; skin color changes; swelling of the feet, ankles, or lower legs; vaginal itching; weight changes; or yellowing of the eyes or skin.

Hormonal Implants

The newest form of contraception is the hormonal implant. With this method, six small plastic rods containing the synthetic female hormone progestin are inserted with a needle under the skin of the upper arm or forearm. The hormone is gradually and slowly released from the plastic rods, thus preventing ovulation. This method is effective for about five years from the time the implants are inserted. The major advantage of this method is that the woman does not need to remember to take birth control pills or use a spermicidal agent or diaphragm before each sexual act. Disadvantages include the high cost of the implants, possible infection at the site of insertion, irregular menstruation, and the necessity for surgical incisions on the arm when the implants need to be removed. Hormonal implants are about as effective as oral contraceptives.

Natural Family Planning

Natural family planning is based on calculating when ovulation (release of an egg from one of the woman's ovaries each month) occurs. The couple then abstains from intercourse during the fertile period.

A man's sperm can live in a woman's body for about two days. The egg can live for about 24 hours after ovulation. A few days are added to this fertile period for safety's sake, because it is so difficult to determine just when ovulation occurs. All told, a couple needs to abstain from intercourse seven to ten days a month in order to have the greatest chance of preventing pregnancy.

There are three methods a woman can use to determine when she ovulates. The temperature method is one of the most reliable. Each morning on awakening and before getting out of bed, she takes her temperature with a special basal temperature thermometer (which measures temperatures only between 96°F and 100°F) and records it on graph paper.

Near the middle of the menstrual cycle, the temperature may drop slightly (indicating that ovulation is about to occur) and then rise rapidly and continue to climb for the next three days. The temperature will not return to preovulation levels until the beginning of the menstrual period. The "safe" days to have sexual intercourse are from four days after the sudden rise in temperature until three or four days after the end of the period. It is important to become familiar with the menstrual cycle by recording the temperature levels for several months before relying on this method of birth control.

The mucus method may also help determine the time of ovulation. Each morning the mucus from the vagina and cervix is examined. Cervical mucus undergoes changes as hormone levels vary during the course of the cycle. To detect these changes, the vaginal area is blotted each morning with a facial tissue, and then the mucus is tested between the thumb and forefinger. After the menstrual period, there will be several days with no mucous discharge. This is followed by several days of a thick, sticky yellow or white discharge. There will then be one or two days when the mucus becomes transparent and very slippery, with the consistency of raw egg whites. The mucus will form a string between the thumb and forefinger. This is when ovulation occurs. After ovulation, the mucus again becomes thick and sticky, or there may be no mucus at all.

The fertile period begins with the thick, sticky yellow or white discharge and continues until about three days after the phase when the mucus has the consistency of egg whites. Intercourse should be avoided during this time. In other words, the safe period is from three days after the slippery mucus stage to about three days after the end of the menstrual period. The use of certain medications (such as antihistamines), which alter mucus production throughout the body, will make determination of ovulation by the mucus method difficult, however.

The calendar method is also an option for women. A record of menstrual cycles is kept for one year or more. The doctor will then use the record to figure out the most likely day of ovulation, based on the fact that the average woman menstruates 14 days after she ovulates. However, any individual woman may vary from that average, so the calendar method is not a precise system.

Natural family planning does not require the use of mechanical aids or drugs. The effectiveness rate for this kind of birth control is currently up to about 80 percent, depending on the care with which the techniques are followed. However, even in women with regular cycles, fluctuating factors such as illness, fatigue, stress, and use of certain drugs can delay ovulation or cause the techniques used to determine ovulation to be inaccurate, thereby throwing off the most careful calculations.

We have now covered the many common methods of brith control. You should consult your doctor for more specifics relating to your own case.