Birth Control

There are two different types of contraception methods. One is a short term option, which consists of male condoms, contraceptive patch, oral contraceptive pills, injectable contraceptives, and vaginal rings. The injectable contraceptives include a progestin only injection and estrogen progestin injection. The progestin only injection is also known as DMPA, which is given by a deep intramuscular injection and is effective for three months, so it is administered every three months. The estrogen progestin combined injection is also known as cyclofem and mesigyna. It has the same technique as DMPA; studies showed there was no difference in efficacy between the progestin only injection vs the estrogen progestin injection.  Oral contraceptive is also another short-term option. There are combined contraceptive pills that inhibit the midcycle surge of gonadotropin secretion to suppress ovulation. The combined contraceptives also stop sperm accessibility in the upper genital tract. There are also progestin only pills that are for women that need to avoid estrogen. The progestin only pill should be taken at the same time each day and every day. If there is any variation of even a couple of hours, it can reduce the contraceptive effectiveness and women would need a backup method of contraception. Male condoms are a single use method, which is used at the time of each coital act; it does not have any hormonal exposure and is the best protection against sexually transmitted infections. Also a diaphragm and cervical cap is another form of short-term contraceptive method; this provides a barrier between the sperm and cervical canal and serve as a reservoir for spermicide. Diaphragm needs to be fitted by a clinician and needs to be removed after coitus but there is a high risk for urinary tract infections.

There are also long term contraceptive options, which includes copper IUD, levonorgestrel releasing IUD, progestin only implants, levonorgestrel implant. Copper IUD releases copper into the uterine cavity continuously and it interferes with sperm transport and inhibits fertilization. Copper IUD decreases the risk of ectopic pregnancies and has a duration of efficacy of 10 years. The levonorgestrel releasing IUD also interferes with sperm transportation and inhibits fertilization and also partially inhibits ovulation. Levonorgestrel releasing IUD has a duration of efficacy of 3 to 5 years and makes periods lighter and irregular especially in the first 3 – 6 months. In the progestin only implants, only the Nexplanon is available in the US. It is a single rod implant, which is used for 3 years by slowly releasing 68 mg of progestin. The Nexplanon causes the menses to be lighter and more irregular and is inserted through a tiny skin incision by a clinician. The levonorgestrel implant is a two-rod contraceptive implant and each rod contains 75 mg of levonorgestrel and can be left in place for up to 4 years.

Permanent contraceptive methods consist of tubal ligation and vasectomies. A vasectomy can be performed in a clinician office with local anesthesia. This procedure is permanent but can be reversed. Tubal ligation are interruptions and occlusion that are surgical procedures and result in sterility but can be reversed. Another way of permanent method is Essure which is a 10 minute procedure that can be performed in physician’s office. Essure is a non surgical transcervical sterilization procedure for women and is more cost effective than bilateral tubal ligation. The procedure consists of tubes that are inserted into the fallopian tubes that induce inflammation process that cause fibrotic changes to cause occlusion and blockage within 3 months. The patient would need to have a second form of birth control for 3 months. There has been a controversy regarding the Essure method that has complaints to the FDA of severe adverse effects leading to surgical extraction.


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