Contraceptive options: Risks m=,. Efficacy side effects, how long to use, health risk if any. Contraceptives for sick women

 

 

 

 

 

Peoples family planning needs last for entire reproductive lifetime. With increasing age the reproductive intentions change and the couple often changes the contraceptives

How little we know about contraceptives!!!!!
We the doctors of India must be aware of 1) Contraceptive selection(contraceptive choices/ options), available contraceptives 2) myths surrounding the  contraceptives, 3) efficacy of a contraceptive  and contraceptive accidents i.e. failure rate of different contraceptive 4) Pearl index of different commonly used contraceptive 5) What is LARC(Long acting Reversible Contraceptives) .

We as health Care provider must be knowledgeable and regular update our knowledge on -6) contraceptive related health risk of users,7)   Contraceptive  for sick women, 8)  Contraception for teen agers  and elderly women

We also need to brush up our knowledge on   9) Mechanism / Mode of action of a prescribed contraceptive 10) its Side effects: 11) Pre prescription minimal investigations and 12)  measures to minimize side effects. Further we should know 13) When to initiate contraceptive 14) Who are ideal candidates for a given contraceptives and lastly     15) how  long one can take such contraceptive , 16) The interval of follow up with doctor or nurses 17) Noncontraceptive benefits?

At the moment there are about 19 kinds of  contraceptives including two permanent methods . These are 3) COC 4) POP  5)  IUCD   6) LNG-IUS  7) Injectables  8) Implants   9) LAM method of contraception 10)   Other NFP 11)Male condom   12) Female condom  13)  Other vaginal Barrier methods   14) Vasectomy  15) Tubectomy 16) Emergency contraceptives 17) Nuvaring 18) Ortho Evra Patch 19)  Newer contraceptives.

We need to discuss all these with contraceptive seekers as we work in hospitals we must have a thorough knowledge about 19 contraceptives available in India. We should also know how to tackle the minor side effects, brands available in local market, warning signs of a contraceptive, and when to stop specific contraceptives, hormone containg contraceptives in particular.

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Admittedly, there is dearth of knowledge about the ‘timing of initiation of contraceptives during breastfeeding period’ and also the selection appropriate contraceptive too. To complicate the issue opinions 6n there two issues varies widely because ‘lactation’, ‘nutrition’ and ‘fertility’ are interrelated, and medication of any one may have unforeseen and adverse effects on the others.

Most Indian mothers are unaware about the return of fecundity after childbirth and some are so pragmatic that they believe she will  remain immune to conception so long as breastfeeding is continued. There is another group of more  conservative couple who have negative connotations and unnecessary fear of using hormonal contraceptive in breastfeeding period because they falsely believe that all contraceptives will harm their infant who are breast feeding. This is more true in cases of women with some medical disorders like diabetes, obesity, metabolic syndrome, PCOS, dyslipidaemia , G B stone  smokers ,Women with Past history of Gestational diabetes, Viral hepatitis, ,   hypertension, migraine, epilepsy, ,women with H/O  heart attack, or cerebrovascular accidents,. There are many such unvoiced concerns about the use contraceptives for which many couple do not use effective contraceptive in breastfeeding period.

Similar contraceptive selection for women with uterine diseases like adenomyosis, Myoma, endometriosis, Dermoid , endometriomata, Cancer cervix or CIN genital Kochs abrupt us un a great challenge  on Contraceptive technology. These results in hundred thousands of unwanted pregnancies and many of them are terminated by surgical abortion with all its attendant risks.

Disappointingly annually seven to ten million abortions are carried out in our country and almost one third of children still owe their arrival more to chance than to caring choice. All these speak of culture and poor knowledge on contraceptives for which we doctors are primarily responsible.

Popularizing contraceptive in India comparable to selling a refrigerator to an Eskimo. It requires considerable effort not only by doctors but also by NGO and committee leaders. How many couple you have motivated for dependable reversible contraceptives in the month of August ???

In this deliberations  a threadbare discussion has been made on sequence of resumption of ‘menstruation’ ‘ovulation’ and ‘fertility’ after a childbirth and need for individualization timing of ignition of contraceptives.

It is true that no single method will suit every Indian couple. Most change contraceptive methods a number of times over their reproductive lives. During the breastfeeding period i.e. one month to two years following childbirth clients have options to a range of family planning methods. However, many couple try contraceptive on trial or error basis and can easily find a suitable method which will suit their sex life.

We the gynecologists must try to furnish most up to date in functions about all contraceptives that may be safely used during 1) different ages 2) contraceptive selection for sick women and 3) for breastfeeding without causing harm to infant. It has been described in a edutainment and dumb down process without becoming techno bubble. It is sincerely hoped than on reading this painstakingly prepared treatise the readers will be closer to wisdom filled with scientific information about selection of contraceptives most appropriate for them.