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Temporary Methods of Family Planning

By Dr Bimal Buch - Family Physician, Rajkot (reproduced from Integrated management of Mother & Child - published on occasion of NAT.RAJ.CON 98 hosted by FFPAI - Rajkot)


Now with the welcome entry of a child in your family, spacing of the next child must be your top priority. If your family is complete with this child, you should still wait before considering sterilization and wait till your youngest is about 4-5 yr old.

Temporary methods are divided into:

  1. Natural methods: Abstinence, lactation, withdrawal, and safe period methods.
  2. Barrier methods: Condoms with/without spermicide, diaphragm, cervical cap, sponge, vaginal spermicides.
  3. Hormonal methods: Oral pills, Injectables, Implants
  4. Others: Intrauterine devices e.g. Cu T
Withdrawal Method

This involves removal of the penis from the vagina just before ejaculation. Complete cleaning of the penis in case of repeated intercourse is a must for success of this method. Ejaculation should be away from the interoitus.

Drawbacks

  • Extreme self-control is required
  • Pre-ejaculatory fluid may contain spermatozoa. This may enter the vagina leading to pregnancy and contributes to high failure rate of approx 35-40% 
Condoms (get you hubby to master the technique)

They act as an umbrella against shower of sperms. Pre-tested condoms are available. The foreskin of the erect penis should be retracted. The condom should be held from the teat so that no air is trapped. Go on derolling the condom till entire shaft of the penis is covered. After ejaculation remove the penis holding the rim of the condom immediately while the penis is still stiff, otherwise there are chances of sperms entering the vagina.

Non contraceptive benefits:

  • Protection from sexually transmitted diseases Hepatitis B and HIV.
  • Diminished risk of infertility
  • Diminished risk of cervical cancer
  • Messy post coital discharge can be avoided

If properly used, almost 98% successful.

 

Vaginal Barrier Methods

With the advent of newer and better methods, vaginal barriers like sponge, diaphragm, cervical cap are hardly used. ;

 

Vaginal Spermicides

Foams, creams, gels, pessaries and films are available They are more effective when used with condoms and vaginal barriers.

 

Oral Contraceptive Pills (OCPs)

Most of these offer combination of estrogen and progesterone in low doses. Their effects are as follows:

Estrogen effects

  • Inhibits release of eggs from the ovary
  • Accelerates transport of eggs in the fallopian tube
  • Causes changes in the lining of the uterus and prevents implantation

Progesterone effects

  • Forms a thick cervical mucus plug which inhibits transport of sperms
  • The enzyme that permit the sperm to penetrate the ovum is not activated
  • Inhibits implantation by causing changes in the uterus lining

Noncontraceptive benefits

  • Increase the regularity of periods
  • Decrease menstrual cramps, bleeding, pre-menstrual tension as the hormonal axis of the body is resting and external hormones from the pill are working
  • Protect against pelvic inflammatory disease, ovarian cancer, uterine cancer, ovarian cysts, benign breast cysts, fibroadenoma, osteomalacia (weakening of bones during menopause)
  • Decreases chances of ectopic pregnancy

Side effects

(These occur on prolonged use. Ideally pills should be taken in the format of 6 months ON and 1month OFF.)

  • Missed periods or scanty bleeding
  • Inter-menstrual (Inter-period) spotting
  • Nausea
  • Breast fullness or tenderness
  • Mood swings
  • Weight gain
  • Darkening of skin over cheeks (chloasma)
  • Headaches
  • Hypertension
  • Stroke

Pills should not be taken in cases of breast cancer, heart problems, pregnancy, liver disorders, hypertension, major surgery or a condition requiring prolonged bed rest.

Contact your doctor in case of

  • Chest pain
  • Abdominal pain
  • Leg pain
  • You need to take some medication as the pills may alter their effect. Certain drugs like anti-tuberculars have specific drug-interaction with OCPs

Note: Stop the pill 2-3 mths before you plan your next pregnancy as sometimes body's own hormones take that long to swing back into action.

 

Progestrone Only Pills

These are less effective than combined pills. They have to be taken continuously without any pill free interval. Also they have to be taken at the same time daily.

 

Non Hormonal Pills

These are marketed under the name of "Saheli". It acts by altering the lining of the uterus and make implantation impossible. Has to be taken twice a week, in the first 3 months and later only once a week.

 

Post-Coital Contraception
 
  1. Morning after pills: Two tablets of OCPs containing 50 micrograms of estrogen and 5 mg of progesterone should be taken within 72 hrs of unprotected intercourse and 2 pills 12 hours later. These may cause nausea and vomiting. If 3 weeks pass without menses, consult your doctor.
  2. IUD insertion, morning after unprotected intercourse.
Intrauterine Devices (IUD's) - Loop, Copper T etc.

They act by immobilizing the sperms and prevent then from fusing with the ovum (egg). They cause changes in the lining of the uterus and prevent implantation of the fertilized egg.

When should the IUD be inserted?

  • Six weeks after child birth
  • Immediately after or within 3 weeks of spontaneous or induced first trimester abortion
  • Any time of menstrual cycle if pregnancy is ruled out. Ideally it should be within one week of menses as the mouth of uterus is slightly open, facilitating insertion
  • Within 6 days of unprotected intercourse for post - coital contraception.
  • Your doctor should teach you to feel the strings of Cu-T as it can at times slip out unnoticed in the toilet etc.

Contraindications

  • Infection of the genital tract
  • Known or suspected pregnancy

Side - effects

  • Spotting, bleeding, anemia
  • Cramps
  • Expulsion of the IUD - partial/ complete
  • Pregnancy
  • Uterine perforation
  • Pelvic inflammatory disease

Contact your doctor immediately if you have

  • Pain - abdominal both upper & lower
  • No periods or abnormal spotting
  • Infection exposure
  • Nausea
  • IUD string is missing, shorter or longer