Birth control options
Dear Dr Mitchell,
I am 37 years old, and up to two years ago I was on the birth control pill. I am in a new relationship and my partner and I are exploring contraceptive options. I don’t want to go back on the pill because of my age. Can you suggest an alternative that would be suitable for me? I have one child, and don’t necessarily want a long-term option like the IUD. We are currently using condoms and hope to start a family in another year or so.
The use of the combined oral contraceptive pill at age 37 years is a relatively safe option. Caution should be exercised if you are overweight, smoke, are hypertensive, diabetic, have a history of clots in the leg or lungs, strong family history of breast cancer, or if you are high risk for cervical cancer. The current low-dose formulation of the oral contraceptive pill can usually be used safely up to age 40 years if you have no significant risk factors.
However, there are other safe options that can be used if you do not want to stay on the oral contraceptive pill. The oestrogen in the pill is the main problem, so a hormonal method without oestrogen such as the mini pill (progesterone only pill), or Depo Provera (Medroxyprogesterone acetate) can be safely used. The mini pill requires a lot of discipline and has to be taken the same time every day. This usually leads to poor compliance and high failure rate because of the difficulty in remembering to take the pill on time.
Depo Provera is an injectable form of contraception that contains progesterone only. It is convenient and very effective. It is given once every 90 days and works well. The injection usually results in the suppression of the periods, and after being on it for a year there is usually no monthly period at all. There can be a breakthrough bleeding in the first few months of taking the injection, but this usually settles down. The absence of the menstrual period is of significant benefit especially in women who have heavy menstrual periods due to fibroids, endometriosis or hormonal imbalances. It is also a good choice for women who have painful periods since the periods are completely suppressed in the long term. The menstrual period usually returns after a few months of discontinuing the injection.
The return of the menses may be delayed in some women. Weight gain and decreased sexual desire may be a side effect of the injection.
The sub-dermal implant is also another option. This is progesterone-only and is safe. The device is implanted under the skin and lasts up to five years depending on the type of the implant. It is effective and is easily reversed by removing the device when pregnancy is desired.
The diaphragm and cervical cap are also options that can be used. These, however, tend to be less active than the hormonal methods.
The intrauterine device is a long-term option that is safe. There is a progesterone-containing device that is now available that lasts for three years. It is very effective and causes the periods to be light and less painful. It can be removed easily when pregnancy is desired. The copper-containing device (copper T380) is considered a long-term option since it can be left in for 10 years. However, this can be removed at any point in time when pregnancy is desired.
Since this is a new relationship, it is important that you use condoms (male or female) to reduce your risk of a sexually transmitted infection. It is also wise to do screening for sexually transmitted infections before you discontinue the use of condoms. The perfect method is to use condoms and a hormonal method or the intrauterine contraceptive device. This will go a long way in preventing pregnancy and sexually transmitted diseases.
Consult your gynaecologist who will advise you further.
Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published.
