IT is estimated that about half of all pregnancies worldwide are unplanned. So between me and you, one of us was likely unplanned.
Unplanned does not necessarily mean unwanted; in fact most women who have an unplanned pregnancy go on to have their baby and have a wonderful relationship with them.
There is still value in planning when you want to have a child. It's always a good idea to be in a stable relationship, be financially able to provide for the baby, have control of any illnesses you may have, and to space the pregnancies so as to avoid complications.
The only way to have a planned pregnancy is with contraception. Contraception relates to any method that you use to prevent getting pregnant (not just the birth control pill). So yes, the pull-out method is classified as contraception.
Which method is best?
The answer to this is specific to each woman. What works for your friends won't necessarily work for you, and just because it didn't work for them, doesn't mean it won't work for you. In general, methods that are not affected by patient error (implants and intrauterine devices (IUDs) have the best outcomes. However, there are various factors that must be evaluated to determine which option is best for you.
Factors affecting choice include:
If you are over 35 and smoke, you are already at increased risks for blood clots, so women in this category are advised to stay away from oestrogen-containing contraceptives such as the combined oral contraceptive pills and the patch.
Contraceptives can have a negative impact on pre-existing conditions. Some can worsen cholesterol levels, others can make hypertension more difficult to control. If you have a problem with recurrent vaginal infections, then the IUD would not be recommended.
3. Cancer risk
Breast cancer may respond negatively to either oestrogen or progesterone, so contraceptives containing those types of medications are best avoided in these patients. If you have a very strong family history of breast cancer, we may also recommend using a non-hormonal method. Other cancers can increase the risk of blood clots, so as with smoking, oestrogen containing contraceptives are avoided here
4. When next you want to get pregnant
We use this information to help determine whether to offer a long-term or short-term method. If you want to get pregnant later this year, it would probably be better to use a method that's short acting, easily stopped with a quick return to fertility, for example, OCPs (oral contraceptive pills) and condoms. If you don't think you'll be ready for another five years or so, then perhaps a long-acting method may be better suited. For example, skin implants and IUDs. Now this is not hard and fast, as you can use the pills/condoms for more than five years, as well as you can use the IUD for six months if that's the method that works best for you.
5. What you've tried before
History tends to repeat itself, therefore we need to know what you've used before in order to avoid past failures. For example, if you had horrible bleeding with the injection in the past, then it would not be top on the list of recommendations this time. The pills, however, are somewhat different. There are many different types available, each with different hormones and hence different side effect profiles. So, if you tried one before that had too many side effects, we could actually try you with another brand with different ingredients that may be better suited for you.
Best contraceptive methods
As mentioned before, the methods that eliminate patient error offer the best protection. It must be stated that no method is 100 per cent effective, with the exception of abstinence of course. Below is a list of the methods commonly used and their efficacy rates:
Sterilisation (Tie Off) – greater than 99 per cent
Intrauterine contraceptive device (IUCD) – greater than 99 per cent
Subdermal implant (skin implant)– greater than 99 per cent
Contraceptive Pills – 91 per cent
Condoms – 82 per cent
Rhythm Method (Timing ovulation) – 76 per cent
Withdrawal (Pull-out) – 78 per cent
Probably one of the best methods is not listed here, vasectomy (male tie off). A simple office procedure which is “permanent”, yet easier to reverse than female tubal ligation, with less risk complications and no long-term effects. However, most Jamaican men aren't ready for that conversation.
The best method is one that's safe, efficacious, and most importantly, one that you will stick to. Sit and discuss with your doctor to find out which one is best suited for you. If the method you choose doesn't work out, choose another until you reach one that works best for you.
Dr Ryan Halsall is a consultant obstetrician gynaecologist who operates at ILAP Medical, 22 Windsor Avenue, Suite 2, Kingston 5. He can be contacted at firstname.lastname@example.org or 876-946-0353. Follow him on Instagram: @drhalsall
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