Dear Doctor,

I had my first child about 6 months ago and my husband and I ready to resume sexual relations. However, I have been looking at different birth control methods and I feel that pills would be the best choice for me as the others seem complicated. However, I have heard that they cause blood clots. Is this true? What side effects should I be aware of? Please advise me.

Susan

Dear Susan,

First,congratulations on the birth of your child. A new mother is protected from pregnancy if she breast feeds her baby. However, this protection is absolute over about three to six months and declines after that, with declining prolactin (hormone responsible for lactation) levels.

Spacing after child birth is always good. It gives a new mother ample time to recover and, take adequate care of the new born. Hormonal contraceptive pills can be used for family planning and delaying birth of another child. They cause thinning of cervical mucus and that of inner lining of the uterine wall, thus preventing pregnancy.  But they are invariably associated with side effects which are deleterious for health.  Progesterone containing injections or tablets can produce swelling over feet, headache, joints pain, weakness, breast tenderness, and etcetera. Estrogen containing pills can cause elevation of blood lipid levels, increased fat deposition over inner lining of blood vessels, high blood pressure and increased risk of heart problems. They also increase tendency of blood to clot, augmenting risk of heart attacks and stroke. The health hazards of hormonal contraceptives increases with advancing age.

Using IUDs (intrauterine device) is a very good measure to prevent pregnancy after child birth. Inserted by skilled hands and with proper aseptic precautions, it is very safe and prevents implantation of fertilised ovum in the inner line of uterus. However, if any aseptic precaution is missed somewhere, there is a real risk of having pelvic infection.  It can also cause trauma to the lower end of the uterus. At times, the I.U.D. may slip, traumatising surrounding tissues and increasing the risk of pregnancy. One may have allergy to the copper present in copper containing IUD, which can be manifested as a skin rash, breathing trouble and even giddiness and sweating.

Condoms, both male and female, are effective as a tool of contraception. If used correctly, a good quality latex condom can very well prevent pregnancy. The only risk with a condom is its tearing off during erection, which could cause spillage of seminal fluid in the vagina, a potential risk which could result in pregnancy. 

Premature withdrawal of the male partner just before erection and semen discharge is a very safe and effective way of birth control. However, one has to be swift and careful, because even the pre-ejaculation seminal fluid can reach the vagina and fertilise the released ovum. 

If a couple has completed the desired family size, then for few years, one of the above methods can be used. Once the new born becomes about five years old, the couple can opt for sterilisation. Male sterilisation is easy, effective and a man recovers faster after vasectomy, as compared to a woman after tubectomy.

Dr Rachna is a specialist in internal medicine  at Ruhengeri Hospital

rachna212002@yahoo.co.uk