What are the effects of birth control?

Dear Doctor,

I can’t seem to find a birth control method that doesn’t affect me. I used to use the arm implant and it me made me gain so much weight, I’m still fighting to lose it. I’m now on the pill and many days, it makes me feel nauseous and dizzy, like morning sickness. However, it has made my period much more tolerable. Anything else you can recommend?  Helen

Dear Helen,

There are many contraceptive methods available. Choice of a particular method depends on one’s age, presence or absence of any chronic medical condition needing drugs, if desired size of family has been achieved or not, and of course, ultimately, it has to be the choice of the couple.

Hormonal contraceptives have several advantages. They are effective, help in regulating irregular periods, can help in resolving conditions like functional uterine bleeding, uterine fibroids and endometriosis. But they are not free from side effects. Progesterone containing contraceptives, as in the arm implant, cause retention of salt and water, which manifests as swelling over feet, weight gain and feeling of heaviness over breasts. It also causes nausea, with or without vomiting. Estrogen containing pills carry the risk of causing clotting in the legs, which can lead to potentially fatal clots in the brain or lungs, increase blood lipids which is a risk factor for hypertension, diabetes and heart problems. They are also a risk factor for cancer of the breast, uterus and other parts. Oral pills interact with many drugs used to lower the blood pressure, lower blood glucose levels or prevent clotting, or treating asthma, thus either reducing their efficacy or enhancing their levels in the blood by causing toxicity.

Moreover, contraceptive pills containing hormones, if taken around menopause, can disrupt the normal hormonal balance of the body for that age, enhancing risk of complications of prolonged exposure to estrogen.

Use of intrauterine device (IUD), is a very effective means of contraception and is safe if put in hygienically by expert hands. A device, once inserted, prevents unwanted pregnancy in majority of cases. However, it has to be put in the uterus after ensuring that there is no pregnancy. Any lapse in hygiene during insertion of IUD can lead to chronic pelvic infections, manifesting as lower abdominal pain, with or without vaginal discharge and painful intercourse. In presence of an IUD, rarely, a fertilised ovum may be deposited outside the uterus, which is called an ectopic pregnancy. It needs a high degree of suspicion for diagnosis in presence of severe abdominal pain and needs urgent surgical intervention.

Regarding IUD, caution needs to be taken that it should be used preferably after giving birth to a child, to delay a second pregnancy. Otherwise if it causes chronic pelvic infection, there is a big risk of sterility due to the tubes getting blocked.

 Use of condom by the male partner is yet another very cheap and effective way to avoid unwanted pregnancy.  Apart from unwanted pregnancy, it also protects against sexually transmitted diseases. However, one has to ensure that the condom is of good quality, preferably a latex one, which does not rupture during ejaculation. It should be put on just before initiating intercourse, so that during ejaculation, semen is blocked inside the condom and prevented from entering the vagina.

Female condoms are also available but are more expensive and cumbersome to use. Female diaphragms and cervical caps are available, which serve as a barrier preventing entry of sperms in the vagina. However, female condom, diaphragm and cervical cap, need to be inserted properly to be effective.

Coitus interruptus is an age old practice for preventing unwanted pregnancy. In this, the male partner withdraws before ejaculating semen, thus avoiding pregnancy. However, the timing has to be very accurate, because even the delay by a fraction of a second can lead to deposition of semen over the vagina, resulting in pregnancy if ovulation has occurred.  It needs self-discipline on part of both partners.

If a couple has completed their desired family size and do not need any more children, sterilisation by blocking the tubes is the best option. It is safe in expert hands and removes any risk of unwanted pregnancy due to unprotected intercourse. Male sterilisation (vasectomy) is easier to perform and recovery is also faster as compared to female sterilisation (tubectomy).

It is usually done when the youngest child is about five years old. This is done so that if anything untoward happens to any of the existing children, and the couple desires one more child, it could be possible. The blocked tubes can be reopened (recanalisation).  Recanalisation may not be effective if a long duration has lapsed since the procedure was done.

Dr. Rachna   Pande is a specialist in internal medicine.