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Opinion - Let’s talk contraception

2021-09-30  Staff Reporter

Opinion - Let’s talk contraception
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Contraceptive methods are used by individuals and couples to prevent pregnancy, anticipate and attain a desired number of children or determine the spacing of pregnancies.  

Several contraceptive methods are available and selection should be based on an informed choice of the user after appropriate counselling.  

The choice of contraceptive method may depend on the user’s personal needs, preferences and ability to adhere, medical contraindications, safety, availability, previous problems and expected efficacy.  

In choosing a method of contraception, dual protection from the simultaneous risk for HIV and other sexually transmitted diseases (STDs) should also be considered.

Almost all contraceptive methods are available on prescription or can be issued by the pharmacist over the counter.  

This allows appropriate counselling and information to be given by the health professional. However, condoms are readily available in most outlets.

The main contraceptive methods include hormonal, intrauterine and barrier contraceptives.

 

Hormonal methods

Hormonal methods contain either one (progestogen-only) or two (oestrogen and progestogen) synthetic sex hormones similar to those naturally produced by a woman’s body available in various dosage forms and drug delivery systems.  

Hormonal methods stop a woman’s ovaries from releasing an egg every month.  

In the absence of an egg, the sperm released by the man during sexual intercourse cannot combine with and fertilise the egg and, therefore, pregnancy may not occur. 

It also thickens the mucous produced by the cervix, therefore preventing the sperm from entering the uterus and cause changes to the lining of the uterus, making it difficult for a fertilised egg to attach to the wall of the womb.

Oral contraceptive pills:  These are taken by mouth once a day – at the same time each day to keep a steady level of hormones in the body. 

They contain either one or two hormones. 

Progestogen: only pills are recommended for breastfeeding women, as they will not reduce the production of breast milk.  This method is 91% effective. Examples available in Namibia include Ginette, Ovral, Yaz and Yasmin.

Another oral contraceptive pill, referred to as emergency contraception (EC) or the ‘morning-after” pill, is taken by a woman after unprotected sexual intercourse to prevent an unwanted pregnancy. 

It contains a progestogen hormone in higher amounts than other contraceptive pills. 

Although it offers immediate prevention of pregnancy, the EC is not the suggested long-term contraceptive. 

The pill should normally be taken within 72 hours after unprotected sexual intercourse for it to be the most effective.  

The sooner they are taken, the more effective they are – an example is Norlevo.

Transdermal patch:  The patch is a 4cm2 of polyester, containing both hormones, which is pasted on the upper arm, buttock or abdomen. The hormones are absorbed through the skin.  The patch needs to be changed every week for three weeks – and on the fourth week, it is not worn – and the woman will have her regular period. This method is 91% effective. An example is Evra patches.

Injection: Injectable hormonal contraceptives only contain progesterone, and it is injected into a woman’s upper arm or buttocks. After the injection, the hormone is released slowly from the injection site into the bloodstream. The injection is given every three months. This method is 94% effective. It can be used by women who are unable to use oestrogen – for example, women who are 35 years old and older, smokers or breastfeeding mothers.  Examples include Nur-Isterate and Depo-Provera. 

Implant: The implant is inserted directly under the skin, on the inner arm above the elbow, where it continuously releases a low dose of a progestogen hormone into the bloodstream over a three to five-year timeframe, depending on the type of implant. This method is 99% effective. The most common side effects include spotting; periods can get longer and heavier or completely stop. An example is Implanon NXT.

Intrauterine device (IUD): It is a small, flexible t-shaped device inserted into a woman’s uterus by a health care professional. An IUD may or may not contain hormones. The non-hormonal IUD prevents the egg from meeting the sperm and attaching it to the wall of the uterus. The hormonal IUD contains the hormone progesterone, which is released slowly into the bloodstream. IUDs can provide protection for five to seven years or maybe longer depending on the type of IUD.  It can be removed at any time. This method is 99% effective.  An example is Mirena.

 

Barrier methods

Barrier methods are devices that either physically block sperm from reaching an egg or chemicals that kill or damage the sperm in the vagina. Barrier methods should be used every time a couple has sexual intercourse.

Condoms: A condom acts as a physical barrier made of latex that prevents sperm from entering the uterus and reaching an egg. Both female (internal) and male condoms are available. It is worth noting that this is the only form of contraceptive that can also protect against sexually transmissible infections.  This method is 79 - 85% effective.  

Spermicides: Spermicide is a chemical that inactivates sperm. In the form of a cream or gel, a spermicide is inserted into the vagina close to the cervix. It takes 15-20 minutes to be effective. This method is 72 - 86% effective.  

The diaphragm: The diaphragm is a small, dome-shaped device made of silicone or latex that fits inside the vagina and covers the cervix. It must be used with spermicide. The diaphragm must remain in place for six hours after sex but no more than 24 hours total. This method is 88% effective. 

It is important to note that to date, the only available contraceptive method for men is the condom. The minor surgical procedure (vasectomy) is usually permanent.

With various methods being available, including surgical methods not discussed here, it is important for couples and individuals to seek further information from their trusted health care professionals, pharmacist, doctors, nurses, etc. to advise on the appropriate choice for them.  

 

*Compiled by Nadine Mouton and Frieda Shigwedha


2021-09-30  Staff Reporter

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