Women's Health Base

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Posts Tagged ‘contraception’

The Buddy System

Posted by hannahflynn on July 4, 2009

Today, the wonderful Scarleteen website published an article on ‘The Buddy System’, explaining the benefits behind using two forms of contraception at a time. 

After a lot of statistical scribbles, the women behind this website have found that no combination leaves you with less than a 95 percent protection rate. The most effective form of contraception is the implant with condoms. 

They are careful to admit that adding a third contraceptive method makes such a slight statistical difference that it is not worth dealing with and some pairings are not suitable, for example two hormonal forms of contraception or the nuva ring and spermacide. 

In a time when the focus of contraceptive choice is being questioned, with more and more doctors recommending long term forms of contraception and the public appearing resistant to the suggestion, then ‘The Buddy System’ seems like a sensible half-way house. 

You can find the article and Scarleteen’s calculations of the rates of protection for various combinations here.

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Behind the label – Depo-Provera

Posted by hannahflynn on May 3, 2009

depo1

It’s being promoted by health care professionals up and down the country, in fact top gynaecologists are lamenting its lack of popularity amongst women in Britain today. But is this aversion based on fact? Just what is it about free, long term, reversible, effective contraception that is putting people off?

Pros

As just mentioned it is long term, three months to be precise. You just have to pop down to your local surgery and the nurse will give you a jab in your bum. It can also stop your periods, which is nice. It is also reversible in that after three months your natural menstrual cycle should return to normal just like the pill, as this is a hormonal based form of contraception. It is also extremely effective, 99.7% to be exact[1]. It is a form of hormonal contraception but it has lower drug interactions than the pill. This is not just good news for people on long term medication but it is also good news for you when you have the odd bout of something nasty and need a course of antibiotics. Furthermore it is discrete, hopefully you shouldn’t need that in this day and age, but if you can’t stand lugging your pill packet everywhere this might be for you.

Cons

Here is the crunch. Ten percent of women experience what the medical establishment euphemistically term ‘menstrual irregularities’. This means on and off periods for three months. Some women cite permanent bleeding for six to 12 weeks. And in the unlucky few this can last for 18 months (if you stick with it for that long). It is also suggested you do not use Depo Provera for more than 2 years due to a causal link with bone loss (likely to be due to the lack of oestrogen). That potentially gives you just six months of ‘pros’. You have also got to live with the fact that you are taking a drug used as a form of chemical castration in men in some states in the US.

Typical use problems

There are none. As long as you go and get your injection every 12 to 13 weeks, which you will be scheduled in for on the NHS you can’t get it wrong. It’s the most effective, easy to use reversible form of contraception.

Controversies

Like some other forms of long term contraception there are claims of coercion and lack of informed consent among illiterate women.

Who would it be good for?

People who can’t remember to take the pill and forms of barrier contraception and people who absolutely can not have a baby, like women on high risk medication.

 


[1] Trussell, James (2004). “Contraceptive Efficacy”. in Hatcher, Robert A.; Trussell, James; Stewart, Felicia H.; Nelson, Anita L.; Cates Jr., Willard; Guest, Felicia; Kowal, Deborah. Contraceptive Technology (18th rev. ed.). New York: Ardent Media. pp. 773–845. ISBN 0-9664902-5-8.

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Behind the label – Diaphragm

Posted by hannahflynn on December 28, 2008

It may be out of fashion but it still has its uses

It may be out of fashion but it still has its uses

Its pretty retro, it doesn’t work very well and only 2 percent of the population use it. Its so archaic the only recent referral to it in modern culture was when Carrie announced she used it in Sex and the City, and even then the dawn of a diaphragm renaissance was queried. Yes, it has the ick factor and many women of a certain generation have a ‘diaphragm-baby’, but it is still a recommended back-up method for the pill, one of the most popular forms of contraception in the UK.

‘Typical Use’ problems

As with any form of barrier contraception, its main failing point is many couples fail to use it every time, people are unable to insert it properly and the diaphragm has to be fitted correctly to be most effective. Typical use sees the effectiveness of the diaphragm fall from 92-96 percent for perfect use, to 83-87 percent.

There is little that can be done to improve these statistics as getting it in and out is irredeemably complicated. Though there are currently trials for a one-size fits all diaphragm, namely the BufferGel Duet and SILCS Diaphragm, which would avoid issues surrounding ill-fitting diaphragms.

Contraversies

Several studies have shown there is little scientific evidence for the recommended use of spermicide with the diaphragm. That is not to say that it is not required, but that the most effective use of spermicide does not require the frequent reapplication suggested by providers of the diaphragm.

Following the publication of a review in 1982, a paper was published showing the two most frequently prescribed spermicides, Ortho Creme and Gynol II were effectivee for 12 hours after insertion as opposed to one hour, as implied by current NHS recommendations. It also showed creams to be more effective than gels.

Due to nonoxynol-9 falling out of fashion after studies showed it could increase the transmission rate of HIV to women, the latest studies for this form of contraception have focused on the possibility of using the diaphragm without it.  

A Brazilian study first showed using the diaphragm continuously (ie. only removing it once a day to wash it) and without spermicide was significantly more effective at preventing pregnancy than traditional use with spermicide.  Later studies have failed to find such convincing results and recommended use with spermicide.

There remains a need for a large-scale study on the effect of alternative spermicides on STI transmission and pregnancy rates.

Who it would be good for?

To put it bluntly, people using another form of contraception or people who would be happy to have a ‘surprise’.

Women planning on starting to use the diaphragm need time on their hands and no sense of shame. Seriously. In the UK you are required to attend two appointments: one for the the fitting and another a week or two later to show the clinician you can insert it and remove it effectively. This service is normally only provided at a family planning or integrated sexual health clinic meaning getting an appointment can be tricky.

All icky complications aside, it is one of the few barrier methods available that is appropriate for couples with a latex allergy as some are manufactured in silicon and the two forms of diaphragm currently in development (see above) are to be made in silicon and polyurethane. It is also cheap, not a concern in the UK where all forms of contraception are free, but a relevant point if living in underdeveloped nations.

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