FEMALE METHODS OF CONTRACEPTION: LONGER-ACTING METHODS, INFRA-UTERINE DEVICES

Longer-acting methods (Depo Provera, Noristerat)

Depo Provera is synthetic progesterone which is given by injection, usually in the buttock muscle. It is slowly absorbed over the next three months and ovulation is stopped. Its use has been controversial but in 1984 in the UK it was granted a license for long-term use and is slowly becoming more available. Most family-planning experts don’t see this as a first-choice contraceptive.

Advantages

• A four-times-a-year injection renders the woman contraceptively safe.

• It is suitable for poorly-motivated women and those of low intelligence who would find other methods difficult to remember.

Disadvantages

• There are several side-effects including irregular and frequent bleeding, weight gain and delays in return to fertility.

Noristerat is a similar type of hormone that lasts for two months. It is used after a man’s vasectomy to tide the woman over the vulnerable time while she needs contraceptive cover.

Infra-uterine devices (IUD, coil, loop)

An IUD works by preventing the newly-fertilized egg from implanting in the uterus. There are several types and your doctor or clinic will advise you which is best for you. Plastic types can be left in indefinitely but copper-containing ones should be changed every 2-3 years. IUDs used to be suitable only for women who had had children but today versions are available even for those that have not.

Advantages

• Once in place it can be forgotten, except for feeling inside each month after a period to ensure that the tail or string coming out of the cervix is still there. If you can’t feel it, see your doctor at once and use another method of contraception in the meantime.

• It doesn’t interfere with love-making and you don’t have to buy replacements.

• IUDs have no bad effects on hormones or on the body generally. They do, however, have local side-effects-see below.

• It can, if inserted in the first few days after unprotected intercourse, act as an abortion-producing agent. It is used in this way as a post-coital contraceptive.

Disadvantages

• Subclinical pelvic infections can cause infertility in a proportion of women.

• During insertion there is a danger of the device being pushed through the uterine wall into the abdominal cavity.

• It can be expelled without the woman knowing it.

• The long-term effects of many years of irritation to the lining of the uterus are not known.

• Tubal (ectopic) pregnancies are more common in IUD users. The IUD should be removed immediately a pregnancy is confirmed.

• Heavy periods and ‘spotting’ are not uncommon.

• Some men complain of feeling the tail or string during intercourse.

• It has to be put in by an expert in the first place and there can be quite a lot of pain for a few hours after its insertion.

• You have to go back 2-4 weeks after insertion to see your doctor.

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