A couple has a lot of different birth control options at their disposal to prevent or postpone a pregnancy. Here is a brief overview.
Birth control methods ( called contraception medically) is what any method is termed that is used to prevent a pregnancy despite normal sexual intercourse. This chapter contains material that may be offensive to some religious groups and it is a factual summary seen through the eyes of a physician. I will attempt to point out the concerns that some religious groups have about some of the methods (see links to this page for more info regarding the various topics).
Common birth control methods (=contraception)
Barrier Methods : male condoms popular in the U.S.; female condoms also available; cervical caps and diaphragms. Can be used with anti-spermacide. High failure rates, but protects against AIDS and VD partially
Contraception (= OC or BCP) : The birth control pill has been in use since the 1960’s; it is relatively safe, but it offers no protection against AIDS and VD
Ethical Concerns re. BCP : religious groups have moral and biological concerns about the birth control pill
Injectable Contraception : Depot-Provera lasts for 3 months; contraceptive implants last for 5 years; side-effects:bleeding disorders, anemia
IUD (=intrauterine devices) : safe, highly effective; no protection against STD’s, AIDS and PID
Periodic Abstinence : works with avoidance of “fertile days” for sex; the Billings ovulation method can lead to 99% success with discipline; for women with irregular periods these methods are problematic and not safe
Postcoital or Emergency Contraception (planB) :about 85% successful within 72 hours. Doubling of BCP (Ovral); problematic for those where it does not work, other side-effect: severe bleeding
Tubal Ligation : permanent method; done laparoscopically, well tolerated
Vasectomy : permanent method; done as outpatient, can lead to autoimmune antibodies and SLE like disease
Birth Control Options
Summary Re. Contraception
The following is a rough guideline through the difficult choice of what to use for contraception in various age groups (modified according to Ref. 16, p. 719).
Recommendations re. contraception (different ages)
___________________________
Age group
teens to 25 : BCP and condoms
26 to 35 : BCP, diaphragm and condoms equally effective; IUD now acceptable risk (steady partner)
35 and above : tubal ligation, vasectomy, diaphragms, condoms
___________________________
There are different requirements for different age groups: in the younger age group there is more concern about prevention of sexually transmitted disease (such as VD and AIDS), but also a desire to avoid an unwanted pregnancy and a combination of condoms and the BCP is likely the best combination.
Contraception in the mid-twenties
By the mid-twenties the confusion about finding the right life partner has settled for many. Once there is a stable relationship and both partners know that they are VD and AIDS free, there would be mainly a need to prevent pregnancy. This can be achieved with any of the methods listed in the table. Even the IUD would now be an acceptable risk despite the slightly higher rate of pelvic infections and possible infertility risk. For longterm use a copper T – IUD (Paragard) could be used, for shorter term Progestasert.
Contraception above age 35
Above 35 many couple relationships are quite stable and they often have the desired number of children. At this time the couple may want to decide to have either a vasectomy (for the male) or a tubal ligation (for the female) done as a permanent sterilization procedure.
If this is not acceptable for various reasons, then other methods including the Billings method could be used. Beyond age 35 for a woman there is an ever increasing risk for genetic abnormalities of the offspring.
Billings method of natural family planning
These are suggestions only. With very disciplined couples’ natural family planning such as the Billings method may be the method of choice. All couples should have an understanding right from the beginning what they would do in case of an unexpected pregnancy because of method failure. This happens a lot more often than couples admit due to alcohol, drugs and a myriad of other reasons. But I am urging people to plan ahead. It may simply be that the couple will accept another child, or give it up for adoption before the last resort of an abortion would be considered.
References
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 235.
2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
3. Ryan: Kistner’s Gynecology & Women’s Health, 7th ed.,1999 Mosby, Inc.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 245.
5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.
6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.
7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B. Saunders Company
8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B. Saunders Company
9. Rakel: Conn’s Current Therapy 2001, 53rd ed., W. B. Saunders Co.
10. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001 W. B. Saunders Company
More references
11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.
12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B. Saunders Company
13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.
14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.
15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby, Inc.
16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams & Wilkins
17. St. Paul’s Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC
18. Gabbe: Obstetrics – Normal and Problem Pregnancies, 3rd ed., 1996 Churchill Livingstone, Inc.
19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.
20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.
21. Ignaz P Semmelweiss: “Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers” (“Etiology, the Understanding and Prophylaxis of Childbed Fever”). Vienna (Austria), 1861.
22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.
23. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.
24. Horner NK et al. J Am Diet Assoc Nov-2000; 100(11): 1368-1380.
25. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
26. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
