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Contraception: Supporting a Woman’s Right to Choose

Since we are in an election year and this always seems to be a hot topic in the media I thought it a good time to revisit contraception. It is a wonderful and amazing option for women and men to be able to choose children, and to me quite disappointing that as a country we cannot come together to promote the ideas of family planning. Because the topic of abortion is so politically charged I think we forget that a secondary casualty of anti-abortion policy is the basic right and access to birth control. Preventing unintended pregnancy is a communal effort, so please pass along any or all information to someone who would benefit from being informed of their choices.

Most of us are familiar with the trusty old birth control pill. There are two main hormones in most birth control pills. Estrogen in the form of ethinyl estradiol and a progestin (a synthetic form of progesterone) of which there are a great variety, and each has a slightly different activity. There are also a variety of choices with the amount of hormones in pills. Some are the same all month long, some get stronger as the month progresses which somewhat mimics our natural rhythm; and then there are some pills which have no estrogen at all and just use the progestin. All these choices give both the patient and the provider a nice variety of options to create a workable match. The major downside of pills are the side-effects (which of course all methods have), and the fact that you have to remember to take it daily.

Some of the newer contraceptive methods have unique delivery  systems, and are invaluable for those who have trouble remembering a daily pill.  My personal favorite is the NuvaRing (www.nuvaring.com).  This is a small (2 inch diameter, 4mm thick)  flexible ring made of an ethylene vinylacetate polymer impregnated with ethinyl estradiol and a progestin (desogestrel) which is inserted into the vagina for 21 days and removed for 7.  It delivers a steady release of low-dose hormones throughout the 21 days.  Side-effects seem to be minimal with complaints of increased vaginal discharge/ irritation, and sexual partners being able to feel it during intercourse.  Another method which offers a unique delivery option is the patch OrthoEvra (www.orthoevra.com).  The patch is a nude colored adhesive impregnated with ethinyl estradiol and a progestin (norelgestromin).  With this method one patch is applied weekly for 3 weeks, and week four is patch free.   Common complaints with this method are irritation/rash at the  adhesive site, breast tenderness, and trouble with patch staying full adhered to the skin.  This method has the potential for higher estrogen levels than most others, which for some women can be a problem, so consult your provider. The next method is Depo-Provera (www.depoprovera.com).  This is a progestin-only method; a small intramuscular injection of medroxyprogesterone acetate is given once every 12 weeks.  There are often complaints of irregular bleeding (especially the first 6 months), significant weight gain, depression, and resuming fertility can take up to 18 months after discontinuing use.   The FDA placed a black box warning on this method to inform patients and clinicians of the risk of bone mineral density loss while using this method for more than 5 years. Finally, there is once again a contraceptive which can be implanted under the skin via injecting a small rod (3mm by 40mm) into the inner upper arm. Called Implanon (www.implanon.com) this is a 3 year progestin (etonogestrel) only method.

IUD’s (Intrauterine devices) are experiencing a come-back, and the interest in these small T-shaped systems of contraception continues to rise.  The use of IUD’s were often recommended to women who had already had children, but new guidelines have broadened potential recipients.   There are currently 2 types available.  The first is the copper IUD (ParaGard, www.ParaGard.com) this is a completely hormone free method offering 10 years of contraceptive protection.  The second is a progestin only containing IUS (Mirena an Intrauterine System, www.mirena.com) which offers 5 years of contraceptive protection.  The IUD/IUS must be inserted into the uterus by a licensed practitioner.  Most common complaints are discomfort during insertion, and irregular bleeding. These devices are easily removed in advance of recommended use.

The final birth control option worth mentioning is continuous use birth control.  Continuous use can be recommended for those who have problems with heavy bleeding, cramping or other PMS type issues, as well as for athletes and special occasions like a honeymoon. Continuous use can be achieved with some pills or the NuvaRing, and is basically the idea that there is no 7 day break between taking hormone containing pills or changing rings.  Research shows that this method of use is safe and effective, as well as FDA approved.  Using your contraceptive method in this manner should be done only with the approval of your health care provider.  For more information consult with your provider or visit www.noperiod.com.

Now for you men, there is indeed a method for you too…vasectomy! And guess what? Federal dollars from the family planning department now include a way for you to receive a free or reduced fee vasectomy, check with your local health department or planned parenthood for details. Yes this is a permanent method. It involves a simple outpatient procedure which severs the vas deferens, stopping semen from exiting during ejaculation. There is still an ejaculatory fluid released, but no sperm. What happens to them? They get stuck at the dead end and are reabsorbed into the blood stream.

As a naturopath I get two common questions regarding birth control. What are the hormone free options and what do I recommend to women taking hormonal birth control? Hormone free options are condoms, diaphragms, ParaGard IUD, vasectomy, and Cycle Beads (these are pretty cool, an easy way to track your fertile cycle days IF you have regular periods…check out their website www.cyclebeads.com). Any hormonal birth control method can deplete B vitamins, so I recommend a good multi or B complex vitamin to be taken daily with food.

All of the aforementioned methods have their own risks and necessary screening before use.  And of course none of these are protection against STD’s (now called sexually transmitted infections, STI‘s); for that use a condom!  If any of the aforementioned contraceptive methods are of interest to you check into the websites given as well as seeking the guidance of a health care professional versed in their use.  Two other websites worth mentioning are www.plannedparenthood.org and www.fwhc.org, they both give a comprehensive overview of the options available. Be thankful for your right to choose!

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!

By Tracy Erfling

Dr. Tracy Erfling is a naturopath physician in the Lower Columbia Region. Questions? erflingnd@hotmail.com