Aug 192014
 

Emergency Contraception – An Important Tool for Contraceptive Emergencies.

What do you do if a condom breaks or your diaphragm slips? What if you get swept away in the heat of the moment and forget to use your birth control?

Post-coital contraceptives are often referred to as the morning-after-pill, and have been around for a long time. Here in the U.S., medications have been used to prevent pregnancy after having unprotected sex since the 1970’s. Over the years these medications have evolved, becoming more effective and safe enough to be sold over the counter in many countries. In the U.S., anyone can purchase them online or in a drugstore without a prescription.

I recently read an article which reported that even though emergency contraceptives are available without a prescription, they’re not being used as much as they could be. Part of the reason behind this is because people don’t know that much about them. So, I would like to make sure you are aware of this important tool, how it’s used and how to acquire it.

There are two main categories of emergency contraceptives: oral medications and the copper IUD. Let’s start with the copper IUD since we were just talking about IUDs last week.

The Copper-T IUD (ParaGard) as Emergency Contraception

There are two different types of IUDs available in the U.S., but only ParaGard, also known as the Copper IUD has the ability to inhibit implantation and as such can be used to prevent pregnancy up until the fertilized egg has implanted on the uterine wall.

This is why the copper IUD can be used as an emergency contraception. The doctor will say that it can be used up until 5 days after you’ve potentially been exposed to sperm.

The truth is, in some cases it can actually be used up to 10 days after exposure to sperm, depending on where you are in your cycle. In my program, I teach my clients how to pinpoint ovulation, so that they know EXACTLY what to do based on where they are in their cycle.

One of the benefits of this particular method of emergency contraception is the long term contraceptive protection it offers without disrupting your cycle. If you have health insurance, getting an IUD is covered under your contraceptive services benefit, unless you work for places like Hobby Lobby or Eden Foods (yes, that’s the one you see in the health food store).

Emergency Contraceptive Pills (ECPs)

There are a couple of different options available for emergency contraceptive pills but we’ll limit today’s conversation to the most common over the counter version, commonly known as “Plan B”. Currently, there are several different brand names available.

The hormone used in Plan B is called Levonorgestrel. You may remember this hormone from my previous post on IUDs, it’s considered to be a very safe form of synthetic progesterone. Research says medications like Plan B made with Levonorgestrel are safe for women who have had breast cancer, cardiovascular issues, stroke, migraines, etc. One of the reasons it’s considered so safe is because there is no estrogen present, and it’s the synthetic estrogen which tends to create problems.

Plan B and similar brands, come in tablet form and you can purchase them from drug stores, many grocery stores and online.

I’m of the opinion that it’s a good idea to have emergency contraceptives on hand, so that if you ever need it you don’t have to go out searching for it. For those who wish to avoid pregnancy, the sooner you are able to use it, the better your chances are to avoid becoming pregnant.

Plan-BLevonorgestrel works by delaying ovulation, so if you haven’t ovulated yet, you’re probably going to be OK. If, however, has ovulation already happened, then the drug isn’t going to help – although the copper IUD is still an option as long as the egg hasn’t implanted in the uterus yet.

You can see where being able to pinpoint ovulation becomes a really important skill.

Because emergency contraceptive pills are hormonal and postpone ovulation, they do disrupt your normal cycle. If you use them and you haven’t ovulated yet, it’s likely that your period will be late. Because ovulation has been delayed, menstruation arrives later than you’d expect it to. It’s important to understand this because a lot of women experience anxiety when their period doesn’t show up as expected.

It can take up to a month or two for your cycle to get back to normal, so be extra careful and be sure to use protection. Emergency contraceptive pills are not a reliable way to prevent pregnancy (20-30% failure rate) so you won’t want be relying on them unless there’s an emergency. Prevention is always the best way to go.

An Important Tool

Emergency contraceptives are an important tool to know about. If you have teenagers, you can help them be prepared by having the conversations about sexual situations they may find themselves in. You can also help them be prepared by making condoms and other methods of contraception available. You may consider keeping both condoms and emergency contraception around the house “just in case”.

Coming up in my next blog post, we’ll finish out the last of the modern contraception options in The Truth about Birth Control Series with a look at sterilization, including one non-surgical method which you may not have heard about. Then we’ll dive into some of my favorite topics including fertility awareness and herbs.

Aug 042014
 

IUDs – Still the Black Sheep of the Contraceptive Family?

Is it really true that IUDs are being recommended for teenagers? This might come as a surprise, but yes, it is true. The American College of Obstetricians and Gynecologists (ACOG) believe that IUDs are a great option for teenagers, especially because teens are at such high risk for unintended pregnancy, all the way through age 25. So 10 years of highly effective long-term contraceptive protection has significant benefits for young women. They also believe that IUDs should be a first choice for woman of all reproductive ages.

If IUDs are so great then why aren’t they used more often in the US? It’s a great question with a multifaceted answer.

The IUD, aka the intrauterine device, currently has over 150 million users worldwide, but isn’t used here in the US as much because of a couple of reasons. A bad reputation along with being expensive along with drug companies and doctors remembering the sting of lawsuits and were reluctant to promote or recommend IUDs.

wiki_dalkonshieldThe IUD was set to become the next greatest thing to birth control pills, but it got a bad rap in the 1970’s due to the poorly tested and heavily marketed IUD called the Dalkon Shield. It really burst the bubble on IUDs in general. I mean just look at this thing, it looks scary and dangerous…..

The main problem with this device was the string. It essentially rolled out the red carpet for bacteria leading straight into the uterus. The result was infection, pelvic inflammatory disease (PID).

Pelvic Inflammatory Disease is a serious infection of the uterus and fallopian tubes which can quickly turn life threatening. It causes scarring in the fallopian tubes leading to an increased risk of ectopic pregnancy, difficulty conceiving and infertility.

Many women died from infections resulting from using the Dalkon Shield, and the company hid information, used research that was known to be flawed and bias. I mean if you know the string is defective…. Replace it… Hello? Yet another example of corporate greed putting their bottom line over the safety and well-being of the women they serve. It’s stupid, really.

A Popular Method Worldwide

Fortunately, today’s IUDs are much safer and it’s one of the most common forms of contraception used all over the world. They are widely used in many parts of Europe and about 41% of women using contraceptives in China, use an IUD.

They are also popular in Mexico, and other countries where contraceptives can be difficult to obtain or where male partners don’t agree to use contraceptives.

Research has shown that IUDs are one of the most effective methods of contraception available, providing long-term protection that you don’t have to think about at least until it’s time to take it out 5 or 10 years later, depending on the type you are using.

failurerates

It is considered almost as effective as the most effective method of hormonal birth control, Norplant, which is imbedded under the skin in the arm.

Today, here in the US, we have three types of IUDs available. The copper IUD which is also called ParaGard, and the hormonal IUDs, Mirena and Skyla.

ParaGard – The Copper T-380 IUD

One of the great things about the copper IUD is that you continue to cycle as normal and it’s your natural cycle. This IUD has no effect on your hormones, so you can use this method while learning fertility awareness and feel confident about your level of protection.

Another advantage is a rapid return to fertility if you’d like to have a baby, because the copper IUD does not mess with your cycle as soon as the IUD is removed you can get pregnant right away.

Or for women coasting towards menopause, it can be a nice way to finish out the last of your fertile years with a high degree of protection should your cycle start to get funky.

In recent years, research has demonstrated that IUDs are safe for women who have not had children, including young women and teens. The copper IUD has also been shown to have no effect on weight gain, libido or mood.

They don’t increase the risk of infection or miscarriage and recommendations were made suggesting this method should be considered as a first line option along with other hormonal contraceptives for teens in particular because of the high rate of effectiveness and no chance for user error.

The copper IUD provides contraceptive protection for up to 12 years, and probably longer but there is concern that the strings may become prone to breaking during removal when it has been left in place too long.

ParaGard has the potential to make bleeding heavier during the first few months after insertion, but many women report no change in blood flow. I’ve even heard reports of cramps lessening after the insertion of an IUD. All this is contrary to what you might be told when getting an IUD, so really, it just goes to show that we are all individuals and often you just have to try it and see how your body responds.

Things to know about the Copper T IUD, research has shown:

  • Safe for women of all ages, including teens and women who have never been pregnant
  • Does not increase the risk of infertility or miscarriage after removal
  • The most common reason for removal is heavy bleeding and painful periods.
  • Research shows it does not increase copper levels in the body, but some women report being sensitive
  • Copper acts like a spermicide, killing sperm and making the endometrium unfriendly
  • If fertilization does occur, it also interferes with implantation (can be used as emergency contraception for this reason)
  • If an egg should get fertilized and implant, the pregnancy will continue.
  • Doesn’t interfere with breastfeeding and can be placed immediately after giving birth, however I wouldn’t recommend it because doing so may cause an increased risk of uterine perforation and the IUD may migrate out of the uterus requiring surgery to find. I think it’s better to wait until the uterus has returned to normal size and you’ve had some time to heal. Some people have them inserted on the 6 week check up but you might want to wait longer than that, your body has been through a lot.

Hormonal IUDs – Mirena and Skyla:

miudMirena offers many of the same benefits as the copper IUD with a couple of key differences. First, these IUDs contain synthetic progesterone and disrupt your natural cycle. Many women experience changes in bleeding, including spotting, lighter periods or you may stop ovulating and menstruating all together.

Hormonal IUDs also do not last as long as the copper IUD, Mirena is only good for 5 years and Skyla, a smaller version of Mirena, is good for three.

Things to know about hormonal IUDs:

  • Works by thickening cervical mucus to prevent sperm from entering the uterus
  • Decreases sperm’s ability to penetrate the egg
  • May inhibit ovulation, prevent menstruation or cause irregular periods
  • May increase the risk of ovarian cysts, even in those with no prior history
  • May increase risk of complications should pregnancy occur, ectopic pregnancies occur about half the time with hormonal IUDs
  • Decreases endometrial development thus causing lighter menses (making it more difficult for a fertilized egg to implant if ovulation should occur) and may be used to treat heavy menstrual bleeding and endometriosis for this reason.
  • Users may experience typical side effects associated with hormonal contraceptives such as weight gain, mood changes, hair loss, hair growth in undesirable places, headaches, migraine headaches, decreased libido, etc.
  • Research has demonstrated that progestin only contraceptives are safer than those combined with estrogen. Studies suggest that women who are using Mirena are not at greater risk stroke, high blood pressure or any other cardiovascular event.
  • Fertility returns in about 3 months after the device is removed, within one year 8 out of 10 women who want to become pregnant conceive.
  • There is some controversy as to whether it is OK for nursing mothers to use a hormonal IUD, some research has found small amounts of the hormones are transmitted in breast milk and infants may be more vulnerable to respiratory and eye infections. No long-term studies have been conducted to determine infant safety. The FDA doesn’t recommend hormonal contraceptives as a first choice for breastfeeding moms.

Things to know about IUDs in general:

  • Over 150 women worldwide use IUDs, it’s the most popular form of long-term reversible contraception
  • Less than 1 in 100 women become pregnant in the first year of use
  • Only increases the risk of uterine infection if inserted without proper sterile techniques or if chlamydia or gonorrhea (STDs) are present
  • Increases the risk of miscarriage only if pregnancy occurs while the IUD is in place, and can cause complications such as an increased the risk of severe infection, toxemia and death
  • Doesn’t increase the risk of birth defects, however the hormonal IUDs may cause problems if left in place (not recommended) for the duration of the pregnancy due to hormonal exposure
  • The skill of the practitioner inserting the IUD may play a role in risk of expulsion and uterine perforation, best to go to someone who has plenty of experience.

 

Why Learn Fertility Awareness when Using an IUD?

Even though IUDs are extremely effective at preventing pregnancy, in fact, it’s one of the most effective options available, pregnancy can and does happen even with an IUD and because there is an object in the uterus it complicates things. Pregnancy with an IUD in place increases the risk of having problems like septic miscarriage and ectopic pregnancy. These events are very rare, and if pregnancy were to occur, the IUD can often be safely removed (still a risk for miscarriage) by a skilled practitioner and the pregnancy continue as normal if that’s your choice.

I just read a blog this morning in Salon, where her copper IUD failed. Women who chose an IUD are looking for reliable long-term protection. Having it fail can feel pretty frustrating. But there are things you can do to make sure you don’t end up in this situation. I can teach you how to bring the risk of 1 in 100 down to 1 in a million. It’s not hard to do and can be easily incorporated into your lifestyle so that it just becomes something that you know.

I’m Curious: What are Your Thoughts on IUDs?

I’m curious and I’d love to have you post your comments below on your initial reaction when you think about getting an IUD? Or if you have a daughter, the thought of her using one. Is the reliability it offers worth the small risk of problems?

I wonder because the IUD is widely used elsewhere in the world, yet few women use them here in the US and I’m curious to know your thoughts. I’ve found women often seem to have strong opinions one way or the other.

I have some ideas on why the IUD isn’t used a whole lot here in the US, and one significant factor has historically been cost. It costs around $700-$800 to get an IUD and while cheaper in the long run than other types of birth control, it’s often difficult to come up with that kind of cash and make the choice to invest in birth control.

Maybe you’ve heard, times have changed and for those who have health insurance… and don’t work for places like Hobby Lobby and Eden Foods…. There’s good news! An IUD is included in the benefits of your health care plan, if you want one, you can use your “well-woman” visit and get your pap and screen for STDs and talk to your health care provider to see if an IUD is a good option for you. You can get all of this done at no cost to you thanks to ObamaCare. I personally think that’s awesome! The more options available to choose from the better, because no one method works for everyone.

Leave your comments below!
Warmly,
Robin

P.S. For more info:

Everything you wanted to know about the copper IUD: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971735/

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