Contraceptive advice can often be obtained from the family doctor with the oral contraceptive pill being the most commonly used method. There are various hormonal preparations available with variable doses of oestrogen and various progestagens to suit the needs of most patients. In some patients who may be forgetful in taking the pill, alternative methods of contraception may need to be considered.
Implanon is an implantable subcutaneous polystyrene rod which slowly releases a progestagen into the blood which selectively inhibits the LH surge or the trigger for ovulation. It is inserted under the skin into the upper arm under local anaesthetic and is 100% effective as a contraceptive device. Side effects may include irregular and unpredictable bleeding which often can be controlled with hormonal treatment. The implant lasts for 3 years but can be removed at any time with immediate return of fertility. Further information can be obtained from the manufacturers on www.implanon.com.
An intrauterine contraceptive device (IUD) may be suitable for those patients who have had pregnancies and delivered vaginally in the past. It is not considered a good option for young women who have not had children in the past because of the risk of infection and subsequent infertility. There are 2 types of IUD’s available, the first is the Mutliload 375 which is a copper releasing device that can be easily inserted in the rooms with minimal discomfort and lasts for 3 years. The second is the Mirena progesterone releasing device which functions by releasing progesterone continuously into the lining of the uterus progressively reducing the menstrual loss each month until the periods stop. It lasts for 5 years and can be easily removed at any time. Further information can be obtained from the manufacturers on www.mirena.com.
Sterilisation procedure is an option which may be considered in those who have completed their family. Under these circumstances the fallopian tubes are blocked by the use of metal clips (Filshie clips) which are applied at laparoscopy performed under a general anaesthetic as a day case. Laparoscopic sterilization is not reversible and in general should not be considered in patients less than 30 years of age.