How effective is it to prevent unwanted pregnancies?

By Dr. Manju Khemani in Obstetrics And Gynaecology

Oct 27 , 2020 | 3 min read

Unintended pregnancies remain an important public health issue. Globally, 74 million women living in low and middle-income countries have unintended pregnancies annually. This leads to 25 million unsafe abortions and 47000 maternal deaths every year. Besides death many women suffer from long-term damage of reproductive organs or disease.

Use of contraception prevents pregnancy-related health risks for older women. It also reduces the need for abortion and unwanted pregnancies. The effectiveness of the barrier method like condoms and oral contraceptive pills depends on their correct and consistent use. If a woman forgets taking pill and is not consistent then the failure rate could be as high as 9 per woman year that means out of 100,9 women will become pregnant in 1 year. But if a woman takes one contraceptive pill every day then the pregnancy rate is as low as1per 100 woman a year. In India, women are scared to take contraceptive pills because of its presumptive side effects. Not many people know its other advantages besides contraception.

The other advantages of contraceptive pills are

Itmakes your period more regular, lighter, and shorter
Reduces menstrual cramps
Decrease the risk of cancer of the uterus, ovary, and colon
Improves acne and reduces unwanted hair growth
Pills can be used to treat certain disorders that cause heavy bleeding and menstrual pain, such as fibroids and endometriosis.

There are two other contraceptives, which are available in India and are not user dependent.

Mirena

Mirena is a small device which is placed inside uterus like a CU T.

So the question is - how is a Mirena different from a CU T IUD? CU T has a copper coil wound around it.80% of women who use CU T IUD have no problem with it but 20% of women may have heavy periods. 70% of women who use Mirena may not have periods as long as they are using Mirena and 20% women may have scanty periods.That’s the biggest advantage of Mirena. It is highly effective, with a typical‐use first year pregnancy rate of 0.1% – similar to surgical tubal occlusion.

It secrets 20 micrograms of hormone everyday.1 mg is equal to 1000 microgram so one can imagine how small dosage is secreted in a woman’s body per day. The licensed duration for the use of a Mirena is 5 years for contraception. That means once inserted, it will work for 5 years in a woman’sbody. But in practice it works well for 6-7 years. Once removed,women can become pregnant without any problem.

First three months after insertion, a woman can have spotting. But afterword, a woman can have either scanty periods or no periods till she is using the device. Once device is removed, the patient will start having regular periods. There is no evidence that IUS use causes weight gain. Some women may have acne because of device but it’s not very common and is treatable in nature. The risk of uterine perforation at the time of IUS insertion is very low (less than 1 in 1000) and depends upon expertise of healthcare who is inserting it. Rarely, it gets expelled on its own. In case woman becomes pregnant while using it, pregnancy in the tube should be ruled out.Women of all ages may use the IUS. The IUS can safely be used by women who are breastfeeding. Women with diabetes can also use it.

Ideal time to insert is immediately after periods. It can be inserted in OPD.

Implanon NXT ---The implant is a small rod inserted under the skin of the arm using a local anaesthetic, and slowly releases the hormone progestogen. It works for three years. It’s a matchstick size plastic flexible rod.

It has a very low failure rate. Periods are less painful. Period pattern changes while woman is using it. Vaginal bleeding may stop, become more or less frequent, or be prolonged during implant use. For a woman who is experiencing prolonged bleeding, a change of contraceptive may be needed. Once implant is removed, one can easily conceive. It’s recommended for women between 18-40 years. It’s inexpensive and cost effective. The implant is normally inserted during the first five days of the menstrual period.The implant can be left in the arm for three years (or removed earlier if desired). Removal is a simple procedure using a small amount of local anaesthetic.