Intrauterine Devices, Natural Planning, and Sterilization
Fewer than 1 percent of American women use intrauterine devices (IUDs), due in large part to the disastrous Dalkon Shield, an IUD that was pulled from the market in the 1970s for causing pelvic inflammatory disease, miscarriage, and death. Today's IUDs have been redesigned and are considered safe.
Copper IUD (i.e., ParaGard)
Progestin IUD (i.e., Mirena)
- How it works: A small plastic device coated with copper is inserted into the uterus and left for up to 10 years. It's not completely understood how IUDs prevent pregnancy, but scientists believe that the copper ion from the device kills sperm. New studies indicate that IUDs may impair how sperm functions to prevent fertilization.
- Advantages: Long-term contraception that will fail in fewer than 1 percent of women in the first year because there's no user error. Doctors should be trained in IUD insertion.
- Risks: Pelvic inflammatory disease, especially within the first 20 days after insertion.
- Postpartum issues: An IUD may be placed immediately after delivery. Otherwise, insertion should be delayed until the second postpartum month because of the risk that the uterus might be punctured.
- How it works: This IUD has a mechanism similar to that of other IUDs, with the addition of a slow-release dose of progestin. The device may be left in place for as long as five years.
- Advantages: Less than 1 percent failure risk in the first year.
- Risks: Similar to other IUDs and progestin-only methods.
- Postpartum issues: Wait until your six-week checkup. Mirena is safe for breastfeeding moms.
So you just had a baby and you're again preoccupied with your "fertile window." Want to use natural contraception? Consider this.
The successful practice of fertility awareness depends on your dedication and the combination of various methods, an integrated approach better known as the symptothermal method. It usually involves analyzing changes in cervical mucus and recording the 0.4? temperature increase that occurs around the time of ovulation. Or you can even add another method, such as calculating fertile days.
If you're not committed to this meticulous charting and your menstrual cycle does not consistently fall between 26 and 32 days, you have at least a 25 percent chance of pregnancy. Postpartum women should keep in mind that their cycles might not be regular for many months, especially if nursing, says Alison Edelman, MD, a professor at Oregon Health & Science University, in Portland.
Can I get pregnant when I'm breastfeeding?
Breastfeeding does have a contraceptive effect, but only for about six months, and only if you exclusively breastfeed your baby.
Nursing seems to release endorphins that depress the production of hormones necessary for ovulation. This temporary period of infertility is called lactational amenorrhea (LAM).
For LAM to work, your breasts must be nearly drained with each frequent feed. The goal is have as much suckling as possible to keep the ovulation hormones suppressed. If your baby drinks formula, uses a pacifier, or if you pump milk regularly, then all bets are off.
Four studies of women who used LAM exclusively for six months showed pregnancy rates that ranged from 0.5 to 1.5 percent. Most gynecologists say that LAM is 98 percent effective for a while. If you want to be absolutely sure of not conceiving, most doctors recommend using an additional contraceptive method, such as a condom, for added protection.
If you've gotten your period, don't rely on LAM. Even breastfeeding moms usually start to menstruate between four and six months after giving birth. Ovulation does not always precede the first postpartum menses, especially if it comes soon after delivery. But the longer the return of your period is delayed, the more likely ovulation, and the risk of pregnancy, will precede that first menstrual cycle.
Is it permanent?
There are complicated surgeries to reverse sterilization, but they're expensive, not usually covered by insurance, and have low success rates.
How does the technique work?
In tubal ligation, the surgeon blocks the fallopian tubes by cutting them, using electricity to burn the tissue, or by clamping off the passage with a clip or ring. Afterwards, eggs can't descend into the uterus, making pregnancy nearly impossible.
In 2002, the FDA approved a new nonsurgical method called Essure. The doctor places what looks like a metal spring into each tube. Over the course of three months, scar tissue builds up around the implant, thereby blocking the tubes.
Can it fail?
The annual failure risk is 0.5 percent. Over a decade, ob-gyns say that the risk of pregnancy is approximately 1 percent. Over two decades, it's 2 percent, and so on.
Because the tubes are blocked, either sterilization method can cause an ectopic pregnancy (when a fertilized egg implants outside the uterus, usually in a fallopian tube) if it fails.
Is menstrual suppression harmful?
"Some women say, 'If I could take something to keep me from having my period, I'd be happy.' Others say, 'My period makes me feel like I'm healthy,'" says Katherine LaGuardia, MD, director of medical affairs for Ortho Women's Health, the contraception maker. "But there's no strong health argument that advocates either position."
In fact, you may not realize that all forms of hormonal contraception -- even the 21-day combined pill -- will suppress your period. In essence, if you're on birth control, the bleeding you experience every month isn't a true menstruation because no uterine tissue is being shed. These "pill bleeds" are the body's reaction to withdrawing from the hormone progesterone.
Basically, there aren't any long-term studies of the effects of menstrual suppression. Short-term studies don't show any danger, because women become fertile again as soon as they stop taking hormones. Yet ob-gyns do point out that women today have far more periods than did their forebears just two or three generations ago. When women had eight or 10 children in a lifetime, they spent much of their fertile years pregnant or nursing -- and not menstruating. Hunters-gatherers might have had 25 to 50 periods in a lifetime. The current generation of women, who live longer and give birth far later and to far fewer children in life, will have between 450 and 500.
Heather Millar is a freelance writer in Brooklyn, New York.
Originally published in American Baby magazine, November 2005.
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