Contraception

Progestogen-only Injectable (POI) Contraception

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Progestogen-only injectable contraception is a hormonal type of contraception that is given through an injection. It contains a synthetic form of the hormone progesterone, known as progestin or progestogen. They provide protection against pregnancy for up to 8 to 14 weeks.

Types

  • Medroxyprogesterone acetate (DMPA)
  • Norethisterone enanthate (NET-EN)

Mechanism of action

  • This hormone works primarily by suppressing ovulation (preventing the release of an egg from the ovaries).
  • It also thickens cervical mucus, making it more difficult for sperm to reach and fertilize an egg.
  • It can thin out the uterine lining, making it less suitable for the development of the fertilized egg.

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Progestogen only pill (POPs)

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This type of pill does not contain oestrogen and the dose of progestogen is significantly lower than in those used in combined oral contraceptive pills (COC). It is also called the “mini-pill” and is useful for women who do not want pills that contain oestrogen or in situations where the oestrogen is not suitable for medical reasons. They are a highly effective method of birth control when taken correctly.

Formulation – Available formulations are:

  • Norethisterone 350 ug (NET) – (Noriday)
  • Levonorgestrel (LNG) 30 μg
  • Desogestrel (DSG) 75 μg – (Cerazette)

Levonorgestrel (LNG) and norethisterone (NET) are grouped as “traditional’ POPs”

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Myths and facts of combined oral contraceptive (COC) pills

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Currently, there is a wide selection of contraceptive methods available to suit the various reproductive needs of couples. Despite these, there is still a huge unmet need with regards to contraception. There are 123 million women around the world who are not receptive to contraception. In the 2015 United Nations Population Fund (UNFPA) report, 15 million adolescent girls in developing countries gave birth and 13 million lacked access to contraceptives. WHO estimated that approximately 214 million women of reproductive age, in developing regions, who want to avoid pregnancy are not using a modern contraceptive method and between 2015 and 2019, almost half of all pregnancies were unintended.

The combined oral contraceptive (COC) pills are readily available in the markets and yet women avoid them due to their belief in the myths surrounding them. Following are some common myths regarding the combined oral contraception pills and the facts to dispel them.

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Vasectomy – Male contraception

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Article contributed by Dr Peter Ng and Dr Beatrice Chua Yoong Ni

The aim of a vasectomy is to prevent sperm from reaching the semen by disconnecting the sperm duct. The resulting ejaculate is therefore sperm-free, eliminating the risk of pregnancy. Sort of like a cheap shark fin soup without the shark fins (sperms).

Vasectomy is the contraception of choice for 6%–8% of married couples worldwide. Vasectomy is a minor procedure that provides effective and permanent contraception. In fact, it is far more effective than many other methods of contraception, including female sterilization.

Prior to a vasectomy, it is important and both husband and wife be present together to be counseled by a specialist on the implications of the procedure. It is important that the completeness of family is ascertained and that both husband and wife had discussed beforehand and agreed that it is the husband who should undergo a vasectomy to attain permanent contraception.

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Contraception – Male condom

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The main purpose of contraception (or birth control) is to prevent an unplanned pregnancy. You should know and understand the different types of methods available to you, the risks and benefits of each, and any possible side effects, so that both you and your partner can able to make an informed choice. Contraception can be broadly divided into:

  1. Temporary or permanent methods – permanent birth control is accomplished through sterilization (tying or removal of the fallopian tubes) or hysterectomy (removal of womb / uterus). The rest of the methods are classified as temporary or reversible.
  2. Short term or long-term methods – short term methods are condoms and oral pills. Long term methods are injectables, intrauterine device and hormonal implants.

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Contraception – Hormonal implant (Implanon)

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The main purpose of contraception (or birth control) is to prevent an unplanned pregnancy. You should know and understand the different types of methods available to you, the risks and benefits of each, and any possible side effects so that both you and your partner can able to make an informed choice. Contraception can be broadly divided into:

  1. Temporary or permanent methods – permanent birth control is accomplished through sterilization (tying or removal of the fallopian tubes) or hysterectomy (removal of womb/uterus). The rest of the methods are classified as temporary or reversible.
  2. Short term or long-term methods – short term methods are condoms and oral pills. Long term methods are injectables, intrauterine device and hormonal implants.

Hormone implant currently available is Implanon NXT®. It consists of a single plastic rod measuring 4 cm and contain a progestogen hormone called etonogestrel. Implanon is inserted surgically, just under the skin of the upper arm. The implant will release a minute amount of this hormone every day for 3 years. It works by preventing the monthly ovulation (the release of an egg from the ovary) during your menstrual cycle. It also thickens the vaginal mucus to prevent sperm from reaching the egg (fertilization). Continuous effect of the hormone will thin out the lining of the uterus (womb) to prevent attachment of a fertilized egg. Implanon does not contain any oestrogen.

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Combined oral contraceptives (COC) pills

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The reason for practicing contraception (or birth control) is to prevent an unplanned pregnancy. Most methods of contraception enable sexually active couples to temporarily avoid pregnancy. Permanent birth control is accomplished through sterilization. There are many types of birth control methods that are currently available. There is no perfect method at the moment. Each has its own advantages and disadvantages. Be sure you know and understand the different types of birth control available to you, the risks and benefits of each, and any side effects, so that you can make an informed choice.

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Post-Natal Care – what to expect

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Most women stay in the hospital for 24 to 48 hours after giving birth (or 3 to 4 nights after a caesarean section). This will depend on the condition of the mother and baby.
The physical changes that occur with pregnancy usually resolve by the end of 6 weeks, although some may resolve much earlier than this. It is important to know all these changes, as it will help you cope better and lessen your worries. Emotional sup¬port and much needed help from your spouse and family members is equally important to assist you in facing these changes and coping with the arrival of a new member into the family. You will also get lots of advice from friends and relatives who visit you – some may be conflicting and may be harmful. There are many ways of doing things with no particular hard and fast rules on what is best for you. It is best to avoid traditional or Chinese herbs during this period. In the end, it is all boils down to common sense and you have to decide what is best for you and your baby. Do some reading and ask your doctor or midwife about your recovery during the postnatal period

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