BIRTH CONTROL (CONTRACEPTION) METHODS
The contraceptive practices used by couples to have as many children as they want are called “birth control”. In this way, families fulfill their responsibilities towards society by having as many children as they can raise well. About 45% of married women worldwide use contraception. There are birth control methods that women and men can apply separately.
We can collect birth control methods under 3 headings;
1. Surgical (surgical) birth control methods:
a- Tubal ligation in women:
In women, the tubes allow the male cell (sperm) to reach the female egg cell, fertilization to take place, and the fertilized egg to be transported back to the uterus. By connecting the tubes, all these processes are prevented. It can be done laparoscopically (closed), open method or during cesarean section. It is a short process. Pregnancy can occur in up to 1% of women whose tubes are tied. If the woman regrets, the tubes can be opened surgically with a 50-60% chance of success. In addition, these women continue to have a chance to have children with the in vitro fertilization method.
b- Occlusion of the duct of the tubes by hysteroscopy:
With hysteroscopy, a spiral-shaped device called Essure made of stainless steel, nickel and titanium is placed at the entrance of the canals through the uterus. Its effect starts in 3 months. Therefore, an additional method of contraception is recommended for the first three months. It has been applied in the world since 2002. After 3 months, medicated film (HSG) of the uterus should be taken. It has a 98-99% chance of success. It can be applied without anesthesia. Channels have no chance of reopening. In case of regret after the procedure, it is possible to have a child only with the in vitro fertilization method. It is a suitable method for women who are obese, have adhesions in the abdomen and which cannot be removed by surgery.
c- Canal ligation (vasectomy) in men:
It is the process of cutting and connecting the channels (vasa deferens) that allow the cells (sperm) produced in the male to be thrown out. It is easier than tube ligation in women. It can be applied with local anesthesia. Surgical reversal success is up to 60%. After the procedure, it is recommended to use a condom for 20 intercourse. Because the cells ahead of the attached part must be completely discharged.
2- Hormonal birth control methods:
a- Birth control pills (combined oral contraceptives):
It contains the hormones estrogen and progesterone. It suppresses ovulation, thins the inner lining of the uterus (endometrium) and prevents pregnancy by changing the structure of the cervical fluid. Apart from birth control, it treats painful menstruation (dysmenorrhea) and excessive menstrual bleeding (menorrhagia). It has a protective effect against uterine and ovarian cancer. It is used on the first day of menstruation. One tablet is taken at the same time each day. In boxes containing 21 tablets, when 21 pills are finished, a 7-day break is taken, and the other box is started on the 8th day. When using boxes containing 28 tablets, they are used consecutively, without interruption. When starting birth control pills, it is recommended to use an additional method of birth control (condom) during the first 2 weeks.
Major side effects;
- Absence of menstruation (amenorrhea): It is recommended to change the medication.
- Fullness and tenderness in breasts: It may decrease within 4 months, if not, change the drug.
- Depression: Birth control pill is discontinued,
- Headache: Birth control pill is discontinued,
- Intermediate bleeding or spotting: If it does not decrease within 4 months, the drug is changed.
It also slightly increases the risk of clotting and blockage in the veins. It is not recommended for women with previous vascular disease.
b- Monthly contraceptive injection (Mesigyna):
It contains birth control pill-like hormones. The mechanism of action is the same. Since it is applied from the hip to the muscle once a month, it can provide ease of use for people who forget the pill.
c- Birth control bands:
It contains estrogen and progesterone hormones. A certain amount of hormone is released from the tape into the blood every day. It can be applied to the waist area. It creates its effect by suppressing ovulation. The tape (ortho-evra) stays for 3 weeks, is removed for 1 week, applied to a different place every month. Its effectiveness is reduced in women heavier than 90 kg . In addition to the advantages over birth control pills, there is ease of use.
d- Vaginal ring:
The rings (nuva ring) also contain estrogen and progesterone hormones like birth control pills. It secretes a certain amount of hormones into the blood every day. It shows its effect by suppressing ovulation. It stays in place for 3 weeks, removed for 1 week. During this period, menstruation occurs. In addition to the advantages over birth control pills, there is ease of use. About 3% of the users abandoned the method due to discomfort during sexual intercourse.
e- Pills containing only progesterone:
It shows its main effect by changing the structure of the cervical fluid (mucus) and the inner lining of the uterus. It should be taken at the same time every day. It is used constantly. The most important area of use is women who are breastfeeding. It does not affect the baby and the structure of the milk. Spotting-like intermediate hemorrhages may be seen.
f- Needles containing only progesterone:
There is a form (Depo-provera) used every 3 months in our country. It is injected into Adele. In the first year of use, 50% of women develop amenorrhea. It is recommended to be used for a maximum of two years. Return of fertility after quitting can be delayed by 9-10 months. It has a negative effect on the fat ratios in the blood and can cause weight gain.
g- Subcutaneous stick (implant) containing only progesterone:
It is commercially available under the name Implanon, it is a stick 4 cm long and 2 mm wide.
It is applied to the inner part of the upper arm, under the skin, with local anesthesia. It is effective for 3 years. Birth control effectiveness is very high. The most important disadvantage is that it requires a minor surgical procedure during insertion and removal.
h- Hormonal emergency contraception method:
In the preparation containing only 2 tablets of progesterone hormone (Nor Levo), both tablets are taken together. It should be taken within the first 3 days after intercourse. Nausea has few side effects. Its effectiveness is very high. It should not be used as a permanent method of birth control.
A second alternative that can be used urgently is a drug called Preven, which contains both estrogen and progesterone hormones. It should be used within 72 hours after unprotected intercourse. It contains 4 tablets. It should be taken as 2 tablets with an interval of 12 hours.
3- Barrier (mechanical) methods:
They are the methods that prevent the female and male cells from coming together.
a- Condoms (Condoms):
There are types for both men and women. It should be applied just before intercourse. In addition to its contraceptive effect, it provides protection against sexually transmitted diseases and especially against Hepatitis-B and AIDS (HIV). Only synthetic condoms have a protective effect against hepatitis-B and AIDS.
The male condom is in the form of a sheath with a flexible ring at one end and a closed end at the other.
The female condom is in the form of a sheath with flexible rings at both ends. One end is closed and this end is applied to the cervix.
It is a plastic membrane, the outer part of which is surrounded by a ring, applied to the vagina in women. It should be inserted at most 6 hours before sexual intercourse and removed at the latest 6 hours later. It provides significant protection against many sexually transmitted diseases, but it does not protect against AIDS. It has three dimensions according to the diameter size. Usually 68-80 mm diameter is preferred. It should not be used during menstruation and should not be kept in for more than 24 hours.
c- Cervical cover (cervical cover):
It is firmly attached to the cervix. It can stay in place for 48 hours. It should be left in place for at least 8 hours after intercourse. It has four different sizes. The woman can try and determine the size that suits her. It should be discarded after 1 year of use. It has significant protection against sexually transmitted diseases.
d- Spermicides (spermicides):
Sponge, foam, gel, vaginal tablet etc. It has shapes. They contain spermicidal substances. They are not protective against AIDS and sexually transmitted diseases. It should be applied to the vagina of the woman 10-30 minutes before sexual intercourse.
4- Intrauterine device (IUD):
It provides birth control by changing the structure of the uterus in a way that prevents the fetus from attaching. There are types with various shapes. Its application during menstruation provides ease of application and reduces the possibility of undetected pregnancy to zero. Its effectiveness starts right after it is inserted, and it expires immediately after it is removed. Ease of use is its biggest advantage. Emergency contraception can be provided by inserting a copper intrauterine device within 5 days after unprotected intercourse.
After the IUD is applied, it should be checked by a physician every 6 months. If abnormal discharge, groin pain and fever occur, the patient should definitely call his doctor.
There is no one best birth control method for everyone. People can use different birth control methods at different stages of their lives. The important thing is to get the right information about the methods before making a decision.