Birth control conundrum

Published On: June 2, 2017 12:19 PM NPT By: Republica  | @RepublicaNepal

The problem is that there are still many Nepali women who continue to waltz into pharmacies and blindly opt for any available contraceptive. When, by now, everybody should be aware that there is no such thing as a universal birth control. There are many factors to be considered before settling on any birth control method. Dr Rangina Devi Laikangbam, OBGY at Alka Hospital, helps The Week readers understand the issue. 

Dr Laikangbam wants to start off with a stern warning: “Emergency pills are not a family planning method.” The mere fact that she needs to clarify this can help us give an idea of the level of awareness on contraceptive methods among our masses. She reports that cases of not only unmarried people but even some newlyweds opting for emergency pills on a regular basis are quite frequent. 

“They complain of irregular periods, and recurrent bleeding,” says Dr Laikangbam, “Then upon further questioning, they casually mention that they have already used emergency pills eight or nine times in the last couple of months, a pill that is designed to be used, as the name suggests, only in emergencies like once a year or so.”   
Dr Laikangbam continues to be really anxious about this lack of awareness. The desire to family plan isn’t enough. A woman must have all the right information to choose the correct contraception for her as well. 

Below are a couple questions you should ask your gynecologist before settling on any contraceptive.

What are the recommended contraceptive’s effectiveness and side effects?
What are the explicit instructions on the use this form of birth control? (Most contraceptive failure is due to incorrect or inconsistent application.)
Will the particular option affect my lifestyle? (Sex habits, smoking, plans to have children eventually (or never), privacy issues and sometimes even financial situation, all factors need to be considered.)
Will my other medications interfere with my chosen contraceptive?
Do I need the full-dose pill or can I opt for the low-dose alternative? (If you are sensitive to or wary of hormonal birth control, you are encouraged to clear out your reservations beforehand.)

The goal is to find the best form of contraceptive for you as what works for others won’t necessary suit you. Here, in our country, we aren’t exactly spoilt with options. Things like diaphragm, vaginal ring, sponge or patches that might be available abroad, aren’t here in our local markets. So some of the most widely used methods include contraceptive pills, Norplant implants, Depo injections and, lastly, intrauterine contraceptive device (IUCD). 

Why you need a doctor to choose a contraceptive method?
Dr Laikangbam talks about the importance of going through each patient’s profile before recommending any contraception. This is because they almost always tend to have some side effects. And factors like weight, age, health history, future family plans are all important as there is also that chance of some forms of contraception aggravating an illness or the patient’s condition.

Dr Laikangbam explains, “For instance, although the low dosage of hormones in the newly available pills doesn’t cause significant weight gain like in the past, we still don’t recommend it to obese patients. Conditions like high blood pressure, migraine, period patterns like cramps and bleeding are also some information that we keep in mind.”
She also shares that seeing women rely on pharmacies to provide them with Depo injections or implants is very worrisome. It’s also not only about if the injections have been maintained properly in appropriate conditions, the health risks need to be taken into account as well. Apparently, she doesn’t allow patients to use Norplant implants if their body can’t handle the Depo injection.

“These two are quiet similar so one way to avoid the unnecessary trouble with the side effects of implants is to initially test it out with the three month injections. If the patient’s body can handle the injections and they don’t have plans to start a family in the three to five year run, we go ahead with the implants,” she says.

Similarly, despite its lasting benefits, methods like IUCD where a foreign object is introduced in the body need to be exercised with more caution.
In short, professional guidance can save a lot of trouble that is often associated with contraceptives. With the help of a doctor’s expertise one might even be able to cancel out most of the side effects. 

Then there is the matter of follow up checkups as well. Dr Laikangbam asks her patients to come for a routine checkup after a couple of months of starting birth control. This applies for pills as well. 

“We have had women who have been using contraceptives for more than a decade or so suffering from some uterus problems in the long run. Some cases of cervical cancer has also been linked with the usage of contraceptives. So developing a habit of periodical screening would be very smart,” she concludes. 

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