In these modern times, women want to be able to control their finances and provide for their families adequately. The use of contraception not only allows a couple to control the growth of their family, but helps women to exact a greater sense of freedom in their lives, according to obstetrician and gynecologist Dr. Laura Dupuch

Gone are the days when women were reared to find husbands, and their pride and joy was in the abundance of children they bore. With this no longer their uppermost priority, for many women, it has almost become a rite of passage to source contraception that will work for them to ensure that they do not fall into a situation where they have children before they are ready and have the means to provide for them.

In these modern times, women want to be able to control finances and provide for their families adequately. The use of contraception not only allows a couple to control the growth of their family, but helps women to exact a greater sense of freedom in their lives, according to obstetrician and gynecologist, Dr. Laura Dupuch.

Dr. Dupuch who operates a practice at Island Lane Building in Sandyport, told The Nassau Guardian that this sense of freedom is important because intercourse is not used solely for reproductive purposes, and most women have careers today and do not want to run the risk of getting pregnant in order to enjoy a healthy sex life.

"Contraception can be defined as any method used to prevent pregnancy. It is hard to say when this concept first came about, but in the last [60-plus decades] or so there have been major leaps and bounds in making products that prevent pregnancy," said Dr. Dupuch.

"Prior to this time, contraceptive measures were often as basic as washing out the female's genital area immediately after intercourse, or using a rhythm or withdrawal method to predict ovulation and herbal remedies to prevent pregnancy, but such means were not very effective. But now it has advanced to the point where certain contraceptive methods like condoms and oral contraceptives work so well that they can guarantee a 99-percent chance of not getting pregnant if used correctly."

Although condoms and oral contraceptives may be the most known and even preferred options for contraception, there are many others. And before people make a decision about which to use, the doctor advises that they look at the pros and cons of the different measures of birth control, and measure them against their needs.

Male contraception
For males the contraceptive options are few, but the most common is the use of a male condom which the doctor said is advantageous because it not only prevents pregnancy 95-percent of the time in their female partner by hindering sperm from entering the vaginal canal, but also protects the male and female from sexually transmitted diseases (STDs). Spermicide is another option that can be effective on its own, but is usually used in combination with other contraceptive tools like condoms or vaginal diaphragms. It can be purchased in the form of a gel or foam.

"Condoms and spermicides are the best means of male contraception, second to the option of vasectomy [male sterilization] which is far superior to any other form of contraception for males or females. But for males who generally don't want to go that far, the condom and spermicide both have a 95-percent success rate of preventing pregnancy," she said.

According to the doctor, the condom's added benefit is that because it is a barrier method of contraception it can also greatly reduce the chance of a person contracting a sexually transmitted disease (STD) if used correctly. She said the downside could be a loss of sensation during intercourse when using a condom, but that it should be used nonetheless.
Female contraception
Whereas men have few options when it comes to contraception, women have numerous choices. Dr. Dupuch said in the earlier interview that on average without contraceptive measures being taken, women in their reproductive years have an 85-percent chance annually to get pregnant.

"Because of the advancements in science today, women no longer have to experience an unwanted pregnancy with the innumerable contraceptive means of preventing it available. The preventative rates of most of the options are really high -- like the oral contraceptive when if used correctly is 99-percent effective. Options like the diaphragm have a 95-percent rate of effectiveness, IUDs [have] a 98 to 99-percent rate of success and, of course, condoms and spermicide are 95-percent effective," she said.

While the rate of effectiveness is a major component in choosing a good contraceptive method, other things like the level of responsibility a person wants in administering the method should also be taken into consideration. Choosing the right one is an individual choice and it should be done with caution.

Barrier methods
The diaphragm or cervical cap, are less common methods for females among the numerous barrier methods.

The diaphragm is a dome-shaped contraceptive device that is placed within the vagina and can be used with a spermicide to increase effectiveness. Dr. Dupuch said many women opt not to use it because it can be messy and has to be deliberate. Much like a condom for men, the woman must stop what she is doing and put the diaphragm into the vagina prior to sex. After intercourse, she has to be certain to leave the device in for six hours before removing it.

"This method while very effective tends to be a mood killer -- and because the device can be used again there is a higher risk for vaginal infection," she said.

A cervical cap which is a similar device that sits over the top of the cervix is also another option but not as common today either.

Female condoms which are fitted to the shape of the vagina and have two rings on both ends to keep them in place are also not well liked, said the doctor, due to their being awkward and sometimes cumbersome to insert correctly. Similarly, the sponge, another device that needs to be inserted in the vagina prior to intercourse, she said, has also lost popularity mostly due to how messy it can be since it has to be saturated with spermicide to be fully effective.

"There are lots of things women can choose from, but many of these barrier-type methods are not that popular because they are really old-fashioned, inconvenient or messy for the most part. But for some women who don't want to go through surgery, insert anything for a long length of time in their uterus or take oral contraceptives, these methods are good," she said.

Oral contraceptives
"Oral contraceptives are likely to be the most common form of contraception in use currently. There are two types -- the first uses both estrogen and progesterone. It has to be taken every day for 21 days and then there is a seven-day period where a female doesn't take any pills or uses a placebo pill. During this time, she should get a period and if she takes the pill correctly every day she has a 99-percent chance of not getting pregnant," said the obstetrician/gynecologist.

While the major downside to oral contraceptive is remembering to take the pill daily, its benefits tend to outweigh that fact. Taking the pill can improve skin, regulate menstruation in people with irregular periods, cause lighter and less painful periods and help with premenstrual syndrome (PMS). It also can prevent ovarian cysts and in the long run may protect a female from ovarian cancer.

"Although many people may be concerned that taking the pill over a long period of time can cause breast cancer, this is not so. Taking the pill can slightly increase one's risk for breast cancer, but this possibility is slight. If a healthy woman, without other risk factors for breast cancer such as strong family history, takes the oral contraceptive pill, her risk of getting breast cancer is only slightly increased and is proportional to the length of time she takes it. After stopping the pill, her risk reduces over the next 10 years back to normal," she said.

According to the doctor, some breast cancers grow under the influence of estrogen, and people with a family history of that kind of cancer would be advised not to use that form of contraception. If breast cancer develops among those women, it is usually detected early, since it is recommended that they do regular breast exams and are monitored by their physicians every few months. She said that their recovery is usually better since studies show that the cancer is normally localized to the breast and responsive to regular chemotherapy treatments, she said.

Dr. Dupuch said it is for this reason that women on birth control pills are closely monitored and a thorough family history is done so the right kind of contraceptive pill can be recommended.

Another disadvantage to this type of contraception is that it can cause nausea, weight gain, breakthrough bleeding and headaches. It can also increase the risk of deep vein thrombosis (DVT) or stroke from five per 100,000 for the average woman not on contraceptive pills to 15 to 25 per 100,000 women a year. The chances for this happening increase even more if the woman is over 35, a smoker, obese or has a family history of the condition.

The other form of oral contraception is a progesterone only pill that differs from the previous type because it has to be taken every single day without any breaks. It is effective in preventing ovulation and some women don't even have a period while on it. An advantage is that it gives a woman a lower risk of developing DVT as it has no estrogen. It is usually used in older women, or those with higher chances of developing DVT and stroke. It is a more rigid contraceptive because most brands of the pill only have a four-hour window of error while the progesterone and estrogen combined oral contraceptive has a 12-hour window of error.

Long term methods
For women who don't want to have the daily responsibility, opting to have injectable contraceptives, hormonal implants or an intrauterine device (IUD) inserted by a physician are good options.

Some females choose to have a progesterone injection every 12 weeks (three months) that is effective for the period, along with other contraceptives to prevent STDs. This option while much more convenient, as a woman only has to think about it every three months has a downside in that it can cause irregular vaginal bleeding, weight gain, reduced libido and even promote depression.

If every three months is still too often to think about contraception, trying hormonal implants could be the best choice for the busy female. It's a method that must be administered in a doctor's office and is usually effective for five years. Much like oral contraceptives, it should prevent ovulation and even stop periods for the period of time it is in use.

Its cons are that it is difficult to remove if a female changes her mind about her contraceptive method, and the place where it is implanted can cause some discomfort for some people. Its failure rate is less than one percent according to Dr. Dupuch.

"Another good long term contraceptive choice is an IUD. It usually contains copper and is inserted into the uterus. It has a mechanism that causes an unfavorable environment in the uterus for an embryo trying to implant itself and it also provides a barrier to prevent implantation," she said. "It also works well because it thickens up cervical mucus making it difficult for sperm and egg to meet. Because it can make contraception worry free for five years due to it having a less than one percent failure rate it is still commonly used."

The disadvantage of this method is that it has to be inserted by a physician. It can also cause heavy bleeding and painful periods. If not inserted properly or if it shifts for some reason, it can perforate the uterus and go into the abdominal cavity, which can cause serious health risks. Also within the first few weeks of it being placed there is a possibility to develop a pelvic infection.

Some inserts use progesterone, which unlike the copper-based device can make periods lighter while also preventing ovulation. This method can even stop menstruation entirely for some women. The gynecologist said it is as effective as female sterilization, but is reversible. Once a female stops using it, fertility returns.

Other methods
For those women who want the benefits of an hormonal contraceptive but not have to worry about taking it orally daily, there is a vaginal hormonal ring which is inserted into the vagina for three weeks and removed for a week (to have a period) before another is inserted. It has similar risks to the oral contraceptive pill but its benefit is that one does not have to remember to take the pill everyday.

For some women who have already had all the children they want, or don't want any children at all, sterilization is a good option. This could mean getting an occlusion -- using a clip to cause obstruction in the fallopian tube stopping eggs from being released. Or one can have a tubal ligation in which a physician ties and cuts the fallopian tubes. Dr. Dupuch said this is a really good option as its failure rate is one in 250 women.

The disadvantage to tubal ligation are that it must be performed surgically, and is also permanent which means if a female changes her mind, there is no reversal in most cases.

According to Dr. Dupuch, no matter which option of contraception a woman chooses, it is essential that it is done consistently and that she is comfortable with it. She said contraception is a personal choice and if a woman is uncomfortable about it, she should see her physician for advice.

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