There are two methods by which abortion can be done:

Medical Abortion - Non-surgical abortion in which medicines are used to induce abortion

Surgical Abortion - Use of transcervical procedures for terminating a pregnancy, including vacuum aspiration, and dilatation and evacuation (D and E).

Surgical or Medical Abortion for Unwanted Pregnancy

If pregnancy is lesser than = 7 weeks; medical method with Mifepristone with Misoprostol is favorable as the success rate is as high as 97%.

If pregnancy is between 7-12 weeks; surgical abortion is the only option.

If pregnancy is beyond 12 weeks - 20 weeks, then the woman needs to be hospitalized and will be given either Mifepristone followed by Misoprostol tablet or only Misoprostol tablets and woman will then abort like a miscarriage in the hospital. If any products are remaining, then it will be evacuated surgically.

Surgical abortion is preferred if patient desires concurrent tubal ligation or IUCD (CuT) insertion.

If a woman fulfills the criteria for selecting either method i.e. before 7 weeks, final choice has to be given to the woman.

Summary of choice between Surgical or Medical abortion in India

lesser than = 7 weeks - Medical method or surgical method

7-12 weeks - Surgical abortion

12 - 20 weeks - Medicines with or without surgical procedure in hospital

Advantages of Medical Abortion

Avoid surgery

Controlled by the woman and may take place at home

No need for admission to the hospital

Usually, well tolerated by women, if properly counselled and motivated

No need to take leave from work, as bleeding can be managed with menstrual pads even while in the office or at work.

Disadvantages of medical abortion

Takes time (hours to days) to complete abortion, and the timing may not be predictable. Women experience bleeding and cramping, and potentially some other side-effects (nausea, vomiting, fever, and shivering). May require more clinic visits than surgical abortion.

Advantages of Surgical Abortion

Quick procedure

Complete abortion easily verified by evaluation of aspirated products of conception

Takes place in a hospital so Sterilization or placement of an intrauterine device (IUD) may be performed at the same time as the procedure. It can be performed under local anaesthesia if woman is properly motivated and counselled

Disadvantages of surgical abortion

Requires instrumentation of the uterus

Small risk of uterine or cervical injury

Timing of abortion controlled by the doctor and hospital

Anaesthesia needs to be administered. Most doctors perform this procedure under short general anaesthesia. A woman needs to be in the hospital for at least 6 hours. Effect of sedation will be there throughout the day.

Methods of Abortion for Unwanted Pregnancy

It is important that you protect yourself from various types of diseases and infections as much as possible. Female condoms are used to have protected intercourse so as to avoid contact with ejaculatory fluids. These condoms help a person to steer clear of blood, semen and vaginal fluids as well. Female condoms fall under the category of barrier contraceptives. They are considered to be less effective in comparison to male condoms, but are nonetheless good for preventing any kind of infection. Ensuring fine health through safe sex is your due responsibility. Hence, a little knowledge about these contraceptives is helpful if you wish to shun chances of unwanted pregnancy or Sexually Transmitted Diseases. 

What is it like?
A female condom looks like an ill  fitting hollow cylinder. It is a thin sheath with a closed end, that goes inside the vagina and an open end that remains outside the vagina covering other external, genital parts. The covered end has to be inserted into the vagina or into the anus. It is a misconception, that female condoms can only be used by females. It is predominantly used by females, but can also be used by any receptive partner during sexual intercourse. The ends have circular rings to keep the condom in place. 

What are they made of? 
Femidoms are usually made up of polyurethane. This material is expensive, making the product costly. The need for a cost effective product was immediately felt to encourage the use of condoms among females. Thus, the next generation of female condoms were made with synthetic Nitrile. Nitrile proved to be a competent substitute as it did away with the annoying noises polyurethane made during sex. It also reduced condom pricing considerably. Researchers have also come up with natural latex female condoms that retain the feel of a male condom. 

Benefits of using a female condom
It is a great barrier in thwarting the flow of semen into the womb. Thus, they reduce the risk of accidental pregnancy. It also protects you against sexually transmitted infections like gonorrhoea, Syphilis, and HIV. Sex partners should be careful to refrain from any sexual contact before the insertion of a female condom. Only after the condom has been placed properly, the penis should enter the vagina or the anus. Femidoms are available in varied sizes, but the average sized condom fits most females. Large sized condoms can be used by new mothers. It is advised to buy condoms that bear the CE mark on them. The CE mark represents European Safety Standards and thus, leaves you least vulnerable to accidents or diseases.

All About Female Condoms

Most medications are used because of their one particular therapeutic effect. However, invariably, they affect other organs or systems and produce some good and some adverse effects. The same happens with birth control pills (BCPs), which are the most commonly used method of contraception. It is also the most effective method. It contains the female hormones estrogen and progesterone in various combinations and these have an effect on various body functions, so it should come as a surprise that regular use of BCPs leads to a number of side effects.

Read on to know more

Intermenstrual bleeding: This is the most common side effect and occurs in about 90% of the women, but usually subsides within 3 months. They experience bleeding between their regular periods. While mere spotting can be ignored, bleeding for more than 4 to 5 days needs a visit to the doctor.
Missed period: It is very essential to take the pill at the same time daily. Sometimes, a period might be missed or may be very light and this should be reported.
Effect on libido: While some report a decrease in libido, there are others who experience an increased sex drive. This depends on the individual and not consistent.
Vaginal discharge: The amount and type of discharge can change when on the pill. Decreased lubrication may lead to a reduced sex drive, as it might be painful. If the discharge is foul-smelling or looks suspicious for an infection, then a doctor should be consulted.
Mood changes: Changes in mood and prominent mood swings are very common in women using contraceptives, with many feeling depressed often.
Effects on breasts: While it is not yet proven if they increase the risk of breast cancer, most women experience breast enlargement, tenderness, and sometimes pain. This is more common in between their periods.
Headaches and migraine: BCPs are also proven to have worsening effects on migraine and headaches.
Circulatory effects: Oral contraceptives increase the chances of heart attack and stroke, especially in women who are over 35 and are smokers. Most women experience a slight increase in blood pressure and are more prone to form blood clots. It is essential that contraceptives are used under medical guidance only.
Digestive effects: Oral contraceptives can cause loss of appetite, changes in body weight, diarrhea, and nausea. The weight gain is also attributed to increased fluid retention, especially in the hip and breast areas.
Skin: Some women may experience skin rashes and acne and sometimes hair loss due to the increased level of hormones in circulation.
It is very important that the pill is taken at the same time for best results. Any suspicious symptom should be immediately reported to the doctor.

10 Side Effects of Birth Control Pills

The contraceptive pill, or simply 'the pill', is a type of hormonal contraception taken by women to prevent pregnancy. Now, even though the birth control pill is extremely effective in preventing unplanned pregnancy, it is not without some side effects. The common side effects of birth control pill include:

1. Intermenstrual spotting: Some women experience intermenstrual spotting or bleeding in the time between their menstrual cycles. This is very common in the first three months of you taking the pill. Most of the times, intermenstrual bleeding resolves itself.

2. Nausea: Some women might experience mild nausea when they take the pill for the first time. The nausea will resolve on its own after some time, but if it gets critical or persists, seek medical help. Taking your pill at bedtime or with food can aid in countering the nausea.

3. Breast tenderness: Breasts can become tender or enlarge as a result of birth control pills. Reducing salt and caffeine intake, and wearing a support bra can be beneficial.

4. Headaches: The development of migraines and headaches are the effects of the sex hormones. Different pills with varied doses and types of hormones may lead to different symptoms of headaches. Studies suggest that pills with low hormone doses are usually linked with headaches.

5. Weight gain: There is no logical link between weight fluctuations and contraceptive pills, but fluid retention (specifically in the hip and breast areas) and enlarged fat cells are common side-effects.

6. Mood changes: Women who may have suffered from depression should consult their doctors when taking the pill. A study discovered that taking pills usually leads to the thickening of the cortexes (outermost layers of the brain involved with analysing incoming stimuli and reward response). However, there is more research pending on this issue.

7. Missed periods: Skipping or missing a period is very common when you are on the pill. Factors such as stress, travel, illness and thyroid or hormonal abnormalities can influence this.

8. Decreased libido: The pills contain hormones that can lower your sex drive or libido.

9. Vaginal discharge: Some women experience differences in their vaginal discharge when they are on the pill. Vaginal lubrication can dip, which causes discomfort during sex.

10. Visual changes: Fluid retention is a side-effect of the pill, which even ends up affecting the cornea; they change shape or swell up.

Birth Control Pills - 10 Common Side Effects!

With an upsurge in the number of women suffering from dysfunctional reproductive system and a myriad of gynecological problems, resulting in irregular periods, infertility and several other complications, it is of paramount importance to keep a record of the dates and duration of your monthly cycles. This is not only useful for future reference when you visit a gynecologist, but it also helps you to understand if there are any delays in your mensuration cycle or you are having excess bleeding in a particular month.

Why tracking your menstrual cycle is important?
Keeping a track of the menstrual cycles is a mandatory exercise for women who are thinking about pregnancy or those trying to avoid it. Based on you period calendar, you can avoid getting pregnant without opting for contraceptive methods, if you have extremely regular period patterns. It is advisable to abstain from intercourse for a few days before and after the period, which is the prime time for ovulation. Keeping a track of your periods will give you a clear indication as to whether you are pregnant, because delay in the menstrual onset can be an indication of pregnancy. The reverse is also true; if you are trying to get pregnant, conception is usually fruitful on these days of maximum ovulation, which you can easily calculate based on your well maintained menstrual record.

How should you go about keeping a track of your menstruation cycle?
While it not possible to note down every possible aspect of the menstruation in a notebook, the easiest way of maintaining a planner is to mark the first day of each period on the calendar. The difference between two consecutive periods will give you your cycle lengths. In addition you can choose to make a note of how heavy the bleeding is or if there are changes in mood and appetite on those days. You will then be well prepared for your next visit to the gynecologist.

How Tracking Your Menstrual Cycles Can Be Beneficial For Your Reproductive Health?

Emergency is helpful in preventing pregnancies post unprotected sexual activity. It can be used in case of contraceptive failure, in case of sexual assault, incorrect use of contraceptives and unprotected sex.

Emergency contraception can be done by three methods. These are emergency contraceptive pills, combined oral contraceptive pills and copper intrauterine devices.



The copper IUD is considered to be one of the most effective forms of emergency contraception, when it is inserted within 5 days of unprotected sexual activity.

However, the emergency contraceptive pill regimen as per WHO is:

1 dose of levonorgestrel 1.5 mg, or 1 dose of ulipristal 30 mg, taken within 5 days (120 hours) of unprotected intercourse

The Yuzpe regimen which consists of 2 doses of combined oral contraceptive pills

What is Emergency Contraception?

Emergency contraception is usually referred to as the contraception which is used to prevent a pregnancy within the first 5 days after an unprotected sexual activity. It is used post failures of contraception, coerced unprotected sex, rape or misuse of contraception.

Emergency contraception is only effective in the first few days after an intercourse and before the egg has released from the ovary, and before there is fertilization between the egg and the sperm. The emergency contraception can do no harm to an interrupted pregnancy and a developing embryo.

Who needs emergency contraception?

Any girl or woman who is at her reproductive age might need an emergency contraception in case of an unprotected sexual intercourse.

Uses
1 Breakage , slippage or displacement of barrier methods 
2. Three or more missed OCPills for more than 12 hours 
3. Missed Mini pill for more than 3 hours 
4. Missed Desoestrel pills for more than 12 hours 
5. DMPA injections taken more than 2 weeks late 
6. Miscalculated dates of last period and present ovulation side effects 
These are meant only for emergency contraception and NOT AS A REGULAR CONTRACEPTIVE. It involves pumping of a hormone inside your body at levels which are 5 times higher than normal. hence excessive and unnecessary use may cause irregularity in the period cycles and an adverse effect on the menstrual health over a period of time. Ideally it should be taken under guided medical supervision.


In what situations should emergency contraception be used?

Emergency contraception can be used after a sexual intercourse. These include:

In case of no use of contraceptives

If it is a case of rape or coerced sex, where the woman was not protected

When there is a contraceptive failure, like

breakage

incorrect use or slippage

OCPILLS,

mini pills

DMPA

3 or more missed combined oral contraceptives, progestogen-only pill (minipill) taken more than 3 hours late, desogestrel-containing pill 12 hours or more, norethisterone enanthate (NET-EN) progestogen-only injection taken more than 2 weeks late

Delay in placing or dislodgement or early removal of the skin patch or the hormonal ring

Breaking, dislodgement, tearing or early removal of cervical cap or diaphragm

Failure of withdrawal that is ejaculation the external genitalia or vagina

The spermicide tablet failure

Miscalculating the periods, failure from using a barrier on the fertile days

Expulsion of an intrauterine contraceptive device (IUD)

Methods of Emergency Contraception:

There are three emergency contraception methods:

Copper-bearing intrauterine devices (IUDs)

Emergency contraception pills (ECPs)

Combined oral contraceptive pills or the Yuzpe method



Safety of Emergency Contraception

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