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

Contraceptives are generally drugs and devices, which are used to prevent pregnancy. A large number of contraceptives are available which allow the couple to enjoy sex without running the risk of unwanted pregnancies. The general categories of contraceptives are explained below:

Barrier Methods:
i. Male Condom: It is one of the most common forms of contraception. They are worn on the penis before sex is initiated. For safety purpose, a new condom should be used every time the person has sex.

ii. Female Condom: Much like male condoms, these are available at over-the-counter pharmacies without prescription. The condoms can be inserted to the vagina anytime within a period of 8 hours prior to sex.

iii. Diaphragm: This should be coated with a spermicide before sex and placed inside a woman's vagina so that the sperms are prevented from entering the uterus.

iv. Cervical Cap: These are used as replacements for diaphragms because some women may develop bladder infections such as cystitis while using it and these caps have lesser contact with the vagina.

Hormonal Methods:
The main implementation of hormonal changes to provide contraception is the pill. This is the most common form of female contraception available. It comes in two forms:
i. Combined contraceptive pill: Contains a combination of hormones such as progestin and oestrogen.
ii. Mini-pill: Contains only progestin: It is available only with the prescription of the doctor and should be used as per the prescription.

Intrauterine Devices
The intrauterine device (IUD) is a long-acting and reversible form of contraception for women. It is of two types: Copper IUD (contains copper) and Hormone-releasing IUDs (progestin hormone is released into the womb slowly). It is a small device that is fitted inside the womb and it provides contraception by facilitating the prevention of fertilization of the egg.

Sterilization
This is a lifelong option that is available for both men and women. In males, the procedure is known as vasectomy which basically ties and cuts off the tubes that carry the sperm.

In women, two forms of sterilization are available; surgical and non-surgical. Surgically, the fallopian tubes are cut and tied using small cuts in the belly so that the ovaries and uterus are not linked. Non-surgically, coils are inserted into the fallopian tubes so the resultant development of scars leads to complete blockage of the tubes.

Other forms of contraceptives include contraceptive patches, vaginal rings, contraceptive injections, spermicides and contraceptive implants.

Different Types of Contraceptives and Its Uses

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

Using contraceptive methods is the easiest method for a couple to avoid pregnancy and enjoy a tension free physical relationship. People have used birth control methods for thousands of years. Today, we have many safe and effective birth control methods available to us.

All of us who need birth control want to find the method that is best for us. If you're trying to choose, learning about each method may help you make your decision. Only you can decide what is best for you. Some contraceptives, such as condoms, will also protect a person from sexually transmitted diseases (STDs).

The methods can be categorised into temporary and permanent methods.

Temporary methods:
1. Withdrawal method: This involves removing the penis from the vagina before ejaculating. Ejaculation should be away from the introitus. However it requires extreme self-control on the part of your man.

2. Barrier methods: These methods prevent sperm from entering the uterus. Barrier methods are removable. Types of barrier methods include:

a. Condom: This is the oldest barrier method. A condom is a thin tube that the man puts over his penis. This keeps the sperm from getting to the egg. Condoms are also called rubbers.
b. Female condom: This is like a condom, but it goes in the woman's vagina.
c. Diaphragm and cervical cap: These are put in the woman's vagina to cover the cervix
d. Contraceptive sponge: This is a sponge that is filled with spermicide and is put in the woman's vagina over the cervix.
Barrier methods can be easy to use and have few side effects.

3. Hormonal methods: These can only be used by women. Hormonal methods cause changes in the woman's reproductive cycle and include Birth Control Pills, Birth Control Patches, Emergency contraception pill, Implants and so on. Unlike barrier methods, hormonal methods do not interfere with sex.

4. Intrauterine methods: In this method an object called an intrauterine device or IUD is put in the woman's uterus. There are two types of IUD: the copper IUD or an IUD with hormones implanted on it. The hormonal IUD has better protection against pregnancy but costs more. You need not do anything once it is inserted. Also it is effective for up to 10 years.

Permanent methods

Of course, the permanent methods are more effective for preventing pregnancy than the temporary methods. The decision to proceed with a permanent method should only be made if a person is absolutely sure that no more children are desired. The biggest problems after a permanent procedure is regret that it was done.

1. Sterilization: Sterilization is a permanent form of birth control that prevents a woman from getting pregnant. These procedures usually are not reversible.

a. A sterilization implant is a non surgical method for permanently blocking the fallopian tubes. The doctor places a coil in each Fallopian tube through the vagina and uterus block each tube completely. It may take up to 3 months to completely block the tubesb. 

b.Tubal ligation is a surgical procedure in which a doctor cuts the fallopian tubes. This procedure blocks the path between the ovaries and the uterus. The sperm cannot reach the egg to fertilize it and the egg cannot reach the uterus.

c. Vasectomy is a surgical procedure that consists in cutting the tubes that carry sperm. This procedure blocks the path between the testes and the urethra due to which the sperm cannot leave the testes and hence cannot reach the egg. It can take as long as 3 months for the procedure to be fully effective.

Temporary & Permanent Contraceptive Methods For Male & Females

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

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

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