Best contraceptive methods for birth control

There are different contraceptive methods used that help women avoid unwanted pregnancies.Since there is no ideal contraceptive that's safe and acceptable to all so any method can be chosen from the birth control options according to the needs and suitability.All the contraceptive methods work to stop pregnancy either by preventing ovulation or stop sperm from fertilizing an ovum or prevent the implantation of a fertilized ovum in the uterus.All contraceptive methods can be grouped in to two classes.

1. Spacing Methods

2. Terminal Methods

Spacing method include Barrier methods , IUDS, Hormonal methods &Post conceptional methods.

Barrier methods:

Barrier methods include physical methods,chemical methods and combined methods. One big advantage of this method is that it has no side effects and is suitable for both men and women and at the same time provides protection from STDs,reduces the incidence of pelvic inflammatory disease(PID) & risk of cervical cancer.For adolescents(15-19 year period) cervical caps and diaphrams are difficult to handle.

Physical methods:

Condom is the widely used and highly effective method of contraception that is safe , inexpensive, easy to use, has no side effect and don't require medical supervision.However,it must be used in a correct way to avoid slipping off or tearing during coitus. The correct way is to fit it on the erect penis, expell the air from the rear end to make room for the ejaculate and hold carefully while withdrawing from vagina to avoid spilling semen after intercourse.If the condom is used in conjunction with a spermicidial jelly, its even more effective.

Female condom is a sheath made of polyurethane,its similar to,but is larger than male condom .A spermicide need not to be used as its already lubricated with silicon. The internal ring of the sheath covers the cervix while external ring remain soutside of vagina.Otherr female barrier methods include: diaphram,contraceptive sponge.Cervical caps and diaphragms are difficult to handle for adolesencts than condoms.

Diaphram also known as dutch cap looks like a shallow cap(5 -10cm in diameter) made of synthetic rubber or other material with a flexible ring of metal or spring.There are no risks involved in using diaphragm.However, it must be used with a spermicide,must be of proper size to avoid the slip down of the rim,remain in place for not less than 6 hours after sexual intercourse.If its left for an extended period of time it may cause toxic shock syndrome.

Vaginal sponge is a disposable,circular polyurethane foam sponge measuring 5 cm×2.5cm impregnated with spermicide which is left in place for at least 6 hours after intercourse.Its less effective than diaphram .

 It is the best method of spacing between one child and another.Synthetic progestogen drugs are often combined with synthetic oestrogen to prevent pregnancy.Oral contraceptive of a combined type has 100% results.Hormonal contraceptives suppress ovulation, make cervical mucus thick & impenetrable to sperm & thin the endomatrium wall to reduce the chance of implantation of the fertilized egg in the uterus.

Contraceptive pills should be used only by younger women,women over 35 years should use other form of contraceptive while beyond 40 years the pills is not prescribed by doctors to avoid cardiovascular complications.It's very useful for adolescents if they don't have cardiovascular diseases.

Synthetic oestrogen:

Two synthetic oestrogen ethinyl oestradiol and mestranol are used in oral conraceptives.Mestranol has its effects when converted into ethinyl oestradiol in the liver .

Synthetic progestogen :

Pregnanes, oestranes,gonanes are the 3 groups of synthetic progestogen.Pregnanes are not recommended now .Some women have better acceptability for oestranes than gonanes.

The bet known form of hormonal contraceptive is the contraceptive pill.Pills are generally preferred but trimestral are monthly injections are also suitable.lmplants are also useful to cover a five year long period. The hormone can also be given as contraceptive implants under the skin ,in the form of injection or released by IUDS.

Classification:

(A)Oral pill

(1) combined pill (2) progestogen only pill, POP

(3)Post coital pill (4)once a month long acting pill

(B)Slow release formulations.

Injectables,Subcutaneous implants , Vaginal rings

Combined pills contains both oestrogen and progetogen in a given ratio.The pill is taken orally for 21 days consecutively preferablly before going to bed at night on the fifth day of menstrul cycle followed by a break of seven days during which period menstrual cycle occurs.When the bleeding occurs this is considerd the first day of the next cycle .

PCP also known as 'minipill or micropill' showed high rates of pregnency among users.So PCP is not considerd a good choice now.They may be used by older women when the combined pill is contraindicated becauce of cardiovascular diseases & in young women with risk factors of neoplasia. PCP contains only progestogen and it's is given in small doses througout the cycle.

Postcoital contraception or morning after pill is recommend with in 48 hours of an unprotected intercourse. Two available methods are inserting IUDS (especially Cu decice) if acceptable OR hormonal methods which are the most preferred at the time.The method is to take a double dose of standard combined pill usually a day i.e two pills immediately followed by another two pills 12hrs later.

Postcoital method is an emergency method.For emergency contaception a woman must take four pills.

There are two methods to deal with an emergency case.Hormonal method and physical method. In the hormonal method oral contraceptive is taken in high dose as soon as possible but no longer than 72 hours after unprotected intercourse with a second dose taken 12 hours later . They may be given as high dose progeterone- only pill or as a high dose combined pill.

Physical method:In the physical method IUD is inserted by the doctor within 5 days of unprotected sex.

B:Slow releasing formulations work for several months or years to control pregnancy and is a reversible process.Injectables,Subdermal implants and Vaginal spong are the slow releasing formulations.

Injectable contraceptives are of two types. Progestogen only injectables and combined injectables.Two hormonal contraceptive based on progestogen are used that are DMPA(Depot-medroxy progesterone acetate) and NEt-EN (norethisterm emenate),that primarly exert effects by spresing ovulation.Both DMPAand NET-EN give by deep intramuscular injecton into the gluteus maximum in a dose 150 mg every three month 200 mg every 60 days respectively.The initial injection of both should be given during the first five days of menstrual cycle.DMPA is more effective in preventing unwanted pregnency.DMPA is effective for three months in 99% women however the adverse effect is that it may reduce fertility among women.

Combined injectable contraceptive are given at monthly interval plus or minus three days. They contain a progestogen and oestrogen .

Sub dermal implants:They are silastic capsules or rods implanted beneath the skin of forearm or upperarm which are effective for 5 year.Its also a reversible way of contraception.Two well known developed implants are norplant and norplant(R)-2, which contain levongesterol in six capsules and two rods respectively.

IUDS are threoratically less effective than pill or injection .But they cover a long period to prevent pregnency.IUDs are made of polyethylene.Insertion of an IUD is a simple procedure that takes few minutes & requires no hospitalization . The major side effect in women fitted with an IUD is increased vaginal bleeding and pain. Other possible complication can be pelvic inflammatory disease,uterine perforation,expulsion of IUD through the cervix and ectopic pregnency.Types:

Two main types are medicated(bioactive IUDS) and nonmedicated IUDs.(inert iUDS).

Medicated IUDs release copper (metal ions) or progestogen hormone.

Non medicated IUDs are often referred to as 1st generation IUDs.Copper IUDs are called 2nd generation IUDs.Hormone releasing IUDs are also called 3rd generation IUDs.

Post conceptional methods (Termination of pregnancy):

Three differnt methods used to terminate the pregnancy are:

Menstrual regulation: Loosely called very early abortion is a simple procedure done before the pregnency test can even determine pregnency at 6 to 14 days of a missed period where contents of uterine are aspirated.Complications can be utrine perforation,menstrual disorder & infertility.

Menstural induction:Prostglanding F2 is applied intrauterinaly to disturb the normal progesterone -prostalglandin balance that causes contraction of uterus, bleeding starts and remains continuous for 7 to 8 days.

Abortion: is another method of birth control and to terminate pregnancy Abortion can be spontaneous or of Induced type.Abortion is generally considerd termination of pregnancy at 28 weeks of gestation when the fetus normally weighs 1000 g .Studies show that the optimal time of termination of pregnency is 7 th and 8th week of gestation.

It's a good contraceptive procedure for those couples who want no more children.Both men and women get sterilizations.The number of women getting sterilized is more than male sterlizations.But the fact is male sterilization is a simpler,safer and cheaper process.Also, the risk of complications are smaller. Male sterilization or vasectomy is performed under local anesthetics.Vasectomies are 100% safe,if care is taken perfoming the operation.

Male sterilization: First of all vas is identified in the spermatic cord.Once it has been identified,its removed atleast 6cm after clamping.The ends are ligated,folded back and sutured so that the cut ends may not recanalize in the future.The stitches are removed on the 5th day of operation.There are between 0-6% chances of recanalization of vas cut ends, a follow up for three years is a good choice to minimize the possibility of re-fertility.

Complications:They are very few suchas pain,scrotal haemotoma,spontaneous recanalization of vas after operation.Another complication is appearance of sperm granules at 10-14days after operation.Sperm granules are hard masses approx. 7mm in size,caused by acculumation of sperm.

How to take care after vasectomy?

The male becomes sterile after 30 ejaculations have occured after the vasectomy not as soon as the operation is over. All vasectomy acceptors must avoid bath for 24hrs after operation. A vasectomy acceptor doesn't need bed rest after the operation but must avoid cycling or lifting heavy weight for the first 15days of operation and wear a T-bandage or scrotal support in this period. Keep the site clean and dry for 15days.

Female sterilization:is less cost effective,it generally costs 5times more than vasectomy.There are two well known techniques to carry out female sterilization namely laparascopy and minilap operation. Laparoscopy:It's a short time operation where the patient is required to stay for a minimum 48hrs stay in hospital after operation.Patient is selected before the operation,if suitable for laparoscopy.During the operation an instrument called laparoscope is inserted into the abdominal cavity and the abdomen is inflated with air to see the fallopian tubes.The tubes are occluded with the help of fallopian rings or clips. Minilap operation:is a safe and simple procedure and is suitable for post partum patients.The operation is a modification of abdominal tubectomy.A small abdominal incision 2.5-3cm is given under local anesthesia.

Complications:Complications are usually uncommon,but they might be of serious nature if occur like puncture of large blood vessels.

 Abstinence,Coitus interruptus,Safe period or rhythm period,Natural family planning methods,Breast feeding and Birth control vaccine.