What are the disadvantages of DMPA as a method of contraception? Expand DMPA changes bleeding/period patterns. These changes are a result of the hormonal effect to the lining of the uterus. It is not possible to predict which changes will occur, but they can include: During the first months of use, episodes of irregular bleeding and spotting lasting seven days or longer are common. The frequency and duration of such bleeding decrease with increasing duration of use. After one year of use, 50 percent of women have no periods and with ongoing use, this rate of amenorrhea (no periods) increases to 70 percent. Or irregular bleeding or spotting Sometimes, prolonged bleeding (this is usually light, but can be inconvenient for some women) Heavy bleeding (rare) Fertility - possible delay in return to fertility; on average, the delay is about 9 months from the last DMPA injection. Return of fertility may be delayed after discontinuing DMPA. the average time to return to a previous menstrual pattern is 8 months after last DMPA. Within 12 months 78 percent of women who are trying to conceive will become pregnant. In a small proportion of women, fertility is not reestablished until 18 months after the last injection.
Other benefits of DMPA Expand Women with heavier periods are likely to have no periods or lighter bleeding Women with period pain will have less or no pain - useful for endometriosis or premenstrual syndrome (PMS) Reduces the chance of anaemia caused by heavy periods Reduces the risk of cancer of the uterus
What are the possible side effects of DMPA? Expand DMPA has few side effects. However, side effects may include: Small weight gain in some women Headaches Acne Change in sexual interest Mood changes The injection is long acting and if side effects occur they may last up to 3 months (it is not possible to reverse the effects of an injection once it is given). Some side effects (especially bleeding changes) may persist beyond 3 months although there are a number of treatment options available with varying success that may help reduce bleeding problems if they occur.
What are the possible risks associated with DMPA? Expand DMPA use is associated with a slight loss of bone density while using the method. Continuing research studies currently suggest: This loss is largely reversible once DMPA use finishes Diet and exercise are other important influences on bone mass in young women There is limited evidence of an increase in fracture risk in women who use DMPA
How to start using DMPA Expand Starting DMPA for the first time requires an assessment by a doctor and a prescription. This assessment enables you to ask any questions you may have and to be certain that it is the most suitable method for you. The first injection of DMPA is usually given during the first five days of a period. In some cases condoms will need to be used for seven days after the first injection. It is very important that there is no chance of an early pregnancy at the time of injection as this may lead to a delay in the diagnosis of a pregnancy.
What do I need to know about the ongoing use of DMPA? Expand Follow up DMPA injections are given every 12 weeks to continue protection against pregnancy. If you go beyond 12 weeks from your last injection you may be at risk of pregnancy. If you aren't certain what to do, seek further advice as soon as possible, particularly if you think you may need Emergency Contraception. To renew your DMPA prescription you will need to see a doctor for review once a year. A review of risks for loss of bone density (osteoporosis) will take place at this visit.
What is an IUD? Expand An intrauterine contraceptive device (IUD) is one of the long acting reversible contraceptive methods (LARCs). It is a small device which is fitted inside the uterus, where it can remain for lengthy periods to prevent pregnancy. Copper IUDs are made of plastic and copper. There are 2 types of copper IUDs currently available in Australia. Once inserted, they are not felt by the woman or her partner. All IUDs available in Australia have fine nylon threads attached to the lower end of them so that when fitted, the threads extend through the cervix (neck of the womb) into the upper vagina. These threads allow the woman to check that the IUD is still in place and allow for easy removal by a doctor.
How do IUDs work? Expand IUDs work by: changing the lining of the uterus making it unsuitable for a pregnancy thickening the mucus of the cervix, preventing sperm entering the uterus
How effective is an IUD? Expand The copper IUD is at least 99% effective. This means that, on average, if 100 women use an IUD for 1 year, it is possible that 1 of them could become pregnant.
What are the advantages of using an IUD as a method of contraception? Expand long acting: 5-10 years depending on type reversible with rapid return to usual fertility when removed – within a month of removal highly effective: the most reliable form of contraception apart from permanent sterilisation relatively inexpensive – initially upfront cost. Over 5 years this is the most cost-effective form of contraception Copper IUD offers a non-hormonal option
What are the disadvantages of using an IUD as a method of contraception? Expand insertion and removal of the device can only be performed by a trained doctor insertion into the uterus requires a procedure which some women may find quite uncomfortable possible changes in periods/bleeding patterns: initial light bleeding or spotting while the device settles in place, expect normal or heavier periods does not protect against sexually transmissible infections, so continue to use condoms for this
What are the possible risks of using an IUD? Expand Abdominal pain - Following insertion, some women notice abdominal cramping pain mostly for a day or two – occasionally longer. Perforation - This is a rare but serious complication where the IUD device passes through the wall of the uterus into the pelvic area, usually at the time of, or shortly after, insertion. This may occur in about 1 per 400 insertions. This requires surgery under a general anaesthetic to remove the IUD. Some studies have found that women who have recently given birth may have an increased risk of this complication, however all women may be at risk of this rare event occurring. Expulsion - Sometimes the IUD device may be partially or completely pushed out of the uterus. It occurs in about 5 per 100 insertions and is most common in the months following insertion. It is important to regularly check for the threads, to detect if this has occurred, as the IUD won't work effectively if not fully within the uterus. Pelvic inflammatory disease (PID) - This is a rare complication of IUD insertion, most likely to occur in the first few weeks following the insertion procedure from an existing infection. It occurs in less than 1 per 300 insertions. PID may in some cases lead to infertility. Possible risks associated with ongoing use of an IUD: Miscarriage - If a pregnancy occurs in the uterus there is an increased risk of miscarriage. If the IUD is then left in place, there is an increased risk of miscarriage with infection in later stages of pregnancy or premature birth. Ectopic pregnancy - If a pregnancy does occur with an IUD in place there is a small chance the pregnancy will develop in the Fallopian tube. However, because the IUD prevents most pregnancies, it is an uncommon complication and less common than amongst women who are not using any contraception. Ectopic pregnancy is a serious condition and often requires surgical management. To reduce complications, in the rare event of a pregnancy occurring with an IUD in place, it is important to see a doctor as soon as possible if you have any reason to suspect you are pregnant, eg, if there is a change in your usual bleeding pattern; if a period is missed; is lighter than usual or you have unusual abdominal or pelvic pain.
Is an IUD suitable for all women? Expand Most women can safely use an IUD. Your doctor will review the suitability of the method with you prior to insertion. In assessing your suitability, consideration is given to a number of important factors: current menstrual and bleeding patterns unexplained vaginal bleeding (this should be investigated before using an IUD) a recent history of a sexually transmitted infection or PID uterine or cervical abnormalities any history of breast, cervical or uterine cancer pregnancy history cervical screening history any allergies including copper allergy the timing of insertion and pain relief needs for the insertion procedure
What do I need to know about having an IUD insertion? Expand Prior to insertion, an assessment of your medical history and suitability for this method will happen. This assessment enables you to ask any questions you may have and be certain that it is the most suitable method for you. Insertion of an IUD involves a procedure. Some women find insertion uncomfortable. This can be managed with the use of local anaesthetic into the cervix. If there are reasons to anticipate difficulties then a woman may choose or be advised to have a sedative or general anaesthetic. The device should be inserted by a medical practitioner trained in the procedure.
What do I need to know about the ongoing use of an IUD? Expand You will be given details of follow up at the time of the insertion. Generally, you are asked to attend for a follow up visit after insertion and/or any time concerns exist. You should contact your doctor if: if you miss a period or you feel you may be pregnant you experience pelvic pain or tenderness, fever or chills, offensive discharge or deep pain with intercourse you cannot feel the string or feel the string has lengthened you (or your partner) can feel the hard stem of the IUD The IUD needs to be replaced with a new device every 5 or 10 years depending on which device is inserted. However, if you have a copper IUD inserted after the age of 40, this expiry date can often be extended and the same device left in for a longer period of time. This is because you have a lower risk of falling pregnant in your late 40s and 50s. Please discuss further with your medical practitioner. It is important to keep a record of the date that replacement is due or remember a landmark event to arrange for replacement no later than this date. The IUD can easily be removed at any time. As fertility can return immediately after removal, it is important to consider alternative methods of contraception, before the IUD is removed, if trying to avoid pregnancy.
Can the IUD be used as emergency contraception? Expand In some circumstances a copper IUD can be inserted up to 5 days after unprotected sex to prevent pregnancy occurring. It can be left in place to provide ongoing contraception or removed after a normal period.
What is the Pill? Expand The Pill contains low doses of 2 hormones – an oestrogen and a progestogen. These are similar to the hormones naturally produced in the female body. There are many combined pills available. They differ in the type and dose of the 2 hormones they contain.
Laparoscopic sterilisation Expand This is a common method of female sterilisation and is usually done under general anaesthetic. Two or three very small cuts are made in the abdomen. The abdomen is filled with a carbon dioxide gas, which allows the organs inside to be seen clearly. A laparoscope (medical telescope) is inserted through one small opening to locate the Fallopian tubes. The tubes are then blocked by heat sealing, clips, clamps or rings.
Mini-laparotomy Expand The mini-laparotomy, also performed with a general anaesthetic, involves a small cut in the lower abdomen, giving access to the Fallopian tubes. Heat sealing, clips, clamps or rings are used to block the tubes.
Hysteroscopic sterilisation Expand The Essure TM method of permanent birth control uses very small coils, which are inserted through the cervix and uterus into the fallopian tubes. After the coils are placed, scar tissue develops around them, causing the tubes to become sealed shut. This process happens gradually over time, and the woman must therefore use another form of birth control for three months after the coils are placed. At this time, an x-ray test called a hysterosalpingogram (HSG) is performed to confirm that the tubes are blocked. Hysteroscopic sterilisation costs less, allows the woman to spend less time in the hospital, is well tolerated, and causes less severe post-operative pain. The disadvantages of hysteroscopic sterilisation include: the possibility that the coils cannot be successfully placed in both tubes (<2 percent) the need for another method of birth control for three months after the coils are placed the need for a test to confirm that the procedure has been successful the some women may report persistent pelvic pain the spotting from 2 weeks to 6 months while the IUD settles in. a follow-up visit will be made for 3-4 weeks to check on the placement and the bleeding pattern.
How effective is female sterilisation? Expand These methods of female sterilisation are 99.5% effective as a form of contraception, starting immediately after the operation. This means that, on average, of 1000 women who have been sterilised, 2-5 of them may become pregnant at some time in the future.
How does the Pill work? Expand It works by: preventing ovulation (egg release from the ovary) thickening the mucous in the cervix to prevent the sperm entering the uterus (womb) thinning the lining in the uterus, making it unsuitable for pregnancy
What are the advantages of female sterilisation? Expand A highly effective method of contraception Effective immediately Does not interfere with sexual function Long-term complications are rare
Emergency Contraception Expand Emergency contraception can be used as a backup and is not intended as a primary contraceptive method. All people in a new relationship should use condoms to prevent STIs and also be advised about emergency contraception. Emergency contraception pills can be used up to 96 hours after unprotected sex and can be obtained without a prescription at pharmacies. The copper IUD can also be used as emergency contraception and can be used up to 120 hours after unprotected sex. An IUD needs to be inserted by a doctor. It is essential to have a follow-up check after 3 weeks to exclude a pregnancy and arrange ongoing contraception. This method is used when: no contraception was used during sex a women has forgotten to take her contraceptive pills a condom slipped off or broke during sex a female has been sexually assaulted