How do I pick the right birth control?

When you encounter a woman at an outpatient department (OPD), you will hear them bemoaning the unexpected outcome of birth control pills/family planning methods.

The complaints can vary from “experiencing irregular menses” to “extended cessation of menses.” This translates to the fact that there is paucity of knowledge and correct understanding about the kind of contraception they opt for.

Navigating in the world of birth control and pregnancy prevention can be fairly a complicated affair, thus I have found that it is imperative and crucial that I write and talk about it so that my esteemed readers can be in the best position to make informed decision about sexual health and family planning but also to dispel rumours and conjecture.

We cannot disqualify family planning methods for the little side effects they have, instead we should glorify them for the great help they offer.

The most common question

Firstly, birth control stops from getting pregnant, other benefits of birth control methods depends on the particular type you use, which may include less frequent and lighter periods, reduction of premenstrual syndrome symptoms and incase of condom use, venereal diseases prevention.

I guess your learning curve is still good, thus I proceed with the most common question being asked by the couples, “What is the best birth control method doctor?”

Every woman, (I say woman because in our setting, men do not bother much about birth control) will need the most iron clad method to prevent pregnancy.

In finding which birth control is right for you, you will have to engross yourself in research since there are numerous birth control options.

Of course a doctor or a nursing officer will help you to opt for the best option for you, it must be well construed that individual circumstances may dictate the type of birth control that is suitable for them.

When I realised that picking the right method can be a challenge and a cumbersome task, I decided to design a special family planning method form, which I named it as an “FPM” form that is supposed to be filled in by any staff who would happen to attend a patient.

This would ease a healthcare practitioner to suggest the best birth control method suitable for a particular patient as per her individual circumstances. It will also enable the health care provider to state the reasons as to why he/she advised the client/patient to use a particular method.

In a nutshell, the birth control methods such as contraceptive pills, intrauterine device, male/female condoms, implant, will help you not to get pregnant except for condoms which can also prevent sexually transmitted diseases.

Worrying side effects of birth control

On several occasions I have been asked by my clients, “HiviDokta, njia za uzazi wa mpangozi naweza kukufanya uwe mgumba?’ (Do birth control methods cause infertility?)

In a quick rejoinder I respond, ‘no’, unless you consider sterilisation - one of the methods of birth control.

But none of the family planning method will permanently make you infertile, they are purely temporary and of course fertility should return after their use is stopped.

However, in the year 1970’s, there was a certain brand of intrauterine device that inadvertently caused infection and infertility but nowadays it is no longer available.

A fortnight ago I cracked a joke to a woman who looked obese at the OPD, “Are you pregnant, I can see your big belly.”

She initially grinned at me and then later on she responded , “ I’m not but I guess it might be because of the injections I’m using for birth control.” She was right to think so since birth control shots can cause weight gain in some women.

A look at some of the methods

Choosing which method is appropriate for you is not an absolute doddle.

All you have to do is to tell your health care provider all your important information such as if you are hypertensive, your age, your menstrual history, whether you are breastfeeding or not, if you are taking any sort of antibiotics currently, if you are already pregnant etc.

For example, for those who are breastfeeding, combined oral contraceptives are contraindicated since they may impair milk production whereas the use of injectable may cause delayed return of fertility, persistent irregular bleeding, and weight gain and they are also contraindicated in liver, arterial and bone diseases.

Furthermore, minipills have fewer side effects than combined pills and they can be taken at any age, unlike the combined pills which is generally phased out after the age of 35.

Minipills can also be taken by breastfeeding mothers, it rarely raises blood pressure.

Moreover, intrauterine devices are contraindicated in patients with mechanical heart valves and in those with previous history of ectopic pregnancy and in those with undiagnosed irregular vaginal bleeding.

Though the good thing with it is that it provides long term efficiency, it can be effective for 5 years and it can be removed at any time when pregnancy is desired.

Implants can be replaced after 3 years, it can be used in breastfeeding mothers, however, on the contrary there can be irregular bleeding in the first year which then settles.

The author is a medical doctor, public health activist, a scientist and a researcher.