Our expert, Paula J. Adams Hillard, M.D., is Professor of Obstetrics and Gynecology at Stanford University School of Medicine where she serves as Associate Chair for Medical Student Education.

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Mitzi Perdue

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REPRODUCTIVE HEALTH IMPACTS OTHER MEDICAL CONDITIONS

The menstrual cycle, contraception needs, and pregnancy will impact many health problems, and those problems in turn may affect contraception and health during pregnancy.  For example, women with uncontrolled hypertension shouldn’t use oral contraceptives, although they need an effective means of birth control, because uncontrolled hypertension can cause severe or even fatal problems during pregnancy (pre-eclampsia or eclampsia with seizures or stroke).   In cases where the impacts on the mother and or her fetus may be severe, it’s important to consider the effectiveness of the contraception she is using.

THE FAILURE RATE FOR CONDOMS IS HIGH

The typical failure rate when using condoms is 18%.  If there are 100 couples relying on condoms, 18 will be pregnant in the course of a year. If a woman has a medical condition that makes pregnancy risky, consider using a LARC method instead.

THE MOST EFFECTIVE CONTRACEPTION

Long Acting Reversible Contraception (LARC) is extraordinarily effective in preventing unintended pregnancy.  LARC methods such as the intrauterine devices (IUDs) and subdermal implants can last from three to ten years. They are as effective in preventing pregnancy as sterilization, with the difference that they are reversible. They also don’t involve the surgical risks involved in sterilization.

LARC METHODS ARE APPRORIATE ACROSS THE REPRODUCTIVE AGE SPECTRUM

We used to think that the IUD was recommended only after a woman had already had her first baby. That thinking no longer holds, and instead we recommend LARC for younger women as well. LARC methods are highly effective with relatively few contraindications and do not exacerbate other health conditions. Today, we see LARC methods as highly appropriate for teens as well as older women.

MINIMIZE DISCOMFORT WHEN INSERTING AN IUD

Inserting an IUD can cause cramping and pain, but there are effective ways of mitigating this.  Recommend that your patient take ibuprofen or naproxen an hour before the procedure. I routinely use a local anesthetic (paracervical nerve block) in the same way a dentist blocks nerve pain before filling a tooth.

IUDS ARE SAFER THAN THEY WERE IN THE 1960s

Intrauterine devices got a bad name in the 1960s and 1970s because users were at increased risk for pelvic infections.  A popular device at the time, the Dalkon Shield, had a multi-filament string attached that was used for removing the device.  Unfortunately, this multi-filament string meant an entryway for pathogens. Because of the increased risk of pelvic infection, IUDs became so unpopular that for a generation, most manufacturers ceased producing them.  However, the new IUDs no longer use the multi-filament string and users are no longer at increased risk of an ascending pelvic infection.

IUDS CAN HAVE MAJOR THERAPEUTIC BENEFITS 

Women who experience heavy bleeding or severe menstrual cramps often find their symptoms are alleviated when they use IUDs that include a synthetic form of the hormone progesterone. The effects can be so helpful that in many cases where a woman might have needed a hysterectomy to deal with her symptoms, an IUD with progestin can make the surgery unnecessary.

HORMONAL IUDS USE A TINY FRACTION OF THE HORMONES USED IN BIRTH CONTROL PILLS

IUDs deliver small amounts of birth control hormone to the target organ as opposed to having much larger amounts circulating in the blood stream.  This means fewer hormonal side effects.