10 December 2010
By Umesh Isalkar
Pune, India
Injectable Contraceptive Gains Acceptance; Medicos Ask Women to Weigh Risks
After a medical check–up, a doctor administers the pregnancy–preventing hormones every three months.The first shot must be given within five days after the start of menstruation, and the medication is effective immediately.
"More women in the city have begun using the injectable contraceptive (IC) in the last two–three years. We see nearly 40 to 50 women who seek contraception advice every month. At least 20 per cent prefer the shot that should be taken every three months," said well–known gynaecologist Sunita Tandulwadkar.
The IC, say medial experts, which came to India only recently, is effective. It results in long–term pregnancy protection and the method is flexible. Women can stop the injections and chose pregnancy after the effect wears down, said Tandulwadkar.
Senior gynaecologist Sanjeev Khurd, expresident of the Pune Obsterics and Gynaecology Society of India (POGSI) said, "There has been a steady acceptance of injectable contraceptives in cities like Mumbai and Pune over the last few years.
As it is just a one–dose injection which lasts for three months, many married working women and newly married ones are opting for it."
"The IC does not affect the woman’s sex drive and she need not worry about unwanted pregnancy. Lactating women can continue with ICs six weeks after childbirth. It does not obstruct breast–feeding," he added.
But experts have warned of side effects. Women may experience nausea, weight gain, irritability, depression, and mid–cycle bleeding. They can also experience a loss of bone density, increasing the possibility of bone fractures and some may take a longer time to return to fertility.
The best way is to talk about these side effects to the doctor when deciding to use this method. A senior gynaecologist said that womenfolk should weigh the benefits and risk ratio first.
"Like every drug, ICs have side effects. But women are choosing it with the help of healthcare professionals who must tell them about benefits and risks," he said. "Some women do not take the subsequent injection on the exact date, which may lead to failure of contraception," Tandulwadkar added.
Khurd warned women about breakthrough bleeding. "Although uncommon, it is an irritating side effect of injectable contraceptives. Bleeding occurs unexpectedly causing unnecessary anxiety and irritation. It happens because of breaking down of endomertium (the lining of the uterine cavity) because of the changing hormonal levels in the blood. In such cases, the woman should consult her gynaecologist immediately," said Khurd.
Tandulwadkar said medical consultation and examination was necessary. "When a hormonal contraceptive has to be prescribed, a gynaecologist takes the detailed history of the woman. Her period, earlier child births, history of diabetes, blood pressure, liver disease, blood clotting disorder, family history of cancer and so on.
An examination that takes into account blood pressure, body weight, breast and uterus examination, and ovaries is also carried out. It basically rules out any disease which IC can worsen. Most importantly, the woman should not be pregnant," she said.
A new study at the world Congress on osteoporosis in Florence, Italy recently showed that injectable contraceptive is associated with higher risk of bone fracture when used alone, and not in combination with estrogen.
"To avoid osteoporosis, we administer the IC along with calcium preparations and phytoestrogen (dietary component of estrogen). Women are also advised to take a soya–rich diet which has a low dose of estrogen. A bone scan is conducted after a year of use of IC to rule out any osteoporosis development," Tandulwadkar said.
Some women hesitate to take IC when they learn that they won’t have a period as long as they are taking the shots. "It scares many women away. But others in the perimenopausal age accept them since they reduce blood loss and do away with the period," she said.
The intrauterine contraceptive devices (IUDs) which can be used after the birth of a child, were safe and better than the pill or injections, said Tandulwadkar. "The advantage is that fertility is reversible immediately if the IUDs are removed. Hormonal pills and injections take longer," she added.
Experts’ Opinion
More women in the city have begun using the injectable contraceptive (IC) in the last two–three years. We see nearly 40 to 50 women who seek contraception advice every month. At least 20 per cent prefer the shot that should be taken every three months
Sunita Tandulwadkar | GYNAECOLOGIST
There has been a steady acceptance of injectable contraceptives in cities like Mumbai and Pune over the last few years. As it is just a one–dose injection which lasts for three months, many married working women and newly married ones are opting for it
Sanjeev Khurd | GYNAECOLOGIST
Thorough Check
When a hormonal contraceptive has to be prescribed, a gynaecologist takes the detailed history of the woman. Her period, earlier child births, history of diabetes, blood pressure, liver disease, blood clotting disorder, family history of cancer and so on. A detailed examination that takes into account blood pressure, body weight, breast and uterus examination, and ovaries is also carried out. It basically rules out any disease which IC can worsen. Most importantly, the women should not be pregnant
In Favour
- Injectable contraceptives are convenient to use
- They reduce menstrual flow and prevents anaemia
- Suitable for lactating women * Best for sickle cell anaemia as it prevents sickling
- Injectable hormonal may cause breakthrough bleeding.
- There may tenderness of breasts and vaginal discharge
- May cause headache and migraine
- May cause weight gain, water retention (SOURCE: DEPARTMENT OF GYNAECOLOGY, RUBY HALL CLINIC, PUNE)
- Male and female condom
- Birth control pills
- Injectable
- Hormonal rings like NuvaRing and vaginal ring
- Female (tubal ligation)
- Male (vasectomy)
- (I–pill/ Unwanted–72)
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