By Dr. Anne Lord-Tomas,OB/Gyn
Why is it important to discuss more convenient contraceptive options? It is truly important because many patients don’t realize that roughly 50% of pregnancies in this country are unintended. Many times this percentage is even higher, including both spectrums of the age range from 18-50. The reasons for this unacceptably high percentage are typically twofold. First of course is the lack of accessibility to health care providers for some women, and secondly, is the lack of compliance for many women with their current method. Who among us has not forgotten our pill at some point in the past or present, or failed to properly renew our monthly Rx? Unfortunately, many women spanning a large age bracket are not educated about their options for more user-friendly contraceptives, which are both safe and effective. The OCP (oral contraceptive pill) has long been an easy start/stop contraceptive for many patients and physicians alike. It still is certainly an acceptable option, but what else is there? Depending on one’s plans for future child-bearing – ie, when and if you plan on future children – Long Acting Reversible Contraceptives (LARC) and even Permanent Contraception are viable options.
Nationwide, LARC’s would include IUDs (Intrauterine Contraceptive Devices) or the Intradermal Implant (Implanon/Nexplanon). IUD’s are typically of two varieties: Mirena, a FIVE year progesterone-containing IUD, or Paraguard, the TEN year non-hormonal copper IUD. The Implanon/Nexplanon progesterone-containing device lasts THREE years. These are excellent options for female patients from 18-45 years or so spanning quite the time frame. IUD’s were traditionally placed in women whom had prior vaginal births selectively. However, this restriction has been removed and IUD’s are acceptable in essentially any age group. The only main relative contraindication is in females with a history of prior complicated STD’s or PID (pelvic inflammatory disease). As with any method, another concern to evaluate prior to placement would be any form of undiagnosed abnormal vaginal bleeding or improperly assessed pathology of the cervix (bad pap smears). A bonus side effect of the Mirena, for which the device also has FDA approval for, is that the majority of patients will eventually have amenorrhea (no menstrual cycles) during its intended time frame.
The Paraguard is a strong choice for many of my patents whom are seeking a hormone-free method of contraceptive. Either IUD is placed in the office setting with same positioning as during a routine annual exam, and takes about 5 minutes! They are very well tolerated in the setting of an average patient and with an experienced provider. Imagine, one day out of your life and then no work on your part for either FIVE or TEN years! The intradermal or under-skin implant is also a simple office procedure requiring about 10 minutes. Also is very well tolerated in the average patients seeing an experienced provider. Again, aside from undiagnosed abnormal bleeding or allergies to its components, there are very few patients in whom this method is not acceptable. THREE years of hassle-free contraceptive management after a single day small procedure (no larger than an injection site) in your non-dominant arm! Most insurance companies do in fact cover these LARC’s allotting for an acceptable copay/percentage on the patient’s part. Even if they are not a covered benefit, the long-term cost is considerably less than the additive monthly costs of a daily contraceptive over the time frame of three, five or ten years. Therefore, for many of our patients, it is easily worthwhile to spend the cost upfront for LARC’s and avoid the recurrent monthly cost of the pill over time. Oh, and the no-brainer part is how much easier it is for their lifestyle! This is especially true for women of any age with various time constraints including school, work and travel – not to mention life in general. The overall failure rate of these types of contraceptives is <1%! LARC are by far the most effective contraceptives spanning any age group. The potential impact on society with respect to unintended pregnancies, especially in younger age females, is dramatic.
For female patients in whom child bearing is complete, typically age 35 and above, permanent contraception is the preferred and recommended safe, effective method. When our male counterparts, if involved, do not step up to the plate and get “fixed” (which is statistically quite typical!), it can be actually liberating to take the step into permanent contraception. This can be done in an out-patient setting in the hospital or ambulatory surgical setting via traditional Bilateral Tubal Ligation/Occlusion during operative laparoscopy; alternatively, it can be done in a private in-office surgical suite via the Essure incision-free tubal. Essure has been FDA approved for over ten years, and actually recently surpassed the traditional tubal in having the lowest failure rate. The implants help to naturally occlude your fallopian tubes in a minor procedure done via the vagina and cervix, thus avoiding any incisions/scars and no downtime! Either procedure is intended to be irreversible, thus any plans for future children would exclude a woman as a candidate. With Essure or traditional tubals, abnormal uterine or pelvic pathology may prevent proper placement of the devices and therefore categorize either as ineffective. A confirmation test is done 90 days after placement to assure success. For many of our more mature patients, this is an effective hormone-free, hassle-free option. Education of women, especially aged 35 and above, regarding this hassle-free option is key in decreasing the unintended pregnancies in this age group. Most insurance companies do cover sterilization procedures with nominal copays/per-
centages expected of the patient. If it is not a covered benefit, for many, the up front cost is outweighed by the comfort and control the women gains in making the final choice for her family planning.
In summary, the discussion of convenient contraceptives is in fact a recommended one between you and your provider. Once your routine Gyn exam is updated/normal and there is no other concerning pathology going on, you are free and clear to consider these options. We try to at least offer information to all our patients so they have more options to make the best choice for their bodies and their lifestyles – no matter what age. IF you are a candidate, Whether Long Acting Reversible Contraceptives or Permanent Contraception, the choice is really quite simple: they are safe, highly effective and easy – I do all the work, you have the control. If only life could be this uncomplicated…
Anne Lord-Tomas, D.O., FACOOG,
Board Certified OB/Gyn
U FIRST HEALTH
Gynecology & Cosmetogynecology
12640 World Plaza Lane, Building 71, Ft Myers, FL 33907
www.ufirsthealth.com | 239.243.8222