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Birth Control: a Q & A with Sheila Mody on contraception
Researchers at the University of Edinburgh say they’ve found a gene that plays a key role in male fertility, suggesting it could be exploited to develop hormone-free birth control for men.
Until that happens, though, the responsibility for contraception seems likely to remain primarily with women. (A recent University of North Carolina survey, for example, polled 326 female students between the ages of 18 and 45. More than 89 percent said contraceptive responsibility should be shared, but just 51 percent said it actually was in their relationships.)
The search for better, more effective methods of birth control never ends. Tweaking the gene that helps make sperm viable is one of the newer approaches, but older methods (beyond the Pill) are constantly revised to improve their safety and efficacy
We asked Sheila Mody, MD, a contraceptive specialist in the UC San Diego School of Medicine’s Department of Reproductive Medicine, to review the latest developments.
Question: There has been considerable media coverage recently of newer contraceptive methods, such as hysteroscopic sterilization (Essure), contraceptive implants (Implanon) and the intrauterine device (IUD). Can you explain how these contraceptives work and relative advantages?
Answer: Essure is a no-incision permanent sterilization method. A small camera is used to go through the vagina and the cervix to visualize the openings of the fallopian tubes in the uterus. Then very small nickel coils are placed in the tubes, which causes scar tissue to form and block them. The scarring process takes three months. This is an outpatient procedure and avoids general anesthesia. It is highly effective with a failure rate comparable to other sterilization methods.
Implanon is a contraceptive implant containing a hormone called progestin. It’s placed under the skin in the upper arm. An Implanon insertion can be done in a clinic and the implant works for up to three years. It’s very effective and completely reversible.
The IUD is a contraceptive method that is becoming increasingly popular. It is a small T-shaped device that’s placed in the uterus. An IUD placement can be done in the clinic. The IUD works up to five or 10 years, depending on the type. Women who have not had children are still eligible to use this method. It does not impact future fertility. It’s a nice alternative to birth control pills because you don’t have to remember to take a pill every day. One type of IUD – the Mirena IUD – can cause menstrual bleeding to be much lighter. Another advantage is that IUDs do not contain estrogen, so women who cannot take combined oral contraceptive pills (containing estrogen and progestin) can often still use an IUD.
Q: In choosing a contraceptive, what factors should a woman consider?
A: Women should first think about whether they want a reversible or permanent method. If they want a minimally invasive permanent method, then hysteroscopic sterilization with Essure is a great option. If they want a reversible method, they should consider a long-acting, reversible contraceptive (LARC) method that requires little compliance, such as the IUD or contraceptive implant (Implanon). These methods are very safe, highly effective and completely reversible.
Q: What about the condom and the pill? How does it compare to these other methods?
A: Women over-estimate the efficacy of condoms and birth control pills. The typical failure rate for the condom is 15 percent and the typical failure rate for the birth control pill is 8 percent. Compare these rates to the typical failure rate of less than 1 percent for the contraceptive implant (Implanon) or the IUDs. Condoms should be used to prevent sexually transmitted infections, but they are not a very effective contraceptive method.
Q: What is the UC San Diego Comprehensive Contraception Clinic?
A: It’s a unique clinic serving women who have complex medical issues, such as epilepsy, bariatric surgery or solid organ transplants who would benefit from counseling about safe and highly effective contraceptive options. If you’ve been told not to become pregnant because of medical issues, we offer advice and services based on the latest evidence. We are also happy to see women without medical issues who are interested in learning more about their contraceptive options.
Image credit: Emma Plunkett