Contraception 101: Permanent Methods of Contraception

Many patients come to see me for advice about contraception. There’s never one right answer as everyone has different needs, and most patients first discuss the options with their mums, friends and of course Dr Google!

In this third and final part of the Contraception 101 series, I'll present an overview of the permanent methods of contraception.

“Permanent Methods of Contraception”

For patients who want permanent contraception, surgical options are sometimes a solution. 

Female sterilisation can usually be performed through key hole surgery and involves either small clips being placed across the fallopian tubes (which connect the ovary to the uterus), or complete removal of the fallopian tubes. These procedures require general anaesthetic. Both are permanent and irreversible procedures, and are usually requested by women who have no desire for fertility and who don’t want to or are unable to use other forms of contraception. Some recent studies suggest that ovarian cancer may actually arise from the fallopian tube, so removal of the fallopian tubes may have this additional benefit compared to use of sterilisation from clips.

In the Contraception 101 series, I've outlined the most common types of contraception I discuss with my patients. It's important that you find a contraceptive that is convenient and reliable, and suits your needs. There are other options available and these can be discussed with your GP or gynaecologist.

Contraception 101: Intra-Uterine Devices, Implants and Injections

Many patients come to see me for advice about contraception. There’s never one right answer as everyone has different needs, and most patients first discuss the options with their mums, friends and of course Dr Google!

In this second part of the Contraception 101 series, I'll present an overview of intra-uterine contraceptive devices (IUDs), implants and injections.

“Intra-Uterine Devices, Implants and Injections”

IUDs are devices that are inserted through the cervix and sit inside the uterus. The implanon is an implant that is inserted just under the skin of the upper arm and Depo Provera is given by an intra-muscular injection. These are useful contraceptives as they are long-acting (IUDs and implants last 3-5 years), reversible and also very reliable, as the user doesn't have to remember to take a tablet or do anything else once the IUD or implant is inserted, or following their injection.

The Mirena is a commonly used IUD.  Apart from being a contraceptive, the Mirena is also very useful for helping to manage heavy and painful periods. The Mirena can be inserted during an appointment with local anaesthetic, however some patients prefer or require insertion of the Mirena under a general anaesthetic in day surgery. After insertion, irregular bleeding is quite common initially, however this usually settles within 3-6 months.

The Implanon is a rod that is inserted just under the skin in the upper arm. It lasts for three years after insertion and, like the Mirena, is a reliable and reversible form of contraception. It also has the side effect of irregular bleeding. The Implanon may be an option for you if you simply need contraception, and prefer not to have the initial discomfort associated with insertion of an IUD.

The Copper IUD is another type of intra-uterine contraceptive device, however it does not contain any hormones. Patients who request a Copper IUD may wish to avoid contraceptives containing hormones for various reasons, but at the same time want a reversible and reliable contraceptive option. Sometimes periods can seem a little heavier after insertion of a Copper IUD.

Depo Provera is given by an intra-muscular injection every 12 weeks. Some women cease having periods after using Depo, but it may also cause irregular bleeding. After discontinuation of Depo Provera, some women experience a delay in return to fertility of up to 18 months.

You should seek advice from your GP or gynaecologist before making a decision about whether IUDs, implants or injections are the right contraceptive for you. IUD insertion can be accompanied by some minor discomfort, so if you plan to have an IUD inserted, you may wish to take some Panadol and Nurofen two hours prior to your appointment.

In the next and final Contraception 101, I'll provide an overview of permanent (surgical) methods of contraception.

Contraception 101: Oral Contraceptives

Many patients come to see me for advice about contraception. There’s never one right answer as everyone has different needs, and most patients first discuss the options with their mums, friends and of course Dr Google!

In this three part series, Contraception 101, I'll present an overview of some of the options for contraception I discuss with my patients, and explain when I usually recommend each. Today's post covers oral contraceptives.

“The Pill”

'The Pill' is probably the most common type of contraceptive for women and is often credited as helping to improve the status of women by offering simplicity and effectiveness in birth control. 'The Pill' refers to the combined oral contraceptive pill, which contains synthetic forms of estrogen and progesterone (the hormones produced by the ovaries). The pill is a reliable contraceptive if it is taken daily, at the same time each day. I often recommend the pill as a contraceptive option for women who also want to regulate their periods. There are many different types of the pill (Levlen, Yaz, Diane to name just a few). Some types of the pill may have additional effects such as improved mood or reduced acne. 

The 'mini pill' is a progesterone only pill. It is less reliable as a contraceptive than the combined pill, but is often used in women who are breast feeding or are unable to take estrogen due to problems with blood clots. 

Pros and cons? The pill is non-invasive and can be easily stopped at any time if you experience side effects. Taking the pill also often causes periods to be lighter and less painful. The main drawback is that you have to be able to remember to take a tablet every day.

What works well for one person, may have different effects for another. If you are thinking about starting the pill, you should seek advice from your GP or gynaecologist.

In part two of Contraception 101, I'll cover intra-uterine devices (IUDs), implants and injections.

Adult Acne – Why? What can I do to fix it?

Unfortunately, skin problems are not something limited to adolescence.  Breakouts can plague us well into adulthood. Adult acne may be lifestyle related, but may also be associated with hormonal fluctuations and conditions such as poly-cystic ovarian syndrome. Being time poor and chronically stressed may put our adrenal glands into overdrive, which may increase the oil flow from our skin follicles. This sets the stage for congestion in the form of blackheads, pimples and pustules. Once started, the cycle can be self-perpetuating. Seeking advice regarding what skin treatments to use is important, as products used to conceal imperfections may aggravate the problem spots rather than aiding them to heal or normalise.

Help your skin help you

1.    Don’t squeeze pimples!  Squeezing will most likely cause more damage by prolonging healing time, increasing the likelihood of scarring and the incidence of a pimple reoccurring in the same place.  Consider applying a spot treatment product instead.

2.    Eat a low GI diet.  There is evidence to suggest that regular consumption of high GI foods elevates insulin production, increases sebum (oil) production and may be associated with hormonal changes, all of which contribute to acne.   

3.    Take time to decompress and relax, which will help keep stress hormones in balance.  Additionally, having some time to focus on yourself can help you review your diet and your skin routine.

4.    Have an appropriate skin routine in place.  At a minimum, cleanse and moisturise twice a day.  Unless you’ve been advised against it, regularly exfoliating will also help promote a clear complexion.  Blemishes are often the result of excess dead skin cells binding with oil and debris to clog follicles.  Exfoliating will help shed the old skin cells and promote the generation of fresh, new cells.

5.    If your breakout levels are closely linked to your menstrual cycle, you may benefit from hormonal intervention in the form of the oral contraceptive pill.

At GAALS we are able to provide advice for conditions such as poly-cystic ovarian syndrome and can make recommendations about who to consult regarding your skin problems.  If you have a gynaecological problem or would like an appointment, please call us on 1300 242 257 or click Contact on our web page.

Endometriosis

Endometriosis is a common condition, affecting up to 10% of women in the reproductive age group.

Endometriosis involves growth of endometrial tissue (the tissue that lines your uterus) outside of the uterus.  Most commonly, endometriosis occurs in the pelvis and around the uterus and may affect the ovaries and fallopian tubes.  The abnormally located endometrial tissue responds to female hormones each month and this causes inflammation and commonly pain.  In severe forms, endometriosis can cause adhesions between the female reproductive organs and other structures such as the bowel.

There is a lot of information and increasing publicity about endometriosis.  I recently found an interesting article that lists 10 things you should know about endometriosis:

Here’s 10 things you should know about endometriosis

1. Endometriosis can affect any woman of child-bearing age (it is rare in women who have been through the menopause)

2. Symptoms include: pelvic pain, heavy periods, bladder and bowel problems, fatigue, depression, pain during or after sexual intercourse, problems conceiving and difficulty fulfilling professional and social commitments. (NB: some women don’t experience any symptoms at all).

3. Any pain experienced often correlates to your menstrual cycle, but not always. Equally, the severity of pain experienced does not always correlate to the amount of scar tissue present, the pain is more dependent on where the abnormal tissue is located.

4. There is currently no cure, no proven cause or known way of preventing endometriosis.

5. There are some ways to manage symptoms. These include: pain relief, complementary therapies, hormone treatment and surgery. The best course of action will be recommended depending on the patient’s age, severity of the disease and desire to have children.

6. The only definitive way to diagnose endometriosis is by a laparoscopy – a small operation that involves inserting a camera into the pelvis via the belly button.

7. The disease can cause infertility. But 50% of women suffering from endometriosis will not experience any problems conceiving.

8. Endometriosis is not an infection and it is not contagious.

9. Some women experience relief from their symptoms during pregnancy but in many cases symptoms return along with a woman’s period. Pregnancy is not a cure for the disease.

10. Having a hysterectomy does not always cure endometriosis. It only treats the disease on the organs that were removed.

You can find more information on endometriosis at:

www.endometriosisaustralia.org

At GAALS, we have a special interest in the management of endometriosis.  If you have a gynaecological concern and would like to see us, please call 1300 242 257 or click Contact on our website for further information.

Polycystic ovarian syndrome

If you have Polycystic Ovarian Syndrome (PCOS) you are not alone.  This condition affects between 1 in 10 and 1 in 20 women of reproductive age.  The impact may be far reaching, and may influence emotional state, body weight and relationships.

What is Polycystic ovarian syndrome?
The diagram below represents the contributing factors:

• Menstrual dysfunction includes irregular or infrequent periods.
• Hyperandrogenism includes bad acne or body hair growth in abnormal distributions. 
• Polycystic ovaries may be detected on pelvic ultrasound. 

To be diagnosed with PCOS, you may not necessarily have all these features, but symptoms from at least two categories must be present.

How is PCOS diagnosed?
Diagnosis will usually follow a discussion of symptoms and medical history with your doctor, ultrasound imaging as well as blood tests. 

Can it be treated?
Unfortunately there is no quick fix for this condition.  The key to managing PCOS is to make lifestyle changes by eating healthily and moderately and regular exercise.   Weight loss may also reduce the risk of associated diseases like diabetes. 

Hormone therapy such as the oral contraceptive pill may also assist in the management of PCOS.

At GAALS, we can help patients with PCOS and provide advice to manage this condition.  If you have a gynaecological concern and would like an appointment, please call us on 1300 242 257 or click Contact on our website.