MEDICAL MATTERS Claire McNicholas Over the past number of years, quite a number of new products have become available in the area of female contraception. If you go along to your doctor, you may be offered new pills, an injection, a new coil, an implant, a ring or even a patch.
Some of these are very recent and as yet are not being used to a great extent in this country.
All of these contraceptions use female hormones, either oestrogen and progestogen together, or progestogen alone.
There are a percentage of women who are not suitable for hormonal contraception, in particular oestrogen. These women include people with very high blood pressure, breast cancer and certain types of migraine and those with a past history of clots and heavy smokers over 35 years of age.
It is important for each woman to consult on an individual basis with her doctor before any form of hormonal contraception is prescribed for her.
There is a new T-shaped coil on the market now called an Intrauterine Device (IUS). On one arm there is a small cylinder which releases a tiny amount of progestogen daily into the cavity of the uterus over five years.
This coil has become very popular, particularly with women who have finished having their family. It is fitted while menstruating and works for five years. Usually, the patient stops bleeding after about nine to 12 months and there are little or no side-effects.
Coils prior to the IUS caused heavy bleeding and cramping, but because the progestogen in the IUS targets the lining of the womb, there is no bleeding and therefore no pain.
Aside from being a popular form of contraception, it is also being used for women who have irregular bleeding around the time of the menopause.
It is important this coil is fitted by an expert - most GPs will know another GP in their area who is expert in this procedure and can refer them on if they themselves do not have the expertise.
A more recent addition to the area of contraception has been an implant. Here, a single rod is inserted under the skin in the non-dominant arm. It measures 4cm by 2mm and it is effective for three years.
Again, because this form of contraception is progestogen-only, it does not have the contraindications to oestrogen and is becoming more popular.
However, there is a small percentage of patients who get a lot of bleeding and irritability in the immediate few weeks after fitting it.
If these women can be counselled about this in advance, they may be more inclined to tolerate these side-effects, knowing that they are probably going to fade away after a couple of weeks.
Another advance in this area is the vaginal ring. This is a small, flexible, colourless ring which is inserted into the vagina on the first day of the period. It is left in for three weeks and then removed.
There is a small amount of withdrawal bleed and a fresh ring is inserted four weeks after the first one was inserted. This is the same way the contraceptive pills are taken - three weeks on and one week off.
Irish women are not very inclined to use medication rectally or vaginally so it will probably take time for this form of contraception to become popular.
However, it may be ideal for women who are forgetful as the manufacturer offers a mobile phone message reminder service.
The most recent launch in the contraceptive area has been a combined oestrogen and progestogen patch which is applied to the arm once a week. It is a three-layered patch - outer layer of polythene, middle layer with the drugs and an inner adhesive layer. It can be applied to the tummy, buttocks, upper arm or upper body.
Three weekly patches are applied and then a patch free week. If the patch comes away for less than 24 hours, it is replaced immediately. If the patch comes away for more than 24 hours, a woman should start a new patch cycle straight away and use extra precautions for seven days.
Unwanted side-effects, while uncommon, are similar to all combined contraceptives and include breast tenderness, dysmenorrhoea , headache, skin problems, weight gain or loss of sex drive.
So with all this choice how does someone choose?
It often boils down to individual preference and the experiences of friends. Most GPs can offer all the above options except the fitting of an IUS or implant for which you will be referred to another GP in your area.
Dr Claire McNicholas is a GP in south Dublin.
Muiris Houston is on leave.