By Ghadeer Ghloum
KUWAIT: To explore the most common birth control methods, their side effects, and how to ensure women’s comfort while using them, Kuwait Times interviewed Dr Ghadeer Akbar, Double Canadian Board-Certified Consultant in Obstetrics and Gynecology, and Sub-Specialist in Reproductive Endocrinology and Infertility (GREI-IVF). Akbar explained the most common birth control methods: "The oldest and most common form of contraception is birth control pills, or ‘the pill’”.
It comes in different brands and names but overall, it’s usually the single or combined-double hormone birth control. The single hormone is least used in both the US and North America due to high side effect profile and failure rate, but we still have to use them occasionally due to specific indications such as breast feeding. The more mainstream and commonly used birth control is the combined-double hormones birth control pills.
This is the most physiologic and has the least side effects and thus, most tolerated by patients. On top of its benefits as a very effective birth control, the combined birth control is known for its non-contraceptive benefits such as cycle regulation, flow control, pelvic pain control, as well as control over acne, hair fall, and PMS symptoms that some women get before their periods. In addition, it has been proven that using the combined birth control pills for more than 5 years in one’s lifetime can prevent ovarian and endometrial cancer incidence for the pill user. Patients sometimes ask about the relation between contraceptive and pain as well as period cycles, and actually as I mentioned above, one of the benefits of contraceptives is its use for pelvic pain management, and cycle regulation.
The details of this are counseled and planned with the patient. Regarding people’s common concerns about the side effects, she said: "Nothing has no side effects. A vital part of a patient’s compliance and comfort is to counsel them about the possible side effects when using the combined birth control pills; this is the doctor’s responsibility. Just like any new medication that goes into your system it is normal to experience some mild bloating, irregular spotting, very mild nausea and mild headache. These side effects are all short lived and should not last for more than the first pack, or at most, the second pack of use. Once we start the third pack all these side effects should disappear, if they don’t, then I usually advise my patients to come back to me to discuss an alternative, this is what ensures the patient is comfortable with their plan and not experiencing any long-term harmful side effects.”
Moreover, Akbar mentioned alternatives to consuming pills on daily basis for birth controlling. "Contraceptive patches are an alternative to the combined birth control pills. It works exactly the same with the same non-contraceptive benefits, as well as side effects. The only difference that exists between the two is that the patches need to be changed once a week, while the pill is taken once a day. So, for those that tend to have a busy work schedule, work in shifts, or have difficulty remembering taking their pill every day, a patch that they would be committed to remembering once a week might be easier for them to comply with.”
However, in some cases, IUD, is a women’s only option, according to Akbar. "IUD is another fairly common contraception. I would definitely recommend it to those that keep forgetting their pill, or just don’t want to have any hormones. Some of my patients have contraindications for the pills, which means that their only available option would be the IUD. The contraceptive device comes in two forms: hormonal IUD (known in Kuwait as the Mirena, and in the US and North America as Kyleena) or the none hormonal IUD (our old friend-copper T IUD).
Hormonal IUD can also have none contraceptive benefits such as control of excessive period bleeding and has been recently used even in the control of pelvic pain originating from endometriosis. The main advantage of all IUDs in general is the fact that a patient does not need to remember checking them except once a year after insertion. As with any contraceptive method, the cons of having an IUD are that it can fall, change position, or fail to protect from a pregnancy, but keep in mind that would be less than one percent of IUD users.”
She further elaborated: "Other contraceptive methods exist and different ones keep coming up. A contraceptive implant has been introduced in Kuwait over the last few years. It works as a hormonal contraceptive; it’s just a single rod that gets implanted under the skin in the arm with benefits and side effects that are very similar to the birth control pills. The depot injection (3 monthly, or yearly) has been used less frequently in the Gulf area overall. It’s more commonly used in the east Indian continent, with a high rate of effectiveness.”
More on people’s concerns over the side effects, especially on infertility, Akbar said: "There has been no proven correlation between the use of contraception, and infertility, this is actually a very common misconception I see with my patients especially in Kuwait and the Gulf. Once you stop the pill, you should be able to get pregnant right away. And if you do not get pregnant then something else is going on so you should see a fertility specialist, well trained in contraception counseling and fertility assessment to sort out the possibilities. Depot form of contraception/injectable contraception is the only method that might delay cycle resumption and thus, one’s fertility.
But as I discussed earlier, it is not even used that often in Kuwait or any of the Gulf countries. Other vital aspects of contraception counseling are a patient’s baseline fertility, how many kids the couple would like to have? How long should the female partner delay get pregnant? If anything would have negative impact on one’s fertility, it’s reproductive ageing. So, exploring these important delicate topics during a contraception visit is the responsibility of, specifically, a well-trained GREI-fertility specialized doctor.”