Contraceptives : Intrauterine Devices, Traditional Methods, Surgical Sterilization

by Food and Drug Administration (FDA)

(Page 3 of 3)

Implantable progestins.

Norplant, approved by FDA in 1990, and the newer Norplant 2, approved in 1996, are the third type of progestin-only contraceptive. Made up of matchstick-sized rubber rods, this contraceptive is surgically implanted under the skin of the upper arm, where it steadily releases the contraceptive steroid levonorgestrel.

The six-rod Norplant provides protection for up to five years (or until it is removed), while the two-rod Norplant 2 protects for up to three years. Norplant failures are rare, but are higher with increased body weight.

Some women may experience inflammation or infection at the site of the implant. Other side effects include menstrual cycle changes, weight gain, and breast tenderness.

Intrauterine Devices

An IUD is a mechanical device inserted into the uterus by a health-care professional. Two types of IUDs are available in the United States: the Paragard CopperT 380A and the Progestasert Progesterone T. The Paragard IUD can remain in place for 10 years, while the Progestasert IUD must be replaced every year.

It's not entirely clear how IUDs prevent pregnancy. They seem to prevent sperm and eggs from meeting by either immobilizing the sperm on their way to the fallopian tubes or changing the uterine lining so the fertilized egg cannot implant in it.

IUDs have one of the lowest failure rates of any contraceptive method. "In the population for which the IUD is appropriate — for those in a mutually monogamous, stable relationship who aren't at a high risk of infection — the IUD is a very safe and very effective method of contraception," says Lisa Rarick, M.D., former director of FDA's division of reproductive and urologic drug products.

The IUD's image suffered when the Dalkon Shield IUD was taken off the market in 1975. This IUD was associated with a high incidence of pelvic infections and infertility, and some deaths. Today, serious complications from IUDs are rare. Side effects can include pelvic inflammatory disease (an infection of a woman's reproductive organs), ectopic pregnancy (in which a fertilized egg implants in the fallopian tube instead of the uterus), perforation of the uterus, heavier-than-normal bleeding, and cramps. Complications occur most often during and immediately after insertion.

Traditional Methods

Fertility awareness.

Also known as natural family planning or periodic abstinence, fertility awareness entails not having sexual intercourse or using a barrier method of birth control on the days of a woman's menstrual cycle when she is more likely to become pregnant.

Because a sperm may live in the female's reproductive tract for up to seven days and the egg may remain fertile for about 24 hours, a woman could get pregnant from intercourse that occurred from seven dkays before ovulation to 24 hours or more after. Methods to approximate when a woman is fertile are usually based on the menstrual cycle, changes in cervical mucus, or changes in body temperature.

"Natural family planning can work," Rarick says, "but it takes an extremely motivated couple to use the method effectively."

Withdrawal.

In this method, also called coitus interruptus, the man withdraws his penis from the vagina before ejaculation. Fertilization is prevented if the sperm don't enter the vagina.

Effectiveness depends on the male's ability to withdraw before ejaculation. Also, withdrawal doesn't provide protection from STDs, including HIV. Infectious diseases can be transmitted by direct contact with surface lesions and by pre-ejaculatory fluid.

Surgical Sterilization

Surgical sterilization is a contraceptive option intended for people who don't want children in the future. It is considered permanent because reversal requires major surgery that is often unsuccessful.

Female sterilization.

Female sterilization blocks the fallopian tubes so the egg can't travel to the uterus. Sterilization is done by various surgical techniques, usually under general anesthesia.

Complications from these operations are rare and can include infection, ectopic pregnancy, hemorrhage, and problems related to the use of general anesthesia.

Male sterilization.

This procedure, called a vasectomy, involves sealing, tying or cutting a man's vas deferens, which otherwise would carry the sperm from the testicle to the penis.

Vasectomy involves a quick operation, usually under 30 minutes, with possible minor postsurgical complications, such as bleeding or infection.

Research continues on effective contraceptives that minimize side effects. One important research focus, according to FDA's Rarick, is the development of birth control methods that are both spermicidal and microbicidal to prevent not only pregnancy but also transmission of HIV and other STDs.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.