Friday, May 17, 2013

"I Think I'm Done Having Babies: Now What?"

The options for longer term or permanent birth control are several.  They include a variety of sterilization techniques, intrauterine devices, hormonal implants, injectable contraceptives, and hormonal contraceptives such as the NuvaRing, OrthoEvra patch and the "pill".  Except for smokers over age 35 and those with signficant risk factors for early onset breast cancer or blood clots, it is perfectly reasonable to continue to use hormonal contraceptives (all of which are very low dose these days) up through to the age of menopause (around 50 or 51 is average).

There are 3 available IUDs, one lasting for 10 years (the Paragard, which is copper based), one lasting for 5 years (the Mirena, which is progesterone based) and the new Skyla, which is a 3 year progesterone-based device.  These can be placed in the office postpartum or during a menstrual period.  They require pre-authorization with the insurance company and then are ordered for you if requested.  The progesterone-based IUDs only act locally, so they are still good options for those who can't or don't like to use hormonal contracetpives such as the pill.  They also generally cause periods to be lighter, which the copper IUD can sometimes make periods a little heavier for some patients.

Sterilization options include a tubal ligation which can be performed laparascopically or is sometimes done right after the birth of a child while you're still in the hospital.  The failure rate is less than 1% but in those rare instances we always caution about the risk of ectopic (usually tubal) pregnancy.  Vasectomy is a safer procedure by and large, since there are no vital organs immediately adjacent to the scrotum where the incision is made.  However, when a woman is having a cesarean section already, the addition of a tubal ligation does not increase her surgical risk considerably over the C section itself.  Of course, a failed vasectomy (also < 1% chance) is not associated with an increased risk of ectopic pregnancy.

The latest addition to the options for sterlization is a minimally invasive surgical placement of a device called Essure, which are very small metal coils inserted into the inside openings of the fallopian tubes via a surgical process called hysteroscopy.  The patient then undergoes a tubal dye study (Xray) 3 months later to make sure that the tubes are completely occluded by the natural scar tissue formation process.  There is no need for an incision and pain is much less than after a standard laparascopic sterlization.  More information on this is available at:  We offer this procedure as part of our office surgery services.

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