Two Contraceptive Challenges with Modern Birth Control Methods
January 14, 2019
Updated April 2023
We felt it was important to discuss the challenges of contraception and how we would usually handle them.
This post considers some contraceptive challenges that women using modern forms of contraception may experience.
Presented below are a couple of clinic scenarios for women using the oral contraceptive and the coil, respectively.
Earlier this week, a young lady came to the clinic wanting to change her method of contraception.
She felt the Mini Pill she was currently using had ’caused her to gain weight.
As she saw it, she had been doing everything right (but piling on the pounds regardless) since she’d started this pill, and it seemed the obvious cause of her problem.
Considering her ‘facts’ objectively, it was difficult to disagree with her.
Of course, actual evidence of whether she was following an appropriate diet and lifestyle supportive of maintaining her weight was subjective.
However, we took her word for it, and the only possible reason for her weight gain must be the daily consumption of Progesterone.
The single hormone found in the Mini Pill is Progesterone.
Interestingly, when the evidence available for the Progesterone effect on body weight was reviewed, it shows:
The Mini Pill does not directly cause changes in weight –
Progestogen-only Pills Clinical Effectiveness Unit March 2015 (Updated January 2016) - Faculty of Sexual and Reproductive Health Clinical Guidance UK
From reliable studies, as part of the challenges involved in contraception, women have reported weight changes, including weight gain and weight loss, while taking the miniPill.
However, there isn’t enough evidence that this change is directly due to the MiniPill.
From the same reports, it seems that where such observations are made with regard to weight gain, it is usually not more than 2 kg in a 12-month period.
So, what did we do? In line with her challenge, we rationalized the above information and agreed to change her contraceptive.
She accepted that the current Pill was unlikely to contribute anything more than a small fraction of her weight gain.
She also agreed to focus her energies more on healthy eating and increased activity to achieve her weight loss goals.
Given her dissatisfaction, we discussed method changes.
Her options included another version of the minipill, the contraceptive implant and the Copper coil.
Of the two IUDs (Intra-Uterine Devices mentioned), the former contains the same Progesterone, and the latter does not.
Since it contains no hormone, the Copper coil is unlikely to be blamed for weight changes.
Preference-wise, she wanted to stick with the mini pill, and we thought a different type could make a difference.
We’ll have to see how it goes.
The solution was a lot simpler with the next contraceptive challenge consultation.
This involved a lady who was very near the expiration period for her uterine coil (IUD).
But she complained that she could no longer feel her threads.
Usually, women are advised to regularly check the Intra-Uterine Device (IUD) (commonly called ‘coil’) threads (after each menstruation or regularly at alternate months) –
Intrauterine Contraception Clinical Effectiveness Unit April 2015 (Updated October 2015) - Faculty of Sexual and Reproductive Health Clinical Guidance UK
The implication of not feeling the threads is either:
1. That the coil has been ‘expelled’ or fallen out of the womb through the vagina; or
2. That the coil may have perforated the womb to advance into the abdomen.
In either case, the next step is to confirm whether she is pregnant.
Once we have confirmed she is not pregnant (as was the case here), the next step is a physical examination to search for the threads within the cervical canal.
If the coil threads have been confirmed absent during examination, we would offer alternate contraception – pills, condom, etc – until an ultrasound scan (and other tests like X-rays if necessary) can be arranged to locate the coil.
And that’s what we did.
It is very rare for the IUD to perforate the womb – rather, more commonly coil has been expelled, or the threads folded upright within the vagina, so they are difficult to feel.
For any enquiries on this topic, please write us.
Editing by AskAwayHealth Team
All AskAwayHealth articles are written by practising Medical Practitioners on various healthcare conditions to provide evidence-based guidance and help promote quality healthcare.
The advice in our material is not meant to replace the management of your specific condition by a qualified healthcare practitioner.
Please contact a health practitioner to discuss your condition or reach us directly
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