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.
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Contraceptive Challenges: Does The Mini Pill Induce Weight?
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.
Looking objectively at her 'facts', 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 the Progesterone.
Interestingly, when the evidence available for Progesterone effect on body weight 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 regards to weight gain it is usually not more than 2 kg in a 12-month period.
So, what did we do? In line with the challenge she was having, we rationalized the above information and agreed to change her contraceptive.
She accepted that it was unlikely the current Pill was contributing 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.
Alternative To The Mini Pill
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.
The Copper coil, since it contains no hormone 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).
When You No Longer Feel Your Thread
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 very next step is to confirm whether she is pregnant or not.
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.
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