| To help you consider the right contraceptive, we explain
some of the risks that contraceptives pose for women with mobility impairments.
As you are reading, keep in mind that the safety of contraceptives varies
significantly from one woman to another, and that only you and your health
care provider can determine whether or not a contraceptive is safe for
you.
If you are not familiar with contraceptives, please consult Planned
Parenthood’s web site. It explains how the various contraceptives work
and discusses their use, effectiveness, cost, advantages, disadvantages,
availability, and risks for women without disabilities.
Contents
________________________________________________
The Pill
What is the Pill?
“The Pill” is also called a combination oral contraceptive or COC.
It is a small tablet that you take once a day. It contains two synthetic
hormones, an estrogen and a progestin, that are very similar to hormones
found naturally in your body, but in much higher amounts. When you
take the Pill:
-
You stop ovulating (ovulation is the monthly release of an egg from the
ovaries).
-
The mucus in your cervix becomes thicker and blocks some sperm from entering
your uterus.
-
The lining of your uterus becomes thinner so that a fertilized egg cannot
implant on the uterine wall.
Is the Pill safe for a woman with mobility impairments?
Taking the Pill increases the risk that you will develop a blood clot
in your veins, though this risk is greatly decreased in the current low
estrogen pill. This risk is higher if you smoke. If your mobility
impairment also increases this risk, then you should not take the pill.
Other benefits of the Pill are that it helps regulate menstruation during
the perimenopause (the transition years between having regular periods
and no periods), decreases the amount of menstrual bleeding, and reduces
the risk of ovarian and endometrial cancer.
________________________________________________
Progestin Only Contraceptives
What are progestin only contraceptives?
Unlike the pill, which contains two hormones, progestin-only-contraceptives
have only one hormone, progestin. Progestin-only-contraceptives come
in three forms:
-
The Minipill: a tablet that you swallow daily;
-
Depo-Provera: a hormone shot that your health care provider will give in
your arm or buttock once every three months;
-
Norplant: six soft capsules, each about the size of a matchstick, which
your health care provider will insert under the skin of your upper arm.
It will protect against pregnancy for five years.
When you take a POC:
-
The mucus in your cervix becomes thicker and blocks some sperm from entering
your uterus.
-
The lining of your uterus becomes thinner so that a fertilized egg cannot
implant on the uterine wall.
Are POCs safe for women with mobility impairments?
Most researchers agree that POCs don't present the risk of blood clots
associated with the estrogen in combined pills. Thus, some health
care providers will give you a POC if your mobility impairment puts you
at risk for a blood clot. However, other researchers believe that
more research is needed to determine whether this practice is safe. For
this reason, the FDA still recommends that the same exclusion criteria
be followed for the Pill and for POCs. That is, the FDA currently
recommends that you should not use minipills, Norplant, or Depo-provera
if you have blood clots or inflammation of the veins.
Be aware that some medications used for seizures may make Norplant less
effective. Also, the implants may leave scars, particularly on women
of color.
If you are taking a hormone-based contraceptive, how will you know
when natural menopause has occurred and you no longer need it?
As long as you are on the Pill, you will continue having menstrual
periods. If you take a POC, you may not have periods until you stop
taking it. Some health care providers automatically discontinue oral
contraceptives at age 51 and switch to hormone replacement therapy, which
is lower dose, if the woman chooses to use HRT during menopause.
Others stop the oral contraceptive for one or two weeks, then measure blood
levels of follicle stimulating hormone (FSH) and estradiol at that time.
During the transition period to menopause (perimenopause), when menstruation
becomes irregular, contraception should continue because pregnancy is still
possible during this time. The hormone levels used for HRT are not
high enough to prevent pregnancy.
________________________________________________
Intrauterine Device
(IUD)
What is the IUD?
The IUD is a small, plastic, T-shaped device that your health care
provider inserts in your uterus. It contains either copper or hormones
that keep sperm from joining the egg and prevent a fertilized egg from
implanting in the uterus.
Is an IUD safe for women with mobility impairments?
The older IUDs increased your risk of pelvic inflammatory disease (PID),
an infection of the fallopian tubes or uterus. PID must be treated
early because it is a major cause of infertility in women. There
is no evidence of increased risk of PID with the use of current IUDs.
However, if you have sensory impairment that would prevent you from noticing
the onset of PID and getting early treatment, or you have had PID in the
past, then you should not get an IUD. Women with disabilities who have anemia
or difficulty with menstrual management should also avoid the IUD, as menstrual
periods may be heavier and last longer.
________________________________________________
Diaphragm
What is the diaphragm?
The diaphragm is a small cup of rubber with a rim formed by a rubber-covered
steel spring. It is fitted by your health care provider to go over
your cervix and prevent sperm from entering your uterus. The diaphragm
can be difficult to insert and remove if you have impaired use of your
hands. You may wish to ask your partner to insert it for you.
Is the diaphragm safe for women with mobility impairments?
The diaphragm increases the frequency of urinary tract infections.
If you already have problems with urinary tract infections, then you should
probably select another method.
________________________________________________
Condom
The condom is the only contraceptive method proven to be highly effective
protection against both pregnancy and sexually transmitted diseases.
However, its effectiveness depends on its not breaking, leaking, or spilling
during removal. The female condom, which became available six years
ago, offers the additional advantage of giving the woman more control over
both contraception and protection against STDs. However, a lot of
practice is often required to insert it properly, and insertion may be
difficult for the woman with limited use of her hands.
________________________________________________
Natural Family
Planning Methods
Women with disabilities who are concerned about the safety or difficulty
of using other contraceptive methods may elect to use natural, commonly
called the “rhythm”, methods of family planning. The success of these
methods relies on accurately determining when ovulation is occurring and
avoiding intercourse during that time period. This accuracy is improved
by using the symptothermal method, in which basal body temperature is recorded
daily. A rise in temperature indicates ovulation. However,
this method may not be reliable for you if you have a spinal cord injury
or other disabilities affecting thermoregulation as correspondence between
body temperature patterns and ovulation may not be reliable. Women
may stop menstruating and ovulating immediately after spinal cord injury,
but ovulation, and the ability to get pregnant, usually resumes within
six months for young women. Body temperature will also be unreliable
if you have frequent bladder infections. As a result, you cannot
accurately determine when you are ovulating to avoid intercourse during
that time. If you have impaired manual dexterity, you may find using and
shaking down oral thermometers difficult and easily broken if they come
into contact with wheelchair parts. Likewise, perimenopausal women
with irregular menstrual periods should not rely on these methods to prevent
pregnancy as ovulation is likely to be irregular and unpredictable. |
|
Previous
Lesson
