Peer Responses – Birth Control

Peer Responses – Birth Control

Responding to Elizabeth Leon

Hello Elizabeth,

Thank you for the insightful post on choices of birth control for a 25-year-old newlywed with plans to conceive in the next two years. The information provided regarding combined oral contraceptives (COCs), intrauterine devices (IUDs), and etonogestrel contraceptive implants is rich and useful. Notably, ACOG guidelines support the recommendations for COCs like ethinyl estradiol-levonorgestrel (American College of Obstetricians and Gynecologists, 2019). Awareness of the high efficacy, pearls, and other non-contraceptive advantages of the method should be emphasized. Nevertheless, the warning about their inadmissibility for some diseases, such as hypertension or a history of blood clots, is no less critical. These contraindications should, therefore, be well-checked by the healthcare providers to avoid harm to the patient.

Moreover, IUDs, in relation to LARC, are more pertinent to women who want contraceptives with the least intervention and quick fertility return. IUDs are a strong contender due to the benefits highlighted, which include high effectiveness, reversibility, and convenience, as indicated by Lanzola and Ketvertis (2022). Also, the last argument regarding the discomfort during insertion and the idea that only medical help can help with the removal explains more practical aspects that patients should consider.

The perspective that the Nexplanon implant is highly effective, easy to use, and quickly removable for those who want a progestin-only method can be helpful for women (Rocca et al., 2021). Potential side effects, including irregular bleeding and mood changes, as well as the cost depending on insurance, are information that can be of help to patients in making informed decisions.

In sum, the post successfully describes the available methods of birth control and the advantages and disadvantages of each. This reaffirms the need for a one-on-one family planning consultation that considers client choice, health, and behaviors.

References

American College of Obstetricians and Gynecologists. (2019). Over-the-counter access to hormonal contraception. Acog.org. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/over-the-counter-access-to-hormonal-contraception

Lanzola, E. L., & Ketvertis, K. (2022). Intrauterine device. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557403/

Rocca, M. L., Palumbo, A. R., Visconti, F., & Di Carlo, C. (2021). Safety and benefits of contraceptive implants: A systematic review. Pharmaceuticals, 14(6), 548. https://doi.org/10.3390/ph14060548

Responding to Kamaljit Sidhu

Hello Kamaljit,

Thank you for the informative post on the type of birth control that will be suitable for a 36-year-old woman who wants to have no more children. Knowledge obtained from the copper IUD, hormonal IUD, and contraceptive implants assist in the decision-making process. The description given for the copper IUD is rather elaborate, and it states that the copper IUD is not a hormonal contraceptive and can last up to 10 years. The rationale for the mechanism of action of spermicidal copper ions, as well as its suitability for those who cannot take hormonal contraceptives, is explained clearly. However, care should be taken because it can aggravate dysmenorrhea or heavy periods, which is important for patients with the condition.

The hormonal IUD-releasing levonorgestrel stands out here as it also has some additional benefits, like lighter menstrual blood loss and possibly ovulation suppression (Bofill Rodriguez et al., 2020). The description of how it works—by altering the cervical mucus and/or, at times, preventing ovulation—is concise and comprehensive. These include hormonal changes like irregular bleeding, which are side effects, yet they serve to balance the trade-offs well.

The debate focuses on the contraceptive implant as an unobtrusive means of birth control that does not require constant attention, which can be useful for women looking for a reliable, non-intrusive solution. The implant is effective in preventing ovulation and thickening cervical mucus besides being convenient to use making it a candidate (Mgobhozi et al., 2021). This way, patients know that they may experience irregular bleeding and other side effects of the medication.

In summary, the post adequately responds to the various methods of birth control for a woman who does not want to have more children. It highlights the need to take clients’ health status, fertility choices, and preferences into account in contraceptive advice.

References

Bofill Rodriguez, M., Lethaby, A., & Jordan, V. (2020). Progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database of Systematic Reviews, 6(6). https://doi.org/10.1002/14651858.cd002126.pub4

Mgobhozi, L. N., Mbeje, P. N., & Mchunu, G. G. (2021). Women’s experiences on the use of Implanon as a contraceptive method in a selected primary healthcare facility in KwaZulu-Natal. Curationis, 44(1). https://doi.org/10.4102/curationis.v44i1.2187

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PEER RESPONSE 1

It’s important to consider birth control options that offer effective contraception while allowing a quick return to fertility after discontinuation for a 25-year-old newlywed with plans to start trying for a baby in two years. The following discussion highlights three different types of birth control methods that could be recommended for this patient.

Peer Responses – Birth Control

According to the American College of Obstetrics and Gynecology (ACOG) clinical practice guidelines, I recommend combined oral contraceptives (COC) such as ethinyl estradiol 0.02 mg-levonorgestrel 0.1 mg (Alesse), which is a once daily tablet to be taken at the same time every day (ACOG, 2022).). The advantages of COC’s include how they are highly effective when used correctly, easy to use, reversible, and can provide non-contraceptive benefits such as menstrual cycle regulation and reduced risk of ovarian and endometrial cancers (Bansode, et. al, 2023). In terms of disadvantages, oral contraceptives are not suitable for women with certain medical conditions like hypertension or blood clot history, and they require daily adherence. For reversible birth control methods, COCs are appropriate for nonsmoking women who are willing to take a pill every day. Medical conditions such as hypertension, blood clot history, or liver disease are contraindications. The estrogen in birth control pills can elevate blood pressure, so patients with pre-existing hypertension may have even higher blood pressure due to the pills (Bansode, et. al, 2023).

I would recommend an intrauterine device as another form of birth control. IUDs are long-acting reversible contraceptives (LARC). It is a device implanted in the uterus that contains hormones such as progesterone and prevents pregnancy. It is recommended to replace a device every 5-10 years depending on the brand. Among the benefits of IUDs are their high effectiveness, reversibility, and long-term use. Furthermore, they provide convenience due to their low maintenance and non-compliance requirements once inserted. Using an IUD has some disadvantages, including pain or discomfort upon insertion, irregular bleeding, and discontinuation must be done by a medical doctor, physician assistant, or nurse practitioner. In this case, since this patient wishes to conceive within two years, inserting an IUD could be appropriate since women seeking long-term contraception and rapid return to fertility after removal would benefit from an IUD. Few absolute contraindications exist and are associated with uterine anatomical defects or allergies (Bansode, et. al, 2023). Patients with an active pelvic infection or pregnant women are absolute contraindications.

Another birth control method we can provide is etonogestrel contraceptive implants, which include Nexplanon. This is a long-acting reversible contraceptive implant that offers several advantages to a 25-year-old newlywed with plans to conceive in two years. There are many advantages to the Nexplanon implant, including its high efficacy rate (99% effective), the convenience of a single insertion every three years, the fact that it lightens periods, it contains only progestin and is well tolerated by those who are intolerant of estrogen, and it results in rapid fertility for the patient once it has been removed. (Bansode, et. al, 2023). There are also some disadvantages to consider such as the possibility of irregular vaginal bleeding, headaches, mood changes, and breast tenderness with these implants. In addition, depending on insurance coverage, the implant may be expensive. Without insurance, Nexplanon implants can cost between $800 and $1300 (Bansode et. al, 2023) Indications for using the implant include women seeking contraceptive measures who want to become pregnant within 2-3 years (ACOG, 2022). An absolute contraindication to the implant is pregnancy, known or suspected breast cancer, or liver disease. As a result, patients should be screened appropriately to determine if they are contraindicated for an implant.

As a result of their high effectiveness, long-term duration, and rapid return to fertility after removal, LARC methods, particularly contraceptive implants, may be the most suitable option for those wishing to have fertility in the future. Individual preferences, medical history, and lifestyle factors ultimately influence the choice, so it’s important for the woman to discuss these options with her healthcare provider before making a decision.

PEER RESPONSE 2:

Several methods of birth control are appropriate for the 36-year-old woman who wants to stop having children, taking into account her reproductive objectives, health concerns, and personal preferences. A copper intrauterine device (IUD) is one of the options suggested; it is a very effective LARC. The spermicidal copper ions released by the copper IUD make the surrounding environment unsuitable for sperm, which is how it works (Smith-McCune et al., 2020). Anyone looking for long-term birth control without hormonal side effects may find it useful since it gives contraception for up to 10 years after implantation (CDC, n.d.). On the other hand, if a woman already suffers from dysmenorrhea or heavy periods, she may find that her symptoms worsen, including cramps and more bleeding.

A hormonal intrauterine device (IUD), such as a levonorgestrel-releasing IUD, is another good alternative. In order to prevent sperm penetration and, in some cases, ovulation, this device slowly but steadily distributes a little quantity of progestin hormone into the uterus (CDC, n.d.). This causes the cervical mucus to thicken. Women who want less menstrual bleeding may find the hormonal IUD intriguing since it is effective for up to three to five years (depending on the brand) and because it gives the benefit of milder periods or even amenorrhoea (Smith-McCune et al., 2020). Nevertheless, women who are sensitive to progestin should be aware of the possibility of adverse effects, such as hormonal changes and irregular bleeding in the first few months.

Another successful alternative is the contraceptive implant, which is a tiny, flexible rod that is implanted beneath the skin of the upper arm. Constant secretion of the progestin hormone stops ovulation and thickens cervical mucus, making it harder for sperm to reach the uterus (CDC, n.d.). Discreet and effective, the implant lasts up to three years and eliminates the need for daily devotion to the technique of birth control. Although irregular bleeding patterns often become less common over time, they might still happen and cause anxiety for certain people.