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Many women are referred to a gynecologist by their health care provider
because they are looking for more permanent methods of contraception. A gynecologist can offer contraceptive counselling which
is professional advice about method(s) of contraception to meet individual medical needs and lifestyles.
With so many options available, making the right decisions about contraception can
be a little overwhelming. However, the most common are:
- Oral Contraceptive Pill
- Contraceptive Patch
- Injection (Depo Provera)
- Vaginal Ring (NuvaRing)
- Intra-uterine System (Mirena)
- Intra-uterine Device (Copper IUD)
- Male Condom
However, a woman is most likely referred to a gynecologist if she wants an IUS insertion or tubal sterilization.
What Is An Intra-Uterine System?
A T-shaped device that contains the hormone levonorgestrel (also called the “hormonal
IUD”) and sits inside the uterus. The hormone is released slowly over time and acts on the lining of the uterus. The
intrauterine system can be left in place for up to 5 years, requires a prescription and has to be inserted by a gynecologist.
It
works mainly by preventing the sperm from fertilizing the egg. It thickens the cervical mucus making it difficult for
the sperm to get through and causes changes in the lining of the uterus. In some women, it prevents the ovaries
from releasing an egg. The IUS is 99.9% effective.
What Are The Advantages And Disadvantages Of An IUS?
Advantages:
- Effective and long acting (up to five years).
- Does not contain estrogen.
- Does not interfere with intercourse.
- Decreases menstrual bleeding and menstrual cramping.
- May decrease endometriosis pain.
- May decrease the risk of precancerous cells developing in the uterus.
- 20-30% of women will stop having periods.
Disadvantages:
- Possible side effects after insertion include irregular bleeding or spotting.
- Perforation of the uterus may occur at the time of insertion (but rare).
- May be expelled (fall out) in up to 6% of women.
- Does not protect against STIs.
- A gynecologist must insert and remove the IUS.
What Is Female Sterilization?
Female Sterilization is a surgical procedure also called tubal ligation to
permanently close or block the fallopian tubes. It is a minor operation done in a hospital by a gynecologist often as
day surgery.
- During a laparoscopy, a camera is inserted through
a small incision below the belly button and a second instrument is inserted through a small incision just above the pubic
bone. The tubes are then blocked by applying a clip or a ring or by burning them.
- During a hysteroscopy, a small camera is inserted through
the cervix into the uterus. Tiny plugs are inserted into the fallopian tubes where they enter the uterus. An x-ray is done
3 months later to make sure that the tubes are blocked.
What Are The Advantages And Disadvantages Of Famle Sterilization?
Advantages:
- Permanent.
- Does not interfere with intercourse.
Disadvantages:
- Permanent and difficult to reverse.
- May regret decision in the future.
- Possible risks of surgery include risk of bleeding, infection or damage to organs
in the pelvis (bowels, bladder, blood vessels).
- Short term side effects after surgery may include abdominal and shoulder tip discomfort
and bruising.
- If pregnancy does occur, there is a risk that it will be an ectopic pregnancy.
- Does not protect against STIs.
It is most likely that there will be one or more tubal consultations with your
gynecologist before they agree to doing the procedure. Your gynecologist will want to be reassured that you are certain
of the procedure, the risks as well as understand the permanency of your decision.
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