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Birth Control

Reprinted from PN/Paraplegia News May 2013

A range of issues challenges women with spinal cord injury who are considering the use of birth control.

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Unfortunately, not many resources have up-to-date information for women weighing these decisions. This month’s article is a look at some of the currently available birth control options.

After reviewing these choices, it’s a good idea to talk with your doctor to see what’s best for you.

Hormonal IUD

The hormonal intrauterine device (IUD) is a small T-shaped device that is inserted and removed by a trained physician.

It stays in the uterus for up to five years. The device releases a small amount of hormone each day that causes the cervical mucus to thicken. This acts as a barrier to prevent sperm from entering the uterus.

Although an IUD may cause some irregular bleeding for a few months, the benefit is that it’s inserted by a physician.

The downside is that some women have a reaction to the hormone and with decreased sensation there is the danger of a perforation (small tear) that may go unnoticed. Infection may also be an issue since this may be difficult to detect due to diminished sensation.

Copper IUD

The copper IUD is inserted and removed by a physician and can last for up to 10 years.

It stops the sperm from reaching and fertilizing the egg. It’s reported to be effective in 99% of women. The benefits are that the woman has up to 10 years of protection.

This IUD is sometimes used as an “emergency birth control.” The doctor can insert a copper IUD up to five days after intercourse to prevent a fertilized egg from implanting in the uterus.

For women with decreased sensation, there is the danger of a perforation. In rare cases, some degree of infection might develop. This may be difficult for women with SCI to monitor due to decreased sensation.

Implant

The implant is a small rod, about the size of a matchstick, that is inserted under the skin by a physician.

Usually, it’s implanted in the upper arm and is good for up to three years. The downside is that there is no protection against sexually transmitted diseases (STD), and it can cause irregular bleeding for some women.

Occasionally, it can affect a woman’s mood and sex drive. Typically, it might be a good choice since it can be inserted by a doctor and forgotten about. It’s effective about 99% of the time.

The Pill

The birth control pill is a combination of hormones that are taken orally.

Like other hormonal methods, the pill suppresses ovulation, thickens cervical mucus and thins the lining of the uterus to help block sperm. The downside is that women must remember to take the pill for three weeks each month. It’s best if the pill can be taken at the same time each day. If done properly the birth control pill is about 91% effective.

The pill can cause nausea, headaches, breast tenderness and spotting between periods. Some doctors are concerned about giving the pill to women with SCI because of the dangers of developing deep vein thrombosis (blood clots) in the legs.

Some people believe there is less of a danger of blood clots with a few of the newer pills. Other doctors think Progestin-only pills are safer for women with SCI.

The Patch

This is a small patch you place on your upper arm, shoulder, abdomen, hip or upper back.

It delivers a combination of hormones that does the same thing as the birth control pill. It suppresses ovulation and blocks the sperm. On the plus side, you don’t need to remember to take a pill, but you do must change the patch weekly.

It has many of the same side effects as the pill and may cause some redness where the patch is applied. The location of the patch can be changed to prevent irritation.

Because of possible blood clots, there are concerns about its safety for women with SCI.

Vaginal Ring

This small plastic ring is inserted into the vagina and slowly releases hormones into the body.

Besides the hormone issue, proper insertion of the ring may be a source of anxiety. Typically, the ring is self-inserted, which may be difficult for women with SCI. Manual dexterity is required.

If a woman isn’t in a long-term relationship, it may be awkward to ask the partner for assistance.

Condoms

The condom is a barrier method and is presently the only form of male contraception.

Female condoms may be an option; however, they can be difficult to insert and fit due to possible atrophy in the muscles of the vagina.

They do reduce the risk of STDs.  Many women with SCI prefer male condoms since the man can take charge of putting it on.

Central Thoughts

The main birth control considerations for women with SCI are issues regarding manual dexterity, diminished sensation and the side effects of hormones.

Unless a pregnancy is wanted, some form of birth control is necessary for women with SCI who are in the childbirth years. After the first few months post injury, spinal-cord injury doesn’t prevent pregnancy.

Contact: ducharme@bu.edu.  

 

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