More and more Indians now prefer effective contraceptives that require minimum intervention. So, it becomes the doctor’s responsibility to guide patients properly to help them choose the best option. Here’s a roundup of the recent advances in the world of contraceptive development.

Contraceptives have evolved a lot from the days when condom, vasectomy, and birth-control pills were the only options. Now, sexually active couples have a host of choices that score high in terms of ease of use and low on the side-effect scale.

NuvaRing

Dr. Chetana V, consultant (obstetrics and gynaecology), Aster CMI Hospital, Bangalore, says, “The newer hormonal contraceptive methods include the combined hormonal vaginal ring (NuvaRing) and the contraceptive patch. These haven’t gained popularity yet among doctors and patients in India."

The reasons could be lack of awareness or personal preferences and beliefs on the part of both doctors and patients. The combined hormonal ring is inserted into the vagina for three weeks and then removed. After one ring-free week, it is reinserted.

This ring releases ethinyl estradiol at a rate of 15 mcg per day and etonogestrel at a rate of 120 mcg per day. If for some reason the ring is out of the vagina for more than three hours, backup contraception should be used.  Studies have shown that the overall failure rate for vaginal ring is 0.65 pregnancies per 100 women.

Studies also show that the insertion and removal are easy. Adverse effects that led to discontinuation of the ring often were related to foreign body sensation, coital problems, and expulsion of the device. The ring is gaining popularity in Western countries.

Long-Acting Reversible Contraceptions (LARCs)

Dr. Neha Karve, attending consultant obstetrician and gynaecologist at Hiranandani Hospital, Vashi, a Fortis Network Hospital, says contraception has undergone a significant change in the recent decade, with the spotlight moving from permanent methods to Long-Acting Reversible Contraceptions (LARCs).

“Comparatively, failure rates are less in these contraceptives and they come with an array of additional benefits. Patient-centered outlook towards choice of contraception is increasingly taking preference over offering just a single method for the patient."

Many new methods such as Mirena (an intrauterine device with progestogen), injectable contraceptives and implants, have risen as a result of the growing demand for contraceptives to go above and beyond just the single-line thought of just pregnancy prevention. They offer additional benefits like menstrual regulation, suppression of endometrial hyperplasia etc.

Contraceptive preference for adolescents

Another aspect that was neglected for long but has received due attention in recent times is contraception for adolescents. Barrier contraceptives still remain the simplest and easiest to use among adolescents and young people, giving the additional benefit of protection from sexually transmitted infections. However, LARCs, which require minimum intervention and attention, such as Intrauterine Contraceptive Devices, are popular among young people.

The newer levonorgestrel intrauterine system releases 20 mcg of levonorgestrel per day and provides effective contraception for at least five years. This is gaining popularity among the urban population. Its effectiveness is compared to surgical sterilisation but is reversible.

- Dr. Chetana V, Consultant, Obstetrics and Gynaecology, Aster CMI Hospital, Bangalore

Side effects are minimal as compared with copper-containing devices. It minimises bleeding, may result in amenorrhoea and reduces dysmenorrhoea. Oligomenorrhoea and amenorrhoea with this method may not be agreeable to many patients, especially from the rural areas.

Risks to warn patients about

The risks associated with new forms of contraceptive methods are similar to the complications associated with oral contraceptives. These may lead to cardiovascular problems, depression, cause hepatic adenomas and may increase vulnerability to breast and cervical cancers.

While counselling for contraception, the physician should be aware that the only effective contraceptive method for any patient is the one that the patient is willing to use consistently and correctly. The physician's role is to educate the patient about the advantages and disadvantages of each contraceptive method that is medically appropriate for that patient and then allow the patient to choose the most desirable method.

- Dr. Chetana V, Consultant, Obstetrics and Gynaecology, Aster CMI Hospital, Bangalore

Male contraception

For men, researchers are devising new contraceptive methods since vasectomy has few takers owing to its invasive procedures and many find condom cumbersome. From sperm-suppressing pills to a gel whose daily application on arms and shoulders stops sperm production, trials are under way to develop birth control options for men so that the responsibility of avoiding unwanted pregnancy does not fall on the woman alone.

This story was contributed by Debdutta Mohanty, a Mumbai-based freelance writer and a member of 101Reporters, a pan-India network of grassroots reporters.