Contraceptive Pill

[brianbrain]

My TG understands the need for reliable contraception, but would rather risk getting pregnant than "face the shame" of seeing a health professional to get suitable contraceptive advice.

As she sees it, Thai girls don't see the doctor/nurse about contraception they just buy it at the pharmacy, if they do anything at all. I know oral contraceptives are freely available at pharmacies, but I'd much rather she had a medical checkup at the hospital as would be done in the UK, and was prescribed the most appropriate medicine and given reliable advice. My question is this: can she get this service at her regular government hospital? This may all be a bit academic as I rather doubt I can get her to see any doctor unless I drag her to the hospital and she will not forgive me for doing so. For reference, she is typical skinny twenty-something Thai. I don’t think she is in any of the “at risk” categories listed below.

Any comments? What do you do? (keep it clean please )

http://www.fwhc.org/birth-control/thepill.htm

Some women may not be able to take The Pill because of the risk of serious health problems. Women who are over 35 and smoke or who have any of the following conditions should not take The Pill:

• History of heart attack or stroke

• Blood clots

• Unexplained vaginal bleeding

• Known or suspected cancer

• Known or suspected pregnancy

• Liver disease

[george]

The nearest Thai Govt Hospital can help her. Or ask her to visit http://www.bumrungrad.com

A bit costly, but that should help you and her out.

[alaina]

If she is too shy to ask for advice on the pill, at the very least she needs a blood pressure screening. Very cheap, I think there are places in the malls to get them.

It is highly advisable that she goes to the GYN and gets a pap smear. Cervical cancer is very dangerous and once it has symptoms, it's often too late. The pill has been linked to cervical cancer so she should get a checkup annually while on it.

Pills here are really good in that they list what percentage of which hormones they have. Too much of one or another can cause different side effects and everyone's body takes to them differently. So you can look up what hormones and all about the pill here

The side effects can be a real pain, and some definitely affect both partners. Loss of libido is common in the first month but generally returns to normal. Extreme mood swings are also common, especially with the new pill yasmin. Warn her about that because it sometimes doesn't occur to the person taking them until it's too late. (I'm still apologizing for my moodiness during a brief stint on those ) If there is any problem, switch immediately. Unfortunately, the pill is not for all women and some can't find any that work without side effects they can't live with.

Good luck.

[Ice Maiden]

My TG understands the need for reliable contraception, but would rather risk getting pregnant than "face the shame" of seeing a health professional to get suitable contraceptive advice. 

As she sees it, Thai girls don't see the doctor/nurse about contraception they just buy it at the pharmacy, if they do anything at all. I know oral contraceptives are freely available at pharmacies, but I'd much rather she had a medical checkup at the hospital as would be done in the UK, and was prescribed the most appropriate medicine and given reliable advice. My question is this: can she get this service at her regular government hospital? This may all be a bit academic as I rather doubt I can get her to see any doctor unless I drag her to the hospital and she will not forgive me for doing so. For reference, she is typical skinny twenty-something Thai. I don’t think she is in any of the “at risk” categories listed below.

Any comments? What do you do? (keep it clean please  )

http://www.fwhc.org/birth-control/thepill.htm

Some women may not be able to take The Pill because of the risk of serious health problems. Women who are over 35 and smoke or who have any of the following conditions should not take The Pill:

• History of heart attack or stroke

• Blood clots

• Unexplained vaginal bleeding

• Known or suspected cancer

• Known or suspected pregnancy

• Liver disease

<{POST_SNAPBACK}>

I'm sorry but if this girl is going to be having sexual intercourse then she should take responsibilty for her actions and go visit the doctor. IMO that is immature.

Like Pearl said blood pressure must be checked and if she is a smoker then a different type of pill should be issued.

Edited September 26, 2005 by Ice Maiden

[alaina]

Oh, and I forgot one more REALLY important thing...

When a woman goes off of the pill after being on it for a few months, she is MORE likely to get pregnant. It's often given to women with infertility problems. Sadly, many doctors don't mention that.

[Orion76]

When a woman goes off of the pill after being on it for a few months, she is MORE likely to get pregnant.  It's often given to women with infertility problems.  Sadly, many doctors don't mention that.

<{POST_SNAPBACK}>

And does one really want to give a TG the responsibility of remembering to take it every day if she is more fertile on forgetful days?

[Ice Maiden]

When a woman goes off of the pill after being on it for a few months, she is MORE likely to get pregnant.  It's often given to women with infertility problems.  Sadly, many doctors don't mention that.

<{POST_SNAPBACK}>

And does one really want to give a TG the responsibility of remembering to take it every day if she is more fertile on forgetful days?

<{POST_SNAPBACK}>

Yes. Every female.

[Thomas_Merton]

There are real alternatives to the pill; these are just as effective and IMHO (being just a man) considerably less prone to being forgotten.

My wife receives an injection* once every three months. This provides the same protection as the pill.

For this (in the UK) she had to visit a doctor before it could be prescribed.

Do you not think your wife's apprehension could also be connected to a Thai preference for self-medication, sparing the added cost of visiting a doctor?

If this is so - a once every three month consultation could be attractive.

And just think, no more after the event panic, "Did you remember to take the pill?"

*****************************************************

*What are contraceptive injections?

These jabs contain hormones. When injected into a muscle (usually in the buttock), the medication keeps you from getting pregnant – for a considerable period of time. So a very good thing about it is that you don’t have to remember to keep on taking anything, which makes this method very useful for the many people who forget Pills!

Also, the jab does ensure that sex is spontaneous; you don’t have to bother about putting on condoms, or inserting chemicals. Quite a few women regard this as a ‘plus'.

In Britain, there are currently (2005), just two types of contraceptive jab available. They are:

* Depo-provera (medroxyprogesterone), which is by far the more commonly-used. It protects you – almost fully – against pregnancy for 12 weeks.

* Noristerat (norethisterone) - which provides contraceptive protection for eight weeks.

Both these jabs contain a type of hormone called a ‘progestogen’ – which has similar effects to the natural female hormone progesterone.

In the USA and in certain other countries, there is another type of contraceptive jab which (like the Pill) contains two hormones. It is called ‘Lunelle’ and the idea behind it is that it should control the periods better than Depo-Provera and Noristerat do. There are plans to bring it to the UK – possibly in 2006 or 2007.

How do these contraceptive jabs work?

They have three useful anti-fertility effects.

* They stop you from ovulating (producing eggs).

* They thicken the mucus in your cervix – making it difficult for sperms to get through.

* They make the lining of your womb thinner, so that if an egg (ovum) became fertilised, it would have difficulty attaching itself to the lining.

How effective are these injections?

They are very efficient indeed. Most experts rate them as around 99 per cent effective, which means that if 100 women used the jab for a year, only about one would become pregnant. This makes the injection one of the most efficient of all contraceptives.

However, you do have to remember to turn up for your next injection. Many of the pregnancies which occur in people who are ‘on the jab’ happen because somehow the injection doesn’t get given on time.

Also, please bear in mind that a few prescription medicines can interfere with the efficiency of the jab. Your doctor or nurse should give you fuller details, but if you prescribed other medications by a doctor, it’s always best to mention that you are ‘on the jab'.

In practice, it is chiefly medicines for epilepsy and for tuberculosis that can interfere with the working of the contraceptive injection.

What are the advantages of the injection?

Firstly, there’s the fact that the only action you have to take is to turn up for your jabs on time.

Secondly, it now (2005) seems probable that Depo-Provera gives you some protection against cancer of the womb lining. Balanced against that is the fact that there is still a chance that it might increase the chances of breast cancer.

Both of the jabs which are used in Britain are thought to help protect you against:

* ovarian cysts

* ectopic pregnancy.

What are the side effects?

Don’t let anyone give you the idea that the jab is without side effects! In particular, there is a very high chance (40 per cent) that your periods will be disrupted in some way.

For Depo-Provera (medroxyprogesterone acetate or DMPA), the commoner side-effects are as follows:

* heavy periods (menorrhagia)

* prolonged periods

* irregular or infrequent periods (oligomenorrhoea)

* absent periods – though many women are very grateful for this effect

* headache

* tummy ache

* weakness

* dizziness

* weight gain

* delayed return of fertility after stopping the jab – however, there’s no evidence at present (2005) of long-term infertility.

There are other (rarer) side-effects, and you should talk these over with the doctor or nurse before you start, and read about them in the leaflet which you’ll be given.

The more rarely used injection Noristerat (norithisterone enantate) has similar side effects, and also may sometimes cause breast tenderness or reactions at the injection site.

Is there anyone who shouldn’t have the jab?

Yes. Neither jab is suitable for women who are already suffering from undiagnosed abnormal vaginal bleeding.

Nor should you have the injection if you’ve had a hormone-dependent cancer. It may not be suitable for you if you have migraine, liver problems, or a history of thrombosis (clots). There are certain rare conditions in which use of the injection is ruled out, but your doctor will advise you if this applies to you.

Also, if during a pregnancy you’ve ever had the condition of cholestatic pruritus (intense itching), then the jab is not for you.

Finally, it has been suggested that regular use of the jab may lead to ‘thin bones’ (osteoporosis). As at 2005, this is still not certain. But if you already have osteoporosis, then I think it would be better for you to choose some other form of contraception.

Where can I get the injection?

Traditionally, the jab has mainly been given by the contraceptive experts – that is, doctors and nurses at Family Planning Clinics. But these days, more and more GPs are prescribing contraceptive injections in their surgeries. Usually, the drug is started during the first five days of your period – because this gives you immediate protection against pregnancy.

However, quite often the jab is given postnatally – that is, by the staff of the Obstetric Department, after you’ve had a baby.

Very commonly, you have the injection about six weeks after giving birth. Having the injection any earlier than this seems to be more likely to cause problems with heavy bleeding. And if you are hoping to breastfeed, you should definitely not have the jab until your baby is at least six weeks old.

From: Netdoctor

[Ice Maiden]

There is also an implant which lasts for a good few years too which is something that maybe you would possibly want to consider. There are side effects though. Everytime I have taken the pill I've suffered from weight gain but as soon as I've come off the pill I've gone back to my normal size. But also some people suffer from weight loss.

My doctor in England thinks this is a better option for me so when I pluck up the courage I'll get the implant done.

Local anasthetic is given to you in most cases when the implant is inserted and it is said to be pain free just a little sore in the healing process.

[brianbrain]

Pearl,

That was a really useful post. Armed with the information you gave me, plus what I have gathered from the Internet, I think it should be possible to persuade her to visit the doctor as I have always recommended her to do.

Best regards,

BB

If she is too shy to ask for advice on the pill, at the very least she needs a blood pressure screening.  Very cheap, I think there are places in the malls to get them.

It is highly advisable that she goes to the GYN and gets a pap smear.  Cervical cancer is very dangerous and once it has symptoms, it's often too late.  The pill has been linked to cervical cancer so she should get a checkup annually while on it.

Pills here are really good in that they list what percentage of which hormones they have.  Too much of one or another can cause different side effects and everyone's body takes to them differently.  So you can look up what hormones and all about the pill here

The side effects can be a real pain, and some definitely affect both partners.  Loss of libido is common in the first month but generally returns to normal.  Extreme mood swings are also common, especially with the new pill yasmin.  Warn her about that because it sometimes doesn't occur to the person taking them until it's too late.  (I'm still apologizing for my moodiness during a brief stint on those  )  If there is any problem, switch immediately.  Unfortunately, the pill is not for all women and some can't find any that work without side effects they can't live with.

Good luck.

<{POST_SNAPBACK}>

[brianbrain]

Oh, and I forgot one more REALLY important thing...

When a woman goes off of the pill after being on it for a few months, she is MORE likely to get pregnant.  It's often given to women with infertility problems.  Sadly, many doctors don't mention that.

<{POST_SNAPBACK}>

Then it's just as well you mentioned it. Thanks again.

[brianbrain]

Thomas,

Thanks for the reply and the supplementary info.

My girlfriend's reluctance to seek medical advice is, I would say, 90% due to embarrasment of admitting to anyone (other than a very close friend) she is having sex outside of marriage, and 10% fear of the drug. She's not bothered about the cost as I would be paying

It has been my observation that Thai girls are so secretive about their sex lives that many are under the mistaken belief that they are the only ones doing the dirty deed. Of course, as a man I know differently.

Thanks.

There are real alternatives to the pill; these are just as effective and IMHO (being just a man) considerably less prone to being forgotten.

My wife receives an injection* once every three months. This provides the same protection as the pill.

For this (in the UK) she had to visit a doctor before it could be prescribed.

Do you not think your wife's apprehension could also be connected to a Thai preference for self-medication, sparing the added cost of visiting a doctor?

If this is so - a once every three month consultation could be attractive.

And just think, no more after the event panic, "Did you remember to take the pill?"

<{POST_SNAPBACK}>

[alaina]

Pearl,

That was a really useful post. Armed with the information you gave me, plus what I have gathered from the Internet, I think it should be possible to persuade her to visit the doctor as I have always recommended her to do.

Best regards,

BB

<{POST_SNAPBACK}>

Glad to hear it.

If a pill is forgotten but then taken within 24 hours, it reduces the effectiveness but it does not make a woman more fertile. If it's more time or pills than that it's time to throw away the pack and start over. The best thing is to tie taking the pill with another daily routine like brushing in the morning.

It's only after a few months on the pill when the body has not ovulated when stopping full on will increase fertility. Same reason women get pregnant easily the first few months after giving birth.

What's really great is that some pills can be taken for up to four months in a row without having a period! The pill really has to have low/no side effects for this to be healthy but that means a woman can have fewer periods.

I've always been leery of Depro Provera (the shot). I'm sure it works for most women but I know a few that have had really bad side effects. Bleeding for months, no sex drive, big weight gains. Problem is once you get the shot it will not wear off for three to four months and cannot be reversed. So, if it causes problems they just have to be waited out. With the pill it's easy to stop taking them or switch.

[Boo]

I had the pill injections for several years & have now suffered from a hormone imbalance for 2 years since stopping the injections.

I am also effectivly infertile whilst the hormone inbalance corrects itself (which could take up to 5 years, there is no treatment except the bodies own chance to heal) & suffer from severe & very heavy periods & PMS. It also did affect my sex drive for a while (thankfully resolved) & I gained a lot of weight whenm I came off it.

I would not recomend the injections to anyone ever, as whilst having them everything was fine, but once off them all the problems started (initially, heavy bleeding for 5 weeks continuously plus every month since, heavy periods, sometimes 2 a month.) Complete nightmare.

The implants are supposed to be better as they can be removed anytime, or else she should look about getting a coil. Easy to fit (by GP) & nothing else needed after that.

If she is shy about going to her doctor why not just find an unknown GP & pay for her check ups there, she should also be having regular smears & just because she is young & looks healthy doesn't mean that she can't suffer from high blood pressure or any of the other problems that women can have.

[Thomas_Merton]

I had the pill injections for several years & have now suffered from a hormone imbalance for 2 years since stopping the injections.

I am also effectivly infertile whilst the hormone inbalance corrects itself (which could take up to 5 years, there is no treatment except the bodies own chance to heal) & suffer from severe & very heavy periods & PMS. It also did affect my sex drive for a while (thankfully resolved) & I gained a lot of weight whenm I came off it.

I would not recomend the injections to anyone ever, as whilst having them everything was fine, but once off them all the problems started (initially, heavy bleeding for 5 weeks continuously plus every month since, heavy periods, sometimes 2 a month.) Complete nightmare.

...

<{POST_SNAPBACK}>

I must supplement here, as my wife has just beaten me around the head, calling me all sorts of names - "typical man" being the only one printable.

She completely agrees with Boo's experiences of the injection. She stopped taking it 4 months ago and has been bleeding for the last 5 weeks and experiencing severe, apparently unexplained, "violent", swings in temperament.

Which only underlines what must be the important point from this thread:

"Chemical" contraception is such a complex process dependant upon the chemistry of each individual woman. Therefore it is imperative that all women - together with their man - be persuaded, by hook or by crook, to visit a medical authority, before putting such substances into their bodies.

[PeaceBlondie]

When you say "implant," is that also called a patch? I think there are dermal patches available in the USA that last for up to 6 months at a time.

The coil - which also has another name in the USA, I think - does that just go inside the cervix and stay there indefinitely?