I recently received a question from a reader and I would like to share it with you, as this may be the question of other people: “I’m 40 years old, no health problems, normal menstruation. I got divorced and stopped taking birth control. Now, I met a person and started having sex again, but I don’t want to take birth control again. Can you help me?”
First of all, knowing that there is no perfect contraceptive is fundamental, and even with as much information as possible, an exchange may be necessary.
In addition, the best method is the one that you adapt well to, thinking about your wishes, your finances, failure rate, form of use and medical indications, thus, weighing these points, which are not unique, but may be the main ones, the choice will possibly become easier.
Among the current options, I will divide them into two groups: hormonal and non-hormonal methods, with an emphasis on non-hormonal methods, which were the methods requested by the reader.
Tubal ligation: tubal ligation, a surgical technique for definitive sterilization, has a failure rate of 1% to 3% per year. For its realization, it is necessary to be over 25 years old or have two children.
Intrauterine device (IUD): It is a contraceptive method that stays in the uterus. It is safe, effective and long-lasting, it can be inserted in the office, operating room with local anesthesia and even with sedation. It can be used by those who have never been pregnant, by those who want a safe, long-lasting method, without the need for daily reminders and without weight gain.
There are 2 types of IUDs: with and without hormones. The differences are in the fact that the hormonal IUD can reduce menstrual flow and even block it completely, it helps people with endometriosis and heavy menstrual flow, however, because it has hormones in its composition it can lead to leaks, skin and hair changes. and libido. The hormone-free IUD has good contraceptive action, does not affect libido, weight, skin or any other point related to hormones, on the other hand, it can lead to increased menstrual flow.
Internal and external condoms (female and male): are the only forms of contraception associated with the prevention of STIs (sexually transmitted infections), with restriction only for those who are allergic to latex.
Behavioral methods: measurement of basal body temperature, assessment of cervical mucus or Billings method, palpation of the cervix and chart, which are methods that require those who use them to have a good knowledge of the body and the cycle.
already among the hormonal options we have: pills with pause and continuous use, patch, vaginal ring, monthly and quarterly injection, hormonal implant and hormonal IUD. They will differ by route of use, dose, failure rate and side effects.
After presenting all the methods, I would like to share a little more about the possibilities of these methods and considerations. I talked to Maria Mariana, gynecologist, specialist in endocrine gynecology, who takes care of contraceptive and hormonal methods.
A frequent doubt among many people and the reader who wrote me is the relationship between age and hormonal methods, Maria Mariana explains: “Age alone is not a contraindication to the use of hormonal methods. Healthy people, non-smokers, can use hormones until menopause. The exception of this is for patients with diabetes and uncontrolled hypertension, migraine, liver disease and smokers. In these cases, age over 35 years is an aggravating factor for the risks of using hormonal methods, especially estrogen and , we usually opt for non-hormonal or progesterone alone.”
Knowing the contraindications of hormones, and with so many non-hormonal methods, it is worth putting hormonal methods on the scale: are hormones villains?
According to Maria Mariana, “We are currently living in the era of getting back to nature and, honestly, I don’t consider that a bad thing. More and more women want to experience their menstrual cycles and get to know their bodies without hormonal blockage. I think it’s interesting that everyone has access to information adequate to choose the method based on scientific evidence, but, at the same time, I do not think it is healthy to condemn the pill and hormonal methods. When they are necessary, they greatly improve the person’s quality of life. As with all methods, they are not risk-free, but, in addition to the fact that serious events related to the use of hormonal methods are extremely rare, we need to think about the benefits they bring throughout their use.”
Regardless of the choice made, we cannot forget that only condoms protect against STIs, even if the relationship is monogamous and stable, fidelity and relationship time should not be the only ones considered when stopping condom use.
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