Monday, September 17, 2012

The Right Way to Change Contraceptives

You did know that half the pregnancies in the United States fall into the category "unintended" didn't you?  I've read numerous articles trying to explain why that is, but while we are all waiting for an answer, there's a relevant and easily solvable issue - how to change contraceptives without risking a period of unprotected fertility.

Most women and many doctors haven't a clue how to do this.  Sounds simple enough - just stop what you are doing now and start doing something else as soon as possible - but there are some important tricks to know and traps to avoid.

NYT's reliable health column "Well" has the details you are missing along with a thoughtful list of reasons why reproductively-vulnerable women find themselves in a contraceptive gap situation.  It's worth reading the whole thing, but as always, WNL includes a nugget here in case you want it boiled down:
Strategies for Transition
Another factor that puts some women at risk of an unintended pregnancy is the false belief that one must wait until the beginning of a menstrual cycle to start a new method. These gaps in protection should never occur, said Dr. Lesnewski, who was an author of a report on preventing contraceptive gaps in American Family Physician last year.
“Many women get pregnant when they stop one birth control method before starting another,” she said. For example, a woman who has been on the pill should not wait for the start of her next period before she begins a different pill. Rather, she should switch directly from one pill to another without missing a day.
For other kinds of changes — say, from a pill to a contraceptive patch — a two-day overlap is needed to prevent a decline in hormone levels and assure contraceptive protection. When switching from a pill, patch or vaginal ring to a progestin IUD or hormonal implant, an overlap of seven days is needed, but no overlap is required if switching to a copper IUD.
On the other hand, if the switch is made in the opposite direction — from a copper IUD to a pill, patch or ring — a woman should use the new method for seven days before the IUD is removed.
Another option is to rely, religiously, on a barrier method of contraception, like a condom or diaphragm with spermicide, to cover any gap in protection. Use of a barrier method for seven days is essential when changing from a copper IUD to a progestin IUD (or for four days when making a switch in the opposite direction) because a woman can become fertile as soon as an IUD is removed.
The Reproductive Health Access Project has posted a chart that spells out in great detail how to switch contraceptives while minimizing the risk of pregnancy. It can be found at www.reproductiveaccess.org/fact_sheets/switching_bc.htm.
If you don't use contraception and are sexually active, how likely is it you will get pregnant, based on your age?  The measurement here is something called the monthly fecundity rate which is the "likelihood of getting pregnant each month if you're having sex without birth control." 

The younger you are (youngest on this graph being 25 which IMO leaves out some sexually active folks), the greater the possibility that unprotected sex will start a pregnancy sooner rather than later.  So, unless you are 45 or older, having accurate information about how to change contraceptives and a plan to manage gaps in your access to contraception should be on your "to do" list rather than the "maybe later" list.

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