Family planning and birth control

Contraceptive methods prevents fertilization or conception, the most used are: hormonal contraceptives (the pill, transdermal patches, vaginal ring, injectable intramuscular and subcutaneous implants), IUDs and the male condom. Contraceptive methods are those that act after fertilization or conception has occurred such as: Emergency method (morning after pill, IUD) and surgical abortion.

At Clínica Médica Sants we put at your disposal methods that significantly prevent or reduce the chances of fertilization for sexually active women. And in this way we act in the field of family planning so that couples can freely and responsibly make decisions about how many children they want or not to have, and when.

Visit us so we can help you choose the right contraceptive methods in Barcelona.

A) Contraceptives:

A.1) Hormonal:

(a) Oral Pill
(b) Transdermal patch
(c) Vaginal ring

(d) Intramuscular injectable
(e) Subcutaneous implant

A.2) IUD

A.3) Male preservative

B) Contraceptives:

B.1) Emergency method

(a) Morning After Pill
(b) IUD

B.2) Surgical abortion

A) HORMONAL:

A.1) Hormonal contraceptives

(a) Birth control pill: It is a contraceptive pill taken daily orally. The combined pill contains estrogen hormones and progestogen that prevent ovulation, it should always be prescribed by a doctor, not all women can take it.

How is it used: If you start taking the pill the first six days of menstruation or the six days after an abortion, it is effective immediately. Starting at any other time assumes that the pill will not be effective until after one month and therefore another method of contraception will have to be used in parallel to prevent the risk of pregnancy.

Efficiency: 99% effective.

Side effects: Some women experience changes in bleeding patterns (milder, irregular bleeding, no menstruation…), headaches, dizziness, nausea, breast pain, weight changes, mood swings and acne.

Pros:

– Helps reduce menstrual pains, menstrual bleeding problems, excessive hair, endometriosis symptoms.
– Does not interfere with relationships.
– Compatible with condom use.
– The use of this hormonal contraceptive method can be combined with the use of condoms, to double protection against STDs (Sexually Transmitted Diseases) and unwanted pregnancies, known as the DOUBLE METHOD.

Cons:
– Requires medical prescription.
– Risk of forgetting intake. You can’t skip any take and you must take it every day at a similar time.
– Efficiency may decrease if you vomit, have diarrhea or are on certain antibiotics.

(b) Transdermal patch: It is a hormonal contraceptive method consisting of a small, thin and square plastic. It is placed on the skin and works by continuously releasing hormones (usually progesterone and estrogen) into the bloodstream through the skin.

How it is used: A new patch should be used every week for three weeks, the fourth week should not be worn. The patch change should always be made on the same day of the week. There are four recommended areas in which to place the patch: abdomen, buttocks, arms and on the top of the trunk.

Like any hormonal contraceptive, before starting using it you should consult with a doctor to make sure that it is the method that suits you best and that it will not provoke any unwanted effects.

Efficiency: 99% effective.

Side effects: May have side effects, such as dizziness, nausea, abdominal pain or headaches.

Pros:

– It does not require any daily action, it is applied once a week.
– It has no influence on sexual intercourse.
– No influence on weight.
– After abandoning its use, the woman immediately regains fertility.
– The use of condoms can be combined with the use of hormonal contraceptives, to double the protection against STDs (Sexually Transmitted Diseases) and unwanted pregnancies, known as the DOUBLE METHOD.

Cons:

– Does not protect against sexually transmitted diseases (STDs).
– The woman needs to change the patch on the appropriate day.
– Not suited for smokers.
– Consult your doctor if you have intolerance or contraindications to the use of birth control hormones.
– May cause skin irritation.
– Less discreet.

(c) Vaginal ring: It is a flexible, soft and transparent plastic ring that is easily placed in the vagina. The ring releases birth control hormones at very low doses steadily for three weeks. The body absorbs them and prevents ovulation.

Medical prescription is required to use the ring.

How is it used: The vaginal ring is used for three weeks in a row and menstruation will normally appear during the fourth.

It should be placed on the first periods day and remain in the vagina for 3 weeks in a row.

The new ring should be placed after one week of having removed the previous one, the same day of the week and at approximately the same time.

Efficiency: 99% effective.

Side effects: It can have side effects like headache.

Pros:

– It must be applied only once a month.
– It contributes to more regular menstruation.
– Once the method is abandoned, the woman immediately becomes fertile again.
– Reduces the risk of uterine cancer.
– No one knows it is being used.
– Contains half the hormones of other methods such as the pill.
– It has no influence on sexual intercourse.
– The use of this hormonal contraceptive method can be combined with the use of condoms, to double protection against STDs (Sexually Transmitted Diseases) and unwanted pregnancies, known as the DOUBLE METHOD.

Cons:

– Does not protect against sexually transmitted diseases (STDs).
– It may be uncomfortable to place.
– It might be noticeable during intercourses.
– It may causes, in extreme cases, irritation of the mucous membrane of the vagina.

(d) Intramuscular injection: It is a rather unknown method despite being very reliable. Intramuscular injectable is a contraceptive preparation in suspension, by injection deposits progesterone at the intramuscular level, from where it is gradually absorbed. After a monthly or quarterly period, depending on the preparation, it must be repeated.

Medical prescription is required to be able to use.

How is it used: The contraceptive injection is administered intramuscularly, its content is progestogens only.

The progesterone injection is given every month or every three months and once injected it is not possible to withdraw treatment until the next administration.

Efficiency: 99% effective.

Pros:

– It does not influence sexual intercourse.
– It does not require any daily action.
– No one realizes that a contraceptive method is being used.
– No menstrual bleeding.
– Great effectiveness.
– The use of this hormonal contraceptive method can be combined with the use of condoms, to double protection against STDs (Sexually Transmitted Diseases) and unwanted pregnancies, known as DOUBLE METHOD.

Cons:

– The woman takes an average of four months to regain fertility after giving up birth control.
– Does not protect against sexually transmitted diseases.
– Risk of forgetting one of the injections.

(e) Subcutaneous implant: The contraceptive implant consists of one or two plastic rods 4cm in length and 2mm in diameter that do not melt in the body. The implant releases a hormone (progestogen) at very low doses.

Medical prescription is required to use the implant.

How it’s used: The implant is inserted just below the skin, on the upper face of the arm. Local anesthesia is used for implant insertion and removal.

It can be worn uninterrupted for 3 or 5 years (depending on model or body mass index). After 3 or 5 years it can be changed to a new implant, immediately after removal of the implant used.

Efficiency: 99% effective.

Side effects: It can have side effects like headache.

Pros:

– Long-term method allowing you to forget about your contraceptive for 3 to 5 years
– Very mild periods, with fewer pains.
– No one knows what is being used.
– It has no influence on sexual intercourse.
– The use of this hormonal contraceptive method can be combined with the use of condoms, to double protection against STDs (Sexually Transmitted Diseases) and unwanted pregnancies, known as the DOUBLE METHOD.

Cons:

– Does not protect against sexually transmitted diseases (STDs).
– Your doctor should perform both insertion and removal.
– Your bleeding may be more variable, you may have less bleeding or even none.
– Consult your doctor if you have contraindications to the use of birth control hormones.

A2) IUD

It is a small plastic device, which may contain a copper wire or contain hormones depending on the type of intrauterine device (IUD).

The copper IUD makes it difficult for sperm to pass along, thus avoiding fertilisation and also implantation in the uterus.

IUD with progestogen free hormones progressively, combining the effects of the IUD with those of progestogen.

Once the IUD is placed it is effective between 3 to 5 years.

How it’s used: Your doctor will perform both insertion and removal. After a review with your gynecologist and deeming you fit to wear it, your gynecologist will place the IUD with an applicator to insert it through your vagina into your uterus.

Efficiency: 99% effective.

Hormonal side effects: Some women experience changes in bleeding patterns (milder, irregular bleeding, absence of menstruation…), headaches, dizziness, nausea, breast pain, weight changes, mood swings and acne.

Pros:

– Long-term method, forget about using it for 3 to 5 years!

– No risk of forgetting.
– Compatible with condom use.
– Additional caution if you have more than one sexual partner and do not use condoms.
– The use of this method of contraception can be combined with the use of condoms, to double the protection against STDs (Sexually Transmitted Diseases) and unwanted pregnancies, known as DOUBLE METHOD.

Cons:

– Can be spontaneously expelled on occasion.
– Copper IUD can cause abundant and painful periods and is contraindicated if you are allergic to copper.
– The hormone IUD may cause irregular menstruation. If you have intolerance or contraindications to the use of birth control hormones, you can consult it at the Sants Medical Clinic.
– Does not protect against sexually transmitted diseases (STDs).
– Your doctor should perform both insertion and removal.

A.3) Male condom

It is a latex and polyurethane sheath that is placed on the penis in erection during intercourse and retains the ejaculated semen.

– It is a barrier method because it prevents sperm from passing into the vagina.
– It should always be placed at the beginning of sexual intercourse.
– At the end there is a tank to collect semen after ejaculation.

How is it used: Always follow the instructions when placing the condom.

Unwrap the condom carefully so you don’t tear it.

Place the condom on the erect penis, press the tip (deposit) of the condom and unfold it along the erect penis to its base.

Leave the tank air tight so that it can retain semen without breaking of the condom.

After intercourse is finished, the condom must be removed before the penis loses its erection, holding it at the base to prevent it from staying inside the vagina.

Efficiency: Efficiency is 95-97%., depending on right positioning and proper use.

Pros:

– Easy to get and place.
– Protects you against AIDS and other STDs (Sexually Transmitted Diseases).
– No control required.
– The use of condoms can be combined with the use of hormonal contraceptives, to double protection against STDs (Sexually Transmitted Diseases) and unwanted pregnancies, known as the DOUBLE METHOD.

Cons:
– Might break.
– It may interfere with the spontaneity of your sexual intercourse.

B) CONTRACEPTIVES:

B.1) Emergency method:

An emergency contraceptive method is a way of preventing pregnancy in women who have had unprotected sex or have failed some form of contraception. There are two types:

(a) The morning-after pill or emergency contraceptive pill: They are usually pills with a higher dose than regular birth control pills, it belongs to a group of medicines called progestogens. This emergency contraceptive pill should be used as soon as possible, preferably within 12 hours and never later than 72 hours (3 days), after unprotected sex or when the contraceptive method used has failed.

Remember that it is NOT a regular contraceptive, and is only indicated as emergency contraceptive. We recommend that you call us for any questions.

How is it used? 

– The tablet should be taken as soon as possible, preferably within the first 12 hours, and no later than 72 hours (3 days) after having unprotected sex.

Efficiency: 75% to 89% effective.

Side effects:
– Pretty common: Irregular bleeding, increased breast tenderness, dizziness, nausea, headache.
– Common: Diarrhea and vomiting.
– Uncommon: Skin disorder; swelling in the face, itching, etc.

Cons:
– It should be used within 72 hours after the unprotected sexual intercourse.
– It has to be available quickly.
– Does not protect against sexually transmitted infections (STDs).
– It is not effective if you are already pregnant.
– If you have unprotected sex after taking the morning-after pill, the medicine will not prevent you from becoming pregnant.

Pros:
– Possibility to continue using other hormonal contraceptives on a regular basis.
– Does not affect long-term fertility if used correctly.

(b) IUD (Intrauterine Device): It is a contraceptive that many women use as a regular method; but it can also be used as an emergency contraceptive.  The IUD may be placed as an emergency method up to six days after an unprotected sexual intercourse to prevent pregnancy. Copper IUD is much more effective than any type of emergency birth control pill (or “morning after pill”), as it reduces the risk of pregnancy by more than 99%. Another advantage of the IUD is that it can be left in place and prevent pregnancy for up to five years.

We recommend that you call us for any questions.

B.2) Abortion pill RU-486 or Pharmacological abortion:

In our clinic this method is performed with two different medicines: “Mifepristone” (RU-486), which stops the progression of pregnancy and “Misoprostol-Cytotec”, which stimulates uterine contractions and cervical dilation until the expulsion of the uterine content; the drugs are administered on different dates.

This method is effective at 95-98%, and in case of failure a mini-uterine aspiration with local anesthesia will have to be performed. Not all women can use this method, but don’t worry, your doctor will inform you of all possible options and the best fit for you.

This method requires a specialized medical professional familiar with the procedure. At Clínica Médica Sants we offer you medical personnel and specialized equipment, contact us.

B.3) Surgical abortion:

(a) Method by aspiration or method of Karman 

It is the preferred method for performing abortions during the first trimester of gestation, i.e. in all pregnancies not exceeding 12 weeks.

It’s a quick and safe method. It allows the woman to get back almost immediately to her usual activity.

The gynecologist will perform a vaginal touch to check the position of the uterus, then insert a speculum into the vagina to visualize the uterine cervix, after preparation of the area will enter through the cervical canal to the uterine cavity to suck its contents using flexible and harmless cannulas, selected by the specialist according to the gestation time.

It can be performed with Local Anesthesia or EV Sedation depending on the patient’s choice and physician’s criteria.

(b) Dilation and Evacuation Method (D&E) or Finks method (>12 weeks up to 22 weeks gestation)

It is the method of choice for termination of pregnancy between 12 weeks and 22 weeks gestation.

It is based on the four basic principles of surgery: working sterile, easy access to the operating field, adequate equipment and absence of blood.

-Absence of blood: it is achieved by not using drugs (vasodilator anesthetics) such as Halothane or Fluothane. Ethereal drugs (Methergin or Syntocinon) are used.

-For access: dilated with conical dilators (Model Ambler-Hawkins), up to 18mm depending on gestational age.

-For fragmentation and evacuation: It has a special forceps, strong and thin with which it is possible to maneuver easily with an expansion of 14 mm in gestations of up to 18 weeks. And another special forceps that maneuver with an expansion of 18 mm in gestations of more than 18 weeks has 22 weeks.

Considerations:
1. According to the physician’s criteria and patient profile, pre-dilation preparation of the cervix may be required with the administration of two cytotec 200 mcg (Misoprostol) tablets orally, a synthesis drug analogous to Prostaglandin E1 which is used as an anti-ulcer.
2. Anesthesia: in all cases EV sedation is preferable.

Price: depending on the weeks of gestation.

Consult our rates and contact Sants Medical Clinic.

We’ll help you choose the right contraceptive methods in Barcelona

To choose a contraceptive method you have to balance the pros and cons of each. First you need to get the right info about its efficiency, which is easiest to use, how to complement it with a protection against STDs (sexually transmitted diseases) and its potential side effects.

You always need to turn to a gynecologist to help you decide which contraceptive method is right for you. At Clínica Médica Sants we have medical experts to help you with this choice, consult with us.

Sants Medical Clinic has affordable packs and prices from visit + clinical laboratory tests to help you choose the best contraceptive method. To see other packs check our prices in the section of our website or call us.