LARC contraceptives, a replacement for the pill

If you had to choose a soundtrack for the pill it would be a Beatles song. Those musicians and the hormonal contraceptive method came almost simultaneously to the lives of millions of women, awakening both the pill and the Liverpool boys, a desire that was somewhat lethargic. But finally it was the pill that contributed to promoting more and better female orgasms. Having sex no longer meant getting pregnant, but the pill meant much more: female desire was beginning to be accepted, thereby significantly changing the sexual behaviors of men and women. Six decades have passed and, although 100 million women in the world still use it, today another soundtrack is heard.

Women are already sexually liberated and are not content with just an effective contraceptive, they want more: they ask that it have no side effects, that it is comfortable and, above all, that it does not further complicate their lives and health. Because with sexual freedom, the pill brought with it an inexhaustible pile of myths, hoaxes and also some certainties about its side effects.that last until today. Some women, judging by the statistics, seem to have said enough. Only 17.3% of Spanish women take it, according to the latest national survey on contraception of the Spanish Society of Contraception (SEC), and each year the number of women who use it falls, since, as indicated by the same shows, in two years (from 2016 to 2018) its use has decreased by 4%. More than 58% of respondents of childbearing age are afraid of causing circulatory problems, more than 57% do not want mood swings and just over 55% are afraid of gaining weight if they take it. In short, there is still great concern about the effects of these pills, which seem to have found a relief.

Contraception between misinformation and fear

study by the University of British Columbia in Canada concludes that those women who took the pill during their teenage years (it has also been prescribed for years to regulate menstruation, menstrual pain, and control acne) have three times more likely to experience depression in adulthood. Other research published in JAMA Psychiatry, which focused on a database of over 1 million women in Denmark aged 15-34, also concluded that those who had taken some form of hormonal contraceptive were 23% more likely to need some type antidepressant. Despite these investigations, gynecologists are reluctant to “attack” the contraceptive pill and, while aware of their bad press, do not hesitate to break a spear in their favor. The head of the Contraception unit of the Dexeus Woman Center, Francisca Martínez, assures that these studies must be taken with caution. “I do not see, for example, that the study conducted at the Canadian university took into account the fact that many young women received the pill for the treatment of menstrual irregularity,

Modesto Rey Novoa, spokesman for the Spanish Society of Contraception (SEC), recalls that “Spain is a country of condoms (it is still the most widely used method, 29.6% of Spaniards use it, followed by the pill) and he talks about the existence of a ‘hormonophobia’ that is constantly reproduced in the media, also in the specialized ones, and which has to do, in his opinion, with the consideration that has been done in our country of the pill and its risks. It should not be forgotten that the incorporation of the pill in Spain came much later than in neighboring countries and has often been surrounded by negative considerations (immorality, vice) “.His colleague Borja Marqués, a gynecologist who is an expert in assisted reproduction at the Institut Marquès, also acknowledges that there is a certain mania for hormonal contraception and calls for caution in this regard. “In the case of its link with depression, more evidence is still needed to confirm that it really is so. In the end, many of the side effects (headache, weight gain, mood swings …) have been related in a way Temporary and as time has passed and studies with a larger population have been carried out, this is when these relationships have been confirmed or denied. At the moment, I think that we should not be alarmists in the short term, “says the gynecologist.

It is true that there are always nuances in all the studies, but other gynecologists do sing the mea culpa, especially because there is something evident: women have been bombarded with many and different data on the side effects of the pill, but nevertheless they You have failed to receive rigorous information from your doctor. Sciencific American , in a special issue published this year, interviewed several gynecologists who did acknowledge a share of responsibility in all of this. Specifically Carolyn Wasthoff, the editor of Contraception magazine , has explained that everything starts from “having treated menstruation as a disease,prescribing pain relievers or the birth control pill to treat severe bleeding and pain, rather than investigating these symptoms further. ”

Not having good information has made women like Alice Pelton take the initiative. She is the founder of Lowdown, which comes to be like the Trip Advisor on contraception, the first platform that collects first-person opinions and experiences on different contraceptive methods. This Londoner told in an interview to The Times that the idea came from her own (and very bad) experience with the pill, a pill that she took from the age of 16 (when she began having sex with her boyfriend) until she was 30. She, without However, it is against the anti-pill movement, on its website it simply raises a reality, and that is that the pill is a contraceptive that is not for everyone and therefore she demands information to be able to choose the right method for each woman.

Long-lasting methods come stomping

Francisca Martínez says that “although the use of the pill has decreased in Spain, there is an increase in the use of the IUD (the hormone is already used by 9% of Spanish women), a method with 99% contraceptive efficacy . That more women choose it has to do with the fact that some misconceptions associated with this device for years have been demystified, such as that it could only be used by women who had already had children, but it also influences the fact that they have been demonstrated beneficial effects of the hormone IUD. ” For example, it reduces the amount of period and pain.

According to Modesto Rey Novoa, “there are various studies that show that when women are provided with adequate and complete information, facilitating access to the different methods and free access to them, there is an increasing tendency to opt for LARC methods (methods reversible long-term contraceptives, especially for its greater effectiveness, an effectiveness that does not depend on the user (unlike the pill, which is reduced when one forgets to take it). ” Because although the use of the pill decreases, the use of contraception in general does not. “There is more and more information and less fear about other methods (IUD, implant, ring, patch) and this makes many women opt for more comfortable methods that do not depend on taking medication daily”, Borja Marqués explains.

LARCs include intrauterine devices (the copper IUD and the LNG IUD (known as the hormonal IUD, because once it is placed in the uterus it releases levonorgestrel, which is the synthetic hormone that prevents pregnancy), implants, the ring Vaginal and medroxyprogesterone acetate injections. Currently, the American College of Obstetricians and Gynecologists recommends these methods as a first choice for all women, including adolescents. The primary reasons are their high effectiveness, with pregnancy rates below 1 %; the comfort of its duration, which ranges from three weeks to 5 years, and, above all, that they are methods that, contrary to popular belief, allow an immediate recovery of fertility after its withdrawal.

In Spain, the most popular are the copper and hormonal IUDs (9% of women already use it), while 2.9% use the vaginal ring, a transparent and very flexible ring that women put on the inside of the vagina every three weeks and that releases small doses of hormones daily). 1% use the implant, which consists of inserting every 3 years a subdermal rod 4 centimeters long that releases small amounts of etonogestrel, a hormone that prevents ovulation, every day, and 0.2% uses intramuscular injections that introduce progestogens every three months, which inhibit ovulation and increase the viscosity of the cervical mucosa, which hinders the progression of sperm to the uterus.

And these figures would be higher if rigorous information were transmitted to women about all of them, since, according to Francisca Martínez, health professionals are not currently offering all the information about them to women,They still mistakenly think that the IUD (a T-shaped device that is placed in the uterus every 5 years) is only for women who have already had children, that it can produce an ectopic pregnancy and that its insertion is painful. They are also afraid of a piercing. All these ideas have been dismantled by scientific evidence, but still professionals criticize that the message does not reach the population. In addition, its cost is still a disadvantage (the hormonal IUD can cost 100 euros plus insertion, which is sometimes not free), especially for young women, which is why for years the SEC has been asking that these Long-term methods are financed in all the autonomous communities.


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