Wednesday, July 17

Education is key to preventing unwanted pregnancies


Dr Lee shows samples of IUDs.

THE much-debated subject of birth control is usually associated with family planning, religion, as well as individual beliefs and choice.

While the pros and cons vary with different cultural norms, it’s undeniable the practice plays an important role in society.

Obstetrician and gynaecologist Dr Lee Joon Lung opined that birth control is vital for many reasons when it comes to sex education.

“When we talk about sex education, we’re not merely discussing about the male and female reproduction systems. We have to highlight the fact that birth control plays a very large part in this – to prevent unwanted pregnancies,” Dr Lee told thesundaypost.

A hormonal patch is highly effective in birth control.

He said birth control or contraception could be divided into five types – hormonal contraception, non-hormonal contraception, barrier method, rhythm method, and withdrawal method (coitus interruptus).

According to him, hormonal method involves taking hormonal pills, which can be divided into two categories – combined oral contraceptive pill (OCP) and progesterone-only pill (POP), hormone injection, hormone patches (Evra), and hormonal intrauterine device (Mirena).

Fourth generation pills

The hormonal pills are now in their fourth generation. The first generation pills were the earliest hormonal pills with a higher concentration of oestrogen and progestin. Although a good contraceptive method, they were linked to some health issues.

Second generation pills containing lower amount of hormones performed like the first generation pill but with fewer side effects. They had progestins such as levonorgestrel and norethisterone, still found in a lot of birth control pills today.

The third generation pills were released a decade after the second generation pill. Their hormonal content evolved from the second generation pills, using progestins such as norgestimate, desogestrel, gestodene, and cyproterone acetate.

The fourth generation pills contain progestins such as drospirenone, nomegestrol acetate or dienogest, apart from oestrogen medication such as ethinyl estradiol, estradiol hemihydrate, and estradiol valerate.

Pearl Index

“Hormonal pills are rated on their effectiveness based on the Pearl Index. The smaller the Pearl Index, the safer it is in contraception,” Dr Lee explained.

The Pearl Index, named after an American scientist called Raymond Pearly, measures the safety of contraceptives – say, if 100 women use the same contraceptive for one year, how many pregnancies would occur during that period.

A sample of hormonal pills.

The Pearl Index is a technique said to be the most commonly used in clinical trials for reporting the effectiveness of a birth control method. The Pearl Index of the majority of the fourth generation pills and skin patches is less than 1.0 – hence they’re highly effective.

Dr Lee said POP were a different birth control pill suitable for mothers who had just given birth or were currently breastfeeding their child.

“POP prevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg. It’s most suitable for breastfeeding mothers as it will not affect their child and milk production. However, it has to be taken on precise time to achieve its effectiveness.”

Apart from oral contraceptive pill, POP is also prescribed as injection known as Depo-Provera, a birth control shot prescribed once every three months.

“Though the side effect is increase in body weight and mood swing, among others, it’s considered safe and convenient.”

Primary and secondary benefits

Dr Lee said taking hormonal contraceptive pills could have primary and secondary benefits.

“The primary benefit is, of course, for birth control while the secondary benefit could be, perhaps, prevent ovarian cancer, uterine cancer, and reduce the volume of blood menses (for those who may face over-bleeding problems).

“However, I’m highly against those who take these pills for the purpose of achieving the secondary benefit. These pills cannot be used as prevention method and one must consult the doctor before taking these pills,” he stressed.

Dr Lee, who has patients as young as teenagers taking hormonal pills, said they did so usually due to other health conditions.

A scale model of the uterine area. The circled area is the endometrium, which becomes thinner from long-term use of hormonal pills or patches and can cause difficulty in conceiving.

“I have patients with issues such as abnormal menses, acne problem or pre-menstrual syndrome. Hormonal pills can help clear their skin complexion while regulating their menses. They also help reduce the menses blood volume. Even so, it’s best for parents to seek the doctor’s advice before allowing their teen-aged children to have these hormonal pills for the sake of their health,” he advised.

Other options

For those who want a long-term, yet reversible pregnancy-prevention method, it’s always suggestible for them to opt for a non-hormonal contraception or barrier method.

“Intrauterine device (IUD) is the most common non-hormonal contraception method as it is a tiny device inserted in the uterus. It’s a long-term and reversible method – one of the most effective birth controls so far.

“Of course, if a woman accidentally conceived during the period of IUD, she must get a check-up with her gynaecologist to take out the device as it may endanger the mother and especially the baby,” Dr Lee pointed out.

Among other contraception options is the barrier method, involving the use of male and female condoms.

Dr Lee said the male condom is, by far, the most effective and safe method that could prevent 98 per cent of pregnancies and also protect against sexual-transmitted diseases (STDs).

Risks and side effects

He warned all hormonal pills and skin patches must not be used long-term, especially for women past 35 years old due to the side effects.

“Long-term use of hormonal pill-patch can cause the endometrium to become thinner. This is a condition causing difficulty in getting pregnant. It may take some time for the body to regulate back and conceive again.

“Another risk is the possible development of blood clots,” he cautioned.

A search on blood clots, associated with hormonal contraceptive pills, shows the oestrogen and progesterone contents in oral contraception are linked to an increase in venous thromboembolism, myocardial infarction and stroke.

The risk occurs mainly to smokers and women over 35.

Dr Lee reminded hormonal contraceptive pill and patch users to read the literature on the packing.

“Knowing the instructions and warnings is very important. The manufacturers have listed all the possible symptoms to take note of.”


Dr Lee pointed out that the permanent method – female sterilisation and vasectomy for males – is non-reversible, hence due consideration is needed before opting for it.

“It’s important to note this procedure does not protect against STDs and is only a solution for permanent birth control. Usually, when done correctly, it’s highly effective in preventing pregnancy.”

Morning After Pill

The Morning After Pill, known as Plan B or Emergency Pill, is a type of contraceptive pill taken under certain circumstances such as unprotected intercourse or rape victim.

“The pill must be taken within certain hours to reduce the risk of pregnancy and the side effect is the occurrence of irregular bleeding.

“One must not over-consume the pill as it contains four times the hormonal dosage compared to the ordinary hormonal pill. And it can only be taken not more than four times a month.

“It’s always suggestible to consult the doctor on possible side effects such as over-bleeding, nausea and menses disruption.”

Consultation before decision

Dr Lee reminded those wanting to use birth control methods to consult their doctor for the best options to safeguard their own health and that of their family.

“After practising as gynaecologist for more than 20 years, I have seen how family planning is closely linked to socioeconomic status. Poorer families tend to have more children than well-to-do families.

“The quality of life versus the quantity of life has always been the debate. However, other reasons such as religion could also be why birth control may not even be an option.

“Still, sex education must not be a taboo but rather, an early exposure of the younger generation to protecting themselves against unwanted pregnancies and STDs and preventing such maladies.”