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Q & A with Dr. Cullins: Birth Control

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    I am 24 years old, have had two strokes, and can't take the pill. I have been on the shot for more than a year, but don't like it. What are my other options besides abstinence and condoms. I heard that said that the pill actually decreased your chance of stroke. Is this true?

    No, it is not true. Combined hormone contraceptives, such as the pill, patch, or ring, can increase the risk of stroke. The increase in risk is very small for healthy women. The risk becomes much larger for women like you who are at much greater risk for stroke than the average woman. You, and other women with medical histories that include blood clots, heart attack, stroke, uncontrolled high blood pressure, or vein inflammation, should not take the pill or use other combined hormone methods such as the patch or ring especially if they smoke. Although a recent study caused a bit of a media stir by claiming that the pill reduced the risk of heart attack and stroke, that study was very flawed, and its claims were unfounded.

    Women who cannot take the pill or other combined hormone methods the ring or the patch do have other alternatives besides abstinence, condoms, and the shot. These include IUDs, diaphragms, Lea's Shield, and FemCap. Depending on your personal medical history, you may be a candidate for the progestin-only pill or progestin-releasing Mirena IUD.

    IUDs intrauterine devices are among the world's least expensive and most effective and popular contraceptives. Two types are available in the U.S. The ParaGard contains copper and can be left in place for 12 years. The Mirena continuously releases a small amount of the hormone progestin and is effective for five years. IUDs work by preventing fertilization. One or fewer of 100 women who use IUDs will become pregnant with typical use, which means not always perfectly consistent and correct.

    Less effective options are prescription latex or silicone barrier methods, including the diaphragm, Lea's Shield, and FemCap. These methods are used with spermicide and placed in the vagina to cover the cervix. From 14-16 of 100 women who use these methods will become pregnant in one year with typical use. (FemCap is less effective for women who have given birth vaginally.)

Published: 05.29.05

This column is for informational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. If you have a medical problem, please call toll-free 1-800-230-PLAN for an appointment with the Planned Parenthood health center nearest you.

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