What they don't tell you about contraceptives

Ensuring women receive all the benefits of family planning relies on the country's ability to give them real choices about available contraceptive options.

23 February 2021 | Health



Namibia has been struggling to provide family planning, which health executive director Ben Nangombe blamed on the Covid-19 pandemic. However, hospitals have started restocking again.

Do you have enough information about the pill, intrauterine device (IUD), injection, patch and condoms? As part of a series of health stories to help Namibian women make better reproductive health choices, Namibian Sun focuses on choosing the right contraceptive methods for your needs. In an interview with Namibian Sun (NS), pharmacist Ndapewa Anguuo (NA) said if women are expecting their healthcare provider to lay out birth control options, they may be in for a long wait.

“It isn't necessarily what they do not tell you, but what most people - both parties - tend to ignore,” she said. Anguuo's main concern is efficacy, which translates to proper usage of the contraceptive. She said the first-year failure rate for some pills is very low. However, the typical failure rate is estimated to be closer to 5% due to late or missed pills.

For most pills, it is stated in the patient information leaflet, which she says most people do not bother to read, that there is a certain specified chance of pregnancy. “Informing patients about all the possible side effects takes long and may cause unnecessary anxiety. It is thus best to inform them about those regarded as frequent and serious. But then again, not all of us experience the same effects, despite us being on the very same medication, therefore, always make time to read the information leaflet,” she stressed. She speaks to us about the most common contraceptives and how they function.

NS: Most common side effects of the pill?

NA: Contraceptive decision-making should include consideration of both the risks and benefits of a given method versus the real consequences of unintended pregnancy. Even though birth control pills are regarded very safe, using the combination pill is associated with well-studied risk of health problems, but these do not spare the mini-pill. Amongst a few: Spotting or breakthrough bleeding, minimal weight gain, breast tenderness, headaches, bloating, nausea and vomiting. Complications such as blood clots, heart attack and stroke are rare, but they can be serious. Some epidemiological studies involving the combined pill reported an increased relative risk of developing breast cancer, especially at a younger age, and apparently related to duration of use.

NS: Can it be used for skin problems such as acne?

NA: Yes, we have specific ones that can be used for acne.

NS: What medication can affect the efficacy of the pill?

NA: We have a few medications that can affect or can be affected by the co-administration with the pill. In most cases, they are listed in the package insert, but pharmacists are supposed to counsel you on these things. As a patient, you must always let your healthcare professionals know about all the medication you take; where possible or needed.

NS: Does the pill have an effect on your sex life?

NA: Sexual specific effects of hormonal contraceptives are not well studied.

NS: What are the most common side effects of the implant?

NA: People do not react the same way to medication. In some people, an implant may cause spotting or light bleeding and in some, it may cause longer or heavier periods with or without cramps. Apart from temporary pain on the insertion site, mood swings, weight gain, acne, headache, ovarian cysts and breast pain are some of the possible common side effects. In some patients, vaginal infection is noted.

NS: What medication can affect the efficacy of the implant?

NA: Some chronic medication, but it is always best to communicate your medication profile with your healthcare professionals.

NS: What are the most common side effects of the IUD?

NA: There are two types: Low-hormonal IUD and zero-hormonal copper IUD.

Because there is no estrogen in a low-hormonal IUD, women experience fewer hormonal side effects, such as mood changes, weight gain, irregular bleeding, lighter periods and some no periods at all. Bleeding during the first few weeks after device insertion and abdominal or pelvic pain are also common.

The copper IUD has zero hormones and it often increases menstrual pain, flow, and duration as side effects. Reaction to the metal is also common.

NS: What medication can affect the efficacy of the IUD?

NA: There are noted potential interactions with insulin, warfarin and steroids, most specifically with the hormonal IUD.

NS: Do you need a prescription to get an IUD?

NA: Yes. All contraceptives, except emergency contraceptives like the morning-after pill are prescription-only. None of these contraceptives protect you from sexually transmissible infections.

NS: Do I need to consider my health condition before taking any contraceptive?

NA: Yes. Always.

NS: Are there any future complications which can result from the use of contraceptives?

NA: Yes. Refer to side effects and complications mentioned under pill side effects.

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