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    So, What Do We Do Now?

    by Ngozi Osuagwu, MD | July 10th, 2022

    So, What Do We Do Now?

    So, what do we do now? I have been asked that question so many times recently. What do we do now that Roe vs.Wade has been reversed? My answer remains the same – EDUCATE. EDUCATE. EDUCATE. My goal is to make sure that I provide the necessary tools for women to prevent becoming pregnant until they are ready to become pregnant. There is the One Key Question® – Would you like to become pregnant in the next year? There are four responses to this question – Yes, No, Unsure, and OK either way.

    You must consider this question if you are a woman of reproductive age (having your periods). If the answer is no, then you need to be proactive. It would be best if you were intentional about not becoming pregnant. In a New York Times article dated 12/14/21 by Margot Sanger-Katz, Clair Cain Miller, and Quoctrung Bui, titled Who Gets Abortions in America? They wrote that 25 percent of women would have an abortion by the end of their childbearing years. The typical patient, in addition, to having children, is poor; is unmarried and in her late 20s; has some college education; is very early in her pregnancy.

    What is the best birth control for the woman who does not want to become pregnant in the next year?

    The one that she will use consistently in the way it is supposed to be used. Typically when we talk of birth control, we talk about the most effective to the least effective. The most effective birth control is abstinence. If you are not having sex, you cannot get pregnant. There are ways to express your love for another without actually having sex.

    After abstinence, there are the long-acting reversible contraceptives, otherwise known as LARCs. LARCs include intrauterine devices (IUDs) and the subdermal implant. There are two categories of IUDs. The one with hormones and the one without hormones. The IUDs that contain hormones include, Mirena®, Skyla®, Kyleena®, and Liletta®. The IUD that does not have hormones is Paragard®. The name of the subdermal implant is Nexplanon®. These can last 3 – 12 years and can be removed when you are ready to have a baby. They are so reliable because once you come to the doctor to get it placed, you do not have to worry about anything until you are ready to have it removed.

    The next effective birth control is the shot or DepoProvera®. It contains hormones, and you have to make an effort to visit the doctor. You will need to visit the doctor’s office every 12 weeks to get the shot.

    Next are the pills. The pills can be very reliable if you take them daily at about the same time each day. The issue is not everyone takes it diligently, and it is not as effective as the LARCs or the shot. We have two major types of pills – the one that contains Estrogen and Progestin and the one that has only Progestin. You can also take pills continuously so that you do not have a period every month.

    Just as effective as the pills are the vaginal rings and the patch. Both contain the same hormones as the ones found in the pills, and you have a different way of getting the hormones in the body. We now have two vaginal rings – Nuvaring® and Annovera®. With the Nuvaring®, you leave it in the vagina for three weeks and then remove it for a week to have a period. The Annovera ring last for one year. You can remove it when you want to get a period or leave it in the vagina for the year. You can have sex with the ring in the vagina. The patch is changed weekly.

    The next are condoms. For condoms to work, you need to use them. The good thing is that, along with preventing pregnancy, it also protects against sexually transmitted infections (STIs) which the others do not. You can use condoms with all the other birth control options I have discussed. We have male and female condoms. Although most condoms are made of latex, there are non-latex condoms for those allergic to latex. Yes, they are a little expensive.

    We also have the diaphragm and the cervical cap. Again, it works by using it. So if you are in the heat of the moment, you have to stop and put it in before having sex. It would help if you used it with spermicidal creams and/or condoms.

    Although there are over-the-counter creams that contain spermicides and the sponge, we have a new prescription cream called Phexxi. Phexxi is a nonhormonal gel inserted into the vagina before sex. It works by keeping the pH of the vagina acidic so that the sperm does not survive.

    We also have Fertility awareness-based Methods known as natural family planning or periodic abstinence, which is also very good. By learning the changes in your body, your safe days within your cycle can be determined to know when is the best time to have sex so that you do not become pregnant. Your periods have to come regularly to use this method. Your doctor can work with you to find your safe time, and there are apps available to help you. You have to be disciplined to use this method.

    Then, of course, we have withdrawal or the pull-out method. Most men release some fluid from the penis before they fully ejaculate, containing sperm. This can be a sure way of getting pregnant.

    We also have emergency contraception or the morning-after pill. This is available over the counter if you are over 17 years old and is cheaper if you have a prescription. It does not cause an abortion. It just delays ovulation. It should be used within 72 hours of a condom accident or when you have forgotten to use birth control.

    One Key Question® – Would you like to become pregnant in the next year? There are many options available. What might be suitable for one person might not be good for another. Do your research and talk with your health care provider to find the best form of birth control for you if the answer to the question is NO.

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    With her trademark wit and straightforward communication, Dr. Osuagwu continues to dole out valuable medical advice using the letter form and addressing women’s health conditions and issues in a method that was praised for its innovative approach in her earlier award-winning book, Letters to My Sisters: Plain Truths and Straightforward Advice from a Gynecologist. In this book, each letter is paired with reference sources and statistics about the condition that is the subject of the letter.

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