When a woman comes in for a family planning visit, we are either moving towards their desire for pregnancy or specifically dealing with the desire to avoid pregnancy.
Preconception counseling is performed when a woman comes in and says, “Hey, I’m ready to get pregnant. Let’s talk about that.”
In preconception counseling we will discuss the woman’s basic medical history.
I want to make sure that there’s nothing that we need to address to optimize her health before she gets pregnant.
I will also review any relevant family history and how their history could affect pregnancy and the health of their baby.
Next, we will discuss when is the best time to get pregnant and go over how conception works with the menstrual cycle.
We will also talk about starting her on a prenatal vitamin and other basic healthy behaviors that we believe are ideal to initiate even prior to conception.
The other side of family planning is when patients are telling me, “It is not right at this point in our life to get pregnant.“
There are many different modalities to help take care of those needs.
Natural Family Planning
One of the most foundational and non interventional methods of controlling when and when not to conceive is natural family planning.
Women who use natural family planning to avoid pregnancy are using the timing of their cycle and using a variety of signs their body is giving to then avoid intimacy during those fertile times of the month.
This is a very natural way to use the body’s own signals, and then choosing intimacy behavior around those signals to avoid pregnancy until the time is right.
When it comes to natural family planning, I can help educate patients regarding their menstrual cycle.
When, in the month, are they the most fertile?
What signs are their bodies giving them, that they could conceive if they were intimate during this time period?
There are also some wonderful natural family planning classes that I can help direct patients towards if natural family planning is consistent with their beliefs and desires.
There are other ways to avoid pregnancy as well, and this is more commonly called contraception.
When we’re talking about the world of contraception, one of the most basic is barrier methods.
Barrier methods are just a way to keep the sperm from meeting the egg.
Condoms are the most common, but diaphragm is also another form of barrier contraception.
Birth Control Medications
The other big category of contraception has to do with stopping a normal ovarian and ovulatory cycle.
So this means providing medications whether it be birth control pills, shots, patches, or vaginal rings that deliver hormones to the body.
These hormones act to interrupt the normal interaction between the hypothalamus in the brain, the pituitary in the brain, and the ovaries.
Specifically, what we’re trying to do is stop ovulation, and ovulation is the releasing of the egg.
Specifically, these medications are trying to stop ovulation, that
When no egg is released, conception does not happen.
Inter-Uterine Devices (IUD’s)
Another form of contraception is an inter-uterine device.
An IUD is a little piece of plastic that’s placed and left in the uterine cavity.
There are two kinds of IUDs. One of them has copper on the arm of the device, and the other has progesterone on the arm of the device.
Most studies indicate that the inter-uterine device works in two fashions.
One, it is creating a thickening of the cervical mucus, and thus creates a barrier, making it hard for the sperm to make it through the cervix, and therefore they’re not making it into the uterine cavity or the fallopian tubes.
Therefore, conception doesn’t happen because there’s no sperm to meet the egg.
These IUDs also create a sterile inflammation in the uterus itself. So that if or when when the sperm does get through, they are actually attacked by the body’s own host mechanism. In this fashion, the IUDs work as a very fancy spermicide.
IUD Side Effects
Some of the side effects of the IUDs, the copper IUD, the biggest side effect is that your periods will be heavier.
With progesterone-laden IUDs, the biggest side effect is that periods become very light.
In fact, the progesterone IUDs are being used now as much as a treatment for heavy periods as they are for contraception.
There are plenty of women that are not using progesterone IUDs for family planning or contraception. Instead, they are using them as a form of treatment for their heavy, problematic periods.