Dear Doctor,

I have been married for two years. I got married after I conceived. After giving birth, I was advised to use contraceptives for family planning. For a few months now, I’ve been uncomfortable using the pill because I tend to forget to take them at times. Please educate me on how to know my safe and unsafe days.

Dora N, 24, Kacyiru

Dear Dora,

There is a wide range of contraceptive methods available. The choice to use one depends on the choice of the couple, its suitability and safety.

Condom use by the male partner is one of the safest and oldest methods for birth control. It also prevents against sexually transmitted infections. But it carries a failure risk of about 8%. Moreover the partner should be vigilant enough to withdraw immediately if there is a tear or rupture of the condom. 

Coitus interruptus is another method, where a man withdraws before ejaculating in the vagina. However studies show that even if few drops of ejaculatory fluid reach the vagina before withdrawal, there is risk of pregnancy.

Regarding contraceptive methods for women, hormonal methods are widely used as pills and implants. Implants of progesterone can be taken, where a very small device is fitted in the upper arm and it releases progesterone in low doses continuously to prevent ovulation and pregnancy.  

Then there are "morning after” pills available. These contain various combinations of estrogen and progesterone as in other contraceptive pills but in higher doses. Taken immediately after unprotected sex act or within few hours, it prevents pregnancy. Any hormonal contraceptives can cause heaviness over breasts, legs, swelling over legs, excess vaginal bleeding, e.t.c, as adverse effects. 

The ones containing estrogens can cause increase in blood lipid levels, thromboembolism, i.e. increased risk of clotting, hypertension and cardiac problems. 

Intrauterine devices have also been in use for a long time for contraception, more useful for spacing of pregnancies. That means delaying the second child after the first is born. I.U.Ds are very safe if inserted with good hygienic and correct techniques, there is minimum risk of infection or trauma.

After a couple has obtained the desired family size and the last born is around five years of age, sterilisation either of the man or woman, remains the best choice.

To know the safe periods for sex, one can count the number of days from the first day of vaginal bleeding at beginning of menstruation. For about three days after this, there is no chance of pregnancy. Gradually, the risk increases and peaks at approximately 14th to 21st day of cycle when ovulation would occur resulting in fertilisation after intercourse. 

However the day of ovulation can vary depending on the duration and regularity of cycles of a woman. Days of ovulation can also be assessed by taking basal body temperature (BBT). Usually the basal temperature rises by a half to two degrees on the day of ovulation. This can be measured by taking oral temperature by putting a thermometer in the mouth first thing in the morning. Days of ovulation are unsafe for sex if one wants to avoid pregnancy.

Dr. Rachna Pande is a specialist in Internal Medicine at Ruhengeri Hospital