Hello Doctor, I am told that using family planning pills/contraceptives isn’t good as they cause complications. What advice do you have for me on how I can safely practice family planning without necessarily using contraceptives, which could be harmful, or condoms, which don’t work really well with me?Irene 31, Kimisagara resident

------------------------------------------------Dear Irene,At 31 years, one needs to use contraception for at least 15 to 20 years more because the risk of pregnancy persists until menopause, and even a few months after that. Hence the method you use should be comfortable, safe and free from side effects. Natural methods: -Coitus interruptus, i.e. the partner withdraws before ejaculation so that semen is ejaculated outside the vagina thus minimizing chances of pregnancy. This is very safe and effective but needs caution and self-restraint on the part of both partners.

- Avoid intercourse on days of ovulation. Usually ovulation is said to occur around 10 -14th day of menstruation. Other signs for detecting ovulation is monitoring the base body temperature, which when taken first thing in the morning would be elevated. But this method is unpredictable as days of ovulation are variable.Barrier methodsUsing an intrauterine device is very effective during middle age to prevent pregnancy. Inserted by qualified health personnel, it is very safe with no risks of infection or trauma.  Once inserted, it can be used safely until the expiry date put on the product by manufacturer which is usually around 2 years or longer.  Hormonal intrauterine contraceptives are available which can be used up to 5 years.

-Female condoms are   available, but one has to learn to use them properly. Another disadvantage is their high cost as compared to male condom.Hormonal contraceptivesThese are available as oral pills, injectable contraceptives, in implant forms.  They are available in combinations of estrogen and progesterone as well as progesterone alone. "Morning after” pills can be used in emergency after intercourse.  Depot Provera injections can be taken once in 3 months. Hormonal contraceptives are very effective but at the age of 31, one has to be careful about the side effects. There is risk of hypertension and increased risk of heart disease. Apart from this, the coagulability of blood is increased with the likelihood of a clot forming in the heart or brain leading to heart attacks and strokes. Studies have shown some increase in risk of breast cancer, endometrial cancer and even hepatocellular carcinoma with use of hormonal contraceptives.  Considering these side effects, they cannot be considered very effective for long-term use after 30 years.Sterilization It is the best option if one has completed family and does not desire more children. Male vasectomy is easier, very safe and does not impair sexual performance as feared by many. One can resume work after 48-72 hours after the procedure.  But if the male partner is not willing, tubal ligation or tubectomy can be done for women.  Tubal ligation can be reversed if needed in future.Contact Dr. Pande at womenstimes@newtimes.co.rw