I am a 26-year-old newly-married woman. I have been advised to use implants for birth control but I’ve heard they make women gain weight yet I don’t want to put on any more weight. What are the best birth control methods that won’t make me gain weight and that will be easier to regain fertility when I am ready to have a baby?

Françoise, Kimihurura

Dear Françoise,

My sincere advice to you is that unless there is a big compulsion to avoid pregnancy, go ahead and have a baby first then plan contraception for delaying another one. That way you are confident about your fertility. 

Regarding prevention of pregnancy, the simplest method to be adopted is the use of a condom by a male partner.  The failure rate is said to be about 14-15%, i.e. in many cases it will still work. With good quality latex condoms, failure is lower.  If this is not feasible, then a woman can use barrier methods or hormonal contraceptives.  

You are correct about the potential risk of weight gain with implants used for birth control. The implant is in the form of a small rod which is inserted in the upper arm. It releases progesterone in low doses which prevents ovulation and hence contraception. The effect of one implant is for about three years. But there are potential side effects, like weight gain, cramps in legs, backache and severe bleeding with attendant complications once it is withdrawn. 

Before using it, practically one cannot say whether it will be okay or will cause side effects.  There are other forms of hormonal contraceptives like contraceptive pills. They come in various combinations of estrogens and progesterone, used to change the hormone level within the body such that pregnancy does not occur. But they are associated with side effects like heavy withdrawal bleeding (bleeding which occurs on stopping the pill), muscular cramps, and risk of thromboembolism, hyperlipidemia and heart problems. Depo provera is a long acting progesterone preparation and one injection is given every three months. But it has the same side effects as other progesterone preparations.

Barrier methods to be adopted by a woman include female condoms, diaphragm and intrauterine devices. Female condoms are expensive as well and not very convenient to use. Diaphragms are shield like barrier which a woman can insert before intercourse to prevent entry of sperms and conception. Intra uterine devices (I.U.D) are T-shaped devices coated with copper or progesterone which are inserted in the uterus to prevent conception. It is a form of long term reversible contraception. Whenever one desires to have a baby, the device can be removed.  

Many women with no children prefer I.U.D. over contraceptive pills because they remain relaxed as they do not have to remember taking a pill every day. But doctors prefer that women should use I.U.D. as a method of spacing pregnancy, i.e. after having one child to delay another. As such they are very safe. But there is a potential risk of heavy bleeding and pelvic infection after insertion of IUD.

In your case, if you really do not want a baby, you can either take pills for a short time or get an I.U.D. inserted.

Dr. Rachna Pande is a specialist in internal medicine Ruhengeri Hospital