Reproductive Health Information--Contraception
To help you consider the right contraceptive, we explain some of the risks that contraceptives pose for women with mobility impairments. As you are reading, keep in mind that the safety of contraceptives varies significantly from one woman to another, and that only you and your health care provider can determine whether or not a contraceptive is safe for you.
If you are not familiar with contraceptives, please consult Planned Parenthood's web site. It explains how the various contraceptives work and discusses their use, effectiveness, cost, advantages, disadvantages, availability, and risks for women without disabilities.
Contents:
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The Pill
What is the Pill?
"The Pill" is also called a combination oral contraceptive or COC. It is a small tablet that you take once a day. It contains two synthetic hormones, an estrogen and a progestin, that are very similar to hormones found naturally in your body, but in much higher amounts. When you take the Pill:
- You stop ovulating (ovulation is the monthly release of an egg from the ovaries).
- The mucus in your cervix becomes thicker and blocks some sperm from entering your uterus.
- The lining of your uterus becomes thinner so that a fertilized egg cannot implant on the uterine wall.
Is the Pill safe for a woman with mobility impairments?
Taking the Pill increases the risk that you will develop a blood clot in your veins, though this risk is greatly decreased in the current low estrogen pill. This risk is higher if you smoke. If your mobility impairment also increases this risk, then you should not take the pill.
Other benefits of the Pill are that it helps regulate menstruation during the perimenopause (the transition years between having regular periods and no periods), decreases the amount of menstrual bleeding, and reduces the risk of ovarian and endometrial cancer.
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Progestin Only Contraceptives
What are progestin only contraceptives?
Unlike the pill, which contains two hormones, progestin-only-contraceptives have only one hormone, progestin. Progestin-only-contraceptives come in three forms:
- The Minipill: a tablet that you swallow daily;
- Depo-Provera: a hormone shot that your health care provider will give in your arm or buttock once every three months;
- Norplant: six soft capsules, each about the size of a matchstick, which your health care provider will insert under the skin of your upper arm. It will protect against pregnancy for five years.
When you take a POC:
- The mucus in your cervix becomes thicker and blocks some sperm from entering your uterus.
- The lining of your uterus becomes thinner so that a fertilized egg cannot implant on the uterine wall.
Are POCs safe for women with mobility impairments?
Most researchers agree that POCs don't present the risk of blood clots associated with the estrogen in combined pills. Thus, some health care providers will give you a POC if your mobility impairment puts you at risk for a blood clot. However, other researchers believe that more research is needed to determine whether this practice is safe. For this reason, the FDA still recommends that the same exclusion criteria be followed for the Pill and for POCs. That is, the FDA currently recommends that you should not use minipills, Norplant, or Depo-provera if you have blood clots or inflammation of the veins.
Be aware that some medications used for seizures may make Norplant less effective. Also, the implants may leave scars, particularly on women of color.
If you are taking a hormone-based contraceptive, how will you know when natural menopause has occurred and you no longer need it?
As long as you are on the Pill, you will continue having menstrual periods. If you take a POC, you may not have periods until you stop taking it. Some health care providers automatically discontinue oral contraceptives at age 51 and switch to hormone replacement therapy, which is lower dose, if the woman chooses to use HRT during menopause. Others stop the oral contraceptive for one or two weeks, then measure blood levels of follicle stimulating hormone (FSH) and estradiol at that time. During the transition period to menopause (perimenopause), when menstruation becomes irregular, contraception should continue because pregnancy is still possible during this time. The hormone levels used for HRT are not high enough to prevent pregnancy.
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Intrauterine Device (IUD)
What is the IUD?
The IUD is a small, plastic, T-shaped device that your health care provider inserts in your uterus. It contains either copper or hormones that keep sperm from joining the egg and prevent a fertilized egg from implanting in the uterus.
Is an IUD safe for women with mobility impairments?
The older IUDs increased your risk of pelvic inflammatory disease (PID), an infection of the fallopian tubes or uterus. PID must be treated early because it is a major cause of infertility in women. There is no evidence of increased risk of PID with the use of current IUDs. However, if you have sensory impairment that would prevent you from noticing the onset of PID and getting early treatment, or you have had PID in the past, then you should not get an IUD. Women with disabilities who have anemia or difficulty with menstrual management should also avoid the IUD, as menstrual periods may be heavier and last longer.
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Diaphragm
What is the diaphragm?
The diaphragm is a small cup of rubber with a rim formed by a rubber-covered steel spring. It is fitted by your health care provider to go over your cervix and prevent sperm from entering your uterus. The diaphragm can be difficult to insert and remove if you have impaired use of your hands. You may wish to ask your partner to insert it for you.
Is the diaphragm safe for women with mobility impairments?
The diaphragm increases the frequency of urinary tract infections. If you already have problems with urinary tract infections, then you should probably select another method.
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Condom
The condom is the only contraceptive method proven to be highly effective protection against both pregnancy and sexually transmitted diseases. However, its effectiveness depends on its not breaking, leaking, or spilling during removal. The female condom, which became available six years ago, offers the additional advantage of giving the woman more control over both contraception and protection against STDs. However, a lot of practice is often required to insert it properly, and insertion may be difficult for the woman with limited use of her hands.
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Natural Family Planning Methods
Women with disabilities who are concerned about the safety or difficulty of using other contraceptive methods may elect to use natural, commonly called the "rhythm", methods of family planning. The success of these methods relies on accurately determining when ovulation is occurring and avoiding intercourse during that time period. This accuracy is improved by using the symptothermal method, in which basal body temperature is recorded daily. A rise in temperature indicates ovulation. However, this method may not be reliable for you if you have a spinal cord injury or other disabilities affecting thermoregulation as correspondence between body temperature patterns and ovulation may not be reliable. Women may stop menstruating and ovulating immediately after spinal cord injury, but ovulation, and the ability to get pregnant, usually resumes within six months for young women. Body temperature will also be unreliable if you have frequent bladder infections. As a result, you cannot accurately determine when you are ovulating to avoid intercourse during that time. If you have impaired manual dexterity, you may find using and shaking down oral thermometers difficult and easily broken if they come into contact with wheelchair parts. Likewise, perimenopausal women with irregular menstrual periods should not rely on these methods to prevent pregnancy as ovulation is likely to be irregular and unpredictable.
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Written and Designed by Carol Howland, Stephanie Pendergrass, and Margaret Nosek Ph.D.
Copyright 2000 Center for Research on Women with Disabilities