Talk:Contraception (medical methods)/Draft

Clean restart

Can I just note that this Draft is open for editing and improvement, without restrictions. There are certainly imperfections in the article, - so just go for it. Get it better. It needs copyediting and enriching; most changes and all minor changes don't need discussion.Gareth Leng 10:04, 13 February 2008 (CST)

Thank you so much for the go-ahead, Gareth, and for archiving the talk page. I really appreciate it.

I'm now starting to implement some of the changes I had suggested on May 19 and 20, 2007. Everyone, please feel free to revert selected changes, with or without explanation since these are minor changes; if I happen to think something is important I might ask you about it. --Catherine Woodgold 18:58, 14 February 2008 (CST)

mechanism/mechanisms

Re a minor change to the approved version:

The approved version said "The mechanism of action for combination pills (estrogen-progestin) and progestin-only pills are different." It was pointed out that "mechanism ...are" is grammatically incorrect, and suggested to add an "s" to the end of "mechanism".

An editor approved the following change: "I'd vote for "The mechanisms are different" and unless there is any further objection, Stephen (or someone else) may kindly fix it. Supten 01:53, 25 September 2007 (CDT)"

However, the change actually implemented by a constable was this: "The mechanism of action for combination pills (estrogen-progestin) is different than the mechanism of action for progestin-only pills." This changes a lot more than one letter. It isn't the change approved by Supten, and it contains the expression "different than," which is considered by many speakers to be grammatically incorrect, or to be accepted in spoken language only but not written language. (See here.)

I suggest that a constable change the sentence to what I understand Supten to have approved, i.e. "The mechanisms of action for combination pills (estrogen-progestin) and progestin-only pills are different." (exactly the same as the original approved version except that a letter "s" has been added to "mechanism".) --Catherine Woodgold 18:59, 15 February 2008 (CST)

Changed in the Approved version per Supten and brought to my attention. D. Matt Innis 19:41, 15 February 2008 (CST)

Comments

I'm not implementing this suggestion now. Would need verification: The section "Pregnancy rates after IUD removal" could also mention the possibility of pregnancy if the IUD is removed within the 2 weeks following intercourse (for those IUDs that act by preventing implantation); perhaps this a reason for removing the IUD during the menstrual period, and that might be worth mentioning as well. --Catherine Woodgold 20:22, 19 February 2008 (CST)

Third paragraph of section "Hormonal medications (systemic): It said, "Since hormonal contraceptives affect the menstrual cycle, these have been prescribed for women who have problems with excessive or irregular menstrual bleeding for several decades - even if the women are celibate." No one has commented whether "for several decades" applies to the act of prescribing or the act of bleeding. I've assumed the former and gone ahead and changed the sentence accordingly. --Catherine Woodgold 20:35, 19 February 2008 (CST)

I have tried to trim this page down without effecting the meaning too much, or when it seemed in error.

Thus, they reduce pregnancy in women (not couples, single women can get pregnant, but never men), I removed sexually active (thinking about rape victims too).

To me, the article "feels" like it was written by an abstinance advocate and needs some tweaking for neutrality yet. Ran out of time and patience, and plan to take a fresh look later David E. Volk 14:52, 14 May 2008 (CDT)

In the current draft it says "Pregnancy can result from intercourse after missing progestagen-only pills at any time of the cycle". It's not clear whether this means that the missing of pills is at any time of the cycle, or that the intercourse is at any time of the cycle. I doubt pregnancy can actually result from intercourse at any time of the cycle; (Normally, advice to avoid unprotected intercourse at all times of the cycle is more because one doesn't know with certainty what part of the cycle one is in, than because pregancy can actually result at any time). This sentence seems to imply that pregnancy can't result from missing pills after intercourse: I doubt that, too. Catherine Woodgold 16:00, 11 July 2009 (UTC)

I agree that the sentence has a problem in that it doesn't make it clear whether it means "missing the pill" or "having intercourse" at any time can lead to pregnancy. I'm just not sure which the source has said... or if either statement is accurate! Let's look into it some more... D. Matt Innis 23:31, 11 July 2009 (UTC)

I found the following at this site. It seems to support the idea that, if you miss one pill at any time, you have messed up the whole month. This is different than combined hormonal pills. I'm thinking that it's likely because, if you miss your pill, you will start the cascade of ovulation and will not be able to prevent fertilization and, more importantly, implantation. Maybe this happens as soon as the progesterone level drops (it's been a long time since I took endochrinology :) That would mean that you would at least need to avoid intercourse for the three days after missing just due to the fact that the ovum will still be viable for at least three days. Sperm can stay viable for three days (if I remember correctly), so in theory, if you had intercourse two days before you missed the pill, you could still get pregnant... that's six days total. Do you think we have enought o at least reword this accurately?

Does the progestin-only pill have any disadvantages?

You might have a little bleeding between your periods for several months after
you start taking the progestin-only pill. This can be inconvenient, but it is not a health risk. The bleeding will 
probably go away on its own after you use the mini-pill for a few months. If the bleeding seems heavy or if it bothers 
you, you can talk to your doctor about it. 

A common side effect of the mini-pill is feeling hungry more often, which may result in weight gain. 
This side effect usually goes away when you stop taking the pill. Tender breasts can also occur. 

Like regular birth control pills, the progestin-only pill has to be taken for a whole month before it can protect you 
from pregnancy. So for the first month, you need to use another kind of contraception, such as condoms, along with the 
mini-pill. 

The mini-pill works best if you take it every day at the same time of day. Timing is much more important for 
the progestin-only pill than in regular birth control pills. If you are more than three hours late taking the 
progestin-only pill, you should take your missed dose right away and use a backup method of contraception 
(such as a condom) for 48 hours.

If you miss a day completely, you have to use a second method of contraception for the rest of the month 
(until your next period). You can't take two mini-pills the next day to make up for a missed pill, the way 
you can with regular birth control pills. 

Whatcha think? D. Matt Innis 00:16, 12 July 2009 (UTC)

Okay, I found the following as well that seems to support the assumptions I made above from the American Academy of Family Physician site (which was used as a source for the last site).

 The progestin-only methods of contraception work by a similar mechanism. Progesterone suppresses gonadotropin-releasing
 hormone, thereby inhibiting the release of follicle-stimulating hormone and luteinizing hormone. This action prevents
 ovulation. The atrophic endometrium that results from prolonged exposure to progestins minimizes the likelihood of
 implantation. By promoting the development of a thick cervical mucus, progestin-only contraceptives also make sperm
 penetration less likely. 

D. Matt Innis 00:46, 12 July 2009 (UTC)

I made a stab at it, but I'm not sure I'm totatlly satisfied I've made it clear. Take a look and feel free to clarify. D. Matt Innis 01:07, 12 July 2009 (UTC)

Reorganization

I think the organization can be improved:

• Group all the methods into one section
  • Place the orphan section Surgery and natural methods into this schema and divide into a surgery section and a natural section.
  • Relocate topics such as latex allergy (currently under effectiveness of condoms) and spermacide (currently under condoms).

Seem ok? Revert or modify if not. Robert Badgett 13:34, 2 June 2010 (UTC)

Another reorganization coming

If no one objects, I'm going to break this article into smaller articles. IUD's, birth control pills/patches, cervical caps, condoms, etc. each have a very different record of effectiveness, and I think the reader ought to be able to see clearly on the disambiguation page which methods are more vs. less effective. It's going to be a lot of work. And really, I think the top-level article ought to be called "birth control" and not "contraception". Why use a great big word that only doctors use, when the rest of the planet uses the everyday words? Maybe when this was all first written, people were trying to avoid controversy, but it can't be avoided. Let's just tell the facts, then separate out the controversy part into separate articles or at least sections.Pat Palmer (talk) 12:13, 22 January 2023 (CST)

In the process of doing this, it means this article will need to be "unapproved", which in a way is a shame, because the bulk of the information has not changed. But I don't agree with having all these many different medical approaches lumped into one article; it's a disservice to women, who cannot quickly and easily decide which topic they want to read about but are instead exhausted with a deluge of technical information. Thus, I will "unapprove" this article, not because it's out of date per see, but because I don't agree with the structure.Pat Palmer (talk) 12:16, 22 January 2023 (CST)

Also putting an important resource here (and one of the reasons this article is out of date). Since it was written, both the morning-after and abortion pill have become more widely available to women. They are drugs and physically non-invasive. They are also controversial (especially the latter). I don't think this article is up to date about them. Planned parenthood has this clear disambiguation of the two: Do I need Emergy Contraception or the Abortion Pill?.Pat Palmer (talk) 10:18, 28 January 2023 (CST)