HORMONAL CONTRACEPTION

Dr. Claude Allouche, Gynecologist HORMONAL CONTRACEPTION (2)
Ahuza Clinic, Raanana
Contact: 058 726 02 64


A/ HORMONAL CONTRACEPTION: PILL, PATCH, OR VAGINAL RING

Hormonal contraception is designed exclusively for women. Its primary function is to regulate the menstrual cycle to:

  • Prevent ovulation
  • Make the uterine lining less receptive
  • Thicken cervical mucus to hinder sperm movement

1/ CONTRACEPTIVE PILL

(In Hebrew: Gloulot – גלולות)

  • One of the most widely used forms of contraception.
  • Pills are classified into two main categories:
    • Combined pills containing estrogen and progestin
    • Progestin-only pills
  • Effectiveness: Extremely high if taken correctly without missing any doses.
  • Prescription: Requires a doctor's prescription and assessment of medical and family history.
  • Pregnancy Risk: Rare but possible if a pill is forgotten for more than 12 hours.
    • Most cases of pregnancy occur due to a missed pill in previous weeks.
  • Side Effects: Can occur but are usually mild and rare. The pill is only available with a doctor’s prescription due to potential contraindications.

2/ CONTRACEPTIVE PATCH

(In Hebrew: Madbeka – מדבקה)

  • Product Name: Evra
  • Application: Worn once a week on the belly, lower back, or arm (but never on the breasts). After three weeks of use, a week off follows, during which menstruation occurs.
  • Hormones Delivered: Estrogen and progestin.
  • Prescription: Must be prescribed by a doctor for women without contraindications.
  • Effectiveness Reduction: Certain medications can reduce the patch's effectiveness, including St. John’s wort, anti-epileptics, anti-tuberculosis, and antiretroviral drugs.
  • Check Frequency: Only checked once a week, unlike the daily contraceptive pill.
  • Forgetfulness: Rescue time is longer than for the pill:
    • 24 hours if the patch falls off
    • 24-48 hours if not replaced on time (compared to 12 hours for the pill).
  • Advantages: Since hormones are absorbed through the skin, there is no risk of non-absorption during vomiting or diarrhea. The patch is water-resistant, making premature detachment very rare.

3/ VAGINAL RING: NUVARING Hormonal contraception3 engl

(In Hebrew: Tabaat – טַבַּעַת)

  • Insertion: Easily inserted at the back of the vagina due to its flexibility.
  • Usage: Left in place for three weeks, followed by removal for one week (during which menstruation occurs) before inserting a new one.
  • Hormones: Estrogen and progestin, providing the same effectiveness as combined pills or patches.
  • Advantages: Continuous hormone diffusion leads to fewer adverse effects.
    • No need for daily contraception management, but strict adherence to deadlines for removal and insertion is necessary.
  • Sexual Intercourse: The ring is generally not felt by partners during intercourse.
  • Temporary Removal: Can be removed for up to three hours without affecting its effectiveness.
  • Prescription: Requires a doctor’s prescription and verification of medical and family history, like all hormonal contraceptives. 

 

4/ THE HORMONAL IUD

Also called hormonal IUS, in Hebrew etken hormonali (התקן הורמונלי) this small flexible plastic rod diffuses a progestin at a regular dose into the uterus. 

After a first visit to check the absence of contraindications, the gynecologist sees the patient again during her first days of menstruation in order to insert the IUD. This gesture is not very pleasant but is not supposed to be painful either, obviously this will depend on the tolerance and personal experience of each patient.

The hormonal IUD effectively protects against unwanted pregnancy for 3 to 5 years, depending on the model. 
This is its most important advantage: once placed, you no longer have to think about it! It can also be placed for a shorter period of 6 months to 1 year if the patient wishes.

Currently there are 3 types of hormonal IUDs: the Mirena, the Kyleena and the Janess (in France Jaydess)

Contrary to popular belief, it is also suitable for women who have never had children.

Finally, it helps reduce pain and the abundance of periods. It is even the treatment of choice for patients who have heavy periods.

It is possible that shortly after installation, some women notice small losses of blood outside their period, which is called spotting. In other women, periods disappear completely, which is called amenorrhea.


5/ THE SUBCUTANEOUS IMPLANT
This small flexible stick is implanted in the upper arm, under the skin, with local anesthesia. You can feel it with your fingers, but you can barely see it once in place.

The hormonal implant releases a progestin in small doses, for 3 years.

It can be removed by the doctor at any time. Very effective, except in the case of interaction with certain medications, it allows you not to think about contraception on a daily basis. It can cause periods to stop, sometimes desired by the woman and without danger for her.

Reported disadvantages include spotting, weight gain, and scarring after removal.
It is called Nexplanon, is available in France but not in Israel where it has very little success because of the frequent spotting it causes and which hinders access to the Mikveh for somewhat religious Israeli women.