A happily married couple in their early 40's is seeking contraceptive advice. they are sure they do not want any more kids and the wife would like to stop birth control pills due to concern of long-term effects.
background information
reproductive anatomy
reproductive organ function
events of the uterine and ovarian cycles
major contraceptive methods
Males
Females
the ovaries produce oocytes and release estrogen and progesterone
the uterine tubes will carry the egg that has been fertilized to the uterus
the uterus houses the egg (and baby) if the egg is unfertilized the uterus will "shed" resulting in a menstruel cycle
the vagina is the canal through which semen enters and the baby comes out. it has external structures (genitalia) that protects it and the cervix seperates it from the uterus.
the male reproductive organ is the testes which produce sperm and male sex hormones
the accessory organs include a complex set of ducts and tubules where sperm mature
additionally a group of male accessory glands help create semen for the sperm to swim
this all leads to the penis the copulatory organ that serves both reproductive and urinary functions.
the ovarian cycle
the follicular phase is the first stage lasting days 1-13 includes the growth/maturation of the follicle that houses the egg stimulated by an increase in FSH
then ovulation occurs on day 14
then is the luteal phase lasting days days 15-28 in which the follicle becomes the corpus luteum which acts as a temporary endocrine gland that helps release hormones that build up the uterine wall for implantation
eventually the corpus luteum regresses into the corpus albicans this results in a drop of hormones that ultimately triggers menstruation
the uterine cycle
the uterine cycle is the changes to the uterus it begins with days 1-5 of menstrual flow
from there estrogen secreted from the ovarian follicles stimulates the prolipherative phase
and then the secretory phase in which the uterine wall is continuing to be thickened until the drop in hormones caused by the ovarian cycle causes menstruation
abstinence- refraining form sexual intercourse
rhythm method- planning intercourse to avoid around ovulation
the withrawal mathod- pull out before he ejaculates has a high failure rate
lactation can prevent ovulation and menstruation if nursing constantly
physical barriers- includes condoms, spermicidal foams and gels, and diaphrams and cervical caps prevent the sperm from reaching the uterine tubes
intrauterine devices contain copper and are effective for up to 10 years
chemical methods include oral contraceptives, hormone patches,injected or implanted progestins, and morning after pills chemically and hormonally effecting your system to preventive pregnancy if used correctly they have a low failure rate.
lastly surgical methods- tubal ligation for women and vasectomy for men usually permanent so not a good option for people who may want more children
I would say the biggest difference for this couple and another one seaking contraceptives is age they already have two older children so they are desiring something very affective they do not want any more kids
additionally they have more financial freedom and knowledge to pursue stronger methods whereas teenages may not feel they can access anything other than condoms and pulling out especially if they are already trying to hide sexual activity from parents they may feel embarrassed or unable to ask for appropriate birth control methods.
best methods
worst options
abstinence- sex is important for a healthy adult relationship
rhythm method- although she may think she knows her cycles well enough they can fluctuate this is not a good method for them as they are sure they don't want more kids and this method has high failure rates
birth control pills- the wife has already expressed her desire to stop taking them if she continued but didn't take them regularly due to not wanting them she could increase her chance of getting pregnant because they wouldn't work as effectively.
though it is the most extreme the most certain way method to ensure they don't get pregnant would be surgical generally the male surgery is less invasive. this could be a good option since they are older and are certain they don't want any more children.
since she doesnt like the pills she could go for more permanent hormone methods such as injections or patches. although she may still not like the effects the hormones can have.
aditionally she could look into an intrauterine device which uses copper to prevent pregnancy and lasts up to 10 years this could protect her up until menopause which happens in the 40's to 50's