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Married couple in early 40s seeking advice on contraceptive methods. -…
Married couple in early 40s seeking advice on contraceptive methods.
For how long she has been on birth control
Her age also plays a factor on the possible side effects
How sure they are that they don't want more kids and if they would consider a more permanent solution.
Finances or the cost of the options available, basically what they can afford.
Female Reproductive System
Ovaries
are located in the pelvis and are anchored by 3 ligaments. The
broad ligament
is a drape of peritoneum that hangs over the uterus. The
ovarian ligament
anchors each ovary to the lateral wall of the uterus. Lastly the
suspensory ligament
attached to the lateral edge of each ovary and projects to the pelvic wall. The ovarian blood vessels and nerves are housed within each suspensory ligament/
mesovarium
and they join the ovary at its helium.
There are 6 types of follicles found in the ovaries.
Primordial follicle:
is the most primitive follicle, it contains a primary oocyte (prophase 1).
Primary follicle:
forms from a maturing primordial follicle, contains a primary oocyte, and secretes estrogen.
Secondary follicle:
the primary oocyte develops two protective surrounding structures called the zona pellucida and corona radiata, and a serous fluid-filed antrum develops.
Vesicular Follicle
contains a secondary oocyte (metaphase 2), the vesicular follicle is developed each month and eventually ruptures to to release the secondary oocyte a process termed ovulation.
Corpus luteum
is what is left after ovulation and secretes progesterone and estrogen.
Corpus Albicans
is the after math of the corpus luteum undergoes regression into a white connective tissue.
Mammary Glands or breasts
are composed of a compound tubuloaveolar exocrine gland which secretes breast milk containing proteins, fats, and lactose sugar to provide nutrition to infants.
Male Reproductive System
, its primary organs are the testis where spematogenesis or sperm production occurs. The accessory organs include a complex set of ducts and tubules leading from the testis to the penis. Other structures include the scrotum and accessory glands.
Ovarian Cycle
occurs when a female reaches puberty. The hypothalamus releses GnRH that stimulates the anterior pituitary to secrete FSH and LH which are responsible for initiating the ovarian cycle. The ovarian cycle is 28 days long, it has a follicular phase and luteal phase separated by ovulation. If the ovulated secondary oocyte is fertilized and successfully implants in the uterine lining the structure becomes a pre-embryo and secretes hCG which mimics LH on the corpus luteum causing it to continue to function. If the ovulated secondary oocyte is not fertilized the corpus luteum stops secreting progesterone, estrogen, and inhibin and the uterine lining is shed (menstruation). This indicates the hypothalmaus to secrete GnRH and the cycle starts again.
Uterine Cycle
is influenced by estrogen and progesterone secreted by the corpus luteum. This cycle is consists of 3 phases: the menstrual phase in which the functional layer is shed. The proliferative phase the initial development of the new stratum functionalis occurs which overlaps the time of follicle growth and estrogen secretion by the ovary. Lastly, in the secretory phase progesterone secretion from the corpus luteum results in increased vascularization and development of uterine glands.
Contraceptive methods
Chemical methods
can include oral contraceptives. Which are pills usually containing estrogen and progesterone that can inhibit the release of an egg. Side effects can include weight gain due to water retention and an increase chance of developing a blood clot.
Abstinence
or refraining from intercourse/sex is the only contraceptive method that prevents pregnancy 100%. A side effect could be sexual frustration as it can also be used as a stress reliever. Also, if it is thought as the only contraceptive method that might mean there is a lack of sex education.
Rhythm method or Natural Family Planning
, it involves a woman her cycle specially when she is fertile and refraining from sexual activities or using a condom during that time. A side effect is that is not entirely effective if the cycle is not tracked correctly or "accidents" happen.
Withdrawal method
or commonly known as the "pull out" method, involves the penis of a man exiting the vagina before ejaculation. The side effects are that it is not very effective since there is a lot of room for errors or bad timing. Also, even if the timing is good there is a chance that sperms leaked into the pre-cum fluid, or if the semen lands close to the vagina the sperm can travel into it. Last, it doesn't protect you from getting an STD.
Surgical methods
can be performed on either women or men. Female sterilization procedures work by blocking the fallopian tubes through either hysterectomy (removing the uterus) or tubal ligation. Male sterilization can be done through a vasectomy that keeps the sperm from reaching the urethra.
Other type of contraceptives include lactation, intrauterine devices. All methods have their pros and cons, it is best to consult with your doctor to decide which one is best for you.
3 best options
Vasectomy, it has a faster recovery time than female sterilization surgical procedures. It is more affordable and has few side effects.
Tubal ligation or hysterectomy, like vasectomy has a higher contraceptive rate than other methods, and is permanent.
Use of an oral contraceptive, there are different formulations that a woman can choose with the help of her doctor. Also, in most cases it is affordable or there are assistance programs for access to it.
3 worst options
Withdrawl method, there is a lot of potential room for unwanted pregnancies.
Rhythm method, it requires consistency and accuracy also leaving quite a bit of room for accidents.
Abstinence, to me although it is the most effective, I am hesitant to it since many times it comes with a lack of sex education and with prejudices. Also, sex is a biological function that needs to be addressed with the best information and tools out avaliable.