CONTRA(MIS)CONCEPTION

WTA PHYSICALLY SPEAKING

Women use contraception for many reasons. Many options are available, which provides the best selection for each woman. Be informed about the different types and reasons to use contraception and have regular check-ups with your primary care physician (PCP) or gynecologist (ObGyn) to safeguard your health, periods (menses), relationships, and tennis performance.

KNOW YOUR FLOW

The frequency of a woman’s menstrual cycle can vary. The following changes in the menstrual cycle require a medical examination (especially when using hormonal contraceptives): periods occurring more often that 21 days, time between periods longer than 45 days, period length exceeds 7 days, change in the regularity of your cycle, no periods for 3 consecutive months, and older than 14 years old and no menstrual history. Low levels of estrogen, which can result in irregular menstrual periods, may cause lower bone density, which increases the risk of osteoporosis and bone stress fractures and can negatively affect the ability to get pregnant.

Closely monitor any menstrual cramps or pain you experience. While these may be normal side effects of your menstrual cycle, prolonged pain or bleeding may be a sign of a more serious condition.

Dysmenorrhea

is painful periods. It is the most commonly reported menstrual disorder. Over 50% of women report menstrual pain a couple days per month. Primary dysmenorrhea is pain that comes from having a period; secondary dysmenorrhea is caused by a reproductive system disorder, it usually gets worse over time and starts later in life. Dysmenorrhea can be effectively treated with over the counter (OTC) pain medicines or with hormonal birth control (BC) methods.

Chronic pelvic pain

is pain in the pelvic area that lasts over 6 months. The pain can be cyclical, constant, or associated with certain activities such as eating, sex, or urination. Chronic pelvic pain has a variety of causes, including medical conditions of the reproductive organs, the urinary tract, bladder, bowel, or a combination of these. OTC pain medications, physical therapy, and nutritional therapy can assist to reduce chronic pelvic pain. Unexplained prolonged or severe pain should be evaluated by a medical provider to determine cause and specific treatment.

Endometriosis

is a condition in which the tissue which lines the uterus grows outside the uterus, which increases the risk of infertility. It affects about 10% of women and is most common in women in their 30s and 40s. The most common symptom of endometriosis is pelvic pain that occurs before and during the menstrual period. Pain may also occur during sex, urination, or bowel movements. Some women with endometriosis have no symptoms, so regular visits to the gynecologist or PCP are important to detect it. Over the counter pain medicine and hormonal forms of birth control can alleviate some symptoms of endometriosis. Occasionally, surgical treatment is required.

Heavy menstrual bleeding

occurs in about 30% of women. It is not normal and may indicate a more serious condition. Heavy bleeding is caused by many factors. It can cause anemia due to iron loss in the blood. Bleeding is ‘heavy’ when:

  • It Exceeds 7 days
  • Saturates more than one tampon/pad every hour for several consecutive hours
  • Need to change pad/tampon overnight
  • Need to wear more than one pad at a time to absorb flow
  • Menstrual flow with blood clots that are equal to or bigger than 1.5 cm (3/4 inch) diameter

See your PCP or gynecologist for an evaluation and probable ultrasound exam to determine the cause and treatment.

Pelvic inflammatory disease (PID)

is a common infection of the female reproductive organs caused by exposure to bacteria during sexual activity. Two Sexually Transmitted Infections (STIs), gonorrhea and chlamydia, are the main causes of PID. Women under the age of 25 are more likely to develop PID. If left untreated it can lead to long term serious effects, such as infertility, ectopic pregnancies and chronic pain. Symptoms can be vague, so it may be challenging to diagnose. Symptoms include lower abdominal pain, pain during sex and vaginal discharge.

Polycystic Ovary Syndrome (PCOS)

is a hormonal disorder affecting women of reproductive age. Its cause is unknown. Symptoms include: irregular menstrual cycles, prolonged periods, increase androgens (male hormones) and enlarged ovaries. An increase in acne, facial hair changes to metabolism, weight gain and infertility result from PCOS.

TYPES OF CONTRACEPTION

When choosing contraception, it is important to consider several factors: efficacy, ease of use, protection against STIs, prescription versus OTC and most importantly, relevant medical history. Consult an ObGyn or PCP before starting any prescription birth control regimen and monitor possible side effects.

BARRIER METHODS

Barrier methods prevent the man’s sperm from reaching the woman’s egg. These methods are easy to use and available OTC, but they are less effective at preventing pregnancy, with 18% to 28% of women using barrier methods becoming pregnant. Proper use is vital to enhance effectiveness. These methods can be used alone or with other forms of contraception. The ONLY barrier methods to prevent against STIs are condoms.

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Type Information Potential Side Effects/Items to Consider
Spermicide Chemical that inactivates sperm Can result in allergic reaction, burning, or vaginal irritation
Condoms Physical barrier that prevents the sperm from entering the uterus and reaching an egg There are male and female condoms. Using both a condom and another form of contraception is the best way to protect against pregnancy and STIs. Possible allergic reaction to latex or polyurethane
Sponge Round device made of foam that contains spermicide Less effective if you have previously given birth
Can result in vaginal burning, irritation, or allergic reaction Do not use during your period or if have a history of toxic shock
syndrome
Diaphragm Small, dome shaped device made of silicone or latex that is inserted into the vagina and covers the cervix. It can be individually sized or obtained as a one-size which fits most women Must be initially fitted by healthcare professional Can increase the risk of urinary tract infection (UTIs) Can result in vaginal burning, irritation, or allergic reaction
Cervical Cap Small plastic dome that fits tightly over the cervix Must be initially fitted by healthcare professional
May cause vaginal irritation or odor

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COMBINED HORMONAL BIRTH CONTROL (BC)

Combined hormonal birth control is a prescription only medicine which contains synthetic forms of two hormones: estrogen and progesterone. These hormones prevent pregnancy by stopping ovulation. If used consistently and correctly fewer than 1% of women will become pregnant in the first year of using BC. Possible side effects include headache, nausea, breast tenderness, and breakthrough bleeding. Most forms of combined hormonal birth control are Tennis Anti-Doping Program compliant both in and out of competition, but athletes should always be vigilant and check with TADP.

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Type Information Pros/Cons
Oral Contraceptive Pill Available in 21-day, 28-day, 90-day, or 365-day formats Pros:
Result in regular, lighter and shorter periods
Reduce menstrual cramps and associated pain
Decrease the risk of uterine, ovarian, or colon cancer
Improve acne or unwanted hair growth
Used to treat other female disorders such as fibroids or
endometriosis
Cons:
Slight increased risk of deep vein thrombosis (DVT), heart attack, and stroke
Do not use in the first 3 weeks after giving birth
Estrogen can affect milk suppl
Vaginal Ring Flexible plastic ring placed in the upper vagina.
Remains in place for 21 days. Can be removed for 7
days during which time you will get your menstrual
period, or a new one can be inserted every 21 days.
Contraceptive Skin Patch Small adhesive hormone patch worn on the skin. The
patch is worn for one week at a time for 3 consecutive
weeks, followed by one week with no patch when you
will get your period. A new patch can be applied every
week for a continuous dose form of BC

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LONG ACTING REVERSIBLE CONTRACEPTION (LARC)

LARC is the most effective form of birth control. It is either an intrauterine device (IUD) or birth control implant; both are inserted by your ObGyn or PCP during a simple outpatient procedure. Recovery time is minimal with brief cramping after IUD insertion, or upper arm discomfort at the insertion site of the implant. LARC is highly effective in preventing pregnancy and can be kept in for several years, so there is no need for prescription refills. Both methods are reversible and can be removed at any time. This form of contraception does NOT affect your ability to get pregnant in the future. LARC does not interfere with sexual or daily activities, including on court performance. It is currently the most recommended form of birth control by ObGyn professionals. The LARC methods do NOT protect against STIs or HIV, therefore a secondary form of protection (such as a barrier method) should be used with LARC to protect against these.

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Type Information Pros Cons/Potential Side Effects
IUD Small t-shaped
plastic device
inserted into the
uterus. Two types:
hormonal (progestin,
used for 3-5 years)
or copper (used up
to 10 years)
Inserted by your doctor in simple in-office medical procedure at
any time during menstrual cycle, but easiest during period.
Recovery time is minimal
Can be inserted immediately after abortion, miscarriage, or
pregnancy
Helps decrease menstrual pain and bleeding. Menstrual bleeding
may stop completely in some women.
Copper IUD is the most effective form of emergency contraception
With copper IUD painful periods and bleeding
may increase during the first months of use
Complete STI screens PRIOT to IUD insertion
Pelvic inflammatory disease (PID) after
implantation is very rarely but may result.
Women with undiagnosed STIs at the time of
insertion are more likely to develop PID
An IUD itself does not increase the risk for PID
Birth
Control
Implant
Flexible plastic rod
inserted under the
skin in the upper
arm. It releases
progestin into the
body and can be
kept for 3 years.
Can be inserted immediately after abortion, miscarriage, or
pregnancy
Reduces pain during menstrual cycle
Short-term pain at insertion site, so may want
to avoid during competitive tennis season
Possible side effects include: digestive
difficulties, headaches, breast pain, weight
gain, and acne
More frequent and longer periods; however, in
many women periods are less frequent or stop

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Annual women’s’ health examinations by a Gynecologist or PCP are important for all women over 18 years of age, even when NOT sexually active. These visits provide important information regarding periods, vaccinations against STIs, contraception, pregnancy guidance, and other information about women’s sexual health.

Please speak with your PCP or gynecologist for more information.

 

The information provided within this Physically Speaking topic is for informational purposes only and should not be treated as medical, psychiatric, psychological, health care or health management advice. If you have my health or related questions or concerns, please consult your physician or other qualified health care professional.

A special thanks to our authors, Dr. Walter Taylor, WTA Medial Advisor, and Lisa Pataky, WTA PHCP

Read more health and nutrition articles →

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