Ortho TriCyclen

Contraception is a term used to prevent pregnancy. There are different types of them around. Some are used by men while others are for women.

There are two major methods of birth control namely barrier or hormonal. Aside from that, the other types include sterilization otherwise known as surgery, withdrawal, natural family planning and the simplest which is abstinence.

Let’s talk about each of them.

• The first is the barrier method wherein the male or the female uses a condom to prevent the sperm from ever entering the female’s uterus. The male condom comes in many brands, color and flavors and is usually made of latex rubber. This is placed over the penis when it is erect prior to intercourse.

The female condom on the other hand is made of polyurethane and is seven inches long. This allows it to protect the cervix, vaginal canal and the immediate areas surrounding the vagina. It is inserted into the woman’s vagina also prior to intercourse.

• Another barrier is known as spermicides. It is a chemical designed to kill sperm and this is available as foam, jelly, foaming tablet and as a vaginal suppository.

• You also have the diaphragm that is a soft rubber dome which stretches over a flexible ring that contains spermicides in the form or cream or jelly.

This is placed inside the woman’s vagina and placed over the cervix. Women should take note that this should not stay inside for more than 3 hours prior to intercourse.

• The cervical cap is a small cup made of the same material as a condom. It is also filled with spermicidal cream and inserted into the girl’s vagina and placed over the cervix.

• The last is the contraceptive sponge which is a soft saucer shaped device made from the same material as the female condom.

Now that we have discussed the different barriers, it is time to discuss about hormonal birth control methods.

Hormonal devices appear in the form or an implant, patch, pill or shot. They are designed to prevent the woman’s ovaries from releasing an egg monthly, cause the cervical mucus to thicken so the sperm will have a difficult time penetrating the egg or thin the lining of the uterus which reduces the chances of a fertilized egg from ever implanting on the uterus wall.

Some experts believe that they are very effective but they cannot protect you from sexually transmitted diseases or STD’s.

• Birth control pills can be acquired from your health provider. Depo-Provera is an injection that costs a little bit more than the pill and can prevent pregnancy for 3 months. Something similar to Depo-Provera is lunelle but this can only prevent pregnancy for up to one month.

• The Nuva Ring or vaginal ring is a flexible ring that is inserted into the vagina for three weeks before this is removed and replaced with a new one. The ring contains chemicals such as estrogen and progesterone that releases this into the body.

• The birth control patch works like the ring as it releases hormones into the body while the IUD is a small plastic device that contains hormones and copper and changes the cervical mucus to decrease the chances of an egg from fertilizing.

• Withdrawal is simply removing your penis out of the girl’s vagina before ejaculation. Sterilization closes the fallopian tubes permanently and this is better known as tubal ligation. Men can have the same thing and this is called a vasectomy.

• Natural family planning is simply controlling the number of kids that you want to have.

• Abstinence is not engaging in sexual intercourse at all that is perhaps the most effective type of birth control.

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Severe acne or moderate acne that is not responsive to topical therapy may require systemic therapy. Such therapy may include oral antibiotics, oral isotretinoin, or hormonal therapy.

Oral Antibiotics

The front-line oral antibiotics for the treatment of acne are the tetracyclines. Tetracycline was popularized in the 1950s and has proven to be a safe and effective agent for treating acne for half a century. Today, it is generally acknowledged that minocycline and doxycycline are even more effective. All tetracyclines are contraindicated in pregnancy and in children who have not yet formed their permanent teeth (risk of discoloration). All tetracyclines may cause some photosensitivity and esophageal irritation. (This is especially true for doxycycline.) Side effects of minocycline may include vertigo, blue-gray discoloration of skin or teeth, and rare events such as a lupus-like syndrome. Both tetracyclines and all other antibiotics list numerous other possible side effects and these need to be reviewed prior to prescribing any oral antibiotic for acne.

Erythromycin has long been considered the preferred second-line oral antibiotic for acne therapy. It does have an excellent side-effect profile (with gastrointestinal upset generally the most common problem) and may be approved for use even in pregnant women. (I recommend clearing this with the patient’s obstetrician.) The major concern over the use of erythromycin today is antibiotic resistance, which has been reported in significant proportion in laboratory studies. Even though the clinical significance of these findings has not been confirmed, prudence would seem to favor restricted use of erythromycin (and other topical and oral antibiotics).

Other antibiotics that have been prescribed for acne include trimethoprim-sulfamethoxazole, dapsone, amoxicillin, and clindamycin. Each has its advocates and detractors. Trimethoprim-sulfamethoxazole and clindamycin are quite effective, but their use is tempered by side-effect concerns (pseudomembranous enterocolitis in the case of clindamycin and hematologic and severe cutaneous reactions such as Stevens-Johnson syndrome in the case of trimethoprim-sulfamethoxazole).

Isotretinoin

Since its introduction in 1982, isotretinoin (Accutane) has been considered the most effective therapy for severe nodulocystic and scarring acne. Today, the drug also is being used in less severe but persistent and/or psychologically damaging forms of the disorder.

Isotretinoin is an invaluable drug, but one with significant associated risks. The most frequent side effects are relatively minor: dry skin, eyes, lips; muscle or joint pain; mild hair loss. More significant concerns include liver damage and elevated triglycerides, both of which require frequent monitoring.

The most serious concerns over isotretinoin use are fetal abnormalities if used in pregnant women and the possibility of depression and suicide (especially in younger patients). Fetal damage with isotretinoin is an acknowledged risk and one that dictates very careful attention to both preventing pregnancies in patients taking isotretinoin and educating patients to this risk.

The relationship of isotretinoin to depression/suicide in acne patients is, however, controversial. While anecdotal reports have described such an apparent association, some studies have shown no statistical increase in depression or suicide in acne patients on isotretinoin compared with those on other therapies. This issue is clouded by the tragic fact that depression and suicide are quite common in teenagers and young adults, those most likely to suffer from acne. One must also consider that severe acne itself may be a cause of depression in these patients and thus merits aggressive therapy.

Due to the above concerns, the use of isotretinoin has been restricted recently. Any physician wishing to prescribe isotretinoin must be registered and pledge to adhere to strict guidelines for the use of the drug. In my opinion, patients who require isotretinoin therapy should be referred for dermatology consultation. Therefore, we will not discuss details of isotretinoin use in this article.

Hormonal Therapy

Oral contraceptives improve acne by decreasing the amount of circulating androgens, and may be appropriate for women with moderate acne who have no contraindications to hormone therapy. If a woman with acne is using oral contraceptives for birth control, it is important to determine that she is not using a formulation containing androgenic progestins that may actually provoke acne.

In 1997, the United States Food and Drug Administration (FDA) approved a triphasic, combination oral contraceptive (Ortho Tri-Cyclen) for the treatment of acne. Two large multicenter trials showed that this oral contraceptive significantly reduced acne lesions compared with placebo. The most frequent adverse reaction in these studies was nausea.

The antiandrogen spironolactone may be used in women with new-onset or worsening adult acne, premenstrual acne flares, and in women who have not responded to traditional systemic therapies. The most effective dosage varies from individual to individual, and finding the optimal regimen may require time and adjustment.

If the treating primary care physician suspects that hormonal problems, such as PCOS, may be the cause of acne in a female patient, a referral to a dermatologist or endocrinologist would be in order.

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