HORMONAL METHODS

Hormonal methods marketed in Canada include the pill, patches, injections and cervical/vaginal ring. (Contraceptive implants were removed from the market in 2002 when some 40,000 women won a 50 million-dollar lawsuit against the maker of the implants, Norplant, following damages due to the serious side effects of the product as well as high inefficiency rates) 27 .

Contraceptive efficiency

Table III of the medical desription paper for the « Nuvaring » cervical/vaginal ring, launched in Canada in the spring of 2005, shows the efficiency rates of each contraceptive method according to "perfect" use and "typical" use 1 .

Perfect use

"Perfect" use means the efficiency of the product in perfect conditions, in the absence of any and all variable factors, that is in the context of controlled clinical research.

Typical use

"Typical" use means the efficiency of the product « in real life », that is when the woman or the couple are exposed to the slew of variables that can alter the efficiency of the contraceptive method. For hormonal contraception, these factors include: alcohol 2,3 , drugs and medication 4,5,6 , diarrhea 7 , vomiting 8 , smoking 9,10,11,12 , secondary smoke 13 and the non-observation of some of the numerous technical requirements  (patch, ring, injection) 14 , related to installation 15,16 , storage (patch, ring, condom) 17 and/or administration (pill) 18 .

Table III of the Nuvaring description paper allows one to observe that the efficiency rates in the "typical use" column are, for the most part, considerably lower than those in the "perfect use" column. The failure rate for "typical use" of hormonal methods, all compositions combined, is quoted at "5%".

The Society of Obstetricians and Gynecologists of Canada (SOGC), for its part, indicates in its Canadian consensus on contraception, published in March 2004, that the failure rate it recognizes for « combined » oral contraceptives  (composed of estrogen and progesterone) is "between 3% and 8% »  19 .

The failure rate the SOGC recognizes in that same document for the « progesterone only pill » (« POP ») is « between 5% and 10% » 20 . In fact, numerous studies show a failure rate with « typical » use, for the pill, of 13 women out of 100, and, for implants, injections and patches, 8 women out of 100 21, 22 .

In the 2006 "Main Guide" of the magazine "A patient's guide to medical information" published by the Canadian Pharmacists Association, the failure rate for combined hormonal contraceptives is quoted at 7%. Progestin-only contraceptives are quoted in the table as "somewhat less effective" than the combined hormonal contraceptives 22.5 .

A variety of studies among the most respected worldwide have established, in the last decade, the alarming fact that one out of two unplanned pregnancies results from contraceptive failure 23, 24, 25, 26 .

Most jurisdictions in North America, more and more confronted with difficult pregnancy (inadequate social or medical conditions for the sustenance of a family) not only despite massive contraception education, but paradoxically, because of the latter, have now come to recognize these scientific facts, and choose the preventive way, by relaying the message that "Ninety-nine percent-effective contraception does not exist in real life".

Health risks

Pages 6 to 10 of the « Nuvaring » medical descriptive paper (see note 1) describe in detail all of the health risks related to hormonal contraception: cervical and breast cancer; thrombosis; heart attack; osteoporosis; gallbladder disease; aneurism; embolism; phlebititus; hypertension; kidney and liver stones; kidney, urinary and vaginal infections; water retention, etc.). Other studies corroborate and explicitate these and other health risks 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 .

Let us add that hormonal contraception in no way protects against sexually transmitted diseases (STDs) and the slew of health problems that they bring about (sterility; ectopic pregnancy; spontaneous abortion; cancer; caesarean delivery; see STD section at the end of the present "Contraception" chapter).

Emergency contraception ("EC")

Emergency contraception can be categorized as both contraception and an abortifacient 38, 39, 40 . Its mechanisms are the same as those of regular hormonal contraception, only more instantaneous because EC contains double to sixty-fold the regular dose of synthetic hormones. EC therefore involves all the health risks of regular hormonal contraception, but that much more pronounced 41 . Either the contraceptive or the abortive mechanism will predominate, depending on whether conception has occurred prior to ingestion of the product. And pregnancy can still continue. Risks of continuing pregnancy are reduced by 75% only with the « Yuzpe » regimen 42, 43 and by a mere 60% with the "progesterone only" regimen 44 . The woman will then have to undergo a second attempted abortion, this time, surgical. It has been observed that EC involves considerable risk of ectopic pregnancy (implantation of the child in an organ other than the uterus) 45 . Ectopic pregnancy is responsible for at least 13% of all maternal deaths 46 .

BARRIER METHODS

Barrier methods include the condom, the intra-uterine device (IUD), the cervical cap, the diaphragm and the cervical sponge.

CONDOM

Contraceptive efficiency

As shown in the Nuvaring description paper (see note 1), the failure rate for the condom with « perfect use » (in the context of controlled clinical study) is 3%, while that with « typical use » (« in real life ») is 14%. In other words, according to this table, « in real life », 14 women out of 100 will become pregnant if they rely on this product.

In the 2006 "Main Guide" of the magazine "A patient's guide to medical information" published by the Canadian Pharmacists Association, the failure rate for for the condom as typically used is quoted as 14% 46.5 .

Another study concludes: "One out of five women (20%) that rely on the condom to prevent pregnancy will become pregnant over two years » 47 .

Health risks

Protection against sexually transmitted diseases (STDs)

In the « Report concerning the efficiciency of the condom for the prevention of STDs », published in July 2001 by the National Institutes of Health (NIH) of the United States, twenty-eight world-renowned experts conclude as follows: « Dues to their important limitations, the one hundred and twenty eight studies on the market on the efficiency of the condom do not allow to conclude that the condom offers  any protection against sexually transmitted diseases. Data on possible protection against HIV/AIDS (that is 'as low as 60%') are gross estimations, subject to numerous confounding factors and other limitations. In addition, they limit themselves to condoms that do not break or slip and to perfect heterosexual use»  48 .

The report makes clear that the condom cannot technically offer any protection against STDs of an ulcerous nature (e.g. herpes, syphilis, warts), as the latter are found on skin areas that are not covered by the condom (thighs, abdomen, buttocks). No protection can be offered either for STDs that are transmitted by all bodily fluids, including saliva (e. g. Human Papilloma Virus, or HPV). The same can be said for those STDs that are found in all genital fluids (gonorrhoea, chlamydia, trichomoniasis), as these fluids can very well be present for the installation of the condom (e. g. in the feminine fluids) » 49 .

Condom tear and slippage rates

"The tear and slippage rate for the latex condom is 3.2%, and that for the new plastic condom is 8.4%. »  50

Spermicide and increased risk of STD transmission

Health Canada: « Spermicide that covers the condom facilitates STD transmission by weakening the immune system and creating genital lesions that facilitate the exchange of blood and fluids».  51

Allergic reactions

Health Canada: « Allergic reactions to latex rubber can go so far as shock and death »  52 .

Latex rubber as a cancer-inducing substance

"Volatile organic compounds contained and released by latex rubber (of which the condom is made) are recognised cancer-inducing substances »  53 .

STD infection and increased risk of AIDS transmission

"Ulcerous STDs (e.g. syphilis, herpes) as well as inflammatory STDs (e. g. gonococcic infection, Chlamydia), act as a transmission factor for HIV infection. The presence of these STDs increases the level of contagion of HIV-infected persons and increases HIV vulnerability on uninfected persons. » (see « On les croyait terrassées - Les ITS bactériennes resurgissent en force ! » in the Prévention en pratique médicale - maladies infectieuses bulletin, Montreal Public Health Department, August 2002, p. 1)

SEXUALLY TRANSMITTED DISEASES (STDs)

No contraception method adequately protects against sexually transmitted diseases (STDs), which is why the world it at grips with a growing epidemic of STDs, which have serious health consequences, can involve much pain and suffering and react less and less to treatment  54 . Eighty percent of STDs are asymptomatic (have no symptoms) 5  : They are passed on unknowingly by both giver and receiver. In many cases, they are discovered too late, when they have transformed into infertility or cancer.

Infertility

STDs the cause of 20% of infertility in Canadian women 56 . In 1993, 1 of 12 couples in Canada was infertile 57 . Today, one out of six Canadian couples experiences difficulty conceiving a child  58 . STDs and the scar tissue they leave behind can block the Fallopian tubes and prevent conception.

Ectopic pregnancy

STDs can lead to ectopic pregnancy, a situation where the conceived child, blocked by infection and/or scarring, implants outside the uterus and can lead to the rupture of abdominal organs if pregnancy is not detected in time 59 . Ectopic pregnancy causes some 13% of maternal deaths 60 , and it is on the increase in Canada 61 .

Spontaneous abortion

STDs can cause spontaneous abortion (stillbirth early in pregnancy) because the child cannot implant in the uterus due to infection and the scarring related to STDs 62 . Spontaneous abortion is on the rise  in Canada 63 .

Caesarean delivery

STDs can lead to the necessity for Caesarean delivery (abdominal incision involving all the dangers of surgery) either because the child has implanted too close to the cervix (« placenta previa ») to avoid the places where there is scarring and/or infection, or to avoid transmitting an STD to the child  64 . The Caesarean delivery rate has almost quadrupled in Canada from 1968 to 1988, reaching 18.3% (that's almost 1 in 5) of all deliveries  65 .

Human Papilloma Virus (HPV)

Health Canada: « HPV is so small it can pass through the condom 66 . This virus, found in all bodily fluids, is related to 90% of cervical cancer cases. Between 20% and 33% of Canadian women are now infected with HPV »  67 .

Cervical cancer is the second most fatal cancer among women in the United States  68 .

« Four out of five adult Quebeckers are now infected with HPV  69 .

NIH report quoted earlier: « There is no epidemiological evidence that the condom protects against HPV »  70 .

The risk of HPV infection increases 1,000% with each new partner 71 .

Hepatitis B

Hepatitis B, a virus that is 200 times more infectious than AIDS, is even smaller than HPV  72 . One point five million people in the world die from this STD each year. Two hundred thousand Canadians are now infected with Hepatitis B  73 . The vaccine developed against it is inefficient in at least one out of twenty cases  74 .

Herpes

Herpes is a chronic (incurable) illness that involves intense burning sensations when one urinates, sits or has sexual relations. It is transmitted through ulcers, whether they be active (releasing puss) or not, ulcers that are present on the skin of the buttocks, thighs or abdomen. A mother can also transmit this infection to her children, which will lead to malformations and handicaps. Fifty-nine percent (59%) of Canadian women are now infected with oral Herpes and 17.3%, with genital herpes 75 .

INTRA-UTERINE DEVICE (IUD)

Contraceptive efficiency

As shown in the Nuvaring descriptive paper (see note 1), the failure rate of the IUD, with « perfect use » (in the context of controlled clinical study) is 1.5%, while that with "typical use" (« in real life») is 2%. In other words, « in real life », 2 women out of 100 will become over one year if relying on his product.

Health risks

The IUD involves the following health risks: Pelvic Inflammatory Disease (PID) 76 ; ectopic pregnancy 77,78,79,80,81,82,83 ; uterine perforations and lacerations 84,85,86,87 .

DIAPHRAGM

Contraceptive efficiency

As shown in the Nuvaring description paper (see note 1), the failure rate of the diaphragm, with « perfect use » (in the context of controlled clinical study) is 6%, while that with « typical use » (« in real life ») is 20%. In other words, « in real life », 20 women out of 100 will become pregnant over one year if they rely on this product.

In the 2006 "Main Guide" of the magazine "A patient's guide to medical information" published by the Canadian Pharmacists Association, the failure rate for the diaphragm as typically used is quoted at 20% 87.5 .

Health risks

The diaphragm involves the following health risks: ectopic pregnancy ; uterine perforation ; bladder infection 88 .

CERVICAL CAP

Contraceptive efficiency

As shown in the Nuvaring description paper (see note 1), the failure rate for the cervical cap with « perfect use » (in the context of controlled clinical study) is 9% for « nulliparous » women, that is women with no previous term pregnancy, and 26% for women having given birth in the past, while those with « typical use » (« in real life ») are 20% and 40%, respectively. In other words, « in real life », between 20 and 40 women out of 100 will become pregnant over one year if they rely on this product, depending on whether or not they have previously given birth.

Health risks

The cervical cap involves the following health risks: ectopic pregnancy ; perforation of the uterus ; bladder infection 89 .

CERVICAL SPONGE

Contraceptive efficiency

As shown in the Nuvaring description paper (see note 1), the failure rate of the cervical sponge with « perfect use » (in the context of controlled clinical study) is 9% for women with no previous term pregnancy, and 26% for women having previously given birth, while those with « typical use » (« in real life ») are 20% and 40%, respectively. In other words, « in real life », between 20 and 40 women out of 100 will become pregnant over one year if relying on this product, depending on whether they have previously given birth or not.

Health risks

The cervical sponge involves the following health risks: ectopic pregnancy ; uterine perforation ; bladder infection 90 .


CONTRACEPTION
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