Why women require screening before choosing contraceptives — Gynaecologists

To prevent avoidable complications, reduce the risk of side effects, and ensure the effectiveness and individual suitability of contraceptives, reproductive and maternal health experts have urged women to undergo medical screening before choosing a contraceptive method.

They stressed that proper medical screening and counselling help to ensure that the lifestyle, age, health history and reproductive plans of each individual are well suited to their contraception choice.

In interviews with PUNCH Healthwise, the gynaecologists warned that using a contraceptive without adequate assessment could increase the risk of complications, including blood clots, stroke, heart attack, pelvic infection and uncontrolled high blood pressure, especially in women with underlying medical conditions.

The reproductive experts further stated that contrary to common misconceptions, screening before contraception does not usually involve extensive laboratory investigations; rather, it consists of taking a detailed medical history, checking blood pressure, assessing weight and height, ruling out pregnancy and identifying risk factors that could make certain contraceptive methods unsafe.

The gynaecologists also corrected the notion that hormonal contraceptives cause permanent infertility or that all contraceptives are safe for every woman, insisting that most methods are effective, reversible and safe when prescribed appropriately.

According to the World Health Organisation, the use of contraceptive methods helps people to plan their families, achieve their desired number of children and to determine the spacing of their pregnancies.

The WHO noted that about 164 million women of reproductive age have an unmet need for contraception due to limited access and choice of methods, fear or experience of side effects, cultural or religious opposition, poor quality of available services and gender-based barriers.

According to the 2023-24 National Demographic and Health Survey, 21 per cent of currently married women and 36 per cent of sexually active unmarried women in Nigeria have an unmet need for family planning.

PUNCH Healthwise earlier reported that despite increased awareness about the different family planning methods, only 17 per cent of Nigerians use contraceptives.

Providing expert insight into the matter, a Professor of Obstetrics and Gynaecology at Usmanu Danfodiyo University, Sokoto, Abubakar Panti, said medical screening helps healthcare providers determine the safest contraceptive method for each woman while minimising avoidable health risks.

The fertility expert explained that although there are several contraceptive options, including barrier methods, hormonal contraceptives, intrauterine devices and permanent methods, not every option is suitable for every woman.

He said, “Medical screening usually helps to ensure that a contraceptive method is safe, effective, and appropriate for an individual’s health and lifestyle.

“This screening allows the healthcare provider to at least do five basic things. The first one is to identify any medical condition that may make starting contraceptives unsafe for that individual, depending on that individual’s health and lifestyle.

Advertisement

“Secondly, to recommend the most suitable method based on that individual’s health and preferences. And that medical screening will also help reduce the risk of side effects and complications to that particular individual based on that individual’s health and lifestyle.

“Also, it helps to be used as a tool to discuss effectiveness, benefits, risks, and the correct use of each of those methods. It also addresses reproductive goals, such as whether pregnancy is desired soon or much later.”

The Honorary Consultant Obstetrician and Gynaecologist at Usmanu Danfodiyo University Teaching Hospital further stated that women with certain medical conditions require special consideration before starting contraception.

Panti explained that women who have a history of hypertension, blood-clotting disorders, or blood clots such as deep vein thrombosis or pulmonary embolism should not be placed on contraceptives containing estrogen.

He said, “Some medical conditions actually increase the risk associated with specific contraceptives, especially those containing estrogen.

“These medical conditions will include patients who have high blood pressure, patients who have a history of blood clots like a deep vein thrombosis or pulmonary embolism. Such patients will avoid estrogen-containing contraceptives.

“Patients who have suffered a stroke or heart disease, patients who have migraine, you know, some people have migraine with aura, patients who have breast cancer, whether current or recent breast cancer, patients with severe liver diseases, and diabetic patients with complications affecting the blood vessels, we call it diabetic angiopathy. Then women who smoke and those above 35 years old will try to avoid estrogen-containing pills.”

The fertility expert explained that such conditions do not mean a woman cannot use contraception at all, but that she may need a safer alternative, “such as a copper IUD, such as a hormonal IUD like Mirena, and implants. This means that they can use a progesterone-containing-only method, or they can actually use a barrier method, depending on their condition.”

The researcher on reproductive health stated that screening usually involves taking a detailed medical history, checking blood pressure, weight, height, body mass index and ruling out pregnancy, stating that additional investigations such as pelvic examination, cervical cancer screening and laboratory tests are requested only when clinically indicated.

“But apart from that, routine blood tests are not required for most women before starting contraceptives. Mostly it’s just talking to them and getting a lot of information from them,” the don added.

Continuing, Panti explained, “Before you start off any patient on any contraceptives, we request a serum pregnancy test to rule out pregnancy before we commence any. Just before you come and tell us that our contraceptive method has failed because you came already pregnant.”

He warned that starting contraception in a woman with unexplained abnormal vaginal bleeding could mask a more serious underlying condition.

Panti also noted that age, medical history, lifestyle and reproductive intentions should guide contraceptive choice.

He explained that women above 35 years who smoke should avoid estrogen-containing contraceptives because of increased cardiovascular risk, while women who may forget to take daily pills may benefit more from long-acting methods.

Panti dismissed the belief that all contraceptives are safe for everyone, saying individual health profiles determine what is safe.

Advertisement

He also dispelled the misconception that hormonal contraceptives cause infertility, explaining that most contraceptive methods are reversible and fertility usually returns after discontinuation, although the time it takes varies depending on the type and duration of the contraceptive used.

The professor of gynaecology asserted, “Medical screening before starting contraception is not meant to create barriers for access. Rather, it helps match each woman with the safest, most effective, and most suitable contraceptive method based on her health, lifestyle and reproductive goals, while minimising the risk of avoidable complications. Many women can begin contraception after a focused medical history and blood pressure measurement, with additional tests performed only when clinically indicated.”

Also speaking, a Professor of Obstetrics and Gynaecology at the University of Uyo, Akwa Ibom State, Aniekan Abasiattai, said there is currently an eligibility criterion used globally to evaluate patients who desire to initiate contraceptive methods, noting that not all methods are suitable for all categories of persons.

He further stated that most of the modern contraceptive agents in use today are effective, safe, devoid of major side effects, and also have several non-contraceptive benefits that women can take advantage of.

Speaking on the need for specific patient eligibility requirements before contraceptive use, Abasiattai explained, “The intrauterine contraceptive device, what we commonly refer to as the IUCD, Copper-T, is the most common IUCD used worldwide. Now, there are certain groups of persons that should not use that contraceptive agent. For example, those who have pelvic infection, and those who have cancers of the female genital tract are not the first choice for that method. Adolescents, those who have a tendency to have abnormal bleeding and blood clotting problems, are not the first choice for that method.”

The Chief Consultant Obstetrician and Gynaecologist at the University of Uyo Teaching Hospital further noted that women who smoke and those above the age of 35 cannot use the oral contraceptive pills because of the increased cardiovascular side effects that could occur in that group of women.

Continuing, he said, “Women who have tendencies to develop blood clots, those with certain types of heart diseases and women who are overweight. If those women are not examined, counselled, and for some reason, they start using these contraceptive agents, obviously, they will develop documented side effects that tend to occur much more frequently in that group of women.”

Abasiattai said the process of contraceptive assessment involves interviewing the patient, examining them physically, taking their medical history and family history, and only requesting tests where indicated.

He also warned that contraceptive failure could result not only from wrong method selection but from improper use due to lack of adequate counselling.

The reproductive health researcher noted that counselling is as important as the screening process because it ensures women understand how to use contraceptives correctly.

Abasiattai expressed concern about the low contraceptive prevalence rate in Nigeria, attributing it to unfounded fears and misconceptions.

He cited beliefs that contraceptive devices could migrate to the brain as an example of the kind of misinformation circulating among Nigerian women.

He said, “The contraceptive prevalence rate in this country is quite low compared to what you see in the developed world. Now, the fears are unfounded, and unfortunately, this has led to the low prevalence. A lot of our women do not use contraceptive agents because of these fears.”

Abasiattai said modern contraceptives offer significant benefits beyond pregnancy prevention that Nigerian women stand to gain from.

The gynaecologist asserted, “The current contraceptive methods are extremely effective. Some of them have so many non-contraceptive benefits, including prevention of some cancers, reducing the growth of uterine fibroids, reducing the risk of ectopic pregnancies, reducing abnormal uterine bleeding and several other health benefits.”

Advertisement

Copyright PUNCH

All rights reserved. This material, and other digital content on this website, may not be reproduced, published, broadcast, rewritten or redistributed in whole or in part without prior express written permission from PUNCH.

Contact: [email protected]