Contraception Article by Doctor Rosemary Prudhoe Club de Mar Medical Centre Palma de Mallorca

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"DOCTOR AT SEA" a monthly Column in The Islander Magazine

Don't just cross your fingers and your legs and hope for the best!

With young men and women making up a sizeable proportion of both crew and guests in the yachting industry, it is in everyone's interest to keep up to date with what is new in contraception.

Even with the luxury facilities available on most modern yachts, what my grandmother called "the curse" still features highly in many women's minds, ie how to avoid heavy or particularly unpredictable "periods" when you don't want them.

With the advent of jacuzzis, saunas and even swimming pools on some superyachts, many women would prefer frankly not to have any bleeding at all if given the choice! There is in fact now a huge choice of contraceptive devices, pills, rings, implants, injections and patches which can confuse even the most well-informed.

Everyone's needs and wishes are different. For some, the security and familiarity of having a regular monthly bleed is important, whereas others would just prefer to forget about their contraceptive and get on with the holiday.

In an ideal world most couples would want an absolutely reliable method of contraception with no side effects, preferably no bleeding…and oh…. protection from sexually transmitted diseases thrown in! Unfortunately, no one product fits the bill.

Everyone has heard of "the Pill", (which contains two hormones, oestrogen and progesterone) but how many have heard about bi-cycling and tri-cycling "the Pill" to avoid bleeding. Does everyone know what is meant by "the mini-pill" (progesterone only). There are many brands of both types on the Spanish market, and they may not be the same as those available in your country of origin. It is important to look at the medical ingredients if you run short and get the advice of pharmacist or doctor as to which will most closely replace your own brand. It is obviously important not to risk an unwanted pregnancy when changing from one to another and if in doubt run the new packet directly into the old one without any gap (and miss any placebo (sugar) pills).

LARCs or Long Acting Reversible Contraceptives are very effective methods which give the user protection from unwanted pregnancy for three months to ten years. They include injections (which last for three months), small implants the size if a hairgrip (which last for three years), and various sorts of intrauterine device (which can last from 5 to 10 years) – one sort of device delivers a low dose of progesterone inside the womb which usually reduces bleeding. All these methods need to be administered initially by a trained health professional, but once "on board" one can forget about them.

Emergency contraception is now available as one pill which can be taken up to 72 hours after unprotected sex and an intrauterine device can also be used for the same purpose up to five days after the "mistake". Of course there are the barrier methods as well, condoms for men and women, and various caps and diaphragms for women. Condoms have the advantage of providing some protection against sexually transmitted disease and they are essential for those with new or multiple partners. Condoms however do split sometimes and should not usually be relied on as the only method to prevent pregnancy.

The "Double Dutch" method of using both a condom and another means of contraception has been around for years and is still a good idea for anyone where an unintended pregnancy would be a disaster for the couple.

Unfortunately, all types of contraception have some unwanted effects…condoms may reduce spontaneity, methods which deliver only progesterone all give an irregular bleeding pattern at the beginning although some settle down later. Women with migraine, high blood pressure, or who are very overweight need special counselling and smokers over thirty five should not take the combined "Pill"

Try not to rule out any method just because a friend has "had problems" or just because you don't fancy the idea of having something inserted into your arm or into your womb.

These devices are very small and the insertion is usually a simple procedure. Sometimes if you discuss things with the doctor or nurse, you may change your mind.

There is no excuse nowadays for ignorance and I found it hard to believe the young stewardess who came to see me who was still "crossing fingers" and "being careful" even though she desperately wanted to avoid a pregnancy.

So…how do you choose? The best idea is to know what is available and to discuss all the options with your own doctor or nurse and have tried the method before you set off for the season or for your holiday. Take plenty of supplies to last while you are away from shore, and hopefully your holiday will be a blessing rather than a "curse".

Dr Rosemary Prudhoe, Club de Mar, is an MCA Approved Tutor and a Diplomate of the UK Faculty of Sexual and Reproductive Healthcare and holds Certificates of Competence in Subdermal and Intrauterine techniques

Dr Rosemary Prudhoe, can be contacted at Club de Mar Medical Centre, Palma de Mallorca. Tel: (+ 34) 6i9 982 142.