Dear B

Many thanks for your question. 

You need to be on the pill for a minimum of three weeks in order to provide sufficient contraceptive protection when preventing an unplanned pregnancy. 

Always use an affective barrier method like condoms in a situation like this so as to prevent this from happening, and then you will save yourself a lot of unnecessary heartache!  

The morning after pill is graded as EMERGENCY CONTRACEPTION and must be taken sooner than later, and definitely before 72 hours, post intercourse.

It is crucial that an emergency contraceptive pill is not taken more than twice in a lifetime please.  This pill is not a smartie and when taken too often, it can introduce and cause cancer. 

Kind regards
Angela

Dear E

Many thanks for your question.  For the information given, it could be one of two things.  Sometimes when there is stress or additional stress, a woman will have a second period in a month  -  e.g.  it could be a loved one who is sick, writing or preparing for exams, moving home, and so on. 

The second reason, would be that your body is saying that it now needs a break or rest from your contraceptive.  It is advisable to have a rest from the pill at least every two years for 1 - 2 months so as to detoxify from the different chemicals in Triphasil, as all pharmaceutical contraceptives are 100% synthetic. 

You are welcome to make an appointment to see me, so that you can be fully assessed and advised in more detail.

Kind regards

Angela

Dear E

Many thanks for your question.  It definitely seems that Oralcon does not suit you, as it has greatly contributed to a fluid imbalance, hence you feeling bloated and as if you are pregnant.  I suggest that you discontinue Oralcon with immediate effect.

I would like to resolve your fluid imbalance first before you commence a new and different contraceptive, should you visit your doctor.  I recommend the following :

NAT MUR TISSUE SALTS NO. 9, as x1 celloid (tablet), every 2 hours for the first day.  Please use the Allison Effting range of tissue salts as this is dose C30 (triple strength for homeopathy).  Take your celloid sublingually (under the tongue).  Thereafter, take x1 celloid 10 - 15 minutes before meals, 4 times a day.  Nat Mur is pure sodium chloride in tissue salt form and will centre down your hatha line (the main miridian line of the body) and pull all your different body fluids into the correct ratio quantities for you as an individual.  For the first day do make sure that you are not too far from a bathroom!  

You might want to consider the 'pearly' which is a feminine handbag-friendly contraceptive computer which has been clinically trialed in Germany for over 25 years.  It is safe, natural, simple, fast, without side effects, and reliable.  The website is info@ecobabe.co.za and the telephone number is 0790960977.  The e-mail address is www.ecobabe.co.za You can ask to speak to Meg or Peter, who will help you.

Do remember to make use of an effective barrier method like condoms, while you decide which contraceptive approach to use. 

I wish you health and happiness!

Warm regards

Angela 

Dear R

Many thanks for your question.

It is really important that you do take your pill every single day, at the same time.  One hour either way, i.e. like one hour before your normal time of taking it, or one hour after your normal time of taking your pill as a once off occasion would be acceptable  -   but not on a regular basis.  Your spotting and light bleeding has predominantly occurred due to an upset of your hormonal cycle with the erratic taking of your pill. 

It is preferable when commencing a new pill pack, to start on the first day of a menstrual bleed.  This really assists the hormonal cycle to get off to a good start, correctly, from the very beginning.

For peace of mind, I recommend that you do a pregnancy test.  You are welcome to chat to me again about any results you may be concerned with.

Kind regards

Angela     

Dear T

Many thanks for your question. 

You are quite correct in taking your oral contraceptive in the evening  -  it is always preferable to take an oral contraceptive in the evening because of the formulation of a contraceptive tablet.  Taking your pill ten minutes earlier is fine, and yes you can still take your pill the following evening at your usual 8 p.m. time.  This will not cause any problems health-wise, and will not result in an unplanned pregnancy.  Your pill should be taken within an hour of the usual scheduled time.  So, should you have taken it at 7 p.m. or even 9 p.m. as a once off situation, this would also have been acceptable.

Warmest regards

Angela

Dear N

Thank you for your follow-on question. 

It is normal to start a period after stopping the pill, as this is already an indication for you that your body is starting to detoxify etc.  It is difficult to say how long it would last, although a maximum length for a period should be no more than 7 days.  Do consider taking the supplements I suggested according to the prescription I have given you.  Your physical medical state can also determine how long you menstruate for, but in your instance I am not currently concerned that there is a problem. 

Kind regards

Angela

Dear K

Many thanks for your e-mail.  I suggest that you please give me a call on 021-4875435 between the hours of 09h00 - 16h00, as I have a few suggestions to discuss with you, apart from my reply below.

Your daughter should not be bleeding for 2 months at all.  Nur-Isterate definitely does not suit her, and should not be administered again.  With her being 17 years, and for the purpose of regulating her menstruation I suggest the following:

AGNUS CASTUSBERRY PLUS by Metagenics , as x1 capsule in the morning after breakfast, and then x1 capsule again after supper.  This nutritional product will support menstrual regularity and relieve menstrual symptoms, and also assist with coming off Nur-Isterate.  This product contains Ashwagandha which is a 2000 year old Indian remedy, and has been included for settling the emotional upsets from detoxifying from a contraceptive, and for settling hormones within the body.  Let her take this for 1 - 2 months, until her menstruation has settled.

EVENING PRIMROSE OIL CAPSULES by Vital, as x1 capsule after supper, or even an hour later.  Evening Primrose oil does take a month to kick in, but will assist in maintaining her menstrual cycle and regularity etc. long after her menstruation has returned.   

Both of the above two mentioned products can be commenced together, and then to safely continue with Evening Primrose oil.  Should she have been prone to painful periods before, you could substitute Evening Primrose oil with x1 Starflower oil capsule daily, instead  -  which is more concentrated.

All the best of luck  -  do as I suggest and your daughter should be fine. 

Warm regards

Angela

Dear T

Many thanks for your question.

I am most concerned that your friend went to the family planning clinic and was given a contraceptive which was meant for you, but for which the clinic sister did not even see you for!  Please rather make an appointment to see me if you can, or rather change your clinic sister!  

There are a number of questions the family planning sister needs to ask you prior to prescribing a contraceptive pill.  I do not want you to become a mismanaged case due to unnacceptable negligence!  Perhaps your friend went to the family planning clinic for herself under the provisio that it was for you, but told the sister that the checkup was for her instead.  No trained professional would give a contraceptive without seeing the person it is for.  You need to also, and importantly, have a blood pressure and weight check with your family planning visit.  And this happens with each family planning visit every time.      

I suggest that you do have a proper clinic visit yourself, or see me please.  I can then assess you physiologically as to which contraceptive would suit you best  -  it would be better to do this before commencing Oralcon.  You are one of many young women who feel conscious about first time contraception, so please do not feel alone.  Your health is my priority and I only want what's best for you.

With warm regards

Angela 

Dear S

Many thanks for your question.

The contraceptive pill usually takes 1-2 months to be detoxified from the different systems of the body.  It is always advisable to give your body a rest or break from the pill after a year, or at most after 2 - 3 years.  I take it that this has not been done, so I suggest that you allow for a minimum of at least 6 months to one year, so as to allow for proper and full detoxification.  This will help with the release of the different chemical components in the pill from the body. 

I don't think there is cause for concern, should you be generally healthy.  Patience is definitely a virtue when planning a baby!  You are welcome to read the many questions already answered on this website about assisting with fertility suplementation. 

I wish you all the best of luck with your baby plans!

Warm regards

Angela

Dear C

Many thanks for your question.  Oralcon is one of the recently sourced and cheaper generics from Malaysia and Hong Kong.  Oralcon is supplied by the government and municipal clinics as a cost effective alternative pill.  As I have not seen the clinical trials for this pill, I am reluctant to recommend it  -  however, I do manage many reported side effects from this particular pill! 

I would prefer for you to visit our Natural Medicine Dispensary at either our Kloof store in Cape Town, or Cavendish in Claremont, and let us have a look at you and recommend from there.  A good cleansing routine for the face morning and evening will assist greatly with controlling skin problems.  In fact there is a lot we can assist you with.  Do eat correctly, and you can be given an eating plan as well. 

I suggest you consider taking EVENING PRIMROSE OIL CAPSULES by Vital, as x1 capsule at night, so as to assist with hormonal fluctuations. 

You are also welcome to see me for an appointment, and I can treat you in total. 

Warm regards

Angela

Dear W

Many thanks for your question.

Most definitely the chemical components of your Depo-Provera contraceptive injection will still be in all the systems of the body.  After prolonged usage of this injection there will be a collection of chemicals from the contraceptive in the linings of all the soft organs of the body.  I suggest that you allow for up to a year to allow for full detoxification, with you having been on Depo-Provera for 6 years.  It will eventually be released from the body. 

Warm regards

Angela

Dear A

Many thanks for your question.  Taking Flax seed and Vitamin A will not lower the effectiveness of Petogen, or any other contraceptive for that matter.  These two products will work parallel with these nutritional topups.

Alcohol when consumed in a large quantity could challenge the efficasy of a contraceptive due to the fact that the body will be thrown out of balance.  Alcohol taken in, in a small to moderate quantity should not impair the effectiveness of Petogen at all.  A contraceptive tablet should not be taken at the same time as alcohol. 

Pharmateutical antibiotics and cough mixtures on the other hand, are a different story all together  -  and yes will definitely affect the effectiveness of all contraceptives, and even more so if the contraceptive has not been taken for more than a few months.  All pharmaceutical cough mixtures contain some alcohol, and certain hoemeopathic cough mixtures contain a very small quantity of alcohol, merely as a preservative  -  as likewise do tinctures. 

I have double checked the above information with our Natural Medicine and Homeopathic Dispensary, and they have confirmed the same.

With warm regards

Angela

Dear Z

Many thanks for your question.

As you have used Nur-Isterate for longer than the 2 year recommended time span, you will take a minimum of 6 months to detoxify.  However, I suggest that you allow for up to a year to detoxify from this contraceptive. 

Should you have a slow metabolic rate, it may take you a little long than a year to fall pregnant.

I wish you all the very best with your baby making plans.

Warm regards

Angela 

Dear M

I am very glad that you have asked this question!  

There are a number of age-old natural contraceptive methods which have been practised for centuries. 

I suggest that you check the website for the 'pearly', which is a feminine, small hand-held, handhandbag-friendly contraceptive computer, which is ideal for active women on the go.  This small computer recording device will take your body temperature morning and evening, and record it up to 2500 times, and then you can start again with a fresh set of recordings.  It is the safest contraceptive approach I have seen for a long time!  The website is www.ecobabe.co.za

The pearly has been clinically trialed in Germany for over 25 years.  You can also contact Meg or Peter at info@ecobabe.co.za  The contact telephone number is 0790960977.

This device will help you to take control of your hormonal cycle without all the side effects of pharmaceutical contraceptives, by simply taking your temperature morning and evening with this recording device.

There are many women who have health problems due to contraceptives, so I have sourced this little computer so as to empower you to take charge of your health without all the nasty side effects of pharmaceutical contraceptives.

All the very best of luck!

Warmest regards

Angela 

Dear M

Many thanks for your question.

I most definitely do recommend that you consider discontinuing these contraceptive injections, and  for at least six months.  Please remember to always use an effective barrier method like condoms, so as to avoid an unplanned pregnancy.

Unfortunately Nur-Isterate is listed to cause weight gain or massive weight gain.  Suggesting that Nur-Isterate will assist you in losing weight is completely incorrect!  The best thing would be to allow your body to detoxify from this contraceptive, and the 'build up' from the Petogen prior to having Nur-Isterate administered.  These injectable contraceptives are pharmaceutical and are 100% synthetic.  Over a period of time they accumulate in the membrane linings of all the systems of the body, thereby contributing to weight gain, and especially when used for more than two years. 

Your age bracket of 41 - 45 years indicates that you might be either perimenopausal or menopausal, so this may be a time in your life when you might be prone to weight gain anyway.  I can assist you with all future queries, but please always refer back to your previous question and the reply ( I answer at least 70 - 80 questions for the website alone, every 6 - 7 days). 

You should be able to win with this problem, but it may take a bit of time, so patience needs to be called upon!

You may also experience a hormonal flux when discontinuing your contraceptive.  

I wish you well, and should you wish for advice about losing body mass, you are welcome to contact me further.

Warm regards

Angela

Dear D

Thank you for your question.

There is a remote possibility that there could be a pregnancy, however this would all depend on how long you were taking the Nur-Isterate contraceptive injection for.  As there is too little history to go on here, I suggest that for peace of mind you have a pregnancy test done please. 

Should you decide to use a home pregnancy kit, only do this in the morning, and preferably before 10 a.m. as the HCG hormone, which is what is checked for in determining a pregnancy, is only raised in the morning. 

Kind regards

Angela

Dear EH

Many thanks for your question.

It is crucial that you take your pill on time, every 24 hours.  Your hormonal cycle will be affected by the emergency contraceptive pill, and yes you may find that you won't have your period on time or for awhile.  And yes, it is preferable to to recommence your pill on the first day of your menstrual bleed, as this will assist in regulating your hormonal cycle correctly from the beginning.  In the interim, I recommend that you do use condoms as a good barrier method.

Kind regards

Angela   

Dear T

Many thanks for your question and appreciation. 

Contraception can be a bit of a 'hit and miss' process, as each woman is a unique individual and needs to feel for herself as to which one she responds to best. 

Trigestrel is a cheap generic sourced by our South African government from Malaysia and Hong Kong.  To date I have not seen clinical trials for Trigestrel, so I prefer to recommend Triphasil which is what was originally dispensed in the government and municipal clinics, prior to the cheaper generics being sourced. 

Your symptoms may persist while on Trigestrel, but would improve should you change to Triphasil.  However, I am trained to look at the individual, assess and determine which contraceptive would suit you according to your physiological makeup.  If you can, I would prefer for you to come in and see me (with an appointment please!) and let me assess you fully.  My primary concern is your health, and the response you would give to the relevant contraceptive recommended.  Of course the contraceptive function is important, but you still need to be well while on it!  And don't worry, 90% of the questions subitted are all to do with reproductive health! 

With warm regards

Angela

Dear P

Many thanks for your question.

Your implant may still have some affect in preventing pregnancy.  I do however recommend that you have it removed, and as this is a surgical procedure, you need to contact your gynaecologist, or alternatively a plastic surgeon or general surgeon.  

I wish you well and good luck with the baby making plans!

Warm regards

Angela

Dear Rose

Many thanks for your question.  The Petogen contraceptive intramuscular injection is of schedule 4 status.  It is administered every 12 weeks in the buttock area.  Petogen is the generic for Depo-Provera, and is the identical replacement.  It is a slow release contraceptive in a milky solution and was originally formulated for the older woman of 28 years and more.

One of the side effects listed is that there can be amennorrhoea (temporary inhibition of menses); or menstruation can disappear altogether while on Petogen.  It does depend on each individual woman, as each one is unique.  So therefore, some women do have menses but it is invariably light, or not at all.  I hope this answers your question.

Warm regards

Angela

Dear A

Many thanks for your question.

I suggest that you give yourself a little longer in waiting for your menses to return.  It is not unusual for a period to take longer than a month to return, so yes it is normal.  Should you be concerned about an unplanned pregnancy, for peace of mind I suggest that you have a pregnancy test done.

Warm regards

Angela

Dear Emma

Many thanks for your question.

Unfortunately I do need to assess you in more detail, as the information given is not sufficient to determine a cause. 

You should not be bleeding every day, even though it is quite light.  You are welcome to make an appointment to see me, or alternatively your general practitioner.  

Kind regards

Angela

Dear R

Many thanks for your question.

Please confirm whether you are in perimenopause or have polycystic ovaries.  Both conditions are different.  Your doctor should have done this for you at the time.

Has your doctor done tests for the thyroid?  This is where I would start with you first due to your clinical profile given.  Also with you having had a tubal ligation 8 years ago, and being in the age category of 41 - 45 years, this alone would begin to indicate a hormonal change. 

You are welcome to make an appointment to see me at the Kloof Clinic in Cape Town.  It is important to be seen and assessed and examined if necessary, as I suspect a hormone imbalance.  There are nine different hormones which need to be considered, when treating a patient for an imbalance like this. 

I do hope that you can make a time to see me, and if possible bring your test results with you.  I do liase with pathology services on a daily basis, so at least know which pathology company your test results came from when you see me.

Kind regards

Angela 

Dear Tums

Many thanks for your question.  It is quite normal for you to go through a hormonal flux when discontinuing the contraceptive pill.  Bear in mind that you have been on it for two years, so detoxification should take a minimum of 2 - 3 months.  However, this can vary from one person to the next. 

You could consider taking CHASTEBERRY PLUS by Metagenics, as x1 capsule twice a day, after breakfast and supper.  This product will assist in regulating your menstrual cycle, and also assist in correcting a hormonal imbalance.  Do this for at least a month.

To determine further answers to your questions I request that you make an appointment to see me, so as to do a proper assessment, and examination if necessary, of you in person. 

You do need to allow for up to a six month time span so as to fully detoxify from the two years of using Oralcon.  Were you on a contraceptive previously before having Oralcon prescribed?  This also needs to be taken into account as well when detoxifying.

I also suggest that you consider have a gynaecological checkup with your medical specialist on an annual basis, so as to determine your ovulation health.

Kind regards

Angela

Dear T

Many thanks for your question.  Unfortunately the government clinics are providing Trigestrel in place of Triphasil, which is a cheaper generic alternative sourced from Malaysia and Hong Kong.

You are welcome to contact me for an appointment for the contraceptive service.  I am able to write the prescription for Triphasil, as Wellness Warehouse sources Triphasil from a private supplier.  Contact me on telephone number 021-4875435, or 4875420 between the hours of 09h00 - 16h00, Monday to Friday, at our Kloof Well Clinic.  

I wish you well.

Warm regards

Angela 

Dear Vasti

Many thanks for your question.  I apologise for the delay as some of us have been on sabatical.

I certainly recommend that you discontinue with Oralcon due to the skin sensitivity.  This contraceptive does not suit you!

It would be best if you could make an appointment to see me so that I can physiologically assess you to see which contraceptive would suit you.

Kind regards

Angela

Dear N

Many thanks for your question.  The 2 month injection is called Nur-Isterate and is given every 8 weeks.  It is better to work with a 'week' quota than a 'month', as weeks vary from month to month.  So then, better accuracy is maintained for contraception and monitoring of your hormonal cycle. 

Changing from one contraception to another will illicit a hormonal change, and this can vary from one woman to the next.  Do be sure of why you want to change your contraceptive, so that there is as little upset as possible, and that it is really necessary for you to change. 

Yes, you might well have a period when changing over, due to the different formulations of Nur-Isterate and Depo Provera ( the generic alternative is Petogen), but this should only be temporary.  

If you were on Nur-Isterate for longer than one year, you will have a measure of this contraception in your systems, so a pregnancy is less likely.  However, I always recommend the use of an affective barrier method like condoms for up to six weeks from the time of change over.  You should have enough contraceptive in your systems to protect you from pregnancy after two weeks of the new contraceptive, but it is better to avoid an unplanned pregnancy where possible.  

Do take care now, and all the best of luck!

Warm regards

Angela  

Dear M

Many thanks for your question, and no your question is definitely not dumb, as each woman is unique and different, and not all women respond to a contraceptive the same way.  Treating and counselling from a website is very different to seeing a client in person, so the detail you have given is much appreciated.

You are well tuned into your body, and your sense of awareness is correct.  The 21 yellow pills in Nordette are the active pills.  The 7 red pills are the inactive pills in the pack.  From your clinical profile your hormonal cycle is well regulated and suitable for using Nordette.  The fact that your menses commences on the third red (inactive) pill means that your required response for hormonal regulation is good.  

Ovulation calenders can be a little confusing  -  count the first day of your menstruation as day 1.  Your particular hormonal cycle is a 28 day cycle.  So day 14 would be your ovulation date, or day of ovulation.  This is your most riskiest day for intercourse.  However, should you be very concerned about having an unplanned pregnancy before you are ready to start your family, take extra precautionary measures for 3 days before your ovulation date and for 3 days after the day of ovulation.  As you have been on Nordette for 8 years you will however be protected.  

I hope my reply has helped to answer your question. 

Warmest regards

Angela

Dear N

Many thanks for your question.  I fully understand your concern. 

As you were only on Nur-Isterate for ten months, and the last injection was given in September 2010, your body has had enough time now to detoxify from this particular contraceptive.

Of course, you do need to eat correctly, drink sufficient water, have sufficient exercise and destress effectively for a pregnancy to occur.  You sound as if you are a healthy individual, and with your age bracket I see no reason for you not falling pregnant. 

However, as I have not seen you in person, it would be a good idea if you could book an appointment with me to do our Wellness Assessment.  This is a non-invasive medical checkup to evaluate your blood pressure, weight, height, girth measurement, body mass index, haemogobin (to check for anaemia), and glucose and total cholesterol screenings.

You can contact me on telephone number 021-4875435, between the hours of 09h00 - 16h00, Monday to Friday at the Kloof Clinic in Cape Town.

Good luck with your forthcoming nuptials and have a wonderful wedding day in December!

Warmest regards

Angela 

Dear L

Many thanks for your question, and I am just in time to answer your query!

You have worked all your dates out correctly, so the 27th May 2011 is correct.

Always think in terms of 'weeks', rather than 'months', as months vary from month to month.

Petogen can cause you to not have your period for longer than a few days, or not at all.  Your abdominal/period pains are how you as an individual are when reacting to your hormonal cycle.  The pains are normal, although not pleasant.  You can overcome this by taking EVENING PRIMROSE OIL by Vital, as x1 capsule every evening about one hour or more after supper.  This will help to aleviate the unpleasant side effects of menstruation, assist you in feeling more on an even keel, and will help you to pleasantly experience your menstrual cycle.  You do need to take this product for at least a month before you experience the full benefit of it.  Just continue with it, as it is completely safe, non-addictive and fully beneficial for this purpose.

With warmes regards

Angela

Dear N

Many thanks for your question.  I fully understand your concern, and thank you for the little detail given. 

The pattern that has occurred with you thus far is normal.  Should you have undue pain, excessive bleeding, mood swings  -  to name a few side effects, then my answer would be different. 

You may or may not have your next period in June  -  there are other factors which can also decide this, like your general health and well being, nutritional status and stress levels.

I suggest that you give yourself until your next Petogen injection in June, and then reassess the situation once again.  In all probability, your hormonal system should have settled down by then.

You are welcome to contact me again, should you still have a problem.

Warm regards

Angela    

Dear L

Many thanks for your question. 

Should you be healthy overall, the best approach would be for you to let your body adjust of its own accord.  This would mean detoxifying for a minimum of six months by just coming off Nur-Isterate.  It is preferable to treat yourself naturally with a supplement like CHASTEBERRY by Metagenics, as x1 capsule, twice a day after food, should you wish to trigger your menstrual cycle back to regularity.  Taking a quality effective multivitamin is essential as well, like VITA LIFE by Amipro, as x2 capsules, 2 - 3 times a day after food, as this product will assist in restoring the depletion of mineral salts and nutrients, caused by using Nur-Isterate as a pharmaceutical contraceptive, which is 100% synthetic.  

The Nur-Isterate contraceptive injection is formulated not to be used for longer than two years at a time.  After two years, the chemical components settle into the membrane linings of the soft organs of the body, and depending on an individual, this is what can can prolong detoxification.  Three years is not too drastic, and I suggest that you take the above approach first.  I have to say that patience is a necessary quality, when planning to have a baby.  Chasteberry may work within a month, or a little longer, as Nur-Isterate does cause the menstrual cycle not to release an ovum and therefore there is no period.  

Once your menstrual cycle has returned, please e-mail me again and then we can look at recommendations for supplements for you in preparation for pregnancy etc.  Please refer back to this original e-mail at the time.

Kind regards

Angela

Dear N

Many thanks for your question.

There is always a possibility of having an unplanned pregnancy when not taking a contraceptive.  It is essential to use a good effective barrier method like condoms when stopping a contraceptive, or changing over to a different contraceptive.

As you have been off Petogen for eight months now, the possibility is there for an unplanned pregnancy happening if you do not take precautionary measures. 

Please take care and look after yourself.

Kind regards

Angela

Dear A

Many thanks for your question.

Unfortunately you have not said which contraceptive pill you are using  -  this is really important in order for me to give you a correct answer.  However, you have approached your problem well by doing what you have done.  From hereon, continue with your pack and please do not forget to take your pill, in the applicable section, and follow your pack through to the end. 

Should you still be concerned about the possibility of an unplanned pregnancy, then I do suggest that for peace of mind, you do a pregnancy test.

Many thanks once again for your question.

Kind regards

Angela 

Dear K

Thank you for your questions.

It is crucial to commence with Triphasil on the FIRST DAY of your menstrual bleed, and then this is counted as day one of your menstrual cycle.  Should you have a 28 day cycle, then day 14 would be your day of ovulation  -  this all happens when you are healthy and well and your body is in balance.  Some women do have a 30 or 31 day cycle,  and this is again an indication of how each woman is unique within herself. 

Please don't get yourself tied up in knots!  It is a lot simpler than it seems, and you will become accustomed to working out your cycle.  I do however suggest that you keep a daily diary of your menstrual cycle. 

Should you wish to AVOID your ovulation date when considering intercourse, then day 14, as explained above is the day to do this.  However, the first 3 days before day 14, and the 3 days after day 14, also have a measure of risk, but not as much as day 14, when considering a 28 day cycle.  Day 14 is noted due to it being a crucial day for ovulation.  The next day after day 14, is referred to as day 15 and so on.  Does this answer your question?  It is not referred to as 14 days, and then another 14 days  -  it is a 28 day cycle for most healthy women.

You are welcome to 'phone me (have your diary handy) and I will 'talk' you through your daily cycle.  I wish you all the best.

Warm regards

Angela

Dear M

Many thanks for your questions, and for giving the detail you have.

You switched over from Yasmin to Nordette correctly, according to which pills to take.  However, it is strongly recommeded that you are always to commence Nordette (just like Jasmine!) on the FIRST DAY of your menstrual bleed.  Should you have done this, then you did change over correctly.  Your clinic sister should also have advised you to use condoms for at least 2 - 3 weeks when changing your contraceptive pill, so as to avoid an unplanned pregnancy.   

It is really important that you fully understand how to take, and or to change over to your new contraceptive pill, before you leave the clinic.  It is the family planning sister's responsibility to explain how to do this and to ensure that you do understand, as this can save you unnecessary hearache and frustration.  

For peace of mind, it may help you to consider having a pregnancy test done.  Depending on your ovulation date; the length of your hormonal cycle; and changing over to a new contraceptive pill  -  my answer is yes, there could be a chance for a pregnancy.

Your approach to continue taking Nordette from hereon is correct.  You seem to have read your packet inserts correctly for Yasmine and Nordette  -  I am impressed,as not everyone does! 

Should you still be uncertain, you are more than welcome to give me a ring on 021-4875435, between the hours of 09h00 - 16h00, Monday to Friday (excluding public holidays).  My goal for you is that your problem be resolved, and that you will feel confident to cope with taking Nordette correctly.

Many thanks again for your queries.

Warmest regards

Angela

Dear K

Many thanks for your question.  Please can you indicate which contraceptive pill you are referring to.  I suspect that you are referring to the Triphasil contraceptive pill,  but request that you confirm this please as there are other types of pills that also have red pills in their packs.  

Many thanks again for your question.  I hope to hear from you soon, and please copy this original query with your reply.

Kind regards

Angela 

Dear A

The correct approach to commencing a contraceptive pill is to start on the FIRST DAY of your menstrual bleed.  You must start with the correct pill for the relevant day.  Should you not have done this, then you need to recommence taking the pill correctly, applying the above approach.  Starting the first pill on the first day of your menstrual bleed will assist in regulating your hormonal cycle, and from thereon a regular menstrual cycle should occur.

There are other factors which could contribute to you not having menstruated already, should you have commenced taking your pill correctly.  For example, iron deficiency anaemia, being overly stressed, incorrect eating habits, and certain medical conditions like recovering from a bad dose of influenza  -  to name a few examples. 

I suggest that you make an appointment to see the nursing sister who dispensed the Triphasil pack to you, and ask her to explain it to you again, so that this can assist you in eliminating any doubt as to how to take your pill correctly.  She is there to help you, and will be aware that you are adjusting to taking the Trigestrel pill.

I hope that my reply assists you.  Alternatively, you are welcome to make an appointment to see me, and then bring your Trigestrel pack with you.

Warm regards

Angela 

Dear A

Thank you for your question.  I apologise for the delay due to illness.  

Primolut N is a schedule 4 pharmaceutical drug and has to be prescribed by a medical doctor.  It is prescribed for certain specific medical conditions like endometriosis and dysfunctional uterine bleeding.  To take medication like this, you should have consulted your doctor please, as I have no record of your previous history.  It is not what I would have recommended for you, due to the possible side effects, and also a complete medical history should be taken and a physical and gynaecological examination should be performed prior to the initiation or reinstitution of the use of Primolut N.  Apart from me not recommending it, and you fly tomorrow, it would be too late for you to commence medication like this now.  I suggest that you speak to your doctor directly about Primolut N, should you still wish to use it. 

You have not mentioned if you are not definitely on a contraceptive pill already.  However, the usual and best approach would be to avoid taking the placebo pills in a contraceptive pack, so as not to have a period.  Any contraceptive pill should be commenced on the first day of bleeding of menses, in order for the hormonal cycle to be regulated from the beginning.  

Please liase directly with your medical doctor about your situation as it is now.  As the situation currently stands, you might still have a period for April, and then avoid it for May, all depending on when your last period was.

Thank you once again for your question.

Kind regards

Angela

Dear C

Many thanks for your question. 

It is vital that the packet insert for the relevant contraceptive pill is read carefully before commencing the contraceptive.  You should have started in the red section with the relevant pill labelled 'Monday'.  

What you should do now, is to wait until the following menstrual cycle, and recommence taking the relevant pill in the RED section for the correct day as of the FIRST day of bleeding of your menstrual cycle.  In the interim, it is vital that you make use of condoms as an affective barrier method so as to avoid an unplanned pregnancy. 

Starting your contraceptive pill correctly will assist you greatly in regulating your hormonal cycle.  Restarting etc. can be very frustrating and annoying, however this is the correct approach for your hormonal health.

Warm regards

Angela

Dear T

Many thanks for your question.  I apologise for the delay, as I have not been available due to illness. 

I would say that you are adjusting hormonally to the Trigestrel contraceptive.  Should you not be experiencing unpleasant side effects from Trigestrel, and feel fine apart from not starting your menstruation yet, I then suggest that you carry on with Trigestrel for a while longer, as in a month, so as to allow your body to adapt further.  Unless you were iron deficient or overly stressed, then yes this could also delay menstruation. 

Otherwise you are welcome to make an appointment to see me for a one on one consultation so that I can fully assess you further.

Kind regards

Angela 

Dear S

Many thanks for your queries.  I fully understand your predicament.

To be honest with you, it would be best for you to make an appointment with me so that I can fully assess you as to which oral contraceptive would suit your physiological profile. 

Oralcon is a cheaper generic sourced from Malaysia and Hong Kong and has a number of potential side effects  -  our Well Clinic service does not stock this contraceptive.  

Sometimes it is necessary to try a couple of contraceptives in order to find out which one suits you best.  You could commence Oralcon and take it for a month, and see how you go. 

Please try and see me if you can, otherwise you are welcome to e-mail me again, or telephone me on 021-4875435, Monday to Friday between 09h00  -  16h00.

Warm regards

Angela

Dear Vanessa

Many thanks for your e-mail.  Unfortunately your e-mail must have been missed when I was ill earlier in the year.  I do sincerely apologise for the inconvenience.

At the time I would have suggested that you not alter the pill dosage for the different days, and to menstruate normally, as my primary concern would have been to avoid potential blood clots from forming, which could have happened with altering the days and your pattern for taking the pill.  Hopefully you were fine and your surgery went well.

Once again, I apologise for the delay.

Kind regards

Angela

Dear J

Many thanks for your query.  Triphasil obviously suited you well.  Trigestrel is the generic alternative to Triphasil as provided currently by the government and municipal clinics.  Trigestrel has been sourced as a cheaper alternative from Malaysia and Hong Kong, by our government for the government and municipal clinics.  

I suggest that you return to the family planning sister and explain to her how you feel, and ask for an alternative form of contraception. 

You are welcome to contact me for an appointment, and then I can advise you further once I have done a physiological assessment to see what other contraceptives would suit you.

Warm regards

Angela

Dear I

Thank you for your question. Unfortunately there are no definite answers when it comes to the game of contraception. Even if you had followed the instructions to the T you still have a risk of falling pregnant. 

My advice would be to use condoms until the onset of your next period and if necessary have a pregnancy test done two to three weeks after the unprotected intercourse occurred,

Many thanks and warm regards

Yesheen

Dear J

Thank you for your question. Ideally the dentist should have advised your girlfriend to continue with the condoms until the onset of her next period. But in my experience the chances of falling pregnant during this period is quite slim. 

To be safe I would recommend continuing with the condoms and waiting for her next period to pass before considering alternative forms of birth control.

Many thanks and warm regards

Yesheen

Dear B

Thank you for your question. I understand your concern. It can be quite disconcerting when you do not understand what is going on with your body. All I can add is that if you understand how synthetic hormones affect your body you will see it is not unusual for you to experience the symptoms you currently are. Synthetic hormones attempt to overwhelm your natural cycle, dictating when and how long your menstruation should be. This is achieved by giving you enough synthetic hormones to silence the effect of your own hormonal cycle and the body starts listening to the synthetic hormones instead. But your body also needs the monthly menstruation as a tool to release, cleanse and ovulate. When you attempted to skip your period you confused you body and it probably began to change the amount of natural hormones it produced itself in an attempt to "fix" the situation and so you have an increase in the production of natural hormones in the middle of your cycle which gives you the spotting you experience.

Your gynae is trying an alternate form of contraceptive in the hope that your body will once again be tricked into believing that the synthetic is what it should listen to and not the natural. Sometimes this works. Often not. I would recommend completing the trial seeing as you've already started. If it does not work after three months then I would recommend stopping the contraception entirely for at least 3-6 months, allowing your body an opportunity to reboot. thereafter if you decide to go back onto the pill you can.

Many thanks and warm regards

Yesheen

Dear Z

Thank you for your question.

Due to your approach of using the Yaz contraceptive pill your hormonal cycle will most definitely be upset.  It is a requirement of the pill that it be taken every day at the same time.  Yaz also has to be commenced on the FIRST DAY of a menstrual cycle.  It is alright to miss the placebo pills in the pack as a once off situation, due to for example, a camping holiday, a honeymoon, or sometimes for very long plane flights  -   but preferably not to be done on a regular basis.

I recommend that you have a pregnancy test done, even if just for peace of mind. 

Kind regards

Angela

Dear S

Thank you for your question.

It is very important that you keep the fertility clinic informed of your progress.  Please always liase with your medical specialist and the nursing sister at the fertility clinic, as each doctor has his or her approach to fertility and the problems posed. 

Always follow the instructions given carefully.  Should you take Clomid differently to the instructions given by your doctor, you will be counter productive to assisting yourself to becoming fertile.  As this process is expensive, you would also be wasting your money if you take your Clomid tablets against guidelines given.  

I wish you well with your baby plans!

Kind regards

Angela

Dear Isabel

Many thanks for your question.  Yes indeed, it is very important that you start your new contraceptive on the FIRST DAY of bleeding of your menstrual cycle.  It is unfortunate that you did not read your packet leaflet carefully before commencing your new contraceptive.  

The ideal situation now would be for you to wait until the first day of your next period and restart again, otherwise your hormonal cycle will be thrown into flux, and could become really topsy-turvy  -  and then this can cause a host of problems you really won't want e.g. like mood changes as in being weepy, depressed, irritable etc.  A fluid imbalance would also be created if you don't recommence your pill correctly.

I suggest that you use a good barrier method like condoms in the interim, and for at least 4 weeks with your change to Oralcon from Triphasil, so as to avoid an unplanned pregnancy.

I wish you luck and good health.  Please do as I suggest, and you should be fine.   

Kind regards

Angela

Dear KK

Many thanks for your question.  You commenced taking Femodene correctly.  Having missed one of your pills around your ovulation time could most certainly have caused you to fall pregnant.  Femodene is a low dosage progesterone based contraceptive pill and it is absolutely vital that it is taken every single day, at the same time.   With you being 15 days late, I suggest that you have a pregnancy test done.  If you had been 1 - 2 hours maximum late in taking your pill, then this would not have made much difference, as a once off situation. 

Should you decide to use a home pregnancy test kit, then this must only be done in the morning, and preferably before 10 a.m., as the HCG hormone is only raised in the morning, and this is the hormone that is tested for a pregnancy.  A blood test for pregnancy can be done at any time of the day, and then would be sent off to a laboratory for analysis.

You are welcome to book an appointment with me should you be apprehensive about doing the test.  Or when you can, I would like to know how you are, and how your result went.

Take care now, and thanks once again for your question.

Kind regards

Angela

Dear B

Many thanks for your question. 

Unfortunately, you have given me no personal medical history, hence my answer as follows.  The efficasy of Nur-Isterate will not be affected with you bleeding, however you should not be bleeding all the time.  The two most likely reasons for you bleeding could be either that you have been on Nur-Isterate for two years or longer, or it may be that it just does not suit you as an individual. 

I suggest that you visit your family planning clinic and explain the situation to the family planning sister who sees you.  Alternatively, you can make an appointment to see me, and we will both look at things in detail for you, as your bleeding does need to be resolved.  The other solution is to see your gynaecologist.

I do hope that your problem is resolved soon and that you will feel better shortly.  

Warm regards

Angela  

Dear S

Thank you for your question. You are correct in your assumption that your mood swings are due to the change in oral contraception. Although they all contain synthetic oestrogens and progesterones the quantities and ratios of each differ between products, and if your body is sensitive enough you will have a reaction to the change. The good news is that in most cases the body learns to adapt after a couple of months to the new drug and you return once again to some form of equilibrium. There are cases of women not adjusting and those are the cases where an alternate will need to be sought.

I think an important question to ask is why are you on the oral contraceptive pill? The reason being the high side effect profile of long-term use of synthetic hormones n the human body. Search for oral contraceptive on Wikipedia.com and read through the long list of conditions associated with the pill, which include both mood swings and decreased libido/sex drive.

If your use of oral contraception is to prevent pregnancy I would recommend investigating an alternative such as a cervical cap, temperature monitoring or a diaphragm as less harmful options.

Many thanks and warm regards

Yesheen

Dear L

Thank you for your interest and questions.  I believe in starting off with keeping things simple, and then with time broadening out to being more detailed where necessary. 

I suggest that you keep a diary of your daily menstrual cycle. 

Most women have either a 28 day cycle, or a 30 day cycle, and then some have a 31 day cycle.  Then there are also women who only have one menstrual cycle every 3 months, or once every 6 months. 

Start counting your cycle on the FIRST day of bleeding of your menstrual cycle.  Should you have a 28 day cycle, then day 28 would be the first day again of your next menstrual bleed  -  don't become confused now!   With a 28 day cycle, day 14 would be your most high risk day for ovulating.  However, I always say the 3 days before ovulation, and then the 3 days after your day 14 are also high risk days.  Just remember, that every woman is unique and different, and no-one knows you better than yourself.  You need to understand your own body and the responses you have to what is happening in your life.  For example, if you have a major upset, or are writing exams -  you could trigger off an extra period in the space of a month.  Should you not be eating correctly for example, with enough iron rich foods, you could either delay a period or even miss a period.    

Having been on the pill for 2 months will give you sufficient contraceptive coverage.  The pill (although you haven't indicated which one it is) should take about 4 weeks to settle into the systems of the body in order to prevent conception.  It is absolutely crucial that you are 100% compliant in taking your pill at the same time every single day.  Most contraceptive pills are listed to preferably be taken in the evening  -  should this not suite you, then you must stay with the same time every day.  Certain medications like allopathic/pharmaceutical antibiotics and cough mixtures can cause the contraceptive pill to lose its efficasy, i.e. effectiveness.  It is always advisable to commence taking the pill on the first day of your menstrual bleed  -  this will assist your menstrual cycle in being regulated correctly from the beginning.  There would definitely have been a reason, once looked at closely, as to why your respective friends fell pregnant.

Having said all of the above, I always find it safest to advise and councel women commencing the pill, to give the pill 6 weeks to be fully effective, and at the same time to make use of a good barrier method like condoms, during this 6 week time span.  

Should you be unsure, you are most welcome to telephone me, and I will talk you through any further queries.  My direct clinic line is 021-4875435, between the hours of 09h00  -  16h00, Monday to Friday.  Or alternatively, you can e-mail me again, always referring back to your original question, please.

All the best of luck, and enjoy your two week break!

Warmest regards

Angela

Dear K

Thank you for your question, and I apologise for the unfortunate delay. 

To put it simply, all you need to have done was to to avoid the inactive or placebo pills in your contraceptive pack.  For Yaz this would mean the 4 white pills. 

So in future, avoid the four white pills all together and just carry on with the next day's pill after the fourth placebo pill.  Should you have done as you have suggested from thereon, your approach would have been correct for your purpose at the time.

I do hope that you were able to come right before your holiday.

Kind regards

Angela 

Dear B

Thank you for your question. I would recommend stopping oral contraceptives altogether for two to three months and seeing whether the leaking around the time of your menstruation stops as well. If it does stop then you can consider restarting on a different one from Femodene. If it does not stop I would consider visiting your gynaecologist for a couple of hormonal tests.

Usually this type of symptom is related to an imbalance in the hormone pathway that leads up to the release of oestrogen and progesterone from your ovaries, and another hormone called prolactin that is related to the production of breast milk. In you case from the history you provide I would suspect that imbalance is caused by the pill. But there are other causes of an imbalance and these need to be investigated if the symptom does not stop when the contraceptives are removed.

Many thanks and warm regards

Yesheen

Dear N

Many thanks for your question.  I apologise for the delay as we have had on-going problems with our systems and internet access. 

The Nur-Isterate contraceptive injection is indeed the problem causing your signs and symptoms of "extreme sweats, and becoming hot at regular intervals throughout the day and night".  Your symptoms are similar to that of menopause, but don't worry, you will not be in the phase of menopause yet!  Your age of 25 years is way too young for this phase.  The youngest age I have treated for menopause was 34 years of age.

I suggest that you consider giving your body a rest or break from Nur-Isterate.  This should be done every 2 years anyway, otherwise the symptoms you have described will occur.  With you having been on Nur-Isterate for 5 years, you will take at least 3 to 6 months to detoxify your body from the chemical components of this contraceptive, which will have accumulated in the different organs of the body.  After 2 years of usage, it can take this length of time, and for some women, a little longer to detoxify.  It is vitally important that you make use of a good barrier method like condoms in the interim, so as to avoid an unplanned pregnancy.   

You should find that once your hormonal cycle has settled, your signs and symptoms will have abated.  Once you have detoxified sufficiently from Nur-Isterate, then you could consider taking the Ovral pill as your doctor has suggested. 

You are welcome to make an appointment to see me, so that I can assess you carefully, as to what other contraceptives would suit your physiological profile, other than Ovral.

My direct clinic land line is 021-4875435, between the hours of 09h00 - 16h00, Monday to Friday.  Should I not be able to speak to you at the time, please leave your name and contact telephone number so that I can return your call. 

Your problem can be resolved  -  it just needs time and patience!  And thank you once again for your query.  

Warmest regards

Angela

Dear C

Many thanks for your query.  I apologise for the unfortunate delay.  

In all honesty, these symptoms are not good and healthy for you, and I suggest that you discontinue Trigestrel.  Having "headaches and bad pains" are a definite indication that Trigestrel is not for you.

It would be better for you to contact me directly for an appointment please, so that I can physiologically assess you for an alternative form of contraception.  My direct clinic landline is 021 - 4875435, between the hours of 09h00 - 16h00, Monday to Friday.

I do hope that you are able to schedule an appointment to see me.

Warm regards

Angela

Dear T

Thank you for your question again.  Have just answered a previous question posed by yourself. 

Please make an appointment to see me should your problem not have been resolved.  Hopefully you have visited the family planning sister at your clinic in the interim.  The clinic sister must reassess you and determine if your contraceptive is not suitable for you, especially with your given signs and symptoms of breast tenderness and headaches.

You are also welcome to contact me directly on telephone number 021-4875435, between the hours of 09h00 - 16h00, Monday to Friday.

Kind regards

Angela

Dear T

Thank you for your question and I apologise for the delay. 

I suggest that you visit your family planning clinic and request that the nursing sister on duty check your bloodpressure.  Alternatively you are welcome to make an appointment to see me. 

A headache can be due to a number of reasons, and as you have not given any other signs and symptoms, the first approach would be to go back to your family planning clinic for a reassessment and blood pressure check. 

To avoid headaches do steer clear of foods like chocolate, coffee, cheese, citrus, and alcohol, either singly or in combination, as they can trigger headaches.  Ask the sister to assess you for anaemia, as this condition can also cause headaches.  Drink at least 2 - 3 litres of water daily and manage stress affectively for yourself as an individual.

Kind regards

Angela
 

D

Dear G

Thank you for your question.  I understand your dilemma and confusion. 

To be frank with you, I have not seen an Oralcon pack or Trigestrel contraceptive pack.  Oralcon and Trigestrel are generic contraceptives sourced by the government from Malaysia, Hong Kong and other countries in the East.  These contraceptives are only supplied by government family planning clinics.  

I have to say that these questions should have been covered by the family planning sister who dispensed the Trigestrel to you, when you changed over from Oralcon.  Not having seen these packs visually, I do not want to advise you incorrectly, so I suggest that you return to the family planning sister and put these questions to her. 

I really would like to help you as much as possible   -   otherwise 'phone me on my direct clinic line of 021-4875435 and ask to speak to me directly, and do make sure that you have your Trigestrel pack in front of you.  Also be aware of the first day of your last menstrual bleed.  Please understand that there are clinic bookings right throughout the day, so I will speak to you when I can.  Try getting hold of your family planning sister first at the clinic which dispensed your new contraceptive.  I wish you much luck!

Kind regards

Angela  

Dear L

Any use of synthetic hormones or oral contraceptives will disrupt your normal menstrual cycle. This can result in either longer heavier periods, shorter lighter periods, more frequent or less frequent periods. There is no real predictive formula that will accurately determine how you will react because every woman's physiology is unique. As such I cannot say whether it is healthy or unhealthy until we see if this pattern stays around for a while, and compare it to how you have or have not been using the pill.

All I can say is be observant, do not stop-and-start your pill too many times as this confuses the body, and determine why it is that you are using the pill and whether there are any alternates available that will accomplish the same outcome but without the side-effect profile of oral contraception.

Many thanks and warm regards

Yesheen

Dear A

Many thanks for your questions.

No, Escapelle should not adversely affect your condition of hypothyroidism at all.  I have double checked this with out senior pharmacist on duty. 

There will always be a bit of a hormonal flux when taking emergency contraception, so yes, your menstruation may be upset with an eratic pattern initially, but will settle down.   

It is advisable not to take an emergency contraceptive pill unless it is absolutely necessary.  Should it be taken too often and with prolonged usage of routine contraception, then there is the possibility of infertility setting in.

I hope this answers your questions.  

Warmest regards

Angela

Dear M

Thank you for your question. What is your primary intention behind the use of the pill? To control your acne or to prevent pregnancy? If it is the acne you are most concerned about I would recommend stopping the pill because it has such a wide variety of side effects and beginning something like Saw Palmetto to help balance out the ratio between oestrogen and testosterone in your body which underlies the development of acne in most females.

If your primary intention is to prevent pregnancy I would recommend researching alternate methods such as condoms, diaphragms and femidoms, which as almost as effective but without the side effects. As to how effective oral contraceptives are in preventing pregnancy? Nothing besides abstinence is 100% pregnancy proof. Oral contraceptives about an 8% failure rate with typical use, the cervical cap 7.6% and fertility monitoring with a thermometer 0.7%.

Many thanks and warm regards

Yesheen

Dear M

Many thanks for your query. 

The red and inert tablets are simply your placebo tablets in the Trigestrel contraceptive pack.  So long as you do not forget to take your pill every day at the same time, you will not fall pregnant.  The placebo tablets are in every contraceptive pack, regardless of the type of contraceptive pill.  A placebo means a non hormonal based pill.  You will not fall pregnant while taking a placebo tablet, unless for example you were also taking an allopathic/pharmaceutical antibiotic, as this can cause a contraceptive not to be fully effective at the time of taking medication. 

So don't worry, you should be completely fine.  On commencing a new contraceptive pill, I always recommend that a woman uses condoms for the first 6 weeks, although it is listed that after the first 4 weeks she would have enough contraceptive in her body not to fall pregnant. 

I hope this helps to reassure you. 

Warmest regards

Angela

Dear J

Thank you for your question.  I apologise for the delay due to illness.

I fully comprehend your problem.  As there is a fluid imbalance with your periods being so erratic, I suggest that you take the following :

NAT MUR TISSUE SALT NO. 9, as x1 celloid, 4 times a day, under the tongue 10 - 15 minutes before meals.  Do this for 3 days.  Then reduce the dose to 3 times a day.   Nat Mur is a fluid regulator, and will assist in regulating your menstrual cycle.

EVENING PRIMROSE OIL CAPSULES by Vital, to be taken as x1 capsule daily after food.  This needs to be done for a month before you experience the full benefit of the product.  Continue even when your periods are more regulated. 

It is better not to interfere with your cycle, if possible.  If you were on a contraceptive pill, then you would avoid taking the placebo or inert tablets in the contraceptive pack and then just carry on with the other pills in the pack.

I hope your anniversary went alright.

Kind regards

Angela

Dear S

All oral contraceptives have the side effect of unhealthy unwanted weight gain. Simply switching oral contraceptives will not prevent this from occurring. Why did you begin the contraceptive in the first place? If it was to prevent pregnancy there are alternative available that do so without the side effects. If it was for other reasons speak to your practitioner about healthier alternatives.

With regards to the weight gain, fat tissue, once present, almost takes on a life of its own, changing your metabolism around so that it can grow bigger, even without the presence of a stimulant such as an oral contraceptive. Once your body is in a cycle of fat storage you have to use the tools of healthy caloric restriction and increased activity to try and switch your metabolism from fat storage to fat burning. One of the way to begin is to have a high protein breakfast such as a rice protein smoothie, within 30 minutes of waking in the morning.

Please stay away from metabolism enhancers and other fad diets because none of them have ever shown sustainable healthy results. For a more tailored plan please feel free to contact us at 076-229-4662.

Many thanks and warm regards

Yesheen

Dear N

Many thanks for your question.  I apologise for the unfortunate delay, due to illness. 

You will most certainly detoxify when stopping the Petogen contraceptive injection.  There is also no harm in having a pregnancy test done, even just for peace of mind.  It can take a minimum of 3 - 6 months for the body to release the chemical components from the different systems of the body.  With you having been on Petogen for 4 years, you may well find that it will take a little longer for your body to detoxify.  All your signs and symptoms are an indication of detoxification taking place.

I do hope that your problem has been resolved, but if not you are welcome to e-mail me again.

Warm regards

Angela

Dear m

Many thanks for your query.  I do apologise for the delay due to illness. 

Your body would have undergone some adjustment hormonally while changing over from Triphasil to Trigestrel. 

The brown discharge you experienced along with pain, should be assessed by having a Pap smear (cervical smear) done so as to rule out the possibility of a vaginal infection.  A possible examination may also need to be done by your medical doctor, should your signs and symptoms not have been resolved.  Should your pain persist, and all other causes are looked at, it might be that your new contraceptive does not agree with you.

I do hope that you are feeling better already at the time of this being sent to you.

Kind regards

Angela

Dear N

Many thanks for your return e-mail, and I apologise for the delay due to illness.  You may have seen your doctor by the time you read this.  Do try and relax, and ask all relevant questions of him, which concern you  -  doctors are there to provide a service which include answering queries. 

You have achieved such a lot by having had three children  -  I only have the one daughter, and although I have encouraged her to be confident, I feel as if I have ten!!

When you can, please let me know how your appointment went, as I am interested. 

Warm regards

Angela

Warmest regards

Angela 

Dear N

Many thanks for your question, and for giving me the detail of your contraceptive profile. 

Well, once Premarin has regulated your menstrual cycle and on condition that there is no underlying medical condition, I see no reason for you not falling pregnant!  You could fall pregnant at any time.

Warmest regards

Angela

Dear T

Many thanks for your question, and I do apologise for the unfortunate delay due to illness.  You may have had this problem resolved in the interim. 

Tri-gestril is the cheaper generic alternative to Triphasil, as sourced at government clinics.  All the signs and symptoms mentioned are an indication of a possible pregnancy, except for the dark urine.  Her dark urine is an indication of a possible kidney infection.  Should you not have taken her to a general practitioner already, and the dark urine and back pain is still present, then I suggest that you do so please.   

The antibiotics your daughter had prescribed for her, can cause the efficasy of her contraceptive to be disrupted, so it was correct for her to have a pregnancy test done.  All pregnancy tests are now designed to check for the presence of pregnancy from ten days post conception.  All pregnancy urine tests should be done before 10 a.m. in the morning, and a blood test for pregnancy can be taken at any time. 

I do hope that your daughter's problem has been resolved, and once again I apologise for the unfortunate delay.

Kind regards

Angela

Dear M

Thank you for your questions, and I apologise for the unfortunate and unavoidable delay.  Oralcon is a generic alternative, and is not the same as Nordette.  Yes, from your signs and symptoms Oralcon is very likely to be the cause of your weight gain and mood swings.  Nordette is not available in all the government family planning clinics.  We do source and stock it at Wellness Warehouse, and then I currently do the private scripts for Nordette at the moment while we can get it. 

I have never heard of Altvera, or Levora, or Portia  -  but would say that they are also sourced as generic alternatives, like Oralcon, from Malaysia, Hong Kong and other Eastern countries. 

I recommend that you try and make an appointment to see me so that I can physiologically assess you as to what would be suitable for you as an individual, with the available contraceptives currently on the market.  

Many thanks once again for your questions.

Warm regards

Angela

Dear N

Thank you for your questions.  Yes indeed, being on the Nur-Isterate contraceptive injection and then the Triphasil contraceptive pill thereafter (and my understanding is that this was done without giving your body a break or rest from these contraceptives during this time span) will cause your body to take longer to detoxify from these contraceptives.

Nur-Isterate is a slow release hormonal contraceptive and should not be taken for longer than 2 years at a time.  A minimum period of 6 months rest away from this contraceptive is then required so as to allow the body to release the chemical components from all the systems of the body. 

On average the pill takes 1 - 2 months to detoxify from.  Another factor to consider is your metabolic rate.  If you have a slow metabolic rate you would be looking at, at least 9 months or a little longer for a proper hormonal cycle to return as a slow metabolic rate can slow the process of detoxification down.

Your own nutritional state, stress levels, and leading a healthy lifestyle can all influence conception  -  so do look after yourself properly.

Warmest regards

Angela  

Dear Ms. T

Many thanks for your question.  My heart goes out to you, as I fully comprehend your dilemma. 

I can definitely help you, but the best thing is for you to make a family planning appointment to see me please.  I can then fully assess you physiologically as to whether Trigestrel or any other contraceptive would suit you.  It is unfortunate that you cannot continue with Yasmin, as it is always best to stay with the contraceptive that suits you personally.  Each woman is unique and different to the next, and this is so important to bear in mind when treating a client.  

All the pharmaceutical contraceptives are 100% synthetic/artificial.  Every single one of these contraceptives has a list of side effects!  Not knowing you or having seen you yet, it would be wrong of me to say if Trigestrel would suit you or not  -  it would be great if you could see me first, prior to commencing Trigestrel or any other contraceptive.  I will tell you that there have been a number of concerning side effects reported to our Well Clinic by patients who have started taking Trigestrel.  Trigestrel is the generic for Triphasil, and is what is dispensed predominantly by the municipal clinics.  I do not dispense Trigestrel, out of choice, due to these reports.

I wish you well with your decision, and hope to see you soon.  Should you be out of the Cape Town area, you are welcome to contact me telephonically on 021-4875435 or 4875420 between 09H00 - 16H00, Monday to Friday. 

Warmest regards, and thank you once again for your question.

Angela

Dear E

Many thanks for your question and for giving me your detailed signs and symptoms. 

Quite simply, you have a mineral salt deficiency, and yes it is due to the contraceptive pill  -  but more importantly, it is due to the length of time you have been taking your contraceptive pills without a respite, which would have assisted your body to replace this mineral salt deficiency.  You should have had a break after two years for about 2 - 3 months and then to have recommenced contraception again.  In the interim of a respite, always make use of an affective barrier method like condoms.     

I recommend the following for you :

VITA-LIFE MULTIVITAMIN capsules by Amipro, as x2 capsules, twice a day, after breakfast and after lunch.  There are 90 capsules in a container.  This product contains calcium, magnesium, manganese, potassium, copper, chromium, boron, zinc, selenium and many other important nutrients like vitamin C and iron, to name a few.  Do take your multivitamin after food, with a glass of water, so as to be beneficial for absorption and assimilation in the gastrointestinal system.  

A good omega supplement like MEGA OMEGA by The Real Thing is always good to take as well.  For the age category of 20 - 25 years, take 2 - 3 capsules at night about an hour after food.  This will add to your general wellbeing and assist with so much like better memory, adaptability to stress etc.

Replacing your mineral salts will also assist in boosting your libido.  

You are welcome to make an appointment to see me so that I can determine any other deficiencies you may have, so as to enable you to then funtion at optimal level.

I wish you well and hope that you feel better soon.

With warmest regards

Angela

Dear K

Thank you for your question.  Unfortunately you do not mention the name of the medication your doctor prescribed for you.  There is also no mention of previous medical history leading up to, and prior to you not having menstruation for 3 months.  Hence not having a full clinical picture so as to be able to guide you fully.

However, when commencing a contraceptive pill, it is advisable to commence taking it on the FIRST DAY of menstruation, as your hormonal cycle will then develop a proper rhythmic cycle.  So for Nordette, take one yellow tablet daily for 21 consecutive days, beginning on Day 1 of your menstrual cycle, i.e. the first day of bleeding.  One red inert tablet is then to be taken daily for the next 7 consecutive days.   Follow the arrow on the back of the Nordette pack, using my guide, as above.  Please do make use of an effective barrier method like condoms for 4 - 6 weeks once a new contraceptive has been commenced.  I hope that this assists you.

Kind regards

Angela  

Dear A

Many thanks for your question.

As you live locally, it would be so much more beneficial for you if you could come in and see me please.  Having a visual and physiological assessment done, including a medical history and family medical history is 100% better for you, especially as I would look at you with an holistic approach.  So before I go any further, contact me for an appointment at the Kloof Well Clinic on my direct clinic line 021-4875435 or 4875420, between the hours of 09h00 - 16h00, Monday - Friday.  

Many thanks once again for your query.

Warmest regards

Angela 

Dear D

Thank you for your question. The answer depends greatly on your body's ability to clear out the remaining drug metabolites from your system and on how long it will take for your ovaries to return to ovulating with every cycle now that the effect of the synthetic hormones are no longer influencing it. It can vary from a couple of weeks to up to twelve months. IF after twelve months of contraceptive-free sex you have still not fallen pregnant I would then consider consulting a gynaecologist. But that is a long time from now so forget about it and enjoy the journey.

Many thanks and warm regards

Yesheen

Dear M

Many thanks for your question.  I do not think that you are pregnant, as with your profile your body has literally started to detoxify from the chemical components in Nur-Isterate.  It is nevertheless always a good idea to do a pregnancy test for peace of mind.  Should you not be planning a pregnancy, it is strongly recommended that you use an affective barrier method like condoms in the interim, until you recommence family planning, or plan for a pregnancy. 

Warmest regards

Angela 

Dear D

Thank you for your question.  Your signs and symptoms cover a wide field of possible conditions.  However yes, there is always a hormonal upset of some kind when coming off a contraceptive, and especially with you having been on Triphasil for a 6 year time span.  Your headaches could be due to the detoxification of the contraceptive being released from all the systems of your body. 

I suggest that you visit your local family planning clinic and request of the family planning sister that she check your blood pressure and your haemoglobin so as to further determine the cause of your headaches.

With best wishes and many thanks once again.

Warm regards

Angela

Dear L

Thank you for your question. There is no 100% effective contraceptive available except abstinence. When we evaluate any contraceptive we score it out of 100 in terms of how many women using this particular contraceptive will fall pregnant. For example surgical sterilisation has a score of less than 0.5 out of 100 because it is very effective. Unprotected sex has a score of over 85 out of 100. Petogen has a score of 3 out of 100, i.e. 3 out of every 100 women using Petogen will fall pregnant. It is slightly better than using the pill or a condom, and definitely better than having unprotected sex.

If you would like to try and fall pregnant after stopping the injection it can take from a couple of weeks and up to one year after your last dose before your body returns to a normal cycle of ovulation.

For the side-effects of Petogen I refer you to the many online resources available. One such resource is http://home.intekom.com/pharm/intramed/petogen.html which is an online copy of the paper insert you were supposed to have received when the box containing your Petogen was opened.

Many thanks and warm regards

Yesheen

Dear W

Many thanks for your question.  Trigestrel is listed to be the generic of Triphasil, and is taken according to the same colour code of pills in the contraceptive pack.  ALWAYS START in the red section, on the FIRST DAY of bleeding, so as to help and assist your hormonal cycle to form a proper rhythmic pattern.  So then e.g. should your period start on a Monday, then you take the pill in the red section of the pack that says Monday.  

I suggest that you wait until the first day of bleeding in your next period, as this would be better all round for your cycle.  The product company also recommends that this particular pill should preferably be taken at night   -   usually between the hour of 5 - 6 p.m., and then at the same time every day thereafter.  Should this time not suit you, choose your time and then stay with it, and your hormonal cycle will eventually settle down.

Warm regards and many thanks once again.

Angela 

Dear M

Many thanks for your question.  No, having a contracpetive injection is definitely not the solution to regulate your periods  -  it will do quite the opposite.  The cause of your bleeding needs to be determined.  I suggest that you make an appointment to see either your general practitioner or gynaecologist so as to determine the cause.  Please make this responsible appointment soon.

Kind regards

Angela

Dear K

Many thanks for your query.  I fully understand your concern.

With you having been on the Depo Provera contraceptive injection for 5 years you would definitely have built up a strong resistance to falling pregnant.  It is advisable to have a break after 2 years, as with this being a slow release hormonal contraception, the chemical components of Depo Provera can accumulate in the different systems of the body over a period of time.  With your set of circumstances it would take a minimum of 3 months to 9 months or a little longer for the accumulation of these components to be released from your body.

The spotting plus and your erratic periods are as a result of the discontinuation of the injection, and your hormonal cycle trying to rectify itself.  Missing your December period can be part of all this.

However, as you indicate that you are experiencing sore breasts (which is another indication of coming off Depo) and your nipples are sensitive to touch, I suggest that for peace of mind you do retest for pregnancy.  The home kit should always be done with an early morning specimen of urine  -  I always recommend by 10 a.m. at the latest, for an early pregnancy.  The current pregnancy tests are now formulated to check for a pregnancy as early as 10 days after conception.  

Your white discharge could be a possible candida (thrush) infection.  On the other hand it could also be just part of your hormonal cycle readjusting.  I suggest that you do another pregnancy test, and all being well and negative, then you can, and only then have a cervical (Pap) smear done.

Once you are all ok with the above, to assist your hormonal cycle in falling back into sync, you could be assessed to take Agnus Castus Berry as x1 capsule twice a day after food.  This product can be ordered online through our Kloof Store and delivered to you.

You are welcome to contact me for an appointment for all of the above at the Kloof Clinic at our Cape Town Wellness Warehouse store on telephone 021-4875435 or 4875420, between the hours of 09h00 - 16h00, Monday to Friday.  

I wish you well and do take care.

Warmest regards

Angela

Dear A

Thank you for your question.  Hearty congratulations on the occasion of your marriage!

The Nur-Isterate contraceptive injection can cause your periods to disappear altogether while you are on it.  Your spotting and break-through bleeding are side effects of having been on Nur-Isterate for 5 years, due to a build up of chemical components in the different systems of the body.  Nur-Isterate is synthetically formulated not to be taken for longer than 2 years at a time.  It is always advisable to give your body a break or rest from this contraceptive after 2 years maximum, so as to clear these chemicals out of the systems, otherwise they can stay in the membrane linings of organs for quite awhile.  However, as you are only experiencing spotting now, you have done quite well so far.

As far as your discharge is concerned, I recommend that you have a cervical smear (Pap smear) done to determine if there is any infection present or change in cervical cell formation.  A cervical smear is a diagnostic procedure  -  I really would like to have an infection ruled out please.  Either you can make an appointment to see your gynaecologist for this purpose, or our Kloof Clinic in Cape Town, to see me for the same.  Having a cervical smear would be your first step to determining your problem. 

Quite frankly, I would not have put you onto a pill straight away as this would overload your systems of hormones.  It would have been preferable for you to to have come off Nur-Isterate altogether and to give your body time to release these chemical components from your body.  For you, this will take a minimum of 6 months or even a little longer due to having had Nur-Isterate for 5 years.  It is advisable to use a barrier method like condoms in the meantime while detoxifying from this contraceptive. 

It is unlikely that you are pregnant with your given clinical picture  -  but nevertheless, I suggest that you have a pregnancy test done for peace of mind.   

Please have a cervical smear done, and then we can take it further from there.  Please also copy this question and answer to me when following up with a further question in relation to the same query.

Many thanks once again for your queries.

Warm regards

Angela

Dear Celeste

Many thanks for your question. 

Thank you for your clinical profile, hence my answer is that your signs and symptoms could be one or the other.  For peace of mind I suggest that you have a pregnancy test done anyway.  A home kit should be used only in the morning and preferably before 10 a.m. as there is a hormone in urine which is only elevated in the early morning, when checking for pregnancy.  Your headaches could be as a result of a number of other factors, e.g. not drinking sufficient water in a 24 hour time span.  You should have 2-3 litres of filtered water daily. 

Many thanks once again for your question.

Warm regards

Angela

Dear Laverne

Many thanks for your question.  The Nur-Isterate contraceptive injection is listed to cause weight gain and or massive weight gain.  When I see a client for a family planning appointment I do a physiological assessment as to which contraceptive is suitable for her.  So it may just be that should you say have a slow metabolic rate, then yes you may well be prone to gaining weight while on Nur-Isterate.  Nur-Isterate would only cause infertility if you were on it for a long time.  I advocate that it not be used for longer than 2 years maximum, and then to give the body a break of up to 6 months from it so as to release all the chemical components out of the systems of the body.  Nur-Isterate when taken for too long ends up staying in the membrane linings of the soft organs of the body, and it can be difficult for this to be released depending on the individual, the individual metabolic process etc.   

It is important that you are aware that all pharmaceutical contraceptives are 100% synthetic/artificial, hence my answer above. 

Before you speculate at random as to what contraceptive might be suitable for you, it is important that you be assessed and even examined, and a full personal medical history and family history noted and recorded prior to starting a new form of contraceptive.  The Marena intrauterine device (IUD) should only be used by a woman who has absolutely no cardiovascular history, or family medical history along these lines, at all.  Even a personal history of one blood clot can trigger off a medical problem.  There are other factors to be borne in mind when assessing for a Marena IUD.

I suggest that you make an appointment to see me for a family planning consultation, or alternatively see your gynaecologist for the same.

Good luck with your decision.

Warm regards

Angela

Dear A

Many thanks for your queries.  Hearty congratulations on your forthcoming nuptuals! 

Trigestrel is supposed to be the same as Triphasil as indicated, and checked in conjunction with our allopathic pharmacy.  Just to reassure you that you are one of an increasing number of women who are complaining of side effects from Trigestrel. 

I would say that Trigestrel does not suit you, and my professional instinct is to suggest that you consider coming off it.  As your wedding is so soon, the best would be to make an appointment with me so that I can assess you physiologically so as to determine which contraceptive would be the most suitable for you.  It would be advisable to commence your new contraceptive at least 6 weeks before the big day.

Alternatively, you could contact me on telephone no. 021-4875435 or 4875420 between the hours of 09h00 - 16h00, Monday to Friday at our Kloof Store. 

Good luck and all the best for your forthcoming marriage.

Warmest regards

Angela

Dear M

Thank you for your question.  I recommend that you make an appointment to see your gynaecologist for a full checkup, assessment and examination.  Your gynae may also suggest checking your ability to ovulate.  A breast examination and a cervical smear (Pap smear) would be also be done at this appointment. 

With you being on the pill for 7 years you will be more than adequately covered to inhibit conception from taking place, unless you were to take a prescribed pharmaceutical antibiotic, and or certain cough mixtures can interfere with the efficasy of contraception.   The pill takes a minimum of one month to work itself out of the systems of the body.  Each woman is uniquely different, and after 7 years of contraception it may take a little longer for you.

The Triphasil and Trigestrel packs are each made up of 28 pills.  There are 21 active pills in a pack, and the remaining 7 pills are the placebos (inactive pills).  The unsafest time for intercourse in your pill pack is the middle week (7 days) of the 21 day section.  

It is best to commence the pill on the first day of menstruation, as this will ensure a regular menstrual cycle  -  this means that you start in the red section  -  think of red for menstruation.   Keep a daily diary, and calculate when the unsafe 7 days would be.   It is actually quite simple once you start.  However, you are more than welcome to telephone me should there be any confusion, on telephone no. 021-4875435 or 4875420 between the hours of 09h00 - 16h00.  Have your pill pack with you so that I can guide you more effectively.

All the best, and many thanks once again.

Warmest regards

Angela 

Dear L

Many thanks for your question.  The Depo Provera contraceptive intramuscular injection is the originally clinically trialed pharmaceutical contraceptive.  Petogen is the generic of Dep Provera.  A generic is a copy of an originally trialed pharmaceutical or allopathic form of medicine.  In this instance, Petogen is an exact quality replica of Depo Provera.  

It is Nur-Isterate as a contraceptive injection that is usually given to a younger woman, below the age of 30 years.  Depo Provera is preferable for an older woman due its formulation.  However, as each woman is a unique individual, her physiological profile should be taken into account, so there can be exceptions to the rule for recommending a contraceptive.

All the pharmaceutical contraceptives are 100% synthetic/artificial.  Your key to maintaining your health while on a contraceptive is to definitely take a good quality multivitamin, as the skeletal structure is depleted of crucial mineral salts over a period of time.  This can result in many side effects like lowered libido, tiredness, weight gain etc.  And to give your body a break from your contraceptive, depending which one it is.  Always use an affective barrier method like condoms when taking a rest from your contraceptive.  

I can go on at length, but this should answer your question.

Warm regards

Angela 

Dear P

Thank you for your question. Firstly whenever you swop oral contraceptives you should expect a period of irregular menstruation as you body adjusts to the new medication. This may mean either a lighter or heavier cycle than usual. I think that the timing of your swop also has a lot to do with your current experience. Usually the pill cycle prepares you for a period towards the end of the pack. From what you write it sounds like your body was preparing for it's regular period when you started a new pack from the beginning, which is usually when the pills are formulated to stop a period. I think you should continue with you new pill as per instructions, and that you cycle should return to normality at the end of your new pack.

That said it is not uncommon during this change-over period for your levels of contraception to fluctuate, meaning the ability of the pill to prevent pregnancy is hindered. The prescribing health care practitioner should have told you to use a condom as well for the first four weeks of the new pill, until a normal period was experienced on it, to protect against accidental pregnancies. As it stands I would suggest having a pregnancy test now, and if it is negative I would strongly recommend using a condom for the following month in addition to the pill.

It is not uncommon for a person to have a fungal overgrowth following a course of antibiotics. A good quality probiotic will be sufficient to rebalance your internal flora and prevent the spread of any untoward fungal infections.

Many thanks and warm regards

Yesheen

Dear P

Thank you for your question. There is a possibility that you may skip a menstruation or two as your body adjusts to the new oral contraceptive. But there is also a possibility that during that adjustment period your level of contraceptive in your body runs too low to afford you appropriate protection. That is why it is usually recommended that when beginning a new oral contraceptive, or switching between oral contraceptives, you use a secondary form of contraception for at least the first two to three months. This includes methods such as condoms and femidoms.

I would have a pregnancy test to get the all clear, and if it's negative I would use a condom until month three of your new contraceptive. 

Many thanks and warm regards

Yesheen

Dear K

Thank you for your question. I think it best you continue with your current pack until the end of the normal cycle, in other words do not go back to the pills you missed out, and then begin with a new pack afresh. Until you have a normal period on the next pack I would strongly advise using a secondary means of contraception, such as condoms of femidoms. 

Oral contraceptives are only assured to work in a predictable manner if they are used as recommended, every day, at the same time every day.

Many thanks and warm regards

Yesheen

Dear E

Thank you for the question. I must apologise for the terrible way in which you were managed. At the very least you should have provided informed consent before being given any form of medication, and that consent includes answering the questions you ask above.

Firstly I want to ask why were you given two doses of Depo Provera? Usually a single dose is sufficient to ensure cessation of ovulation. Doubling the dose doesn't increase the strength of the contraceptive, only your risk of the more harmful side effects of the drug. Secondly Triphasil is often used temporarily after coming off Depo Provera if the Depo has resulted in your periods stopping altogether. The Triphasil is thought to encourage your body to return to a 28 day cycle, but once your cycle is regular again it should have been stopped. It is another form of contraception and if your aim is to fall pregnant it will most certainly negatively impact on you achieving your goals. 

I would suggest that you stop the Triphasil and continue with you efforts to fall pregnant. In the interim please use a multivitamin specifically designed for expecting mothers which contains extra Folate, Iron and Vitamin B12. These three help prepare your body for the expectant baby. If after twelve months of trying after stopping the Triphasil you are still unlucky then I would suggest contacting your gynaecologist for further advice.

Many thanks and warm regards

Yesheen

Dear D

Many thanks for your interesting question.  Congratulations on planning a new addition to your family!  I am not aware of toxicity from a copper T causing harm to a pregnancy.  Perhaps you could e-mail me the article or give me information as to how to source it, so that I can cross reference it. 

I do recommend that a woman allows her body to detoxify from a pharmaceutical contraceptive, and this would include copper T's, prior to falling pregnant  so that there are as few chemical components in the blood and the systems of the body.  Detoxification should be done for a minimum of 3 months, and even up to a year can be allowed.

There is no harm in you doing a heavy metal challenge test prior to having your next baby.  It is important and relevant to note if there is anything metal in your body other than having had a copper T, e.g. amalgam dental fillings; a metal plate in the knee; metal pins in a joint, arm, leg or hip; or even a pacemaker, as then the levels could be high anyway.

Good luck with your future plans!

Warmest regards

Angela

Dear N

Congratulations on the happy occasion! I understand your need to be in top form during the special event and an uncomfortable menstruation may be something of a loose cannon. To temporarily prevent the onset of menstruation you can skip the inactive tablets on your sheet of triphasil, usually the red ones, and go from the last of the yellow one's straight on to the brown ones.

It is best advised to only skip a single month.

Many thanks and warm regards

Yesheen

The natural approach entails treating with supplements to normalise the cycle to allow for optimal chances of contraception. We'd look at herbal complexes such as Femitibb or Fertiboost. Products in the Heel range such as Hormheel can also be of great benefit. This can take a few months to achieve (3-6 months). A practitioner would also look at diet, lifestyle, stress and your partner's health and emotional statis. Homoeopathy is very useful for fertility as it addresses all of these aspects, treating a person on the mental, emotional and physical level simultaneously. I would encourage you to embark on treatment with your partner as this will further increase your chances of conceiving. Warm regards, Dr. Megan Jones, Homoeopathic Doctor and BEST Practitioner

Dear T

Thank you for your question.  Your body will have absorbed enough of the Nur isterate contraceptive 3 weeks after administration of this injection.   However, I recommend that you allow for 6 weeks, and at the same time to make use of a condom each time there is intercourse in this time span so as to ensure that there will be no unplanned pregnancy. 

Kind regards

Angela 

Dear T

Thank you for your question. It is not unusual to experience breakthrough bleeds when using Petogen for the first time. What is unusual is the duration that the bleeding has lasted. This constant loss of blood, although more of an inconvenience at the moment, can in the future lead to more serious problems such as anaemia and infections. I would suggest visiting the doctor or gynaecologist who recommended you use Petogen and ask for an oestrogen-only pill to stop the bleeding. This usually takes the form of a once-daily pill for three to five days, whereafter the bleeding should stop. I am assuming of course that it is a simple vaginal bleed, without any clots, irritation, dysuria or discharge present.

Please don't hesitate to ask if there are any further questions.

Many thanks and warm regards

Yesheen

Dear C

Thank you for your question and also for giving a detailed clinical profile.

You have a small overload of hormones in your body as a result of changing over from one contraceptive straight away to another contraceptive.  As a result, your hormonal cycle has been thrown out of sync.  This is not serious in your case though. 

So, there are two ways of approaching the imbalance introduced.  Either, you can not have your next Nur-Isterate injection and wait for all the chemical components to work their way out of all the systems in your body  -  this can take a minimum of 3 months in your case.  Or, you can carry on with the Nur-Isterate contraceptive injection, and then to have a break from it in a year's time for a minimum of 6 months.  This break/respite is important for your health, as there are side effects to all the contraceptives, and a buildup of the chemical components can cause other imbalances, inclusive of possible hypertension and weight gain.  Do make use of condoms as a barrier method when not on a pharmaceutical contraceptive.

Either way will work for you, you just need to decide which will be the most suitable approach for your circumstances.

You are welcome to contact me telephonically should you need further clarification.  My direct clinic landline is 021-4875435 or 4875420 between the hours of 09h00  -  16h00, Monday to Friday.

Warmest regards

Angela

Dear K

Thank you for your question. The red pills are placebos, inserted into the pack to give your body a break from the exposure to the synthetic hormones in the active pills. It is usually during your use of the inactive pills that you menstruate. Sometimes, under the supervision of a doctor, a woman may skip the red pills and prolong the period of amenorrhoea (absence of menstrual bleeding) by moving directly on to the next cycle of pills. 

There isn't really any physiological reason for you to skip the inactive period, but if beginning a new pack on the red pill is becoming a cause of tension for you then do it, but be aware that you may not have a normal menstruation for the next couple of months and I would recommend a barrier method of contraception, i.e. condoms or femidoms, as an additional measure for the initial two weeks of the second pack.

Many thanks and warm regards

Yesheen

Dear R

Thank you for your question.  Your body is trying to re-establish a hormonal cycle, so that once again your periods will be regulated.  However due to your back pain and leg pain I am still going to recommend that you see your medical doctor so that you can be checked out fully.  For peace of mind, do a pregnancy test again, and make sure that it is at least 10 days after intercourse  -  pregnancy tests are formulated to detect a pregnancy from 10 days onwards.

Kind regards

Angela
 

Dear D

Thank you for your query.  Your body is adjusting to the contraceptive.  You do need to give yourself time to establish a hormonal pattern while having commenced Nordette.  You need to give yourself at least a month.  As I have no clinical picture from you with which to work, this is the adivice I can give you with so little information.  

For peace of mind, you can have a pregnancy test done at your local clinic, so as to rule out an unplanned pregnancy.

Kind regards

Angela 

Dear K

Thank you for your query.  I do sincerely apologise for the delay due to being away on leave.

You are very young at 22 years to be considering sterilization  -  medical doctors would be reluctant to perform this surgery unless there was a serious medical condition which would hinder your health.  And, believe it or not, individuals do change their minds, although you seem to be decisive about this which is also fine.

Both of the contraceptive injections give off side effects, one being weight gain.  Should you have a slow metabolic rate, then perhaps the injection is not for you.  Have you considered the Marena intrauterine device?  This is inserted for 5 years and must be done only by a gynaecologist.  There must be no family history or medical history of any cardiovascular disease whatsoever, as this IUD could then affect your health.

All the pharmaceutical contraceptives are synthetic, and it would be great if you could make an appointment to see me in person, so that I can do a visual assessment and guide you further.  Alternatively, please contact me on my direct land line 021-4875435 or 4875420 between 09h00  -  16h00, monday to friday, at our Kloof Store.

I have not had a query about workout supplements being hazardous while being used in conjunction with family planning, but give me the name(s) of your supplements and I will look into it for you.

Warm regards

Angela

Dear M

Thank you for your question. The morning after pill is usually a higher dose of the synthetic oestrogen and progesterone compounds found in ordinary oral contraceptives. Use of any synthetic contraceptive will disrupt your normal menstrual cycle. It is therefore unusual for you to experience the irregularities in your menstrual flow that you report to have experienced. 

I would however have a pregnancy test to make sure that the bleed you experienced was not an "implantation bleed" which is related to falling pregnant. If the test is negative be patient and simply wait for your ovaries to "recalibrate" and for your cycle to return to normal. If the test is positive please visit your nearest clinic to ascertain the gestation or age of the pregnancy, and to begin an antenatal program if appropriate. If you had unprotected sex I would also get an STI screen done to exclude the transmission of diseases such as Chlamydia, Gonorrhoea, Syphilis or HIV.

In future prevent these sort of dilemmas by using some form of contraception. 

Many thanks and warm regards

Yesheen

Dear A

Thank you for your question. The question of the safety of Nur-Isterate should have been discussed with you prior to the first administration of the drug to you by the health care provider involved. In any case this form of contraceptive is a progesterone-only form, and works by changing the cervical mucus making it more difficult for sperm to pass through. To a lesser degree it also suppresses the release of eggs from the ovary and alters the lining of the uterus making it less hospitable to a fertilised egg.

This contraception has been associated with increased risk of arterial thrombosis (i.e. stroke, myocardial infarction) especially when combined with smoking, increasing age and other hormonal contraceptives. There are additional risks if you have porphyria or sickle cell anaemia. In addition it has been associated with insulin resistance, the precursor to diabetes type two. There are also increased risks of particular cancers with extended synthetic hormonal use.

That said, any use of an hormonal contraceptive carries a similar risk profile, yet there are millions of women on contraceptive pills, injections, implants and IUD's worldwide. So if this is a method that works for you just be vigilant for the development of possible side-effects as you continue your use, and limit your use of it to a couple of years at most. I would definitely consider cycling on and off a contraceptive just to give your body a chance to recalibrate and remember how to function normally without the presence of the synthetic hormones in your system.

Falling pregnant after the use of a long-term contraceptive can take up to one year after the last dose of contraceptive used. So if that is something that you want to plan for in the near future I would reconsider going for my next dose. In addition I would begin a supplement formulated for pregnant women which should contain higher doses of Folate, Iron and Vitamin B12 to support healthy ovulation and nidation.

Many thanks and warm regards

Yesheen

Dear N

Thank you for your query.  Quite simply, should you not have given your body a break or a rest after using the Depo Provera contraceptive injection and prior to commencing the Nordette pill, you will have an overload of hormones in your body.  Depo Provera is a slow release contraceptive and can take a minimum of 3 months to 6 months to be released from the different systems of the body, and that is depending on how long you were on Depo for. 

Other factors which can also cause menstruation not to occur would be incorrect eating habits, not having a high enough iron intake resulting in a low haemoglobin (an adult female should have a haemoglobin between a minimum of 12 - 14 gm%), and having lots of stress.   

You could continue with the Nordette pill, but I do suggest that you take a multivitamin like VITALIFE by Amipro so as to replace the vitamin deficiencies which all the contraceptive pills cause depletion of in the body.  Consider also having your haemoglobin checked at your local pharmacy so as to ensure that you are not iron deficient.  You are welcome to see me, but as I am on leave as of tomorrow, this would only be possible from the 01/12/2010.

Warmest regards

Angela

Dear C

Thank you for your question. Both Serlife (Sertraline) and Wellbutrin XL (Bupropion) are advised to be used concurrently with an "adequate" contraceptive in women of child-bearing age. The pharmaceutical companies who manufacture these drugs both say that although animal studies have shown no adverse effects on developing fetuses they cannot convincingly draw the same conclusion in humans without further studies.

When choosing a contraceptive I would look at the lifestyle you lead. Are you able to remember to take a pill at the same time every day? Or would you prefer a more long-term solution. If the latter would you prefer something that is repeated every 6-12 weeks, or something that gets exchanged every couple of years? An injectable contraception is a convenient form but once it's in it is irreversible. An intra-uterine device is similar to the injectable in that it provides a long-term solution, but it is much easier to regulate. 

Without knowing anything about your other medical history, your family history and predisposing genetic, lifestyle and physiological factors I would suggest an intra-uterine device. Please consult with a trusted gynaecologist about getting one fitted.

Many thanks and warm regards

Yesheen

Dear L

Many thanks for your queries.  I fully comprehend what you are saying.  Yes, there is a possibility that the hormones in your contraceptive injection could have contributed to the formation of the gall stones, however it would not be the primary cause.  Not having seen you for an assessment and not having seen any diagnostic tests done on you, all I can say at this stage is that definitely not eating a nutritionally healthy eating plan is usually the first and foremost reason.  A high fat intake is also usually the ultimate cause.  This can be aggravated by injesting too much acid as in vinegary foods, condiments, and alcohol like wine with an ascetic content.

All the pharmaceutical contraceptives are synthetic!  Your decision to come off the contraceptive injection would assist in the healing process, but you would still have to adhere to a strict and correct nutritional intake to alleviate the stress your gall bladder has undergone. 

Yasmine must be commenced on the FIRST DAY of your menstrual bleed.  Commenced at any other time during your hormonal cycle will upset everything for you. 

It is important to use a backup barrier method like condoms (and reliable ones please!) for a minimum of 3 weeks while changing over to a pill.  However, I always recommend 6 weeks in total so as to avoid the possibility of an unplanned pregnancy.  

All the best of luck!  I hope you recover soon.

Warmest regards

Angela  

Dear A

Thank you for your query.  It is always recommended that you commence taking Triphasil in the red section of the pack on the applicable day, and always on the first day of bleeding of your period.  It is also better to take Triphasil in the evening due to the formulation of this particular pill.  Should you have commenced taking Triphasil correctly, then just continue with the pack and the follow-on pack after that.  Unless there is a medical condition or problem, your hormonal cycle will fall into sync.   

Kind regards

Angela

Dear P

Thank you for your query.  First of all, it is relevant that you know that all the pharmaceutical contraceptives are 100% synthetic.  This alone can initially upset the hormonal system.  My concern is that you have irritation and inflammation.  Your panty liners and pads should not be the cause of this.

I suggest that you schedule a Pap (cervical) smear with your family planning sister or gynaecologist, so as to rule out the possibility of an infection including candida (thrush).  This diagnostic procedure is an excellent result tool to guide a patient with.  In the event of an infection, scheduled medication would have to be prescribed to assist in the healing process.

For your comfort, I recommend a natural vaginal wash like NATURE FRESH with Tea Tree.  This solution has a pH level of 5,5.  Do NOT use soap  -  using soap will upset the pH level of the vaginal mucosa, hence accelerated irritation. 

Please schedule a Pap Smear appointment and once those results come in, you can be guided more specifically.  Do discuss your hormonal pattern with the clinic or specialist  -  there is a possibility that this contraceptive does not suit you, however there are many other factors to be considered.  

Commence using the Nature Fresh solution in the meantime. Avoid all acidic foods and drink 2 - 3 litres of water daily.  Avoid mushrooms and full cream dairy products in the event of a possible thrush infection.  

Warm regards

Angela

Dear M

Thank you for replying so promptly.  You may find that it could take up to a year, or even a little longer for you to fall pregnant.  But definitely don't lose heart as you are still young and you do have time on your side.  Patience is often one of the qualities required when trying to fall pregnant!  I am sure it will happen, just apply everything I have suggested to you in my previous e-mail.  

All the very best of luck to you and your husband!  Just relax and enjoy each other until that little hand holds both of yours!

Warmest regards

Angela

Dear N

Thank you for your query. 

Please note that this is not an SMS facility.  It would be appreciated please if you would send your request in full.  There are many queries to be answered daily.

The Nur Isterate contraceptive injection will cover you fully for contraception after 3 weeks post administration.  Ideally, intercourse should be from 6 weeks post abortion so as to give your body time to recover hormonally and physiologically.   The possibility of you falling pregnant so soon is less likely, and yet with the pregnancy test result you have given of being positive, I strongly suggest that this be done again, but at your local clinic with the nursing sister in attendance.  I suspect your result is a false positive.  Please make this responsible appointment soon.

Kind regards

Angela 

Dear Ella

Thank you for your query.  I apologise for this late reply, due to having been on leave recently.  I have looked into  the comparison of Triphasil and Trigestrel and find it to be exactly the same.  Our senior pharmacist on duty has assured me that this is so. 

However, I am trained to treat specifically according to the individual, so if you are not feeling as well on Trigestrel as you did on Triphasil, then it would be better to change to a different contraceptive. 

All the pharmaceutical contraceptives are synthetic and artificial  -  there is absolutely nothing in them that is natural!  The key to using a contraceptive that suits you  is to 1) listen to your body  -  if it does not agree with you, then it is time to try something else.  2)  Do please give your body a break or a respite from your contraceptive, e.g. with Triphasil, the ideal is after 1 - 2 years for 1 - 2 months, so as to clear out the chemical components from all the systems in the body.  3)  It is important to attend a family planning clinic regularly so as to have your blood pressure and weight monitored.  There are many different side effects for each contraceptive, and the family planning appointment would provide an opportunity for you to air your queries with the nursing sister on duty.  I always discuss side effects fully so that a client is prepared.

You are welcome to make an appointment to see me at our Kloof Clinic in Cape Town on telephone number 021-4875435 or 4875420, Monday to Friday, from 09h00 - 14h00. 

Warmest regards

Angela

Dear A

A very relevant question!  Always start in the red section when following on from the previous packet of pills.  Start with the pill which is designated for that particular week day in the red section e.g. if your new pack starts on a Monday, then you take the pill in the red section which says Monday.

Should you still be confused, give me a ring on 021-4875435 and have your new pill packet in front of you.  It really is quite simple.  You will get used to taking it correctly.

Warmest regards

Angela   

Dear R

Many thanks for your query, and also for your clinical profile.  As you went straight onto the Triphasil contraceptive pill after stopping the Petogen contraceptive injection, you will still have been covered for full contraception, this is due to the profile you have given.  In addition to this, the morning after pill was taken  -  this is emergency contraception and is high in hormones to prevent an unplanned pregnancy.  

It is quite the usual for you not to have had a return of the menses yet.  Due to all of the above you may only experience a hormonal cycle returning in 6 - 9 months.  And in some cases it can take a little longer.  Petogen is a slow release hormonal injection and takes time to be released from all the systems of the body, whereas the pill is shorter acting  -  so you will have been covered for contraception. 

In spite of this and for peace of mind I would encourage you to use a home pregnancy test ( to be done in the morning before 10h00 and with urine) so as to clarify that there is no pregnancy  -  so that you need not worry.  With the information you have given at this point, I do not think that you are pregnant, however  there is still no harm in you doing the pregnancy test to ensure this.  

All the best of luck to you!

Warmest regards

Angela   

Dear Anonymous

Thank you for your questions. 

There could be a number of reasons for you not ovulating at this stage.  Please make an appointment to see me at the Kloof Clinic so that I can assess you in total and compile a medical history and clinical profile for you.  You can make an appointment between the hours of 09h00 - 16h00, Monday to Friday (excluding public holidays) on telephone number 021-4875435 or 4875420.

Kind regards

Angela

Dear J

Thank you for your query, and I do apologise for the delay. 

It is advisable not to be on the Nur-Isterate contraceptive injection for longer than 2 years at a time.  It is best to have a break for a minimum of 3 months to 6 months maximum after this suggested 2 year time span, so as to release the overload of chemical components which collect in all the systems of the body.  As you have not done this, it may well take you a little longer to fall pregnant.   

Ultrogestan is pharmaceutical medicine to assist in draining the cysts of fluid and to make the uterus more receptive to having implantation of the ovum (egg cell). 

Pregnancy may not happen quickly for you as you were on the contraceptive injection for a good number of years without a break.  However, do take heart and don't give up.  Aim for a healthy body and prepare yourself for a health inception.  Do take a multivitamin and an omega supplement for 3 months minimum prior to pregnancy, during the pregnancy and even for at least 3 months post delivery  -  see other questions answered on the website for conception, pregnancy and fertility.

Take one step at a time, and work on your own health first so that ultimately you can have a healthy child. 

Warmest regards

Angela

Dear L

Many thanks for your query.  There is medication specific to treating your on-going bleeding problem.  But it does require a prescription from a medical doctor.  This medication is called Cyklokapron T 500, and is schedule 4 and must be prescripted by your doctor, not a pharmacy clinic.  Please also request for him to assess and examine you for a corrective approach for family planning when he sees you.

I hope you feel better soon.

Warmest regards

Angela  

Dear N

Thank you for your question.  No, you are safe  -  you do not need to use condoms, unless you feel more comfortable for peace of mind.  However, if your 3 month break was recently, then yes I do suggest that you use condoms.  Otherwise you will be fine.  Relax!  

Warmest regards

Angela

Hi

No, all of the yellow pills are the same so it doesn't matter if you started at the wrong end. The only problem is that it is then easier to get confused about which day you've taken. Take all the yellow pills until done and then carry on as you normally would.

Warm regards

Gabriell

Dear T

Thank you for your question. Both of these drugs have quite powerful effects on your neuro-endocrine system, albeit along quite separate pathways. PhedraCut uses a combination of herbal and stimulating ingredients (not listed) to increase your basal metabolic rate through the up-regulation of the sympathetic nervous system. Femodene is a monophasic combination pill and these have their own complicated effects on your hormonal system. There have been no studies released examining the possible cross-interaction between the two but I would recommend that you apply the 7 day rule and use extra contraception (e.g. condoms) while you go have a pregnancy test done. 

If it is clear I would continue with the condoms until you are scheduled to have your next period. If you do experience them then we know all is well. If not that we need to investigate further, perhaps by doing a hormonal profile.

One added note: A women requires a minimum level of body fat in order for her to go into her menstrual cycle. I don't know what your body fat percentage is or what your BMI is but if they are both low please be aware of this interaction.

Many thanks and warm regards

Yesheen

Dear R

Thank you for your query.  It is vital that you commenced the Yaz contraceptive pill on the FIRST day of bleeding of your menstrual cycle.  This is clearly indicated in the booklet contained in the Yaz box.  Should you have done this, then I suggest that you persevere for another month and see if your cycle settles down, which it should do.

However, if you did NOT commence your first Yaz pill on the first day of bleeding, then unfortunately you do need to wait until your next period, for the first day of bleeding, and start all over again!  Yaz is very specifically formulated only to be commenced on the first day of bleeding of a period. 

Some other factors which can influence menstrual flow and a hormonal cycle are a low haemoglobin count (iron levels), stress, an incorrect nutritional intake, and not drinking sufficient water thereby introducing a fluid imbalance. 

You are welcome to contact me for further clarification on telephone number 021-4875435 or 4875420 between the hours of 09h00 - 16h00, Monday to Friday.

Kind regards

Angela

Dear W

I admire you for having 3 children, you must be incredibly busy!

It is preferable not to be on Nur-Isterate for longer than 2 years.  The correct approach for you to take is to have this contraceptive for no longer than 2 years, and then to have a break/rest from this contraceptive for an absolute minimum of 3 months but preferably 6 months, so as to release the chemical components from this contraceptive, which due to its formulation, sits in all the systems of the body. 

Nur-Isterate is a slow releasing hormonal intramuscular contraceptive injection, which when taken for longer than 2 years quarantees either weight gain or massive weight gain, and often spotting and or breakthrough bleeding.  I tell you this because you need to be aware of the side effects of going beyond 2 years of using this contraceptive.  Some women even experience these side effects before 2 year usage!  And then there are further side effects as well .......

During the 3 - 6 months break/rest it is advisable to use a good barrier method like condoms.  After this rest you can recommence Nur-Isterate again.  Once you find that a contraceptive suits you, stay with it for the recommended time of usage, before a break is required again.

Warmest regards

Angela  

Dear  L

Many thanks for your question.  The ideal situation is not to go beyond 2-3 years of usage for the contraceptive pill, as the body does require a break or rest from all the chemical components in the formulation of a contraceptive.  All the pharmaceutical contraceptives are 100% synthetic/artificial, so the key to taking care of your body with a view to starting a family in the future, would be to give your body this 'break'.  Usually it only takes 1-2 months for the chemical components of a contraceptive pill to be released. 

However for you, I suggest that you give yourself at least 3 months.  You may experience a little bit of a hormonal flux as a result of coming off the Triphasil pill  -  this is normal!  Should you be able to have a longer break, this would be even better.  I have no history given of regularity of your hormonal cycle,  so my reply stands as above.  Should you decide to do this soon, you should not have a problem falling pregnant later on.  I also recommend the use of condoms as a barrier method in the meantime.  

You are always welcome to contact me further for clarification.

Many thanks and warmest regards

Angela

I think that Agnus Castus is a great idea and should definitely aid you chances of conceiving. It is a well-known and well-researched herb. I'm glad to hear that you are already taking prenatal nutrients as the first few weeks of pregnancy are often the most crucial for the foetal neurological development. It is also a very mentally positive action to take at this time. I think that a visit to your gynaecologist would not be a bad idea to ensure there are no other physiological issues preventing pregnancy (eg. obstructed fallopian tube). It is also important to visit your gynae for regular pap smears and they will most likely do an internal examination and ultrasound to ensure that your uterus is well and that you are ovulating normally. There are many factors that can prevent pregnancy and these need to be explored properly. These include environmental, emotional and physiological factors. There is also a range called Fertiboost that combines Traditional Chinese Medicines and Homoeopathy to optimise fertility. Also keep in mind that just because your husband has fathered a child in the past, this does not guarantee his virility. A simple zinc deficiency could hamper his sperm motility. It is worthwhile to both be thoroughly checked-up. Warm regards, Dr. Megan Jones, Registered Homoeopath and B.E.S.T. Practitioner 

Dear F

Thank you for you concerned queries. 

With you having discontinued the Nur-Isterate contraceptive intramuscular injection, your body will be adjusting back to normal.  Certain chemical components will be released from the different systems of the body thereby also causing your body to go into flux. 

This contraceptive will take at least 3 months to be fully released for you, with the clinical profile given.  Spotting and breakthrough bleeding are listed as signs and symptoms of coming off this contraceptive.  My concern for you is the extent of the bleeding.  I very much doubt if you are pregnant as you have not had the typical symptoms of pregnancy and because of the consistency of the bleeding experienced. 

You need to make an appointment with your general practitioner, or a different gynaecologist, so as to be seen much sooner than 3 weeks please.  Medication is quite simple for mennorrhagia (excessive bleeding) to this extent, but has to be prescripted by a medical doctor  -  this cannot be done at a pharmacy clinic.  Your doctor will assess and examine you fully so as to establish the severity of the bleeding.

Please make this responsible appointment soonest.

Warm regards

Angela

Dear S

Thank you for your query.  It does depend on how long you have been on the contraceptive injection for.  When unsure and for peace of mind, I suggest that you do have a pregnancy test done please.

Kind regards

Angela

Dear A

Thank you for your very relevant query.  I do apologise about the delay.  It would have been perfectly fine for you to have taken your pill within the first 24 hours of starting your period.  In other words, before 22h00 the next evening.  Triphasil is formulated to preferably be taken at night.  However should this be inconvenient, you must still take it every day at the same time.   

Warmest regards

Angela

Dear J

Thank you for your question.   For a healthy woman it usually takes the body up to 6 months to release all the chemical components from this contraceptive.  Petogen is the generic for Dep Provera, and is a slow release contraceptive, hence this length of time required to recover, after using Petogen for a maximum of 2 years.  I have no previous history from you, so your doctor may be advising you according to a clinical profile he has documented for you specifically.  His suggestion of 18 months recovery time prior to falling pregnant successfully may also be due to fertility issues he has dealt with which were problematic specific to patients referred to him.   

As your doctor has seen you and assessed you, I suggest that you stay with his guidance.  There is no harm in the approach he has suggested for you with the information you have given me.

Take care and all the best of luck!

Warmest regards

Angela 

Dear S

Thank you for you query.

It sounds like you have a slow metabolic rate.  My first instrinct is to request for you, if at all possible, to make an appointment to see me, as in doing a quick physiological assessment certain contraceptives can be ruled out, and due to the clinical profile already given.  The contraceptive pills have different combinations of hormones, hence my above request, as certain pills can upset your metabolic rate further.  I do prefer to prescribe the lower dosage pills as they tend to have fewer side effects.

It is advisable to use an additional barrier contraceptive like condoms for a minimum of 3 weeks while changing over to a different pill, although I always recommend 6 weeks so as to definitely avoid an unplanned pregnancy. 

After you have received your first contraceptive injection, you should use condoms for a minimum of 2 weeks.  With the administration of the follow up injections thereafter, it is not necessary to use condoms as an additional barrier method after each injection.

Please come and see me, if possible!

Warmest regards

Angela

Dear R

Thank you for your concerned query.

I have just answered another question in relation to Trigestrel on this website under contraception.  Have now gone into the sourced hormone constituent comparison for Trigestrel and have compared it to Triphasil even further.  The content of both of these similar contraceptive pills is exactly the same!

I suggest that you complete one month's supply and see how you feel at the end of this first month of taking Trigestrel.  Should you still feel out of sorts, then make an appointment to see me and I can reappraise the situation for you.  You are welcome to contact me on telephone number 021-4875435 or 4875420 between the hours of 09h00 - 16h00.

Warmest regards

Angela

Dear C

I apologise for the delay as some of our practitioners are on sabatical.  Depo Provera is administered every 12 weeks.  Your due date for your next contraceptive injection would be 30th December 2010, a Thursday.  Do check that your local clinic will be open around this time as the new year will be pending.

Warmest regards

Angela

Dear L-l

Thank you for your detailed profile  -  I do appreciate this.

What you are experiencing is a combination of spotting and break-through bleeding as a result of discontinuing Nur-Isterate.  Your hormonal cycle is basically trying to rectify itself, and all the systems of the body are slowly releasing the chemical components which have built up over the 2 years or more while using this contraceptive injection.   

I am glad to hear that you are preparing your body for conception with a multivitamin supplement, and by all means continue taking it before pregnancy, during your pregnancy, and even for at least 3 months post delivery.  It can only benefit you and your baby. 

The mild abdominal cramps are a side effect of stopping the Nur-Isterate injection.  However, should they worsen, I suggest you see your medical doctor for a full assessment and examination.  

Kind regards

Angela

Dear M

Thank you for your concerned and very relevant query.

I am not familiar with Trigestrel.  However, having sourced information, it appears to be the generic of Triphasil.  I have not found any clinical trials done for Trigestrel, and this is what concerns me as I firmly believe in prescribing contraceptives cautiously.  A generic is often a copycat version of a medicine, using another company or individual's research done without laying out all the finance to do so. 

I suggest the following  :  Go into your local pharmacy or make an appointment to see your medical doctor, and ask one of these trained medical professionals to check up on the dosage of the oestrogen and progesterone content of Trigestrel.  Should Trigestrel be an exact copy of Triphasil, then you can consider staying with it. 

Should Trigestrel not be the same as Triphasil, please be guided by your doctor to use a similar contraceptive that has been clinically trialed. 

Good luck!

Warm regards

Angela  

Dear C

Thank you for your concerned queries.  It definitely sounds like the Yaz contraceptive pill does not agree with you.  Unfortunately there are a number of side effects of pharmaceutical contraceptives, and the extent of your high blood pressure, terrible mood swings and drop in libido are extreme, and my instinct is to advise you to come off it immediately.   Certain contraceptives suit certain individuals, and sometimes a change to another is required. 

From what you have indicated, and that you were on Yazmin for 2 years, this must have had fewer side effects than Yaz for you. 

I sense and appreciate your distress, hence my next piece of advice. 

As you were on Yasmin for 2 years, you were due to give your body a break of at least 2 months so as to release the build up of hormones in your body, which by the way settle in all the systems of the body, and not just in the gynaecological area.  Yaz definitely does not suit you, so I suggest you do come off it.  Talk to your partner about using condoms as a barrier method  -  family planning involves both the man and the woman, and is not just the woman's responsibility!  Two caring individuals should be able to do this, and it is vital that he tunes into your needs and health requirements.  My concern is your health, and to prevent an unplanned pregnancy.  

Once you have given your body a break/rest you could continue with Yasmine again.  Or to try the Femodene contraceptive pill, which is on of the lower dosage pills.  The pill is the most cost effective route for you. 

You are very young to start using the loop.  I always suggest that a woman be at least 28 - 30 years of age, as I have dealt with numerous problems in the past where there have been blockages in the Fallopian tubes due to the loop having been inserted prior to 28 years of age.  Also, a very careful family history and your own medical history is essential before being considered for the loop  -  i.e. no cardiovascular history of blood clots, heart attacks, strokes, heart murmers etc.  The Mareina intrauterine device (loop) has been carefully clinically trialled and is the best device on the market.  It is expensive, about two thousand rand, and it must be inserted by a gynaecologist as it is a specialized surgical procedure.  So there are extra consultation costs again.

The key to careful usage of pharmaceutical contraceptives, is to take care of your body correctly while on whichever one you decide to take.  Giving your body a rest or break from a contraceptive is important so as to release the build up of hormones in all the systems of the body. 

If you can come and see me, or telephone me so much the better, and then let me do a visual physiological assessment to see what other contraceptive would suit you.  As it is now, I recommend that you do the above with Yasmin.  The rest from a contraceptive will also ensure that infertility will not be introduced later on, should you decide to have children later.

I hope this helps  -  take care now,

Warm regards

Angela

Dear B

Thank you for your query.  The fact that your menstrual cycle is every 26 days  instead of being 28 days, is more likely to be an indication of high iron levels in the blood and a correct nutritional intake of foods containing iron.  However, on the other hand, it could be due to stress or medication containing anticoagulant properties that could have caused your period to be early, although it is probably the former.  From the information given, there is no cause for concern.

Many questions have already been answered under conception, fertility and pregnancy, and can be sourced as such, as to what supplements are suitable for each planning stage so as to stay healthy.

Take care now,

Warm regards

Angela

Dear B

Many thanks for your concerned query.

I suggest that you see your gynaecologist for a full gynaecological check up so as to be fully assessed and examined as to which contraceptive would suit you.  There are a number of factors which determine a correct choice of contraceptive for a patient.  Some of these factors are metabolic rate and weight.

Any family medical history or your own personal medical history where there is a tendency to any form of cardiovascular disease needs to be worked with carefully.  The IUD is not ideal for this kind of history  -  i.e. blood clots, heart murmurs etc. 

If you could make an appointment to see me, I will be able to guide you as to which contraceptive would suit you.  My contact telephone number is 021-4875435 or 4875420 between 09h00 and 16h00, monday to friday in Cape Town.

There are many different side effects to taking contraceptives, as they are all chemically based and synthetic.  So hence my suggestion, that you be assessed properly first. 

The pill takes 1-2 months to work out of the systems of the body after a year of usage.

The injection (there is a choice of two) takes a minimum of 3 months after a year of usage to be released from the body.  After 2 years of usage, up to 6 months can be required to be released from the systems of the body. 

If you can't get to see me due to being far away, contact me and I will talk you through the guidelines.

Good luck and take care.

Warm regards

Angela

Dear S

Many thanks for your query. 

It is recommended that for the first 3 weeks, once Triphasil has been commenced, that condoms are used as a barrier method.  However, I always suggest 6 weeks so as to allow the contraceptive pill to establish itself in the systems of the body for extra protection.  After the 6 weeks, you will be more than adequately safe not to fall pregnant. 

Just remember though please, that  a conventional antibiotic and certain cough mixtures can cause the pill to lose its efficasy temporarily, allowing the possibility of a conception.

Good luck and take care!

Warm regards

Angela

Dear B

Yes, you can fall pregnant within the first week of commencing the Petogen contraceptive injection when having unprotected intercourse.  However, it does depend on when your ovulation day would have been and if intercourse happened around that date. 

When in doubt, and as you are concerned, I do suggest that you consider having a pregnancy test done  -  although this would only read correctly after 10 days of the intercourse.   A simple urine test for pregnancy can be done first thing in the morning with a pregnancy test kit.  Our Wellness Warehouse Kloof Clinic does provide a service for checking all the different types of pregnancy tests should you wish to make an appointment for such.  

I suggest that you use condoms for preferably 3 weeks, and not just 1 week.  One week of protected sex is not really sufficient.  

Warm regards

Angela

Dear C

Thank you for your query. 

The best and safest contraceptive pill for you to take while breastfeeding is Microval.  Microval is often referred to as the 'mini pill' as it has a low dosage of oestrogen, and has been formulated specifically with breastfeeding mothers in mind.  I would prefer you to take Microval instead of Biphasil, due to the above reasoning.  Biphasil also has more oestrogen than is advisable while breastfeeding.

Contraceptive pills are not adivisable should you be a smoker.  This is particularly applicable to a woman who is 35 years of age and older, which you have already indicated that you are not. 

It is advisable to visit your gynae for a thorough checkup prior to going on to any contraceptive, so that a full family medical history and your own personal medical history is recorded.  Your medical specialist may suggest having a breast examination and cervical smear done as well. 

Good luck in enjoying your little daughter!

With warm regards

Angela

Dear K

Thank you for your question.

The description of your 'light' bleeding is a side effect of you coming off the Nur-Isterate contraceptive injection.  Light bleeding like this is called spotting or break through bleeding  -  from your description given, you are experiencing break through bleeding. 

You do need to keep your appointment with your gynaecologist as I am concerned about the 'bad smelling discharge.  A a cervical smear (Pap smear) is a diagnostic test done to determine an infection, and most definitely you do need to have a cervical smear done.  In the event of an infection, this can also prevent your periods from being normal.

My first instinct is to advise you to do the above, and then once there is a diagnosis we can treat from there with regulating your hormonal pattern.  You could also ask your gynae during your appointment his particular conventional approach to rectify your hormonal imbalance.  

Warm regards

Angela 

Hi

Conception (becoming pregnant) can occur only when a woman ovulates. This is around day 14 of the regular hormonal cycle. While taking contraception, if the hormonal levels drop (either as a result of missing a pill or injection, or taking something else that interferes with it) it is possible to ovulate and therefore conceive. Generally when a woman is fertile she will have a period, but it is possible to ovulate and therefore become pregnant without having a period.

While it is possible to become pregnant on the injection it is highly unlikely. It is however important to take it on time. In addition some antibiotics can speed up the metabolism of hormonal contraceptives and make them less effective.

While there are other possible causes for your symptoms, if you are concerned, it is best to do a pregnancy test to confirm.

Warm regards

Gabriell

Dear G

Thank you for your query.  Yes, vaginal dryness is listed as a side effect of all contraceptives. 

Do drink sufficient water of 2-3 litres daily.  You can use a personal lubricant like K-Y GEL prior to intercourse.  A multivitamin is essential when on any contraceptive.  A good quality one for your condition is WOMEN'S MULTI PLUS by Goodhealth, a New Zealand product, as x1 tablet daily after breakfast.  This product will also help to correct any hormonal imbalance caused by this contraceptive  -  indicated by the 'dryness'. 

Take care -

Warmest regards

Angela

Dear Anonymous

Thank you for your concerned query.

Triphasil is formulated to be commenced on the first day of bleeding of your period, with a red pill in the red section of the pill pack.  This is important as the pill will then work with your hormonal system for regularity.  Should you have done this, then I suggest that you have a Haemoglobin test to check your iron levels so as to determine that you are not anaemic.  A haemoglobin should be between 12  -  14 g% for an adult female.  At the same time check for another pregnancy test, for peace of mind. 

You are welcome to contact me for any further concerns about this query monday to friday, from 09h00  -  16h00 on telephone number 021-4875435 or 4875420.

Kind regards

Angela   

Dear V

Thank you for entrusting your query to me.  I fully understand your concern.

First of all, the after morning pill is formulated to prevent conception from taking place, and the sooner it is taken, then so much more effective.  It is hormone concentrated, so yes indeed it can, and in most instances does, affect the hormonal cycle by delaying a period for at least a month or even two months.  Having taken two after morning pills will definitely have affected your cycle even further. 

However, I do recommend that you have a pregnancy test done for peace of mind.  A simple urine test should be sufficient at this stage, but this should always be done in the morning, preferably before 10 a.m.  The reason for this is that the HCG hormone (human chorionicgonadotrophin hormone) is only raised in the morning, and this is what determines whether there is a negative or a positive pregnancy.  All pregnancy tests are sensivitely formulated to determine a pregnancy after 10 days, post intercourse. 

You can buy a simple pregnancy test from a pharmacy and do the test yourself  -  you are welcome to e-mail me again if unsure, or contact me on my direct clinic line on 021-4875435 or 4875420 between the hours of 09h00  -  16h00, monday to friday.   Either way, I am here to help support you.

Take care now,

Warmest regards

Angela 

Dear V

Thank you for your question. Three years of nur-isterate is a long time, especially if you haven't had a menstruation in that time. I do not think that it is surprising that you are having difficulty conceiving so soon after stopping the contraception as the drug can adversely affect your ability to ovulate and conceive up to a year after your last dose. I would just be patient and wait it out until 6-9 months post-injection and then re-evaluate your menstrual symptoms to determine if any medical intervention is required. Until then just relax..

Many thanks and warm regards

Yesheen

Dear A

Thank you for your query.  I understand your concern.

Continue taking your Microval pill up until the day before you start your next period.

Only commence with Nordette on the FIRST day of this next period, i.e. the first day of bleeding. 

Flip your pill pack over with the gold coloured foil facing you.  Now, the first pill to take from your Nordette pack will be the VERY first yellow pill in the top left hand corner, with the black arrow pointing to the right.  There are 21 yellow pills altogether.  Continue taking one yellow pill for each of the following 20 days i.e this is for 3 weeks. 

Only then, will you start taking the red pills, and these you will take for 7 consecutive days.  The red pills in Nordette are your inactive pills. 

After this, you will commence a new Nordette pack and just carry on with each yellow pill etc. until you arrive at your red pills again.

NB.  It is best to take Nordette in the evening between 5 and 6 p.m. or after supper.  This is due to the formulation of this particular pill.

I hope this all helps you  -

Warm regards

Angela

Dear M

Thank you for your query.  It is unfortunate that you had an unpleasant and inconclusive consultation with your doctor.  Correct usage of a contraceptive and side effects should always be discussed with a patient at a consultation  -  you are also paying for a service.

The first Nur-Isterate injection is best given within the first five days of commencing your menstrual cycle.  So the timing of your injection being administered by your doctor was correct. 

The exact date of your next Nur-Isterate injection is worked out as follows : 

Have a diary or calendar in front of you when you do this and then make a note of the date due for the next injection. 

Recap the date of the injection administered by your doctor, and work out exactly 8 weeks forward from this day. 

In other words, if your injection was administered on say Wednesday the 15th September 2010, the 8 weeks from this date would then be Wednesday the 10th November 2010.  It really is quite simple, but it does help and for accuracy as well, to work with a calendar diary. 

It is recommended that this contraceptive injection be administered every 8 weeks.

The first initial 3 weeks minimum, after the first injection administration, should also be covered with a back up barrier method, like condoms, so as to avoid an unplanned pregnancy.  Once 3 weeks is past, you should have enough of Nur-Isterate in your body to prevent conception. 

Our Kloof Clinic at our Wellness Warehouse store in Cape Town provides a family planning service daily, Monday to Friday with an appointment.  A first time appointment is R60,00c and every follow up appointment for family planning is R40,00c.  An appointment time is 20 minutes, and where necessary 30 minutes is allocated.

You are welcome to contact me with any further queries or problems you may have.  I hope the above assists you.

Warmest regards

Angela

Dear A

Thank you for your queries.  Your health problems do most definitely need to be assessed and examined by your general practitioner and gynaecologist.  You need to take care of yourself by seeing these doctors in person.  Your GP would do a full blood count blood test (FBC) and send it away to a laboratory for analysis to check your different groups of blood cells and haemoglobin.  He would also check on examination the abdominal area of which there are eight different quadrant areas. 

Your gynaecologist needs to do a full internal examination and cervical (pap) smear with the problems listed. 

It would be incorrect for me to treat you from a website question and answer aspect, when it is crucial that the above is done first.  However, I do feel that there is a magnesium deficiency and a fluid imbalance.  The above diagnostic tests do need to be done first.  Your Nur-Isterate contraceptive injection should not have created the back problem.  I suspect there is another reason for this.  A much more detailed and full comprehensive personal medical history and family medical history is required.  

Please make these responsible appointments soon.

Kind regards

Angela 

Hi

The rule of thumb is that you need to have been taking the active pills for 7 days before you are safe to have unprotected intercourse. So if you have been taking the pill each day at a similar time, you haven’t taken any medication that will interfere with the efficacy of the pill and haven’t had diarrhoea, then it is unlikely that you are pregnant.

When one starts to take the pill your hormones need to find a new balance. Sometimes it may take a few months to establish this new balance before you have a period.

If you are ever concerned about the possibility of being pregnant, the best way to know for sure is to get a pregnancy test and check.

Warm regards

Gabriell

Hi

While it would be highly unusual to become pregnant after only a few missed days, it is possible. If you are having symptoms similar to your first pregnancy then I would suggest going for a pregnancy test now before going for your next injection. If the pregnancy test is negative retest 14 days after the last unprotected intercourse. Use a condom now and for the first 2 weeks after having the injection.

Warm regards

Gabriell

Dear A

You have been using this contraceptive injection for over 10 years now, which is a long time.  I take it that you have not had a break from it in all this time?  You now have what is called breakthrough bleeding.  You should give your body a break or rest at least every 2 years from using this type of contraceptive so as to release the buildup of hormones in the body.  This rest assists the body in rectifying hormonal imbalances etc. I suggest that you consider doing thisfor up to 6 months, and then use condoms as a barrier method.

Dear L

Thank you for your query once again.

Not having seen you in person for an assessment and examination, there does come a point when a question and answer website is no longer enough, and for you now, you do need to make an appointment to see your medical doctor, as already advised. 

I cannot say if this is a period or not, or if you will commence your usual period on 25/09, as I have no diagnostic tests from you to assist me with a diagnosis.

Either an appointment with your local GP or your gynaecologist should suffice in resolving your problem, once you have been fully assessed and examined in person.

I hope you feel more like your old self soon.

Kind regards

Angela

Dear M

Thank you for your query. 

The company that formulated the Nur-Isterate contraceptive injection is Schering in Germany.  Schering advises clients on their Nur-Isterate packet insert to use this contraceptive for not longer than 2 years at a time, and then to take a break.  One of the reasons being that all the chemical components in this medication settle in all the systems of the body.  After a use of 2 years, it is always advisable to give your body a break from this contraceptive for a minimum of 3 months to a maximum of 6 months so that these chemicals can be released .  You have been off this contraceptive for 6 months now exactly.  However, you did take it for 4 years, so it may take you a little longer to fall pregnant. 

I suggest that you carry on with your omega and folic acid supplements for at least another month.  I always recommend a minimum 90 day programme of doing this prior to conception, and then to continue during your pregnancy and for 3 months post delivery. 

I cannot guarantee when you will fall pregnant as you have not been seen for a clinical assessment by our Well Clinic.

Should you not have started a regular hormonal menstrual patternwithin the next month, I suggest you make an appointment to see your medical doctor for a full checkup.

Kind regards

Angela

Dear K

Thank you for your query.  It is definitely advisable to use condoms for a minimum of 3 weeks after commencing the pill, and this applies to Triphasil as well.  However, I always recommend to my clients to do this for 6 weeks so as to be absolutely safe in avoiding an unplanned pregnancy. 

Vitamin C should preferably not be taken with your pill, purely because the pill depletes the skeletal structure of the body of mineral salts like calcium, potassium, magnesium etc.  Vitamin C is needed in the body for better absorption of these mineral salts from the foods you eat.  So I suggest that you don't take your Vitamin C and pill together.  The contraceptive function of your pill will not be affected by taking Vitamin C at the same time though  -  so this is the answer to your question. 

I recommend that you take your Vitamin C supplement after breakfast (always after food), and your Triphasil pill is listed to preferably take it in the late afternoon or early evening at either 5  or 6 p.m.  In short, take the two at least 4 hours apart, in that way you will get the full benefit of both.

With warmest regards

Angela

Dear M

Thank you for your recent query.  All the pharmaceutical contraceptives are synthetic and artificial.  Each woman is unique and different to the next one, so if a contraceptive has suited you up until now like Ginette and you have had few or no side effects so far, then perhaps you should consider staying with it for the time being. 

Your gynaecologist will be at an advantage in seeing you in person for an appointment where she can assess you visually and physiologically as to whether you should stay with Ginette or move over to Yasmin.  I am glad that you have heard good things about Yasmin, but not every woman who tries it has a positive response and side effects have been reported to our Well Clinic e.g.  chloasma (facial pigmentation) and an increase in hair above the top lip area.  Hence me saying that if Ginette has suited you so far, perhaps then think of staying with it for awhile.

Yasmine was formulated as an androgen based pill.  In other words, it was put together to treat acne based skin and at the same time to funtion as a contraceptive.  I have often recommended Yasmine to a client, but then only if I have visually assessed her first and taken a careful medical history. 

Any contraceptive pill should be avoided if a woman smokes, especially after the age of 35 years.  The reason being that the possibility of blood clots, strokes and cardiovascular disease is far greater. 

When on a contraceptive pill it is always advisable to take a good multivitamin as well, as all the pills deplete the skeletal structure of mineral salts like calcium, potassium, magnesium, etc.  I always recommend excellent products like :  VITA-LIFE by Amipro, taken as 1-4 vegicaps once daily after breakfast or lunch.  As an alternative, the MULTIVITAMIN + MINERAL FORMULA by Foodstate, taken as 1-2 tablets daily after breakfast.  Many of my clients have said they feel the difference.  All our Wellness Warehouse stores stock these multivitamins  -  you can order on line, and products can be delivered to you.

By all means discuss everything with your gynaecologist  -  it is good to have a second well balanced opinion.

Good luck with your future plans!

Warm regards

Angela

Dear Private

Thank you for your queries.  With your own personal medical history and the side effects listed for Yasmin, I strongly recommend that you consult with your medical doctor who prescribed this contraceptive for you.  A full comprehensive medical history needs to be established prior to prescribing a contraceptive. 

I do suggest that you also discuss your concerns about Celestamine with the same doctor, as he is the one who prescribed it for you and would have assessed you for the suitability of this medication.  In all fairness, your doctor knows you best and has seen you in person.  

Should you have been taking your Yasmin pill consistently every single day at the same time you would have a 98 - 99% contraceptive coverage.  You can be as intimate with your husband as much as you both would like, and still be assured of the efficacy of this contraceptive.  It is important to feel relaxed and know that you can still have lots of fun safely without the fear of a potential pregnancy.  Being on Celestamine at the same time as being on Yasmine, would not affect the efficacy of your pill.

I hope this helps you.

Warmest regards

Angela

Dear A

Thank you for your concerned query.  I do apologise for the delay.

Due to the formulation of Triphasil, it is crucial that you commence taking this contraceptive pill as a RED tablet (not the orange or yelow) for the relevant day on the first day of bleeding of your menstrual period.  When commencing Triphasil specifically for the first time, please always start in the red section of the pack, on the first day of your menstrual bleed.  Unfortunately, you were not advised correctly.  You can now either restart a new pack correctly, if this problem has not already been resolved for you, and purely for peace of mind you could do a pregnancy test to ensure that there is no pregnancy present.     

You are welcome to contact me telephonically on 021-4875435 or 4875420 to further resolve any additional or final query to your original problem posed.  

Warm regards

Angela

Dear C

Thank you for your questions. Skipping any of the pills on the Triphasil packet interrupts the regular cycle of hormones in your system, and depending on how sensitive your body is this may or may not result in a change to your menstrual cycle and protection against falling pregnant. I would advise that if you do skip any particular pill you should continue with the following day's pill as normal but with the added protection of condom use until you have completed your cycle.

Warm regards

Yesheen

Dear A

Thank you for your query and for the detail given.  I fully comprehend your concerns.

Your correct approach now, is to commence a new pack of Triphasil,  always starting in the RED section on the FIRST day of your NEXT menstrual bleed, with the day marked as applicable for that first day of bleeding.  It is really important to follow this instruction, as a result of the formulation of this particular contraceptive pill.  In the interim, it is strongly recommended that you use a backup barrier contraceptive method, like condoms.  And I suggest that you use condoms for a minimum of 3 weeks even after recommencing Triphasil. 

Should you remain worried about a possible pregnancy, you could always do a simple urine test for pregnancy, preferably to be done before 10h00 in a morning, so as to establish a correct reading  -  The HCG hormone (human chorionicgonadotrophin hormone) is only raised in the morning in an early pregnancy.

You are welcome to contact me on telephone numbers 021-4875435 or 4875420 should you need further clarification, or through our Well Panel.  Just please do attach your previous query when asking for additional information in relation to the same query.

I wish you well.  Take care now,

Warmest regards

Angela

Dear S

Thank you for your query, and for your detailed clinical picture. 

Your problem is a common one.  It is advisable to take Nur-Isterate for not longer than 2 years and then give your body a break for a minimum of 3 to 6 months so as to release all the chemical components from the different systems of the body.  As you have had Nur-Isterate for about 3 years now, you are experiencing break through bleeding and spotting as side effects of being on this contraceptive for longer than the 2 year recommended time span. 

All you need to do is come off Nur-Isterate for, and for you I recommend 6 months, and to use a barrier method like condoms in the meantime. 

Should you not have seen your gynaecologist for an appointment in the last 3 years, then I do suggest that you make this responsible appointment for a full checkup, which should include a breast examination and cervical (pap) smear.

All the best of health to you.

Warmest regards

Angela

Dear J

Thank you for your question. Yasmin is a combination pill, containing both oestrogen and progesterone derivatives. One of the side effects of the drug is intermenstrual bleeding, as well as migraines, nausea, vomiting and hypotension, and it is contra-indicated in undiagnosed vaginal bleeding. I'm surprised your gynaecologist prescribed the drug for you given the information you provide in your question.

When you had your bloods done were your sex hormones also tested? If yes on which day of your cycle were the tests done? If not I would consider asking your practitioner to retest on the most appropriate day to find out where you baseline levels are. 

Regarding management I would consider stopping the Yasmin, adding a good quality Vitamin D3 supplement as well as adequate doses of Maca root powder into you daily diet. If you need to make use of a contraception I would go the progesterone-only route, and even make use of the skin implant or IUD if appropriate. There are still quite a few missing pieces in your puzzle but I hope the above can help. Please don't hesitate to contact me again for further information.

Many thanks and warm regards

Yesheen

Dear C

Thank you for your query.  The Depo Provera contraceptive injection certainly seems to have quickly regulated your cycle, due to you already having had menses for 5 days.

I definitely suggest that you have a pregnancy test done now.  The BHCG Quantitative blood test would be your best option at present.  This blood test is done by our Kloof Clinic in Cape Town and is sent away for a laboratory analysis to determine pregnancy and how many weeks gestation there is.  Alternatively, you can contact your general practitioner, who would do the same.

There is a chance that you could be irregular which would simply mean that your hormonal cycle is settling down, however please do check to see if you are pregnant please.

Warmest regards

Angela

Dear L

Thank you for your query. 

I recommend that you only consider having an IUD (intrauterine device) fitted by a gynaecologist.  I am not currently aware of general practitioners performing this procedure any more  -  they also prefer to refer patients/clients to a gynaecologist as it is a specialist surgical procedure and the device must be inserted correctly.  The family planning clinics do not insert the coil/copper T or any other IUD as family planning sisters are not trained to do this procedure, due to South African legislation. 

For the cost you are looking at a gynaecological appointment fee, and in addition, depending on the type of IUD used, the cost of that as well.  It would be best to discuss with your gynae which one would be the most suitable for you specifically, once he/she has seen you in person and assessed and examined you and taken a thorough personal and family medical history. 

Your least expensive approach is the pill or the contraceptive injection.  Should you decide to make an appointment to see me, you would be assessed and guided as to which contraceptive would suit you best due to your physiological profile.  

My contact telephone number is 021-4875420 or 4875435 between the hours of 09h00 - 16h00, at the Kloof Clinic in our Cape Town Wellness Warehouse Store. 

Warm regards

Angela

You could consider the EVRA TRANSDERMAL PATCH.  

Hi

If you want to stop you can just stop - don’t go for the next injection. You may experience some mild symptoms as your hormones adjust but anything you feel will be no more than you felt when you started the injection – nothing to be worried about! Often people don't feel anything different. Obviously you would need to use a barrier form of contraception.

The contraceptive injection doesn’t affect your ability to have children later in life. However, once you stop the injection it can take a few months for your hormonal cycle to re-establish its natural balance before you can conceive. As your hormones find their natural cycle, your period should become more regular.

Unfortunately all hormonal contraceptives – both injection and oral can result in weight gain. It is easier to lose this once you stop the injection. Headaches can be triggered by the hormones in the injections, but also by many other things. If the headaches improve when you stop the injection then you know they were hormonal; if not you need to look for another cause.

So, you do not need to worry about stopping the injection of you no longer want to use it.

Warm regards

Gabriell

Taking a hormone contraceptive is a very common, yet controversial choice. It is thus a very personal choice, with either option having pros and cons. Smoking whilst taking the pill does predispose to clotting which can cause very serious complications. My first recommendation would be for you to stop smoking, as it obviously jeopardise one's health tremendously in many different ways.

You could also look at the contraceptive injection, as this does not have the same risks as taking the pill and smoking. Some women react better to the pill and others to the injection. It would be best for you to discuss these options with your gynae or general practitioner.

There is controversy as to the long term effects these hormones have on fertility.

As alternatives, the only relatively safe options are condom usage and possibly the rhythm method, whereby you carefully monitor your ovulation and abstain or use condoms on those risky days.

You could also stay on the pill and take an alternative to asprin to aid in blood thinning, such as Omega 3 fish oils (The Real Thing does a nice one), or Vitamin E (Solgar does a good one).

Warm regards, Dr. Megan Jones, Registered Homoeopath

Dear L

Thank you for your query. 

Your pharmacist has advised you correctly.  However, you should not bleed for longer than 7 days with menstruation.  The after morning pill is hormone concentrated, so it is not unusual for a period to be triggered. 

Should you bleed for longer than the maximum normal time span of 7 days for a period, I suggest that you contact your general practitioner for an appointment so that he/she can assess you fully.

With warm regards

Angela
 

Dear C

Thank you for your query.  I fully understand your concern.

Yes indeed, Triphasil can affect you this way the second time around, although this is not common.  But then that is the uniqueness of each woman!

However, even more importantly, it may not be the Triphasil which is causing your signs and symptoms.  I suggest that you have a pathology blood test done for your thyroid   -   this test would be called :  thyroid function test, inclusive of T3.

This blood test is sent away to a laboratory for analysis to determine the functionality of the thyroid and to assist in establishing where the deficiencies lie for the thyroid.  Our Kloof Clinic in Cape Town does all pathology tests with a specialist laboratory service.  It is cost effective and a result can be given within 2 - 3 days.

You are welcome to contact me for an appointment on telephone number 021-4875435 or 4875420.

Warm regards

Angela 

Dear N

Always read the packet insert in the box before commencing a new contraceptive pill.  Due to the formation of this pill, the correct approach is to commence taking your pill in the RED section on the FIRST DAY of your menstrual bleed.  From the way in which your query is worded, this was not done   -    However, should you have commenced your Triphasil pill correctly and it is just the one white pill that you missed, then all you need to do is to carry on and take the next white pill.  This will not upset your hormonal pattern. 

But if you did not originally start in the red section on the first day of your menstrual bleed, and only started with the white pills, then in essence you should really wait until your next menses and restart taking Triphasil as mentioned above.  I strongly recommend that you use a barrier method like condoms in the interim, for at least 3 weeks while your body builds up enough of the inhibiting factors to prevent conception from forming.

Should you still be confused, you are more than welcome to contact me again, but you should be more than fine when applying the above.

Warmest Regards

Angela

Dear T

Thank you for you query.  Both the Mirelle and Nordette contraceptive pills are of schedule 3 status medication.  They are both low-dosage pills with estrogenic and progestogenic effects.

Mirelle is prescripted only by a medical doctor, as in a general practitioner or gynaecologist according to South African legislation.  Nordette is part of the government regimen for family planning as one of the pills available in the government sector.  Nordette can also be prescribed by a nursing practitioner at a pharmacy clinic or primary health care clinic in the private sector. 

The pill generally should not be taken by a woman who has a personal medical history of cardiovascular disease, and or a family history of such.  Smoking is a definite NO when taking the pill.  It is always advisable to see a health professional in person who is qualified to assess, examine and determine which pill would suit you the most.      

Both respective pills are similar in their action and hormone dosage.  Both are synthetic, just like all the conventional/pharmaceutical contraceptive pills.  A leaflet insert is in each contraceptive pill packet and it is really important to read this first prior to commencing a new pill type.  Side effects are listed.  Mirelle advises against anyone using it who has a medical history of the liver.  Otherwise for both pills, there must be no cardiovascular history. 

Standard common side effects are a raise in blood pressure, weight gain, and less frequently headaches  -  remember, these pills are all synthetic.  Therefore, it is important to visit a family planning clinic at least every 3 months for a family planning checkup with a family planning nursing sister. 

You need to establish yourself as to how you feel when on a contraceptive.  Each person responds differently.  It is difficult for me to say how you would react/respond to a pill as I have not seen you for family planning myself.  None the less, all the above applies.

Good luck with your choice!

Warm regards

Angela 

Hi there J

Thanks for your queries.  I fully understand all your concerns.

Firstly, when taking any of the oral contraceptives, it is absolutely vital that you are 100% compliant in taking your pill every single day and at the same time  -  now this you have assured me you already do  -  which is great. 

I take it that Triphasil so far agrees with you.  This contraceptive pill is a schedule 3 medication, and is regarded as one of the low dosage pills, although mainly oestrogen based, hence again the importance of remembering to take your pill on time.  All conventional/allopathic (i.e. pharmaceutical) contraceptives are synthetic (artificial).  The 4 different contraceptive pills you have mentioned having been on, are a few examples. 

Your pill pack should always be dispensed to you with a leaflet insert which fully explains the usage of your pill.  Please read it  -  Triphasil has undergone clinical trials, and all side effects have to be listed in a minimum five year research time span.  It is recommended that this pill be taken early evening or at night, however it must be a time that will be easy for you and which will fit in with your schedule. 

Don't panic about what happened with your Mum while she was on Triphasil  -  there would have been a reason e.g. she might have been late in taking her pill, or she could have been on a course of antibiotics, or she could have changed her contraceptive and had not been on it long enough, these are some of the simplest of reasons  -   a problem like this is not hereditary! 

"Natural Family Planning Methods" can be googled and used as a back-up form of contraception.  These methods have been used for a very long time.  They do require the full co-operation of both partners though.   The natural family planning method I am thinking of, with you in mind, is the Billings method which checks the mucous viscosity of the vaginal fluid.  This is done by you on a daily basis.

You are welcome to make an appointment to see me at the Well Clinic at our Kloof store in Cape Town, should you live in the western cape.  When I see clients for family planning, I do a physiological assessment to see which contraceptive would be suitable for you.  You are also welcome to telephone me with any clarification needed.

It is also very important not to smoke when on any pill.  

Get to know your body by keeping a daily record in your diary of how many days your hormonal cycle covers i.e. is it a 28, or a 30, or a 31 day cycle.  Most healthy women have a 28 day cycle.  The first day of your menstrual bleed is day 1 of your hormonal cycle.  Therefore day 14 will be your ovulation date, and would be your most risky time for a potential pregnancy  -  hence me emphasising the importance of compliance and correct usage for Triphasil.  In total, the 3 days prior to the ovulation day, on the day of ovulation, and the 3 days after the ovulation date is the riskiest time.  But being on the pill regularly will give you 98-99% coverage.  During this time you could use condoms, instead of one of the natural family planning methods.  Try and relax, and remember to take your pill correctly.   

I hope that all this helps you.  Take care now,

Warm regards

Angela

Dear C

Thank you for your query. 

The loop or IUD (intrauterine device) is a contraceptive option for a woman who has no personal medical cardiovascular history, or family medical history with heart problems.  The IUD must always be inserted by a gynaecologist as it is a specialist surgical procedure.  The legislation in South Africa does not allow family planning sisters to perform this procedure, besides of which they are not trained to perform this procedure.  I do not know of any current general practitioners who do this procedure either  -  they prefer to refer patients/clients to a gynaecologist.   

The MIRENA INTRAUTERINE DEVICE (Loop) has been carefully and clinically trialled.  This IUD is inserted for five years, and again done by a gynae only.  It is expensive.  You could discuss other loop options with your doctor.  Again there must be no cardiovascular history whatsoever.

Good luck with your choice!

Warmest regards

Angela

Dear T

Thank you for giving a detailed clinical profile. 

All your signs and symptoms are an indication of an early pregnancy.  However, this does need to be confirmed with a diagnostic test to determine such.  I suggest that you have the BHCG Quantitative blood test done, and not just a urine test for pregnancy.  This blood test would determine how many weeks gestation there is.   

Should there not be a pregnancy, then it would most likely be an iron deficiency anaemia. 

I suggest that you contact your general practitioner or nearest pharmacy clinic so as to have the BHCG quantitative test done.  Our Well Clinic in Kloof Street, Cape Town, does these tests mentioned.  You can contact the clinic for an appointment on telephone number 021-4875420 or 4875435.

Good luck,

Warm regards

Angela

Dear F

Unfortunately you have not said which of the two contraceptive injections it is that you are on.  I suggest that you visit your family planning clinic and see the family planning sister for a check up. 

With your indications given, this is indicative of a woman who has been on the contraceptive injection for a minimum of two years or longer.  Break through bleeding and small, short menses can occur, notably more with the Nur-Isterate contraceptive injection (given every 8 weeks, and often referred to as the 2 monthly injection).    

I doubt very much that there is a pregnancy, however for peace of mind and due to your concern you could always make extra sure by having a pregnancy test done.  Our Well Clinic in Kloof Street, Cape Town does all the different pregnancy tests.  Contact the Well Clinic directly on telephone number 021-4875435 or 4875420 for an appointment between the hours of 09h00  -  16h00.   You are also welcome to contact me directly on these numbers during these hours.

Take care now,

Warm regards

Angela

Dear S

Thank you for your query.  Should you only have commenced having the contraceptive injection for the first time on 03/06/2010, and then do not have it administered again, it will take up to 3 months to be released in total from your body.  The return date of 25/08/2010 is correct, and with the time span you have given, the contraceptive injection you are speaking about would be Depo Provera or the generic version, which is Petogen. 

Changing your contraceptive to a pill would provide a 1  -  2% possibility of falling pregnant.  I recommend that you make use of a barrier method like condoms as well, from the time that you change over to your pill for 3 weeks  -   this is my recommendation as I do believe in working cautiously with contraceptive changes.  

Good luck, relax and have fun!

Warm regards

Angela

Hi

You don’t need to worry!

The injection is more than 99% effective at preventing pregnancy if used correctly. So if you have been getting the injection regularly and on time then you can be assured that you can have as much sex as you like with your husband ejaculating inside you, without becoming pregnant.

Have a wonderful wedding and have lots of fun!

Warm regards

Gabriell

Dear N

Thank you for your query. 

24th June was a thursday, so you count the next thursday as the full first week. 

12 weeks exactly from 24/06/2010 will be thursday 16TH SEPTEMBER as your RETURN DATE.  (The 10th September is a friday and would be 6 days too early for you to have your next injection for Petogen). 

Warm regards

Angela

Dear X

Congratulations on the happy occasion! An injectable contraception has a 3% typical-use failure rate. That means that if all external factors are taken into account there is a 3% probability that a woman on an injectable contraception could fall pregnant. If you want to make doubly sure that you don't use condoms in addition to you injection.

Many thanks and warm regards

Yesheen

Dear J

Thank you for your question.  With the brief profile given, there would be a small possibility of you falling pregnant.  Antibiotics have been proven to affect the efficacy of contraception. 

Pregnancy tests are formulated to determine conception from ten days after intercourse.  For peace of mind and due to your concern, I suggest that you have a pregnancy test done so as to determine either way. 

Kind regards

Angela

Dear L-A

I suggest you visit your clinic sister or general practitioner and have a B-HCG quantitative blood test done to determine whether you are definitely pregnant or not.  This test will also determine how many weeks you are pregnant.  The blood is sent away to a pathology laboratory for analysis.  The results are specific.

Our Kloof Clinic in Cape Town does all pathology tests, inclusive of pregnancy tests. 

To make an appointment please telephone 021- 4875420 or 4875435.

Kind regards

Angela

Dear A

Unfortunately you have not stated which contraceptive pill you are on. 

There are a varied assortment of different contraceptive pills available.  To advise you correctly, you need to please indicate which one it is that you are currently on.  I have looked at those available  -  however, they are similar in colour and appearance, but differ in the way they are formulated, and this is why you need to indicate the name of the contraceptive. 

Should you be unsure about a possible pregnancy, I suggest that for peace of mind, you consider doing a pregnancy test in the interim.

Kind regards

Angela

Dear Eska

Thank you for your query.  First of all, as you have been on a variety of contraceptives for a few years now, it really would be advisable if you could now give your body a break by coming off contraceptives for at least 2 - 3 months, so as to assist your body in releasing all the chemical components from the different systems in your body.  The signs and symptoms experienced after each contraceptive are as a result of being on the respective contraceptive for two years or more at a time.  It is advisable to use a contraceptive barrier method like condoms, while not taking the pill, and then for a minimum of 3 weeks once you recommence taking the pill. 

Each woman is unique.   Sometimes one has to establish with trial and error, which contraceptive suits you best.   I recommend that you choose one of several choices, for your problem  : 

1)  As you felt well on TRIPHASIL previously, and once you have had a rest from taking all contraceptives, you could take this particular oral pill again.  It really is advisable to take it for a maximum of two years, and then give your body a rest, as stated above.  

2)  There is a choice of two other oral contraceptives which may well suit you.  However they have to be prescripted by your medical doctor, so you would need to schedule an appointment to see him/her.  FEMODENE is a schedule 3 contraceptive pill, and is progesterone based.  This is a low dosage pill and has few side effects listed.  It is important that you still have your blood pressure and weight checked at a family planning clinic at least every three months so as to ensure that you do not develop hypertension and gain weight  -  2 of the main side effects of all pharmaceutical contraception.  The cost of Femodene is R86,40c.

3)  My third alternative choice for you would be the YASMIN contraceptive pill.  Again of schedule 3 status and a low progesterone based pill.  The cost of Yasmin is R119,35c. 

 Please read your packet insert correctly before  taking any pill, so as to commence taking the pill in the correct colour section  -  this is very important.

I hope all this helps you. 

Warm regards

Angela

Hi there,

The contraceptive injection starts giving proper contraceptive coverage from 3 weeks after the injection administration.  I always recommend the use of a good barrier method, like condoms, to be used for the first 6 weeks though. 

In your particular case, you would still have a measure of the contraceptive in your body, so there may still be a small chance of contraceptive coverage.  For peace of mind, I suggest that you have a pregnancy test done anyway  -  this will confirm either way for you, and also release the worry factor  -  I fully understand how you feel  -  so do all this, and if necessary, we can look at your situation again.

Take care now,

Warm regards

Angela

Thank you for your query, and congratulations on being a mum! 

I suggest that you make an appointment to see your local clinic and request a blood pressure reading and also for a haemoglobin test to be done.  Your severe headaches and dizziness could be a result of a raise in blood pressure.  Two of the main side effects of any of the pharmaceutical contraceptives are, a raise in blood pressure and or weight gain.  

I suggest a haemoglobin blood test as well, because should anaemia be a problem, headaches of this nature and dizziness, are also signs and symptoms of anaemia.  Nausea and heartburn are indicative of a gastrointestinal condition, and among other things, stress.  Nausea and heartburn are not typical side effects of Depo Provera.

As your signs and symptoms are obviously causing discomfort and concern, I do encourage you to make that visit to a clinic or your general practitioner. 

Should your BP be normal you could continue taking Depo Provera.  However, if you feel that your body is telling you that it is not right for you, you could revert back to having the Nur-Isterate injection, as you say this did suit you.    

Good luck  -  I hope you feel better soon.

Kind regards

Angela 

The Nur-Isterate contraceptive takes between 3 to 6 months to be fully cleared from all the systems of the body.  However, in your particular instance, it will take at least 6 months. 

It is advisable, when taking Nur-Isterate, to give your body a break after every two years from this injection for 3 to 6 months so as to release the chemical components from the body.  Otherwise, there can be a buildup of such in all the body systems, often resulting in weight gain or massive weight gain  -  resulting in difficulty in losing body mass. 

It is always advisable to use a backup contraceptive method like condoms when not using other contraceptives, as there is always even the remotest possibility of falling pregnant  -  although for you, with your given information, I really don't think that you are pregnant.  If you are worried about this, I suggest that for peace of mind you have a pregnancy test done.  This service is provided at our Well Clinic in Kloof street, Cape Town from monday to friday between the hours of 09h00 - 16h00, with an appointment.  The contact telephone numbers are 021-4875420 or 4875435. 

Kind regards

Angela

Hi

One generally starts the pill on a Sat, so did you start on the 31st of July?

If you did then you will finish the active pills of the second pack on the 17th of September and would have had a period the following week. You can skip the inactive pills and go straight to the active pills of a new pack. This isn’t ideal and definitely shouldn’t be done frequently, however it is fine to do it once. You will still have effective contraception and won’t have a period that month.

If you haven’t started taking the pills yet then I would suggest starting on the 7th of August. Your period will then start about the 29th of September.

Enjoy your wedding!

Gabriell

Your pharmacist has correctly advised you to take the Microval mini pill, which is definitely better and more suitable for you whilst breastfeeding.  Yes, your body has been thrown out of sync, and although not serious at all, you need to be patient for your hormonal cycle to re-establish itself.  You could give yourself a month to recover with a proper hormonal pattern, but in the meantime if you are concerned about another possible pregnancy, then for peace of mind you can have a pregnancy test done.  Our Well Clinic at the Wellness Warehouse store in Cape Town provides this service monday to friday, with an appointment.  

Take care and good luck!

Warmest regards

Angela

If at all possible, I would recomend that you consider giving your body a break from contraceptives for 1 - 2 months so that the chemical components can be released from all the systems of the body from you having been on Yasmin.  This would be the ideal situation, if you can do this.  In the interim, it is always advisable to use a backup barrier method like condoms.  The pill can sorely deplete the body of mineral salts and nutriments, and if you are not already on a good quality multivitamin supplement then I recommend this be considered.  Once you have given your body a break, then you could resume with the 3 monthly contraceptive injection.

Kind regards

Angela

Hi

If I understand you correctly, you missed one pill, a few days later you had intercourse then about 5 days later missed 2 pills?

It is impossible to say for sure, however I would say that the chances are small. One missed pill shouldn’t make much difference, however the problem is when several pills are missed and hormonal levels drop. The 2 pills that you missed in a row occurred after ovulation. This would mean that you are unlikely to be pregnant now, however you might ovulate sooner than normal in the future and so are at risk of becoming pregnant if you continue to have unprotected intercourse. I would suggest that you complete the rest of the pack without skipping any. If your period doesn’t come as normal do a pregnancy test (this can be falsely negative if done sooner). Start the next pack as normal and use a barrier form of contraception such as a condom from now until you have completed 7 consecutive days of taking the pill.

Warm regards

Gabriell

Dear A

Thank your for your questions. In my personal opinion it is never a good idea to combine two different medications into one syringe prior to administration. The active ingredients within each drug have only been tested for effectivity and safety only when present together with the other ingredients that come in the pre-prepared injection. Usually you are allowed to dilute with sterile water if need be but that too is only if stated as such on the package insert. Often times the ability of the drug to do what it is purported to do is reduced or increased by the addition of a second drug into the syringe prior to administration. I would thus be hesitant to combine Vitamin B, B Complex and Nur-Isterate into one syringe, unless you don't mind running the risk of an accidental pregnancy to save yourself a little pain...

Regarding the use of oral contraceptives while on a more long-term one such as a depot preparation I would first have to ask what injection are you on, which oral contraceptive did you use and why did you use it? The plan is usually to make a decision on whether to go the oral or the intramuscular route, and then to stick to it unless complications arise, which then may necessitate the temporary use of, or permanent switch to, a secondary form of contraception. I would recommend you speak to your local nursing sister or doctor regarding the reason why you feel the need to use both and see how they can help you streamline your contraception use.

Many thanks and warm regards

Yesheen

Thank you for your query  -  right now you must be feeling very uncomfortable.  I do apologise for the 4 days delay and thank you for your detailed clinical picture. 

Ciprofloxin and Millespas are strong antibiotics and can upset the gastrointestinal flora and fauna in the colon, should you not have been taking a probiotic as well.  A probiotic helps the flora and fauna (the friendly bacteria) to grow back again  -  otherwise thrush can settle in and so cause an imbalance in the body, hence a yeast infection.  

The few days difference in being late for your Nur-Isterate injection would not make that much difference, but having been on the antibiotics as well is where the efficacy (effectiveness) of the contraceptive injection come in.  Your signs and symptoms can also be indicative of a pregnancy.  So yes, my advice is to redo a pregnancy test.  A pregnancy test using a urine sample is very sensitive and is designed to determine conception from 10 days, once ovulation has occurred.  A urine test should be done in the morning, preferably before 10 a.m. when urine is concentrated with the HCG (human chorionic gonadotrophin) hormone.  Doing the pregnancy test will also help to give peace of mind.   

I hope you feel more like your self again soon  -  take care now.

Kind regards

Angela

Hi

Yes you will still be able to conceive however it does take the body a few months to re-establish a regular hormonal cycle after stopping the injection. I would suggest that you stop the injection about 6 months before you would like to conceive to allow time for your body to re-establish its natural balance. You can then use a barrier form of contraception until your periods are regular and you are ready to conceive.

Warm regards

Gabriell

Many thanks for your query.  I fully comprehend your predicament .  Your clinical picture is typical of having been on the Depo-Provera contraceptive injection.  This is a schedule 4 status medicine and is concentrated.  It was originally formulated to be used by older women.    

There are numerous side effects for all the different contraceptives, as there is for this particular contraceptive.  Undiagnosed vaginal bleeding is one side effect, and especially when used for longer than two years without giving your body a break from it.  This seems to be the possible cause of your bleeding.  The fact that your bleeding is reoccurring and for lengthy time spans is not where you want to be. 

I suggest the following  :

It is most definitely time to give your body a break from Dep-Provera.  The ideal approach would be to not have it for a minimum of 3 months.  If you can, 6 months would be even better.  In the meantime, use a barrier method like condoms.  The chemical components deposit or lodge in all the different systems of the body, and after 2 years any number of side effects can occur.  Should you not be taking a multivitamin, then this is also necessary, so as to assist in replacing the mineral salts lost from the skeletal structure, as a result of being on Dep-Provera.

If you are able to make an appointment to see me, so much the better, then I can do a full assessment for you and guide you from there.  I am based at the Well Clinic at our Kloof store in Cape Town on telephone number 021-4875420, mondays to fridays from 09h00  -  16h00.  Please let me know how you do. 

With warm regards

Angela 

Hi

I think that it is highly unlikely that you are pregnant. While the first sign of pregnancy can be implantation bleeding, this spotting and/or cramping usually occurs around 8 days after conception. Bleeding 3 days after intercourse is more likely to occur from an internal abrasion from the sex. While contraception isn’t 100% effective most forms provide very high levels of protection, so if you had used the contraception according to the instructions then there is probably nothing to worry about.

So you can relax and breathe easily. I am sure that your period will start around the 18th as usual.

Warm regards

Gabriell

Dear Prosperity

The Family Planning Clinic on Cape Town Station provides the government family planning regimen.  It does practice on a first come, first serve basis.  The contact telephone number is 021 - 4252004.  

The Dorp Street Clinic in Cape Town also provides the government regimen.  The address is No. 3 Dorp Street, and the contact telephone number is 021 - 4834662.

Both of these clinics provide free family planning uner the government regimen.

Warm regards

Angela

Thank you for your very relevant query.  It is very important that you took your pill from the red section of your Triphasil pack marked with the appropriate day of the week, on the FIRST day of your menstrual bleed.  Withdrawal bleeding would normally only occur after finishing the last pill in the yellow section.  Should you have started taking the appropriate pill in the red section 5 days after ovulation, it is listed that conception can occur.  And yes, it is recommended and preferable that condoms be used for a minimum of two weeks when changing over from Microval to Triphasil. 

I understand your concern about an unplanned pregnancy, hence me suggesting that you have a pregnancy test done so as to make sure.  There may be no cause for alarm, but to make sure and for peace of mind, do a pregnancy test at your local clinic. 

Kind regards

Angela, Nursing Practitioner.

Hi

Yes rather confusing!

While on the pill, whenever the hormone levels in your body drop, there will be a period, so that would have been your period. If you haven’t worked out a plan by now, I would suggest just continuing on sequentially from where you are. Your body is probably a bit confused so you might have odd bleeding or spotting – don’t worry about it! Your next period will be sooner than normal – that’s absolutely fine. For the next couple months take all the pills in sequence to allow your body to get back to balance. I would also suggest using condoms until you’ve had a full week of taking the correct pills again.

In general if you don’t want to have a period it is best to skip the inactive pills (as you are doing) and then just continue through the rest of the pills without going back to the inactive pills. So instead of delaying your period, you just don’t have it for that month. It is important to have the continuity through all of the active pills. While skipping ones period isn’t ideal on a regular basis, it is absolutely fine every now and then.

Don’t worry about this! Your body will just be a bit confused but will quickly get back to balance.

Warm regards

Gabriell

The pill is designed to mimic the body’s natural hormonal cycle as closely as possible. The inactive section is created to mimic the time when our hormones would naturally decrease so that we have a period. It usually takes a couple days after stopping the active pills for the period to start and the period usually lasts several days. While it is not necessary to actually take the inactive pills, it is important to allow the days without hormones. Ideally no days should be skipped. So the inactive pills don’t mark the time when you will have a period; they mark the time that your body needs a break from hormones. It doesn’t matter exactly when your period starts and stops, your body will find its own rhythm while on the pill.

According to drug guidelines you need to wait 1 month after stopping Acnetane before conceiving, however I would suggest 6 months to be sure. Generally once you stop using Acnetane your acne will be gone or much better. However it is important to stay relaxed and healthy, as stress and toxins contribute to developing acne.

Kind Regards

Dr Gabriell Prinsloo

Hi Zama

I am so glad that you have done all this for yourself and in preparation before having your baby! 

You can keep on taking your supplements right up until conception, during your pregnancy and postnatally for 3-6 months after the delivery.  The supplements will keep you in peak condition and at the same time ensure that your baby develops a healthy brain, nervous system and musculoskeletal system. 

Continuing with your supplementation can only assist you, it will in no way harm you or your baby at all.  You can only reap the benefits!  All the best of luck to you.

With warmest regards

Angela, Nursing Practitioner. 

Virtually all women on Petogen experience some change or irregularity of menstruation. The injection is still working effectively and as long as you are having the injection on time you are protected from becoming pregnant.

Kind regards

Dr Gabriell Prinsloo

Yes this is normal. When you stop taking the contraceptive pill your hormones need to find their natural balance again and this can take up to a few months. During that time you might have a very irregular bleeding pattern. Don’t worry about this and just give your body some time to rebalance. It is most likely that you will get pregnant when your body has re-established its natural rhythm.

You can use this time to prepare your body to be pregnant by eating well, taking all of the right supplements and getting (or staying) fit and strong.

Kind regards

Dr Gabriell Prinsloo

Hi

The majority of antibiotics do not decrease the effectiveness of the 2 month injection. While there are a few that can affect the injection, most commonly prescribed antibiotics don’t. In addition, having intercourse during a period doesn’t increase the chance of pregnancy.

If you are getting your injection on time and you abstained while you were on antibiotics it is highly unlikely that you are pregnant. It is most likely that your body doesn’t feel right as a result of the illness that you had and the antibiotics that you took! Not only do antibiotics kill the bad bacteria, they also knock out the good ones in the digestive system which can result in indigestion and bloating.

I would suggest taking some probiotics to restore the good bacteria in your gut, and giving your body some time to heal. If your body still doesn’t feel right or if you are still in doubt then do a pregnancy test to be sure (they are not expensive and easy to use). You are also welcome to send me the name of the antibiotics and I will let you know if those specific ones affect the injection. The Doctor who prescribed the antibiotics would also be able to tell you if it interacts with the contraceptive injection.

Kind regards

Dr Gabriell Prinsloo

Thank you for your measurements.  With a height of 1.72 m and a weight (body mass) of 52 kg, your BMI (body mass index) is 18.  A BMI of 18 indicates that you are 7 kg underweight for your particular height.  Your BMI should be a minimum of 20.  In order to gain weight, you need to firstly create a realistic goal by setting a minimum target of a BMI of 20 (i.e. 58 kg).  Once your BMI is 20, the next step would be to work towards a BMI of 22  -  this means that your weight would then be 64 kg. 

'Cod liver oil extract of moult' is a thick dark brown substance which is often taken to assist in providing oils to help line the chest so as to prevent respiratory infections.  Moult when taken 3 times a day as in x2 dessert spoonfuls can definitely help to slowly gain weight.  Your skin, hair and nails will also be much healthier all round. Apart from just taking moult, a healthy and properly balanced nutritional eating plan is essential in order to maintain correct body mass.  An intake of 2-3 litres of water a day is also important.  And of course, smoking is a definite no-no! 

Good luck. 

Kind regards, Angela, Nursing Practitioner.

Each different combined contraceptive pill contains oestrogen and progesterone and so can potentially cause side effects. However different pills contain different forms of hormones as well as different amounts, and so each person will respond differently (as each body is slightly different). So while one person may have side effects (such as weight gain) on one, another person will not. The trick is to find the one that you feel good on and not to worry about what everybody else says.

In general, the lower the dose of hormones, the lower the risk of side effects. So Minerva, which contains a higher dose of hormones, may have more side effects. The dose in Triphasil varies throughout the cycle. In general there aren’t adverse effects from using the pill long term, however it is important to make sure that one doesn’t have any risk factors (such as smoking, immobility, cardiovascular and other disorders) before using it. Your Dr would have checked for these before prescribing the pill.

So the choice of pill is highly individual and it is difficult to predict who will respond in a specific way. I would suggest that you stick with the Triphasil if it is working for you and you feel good. If you would like to explore other options, chat with your GP about the differences and which other options would be good for you specifically.

Kind regards

Dr Gabriell Prinsloo

With the Nur-Isterate injection it is very common that your period will settle down to the extent that initially you will still have it, but then this contraceptive is listed to eventually prevent you from having a full menstrual flow as previously experienced.  Your brown spotting and lengthening time of up to 36 days between your last menses, is due to your body adjusting to this contraceptive, and is quite normal.  I suggest that you still keep a record of when you do have your menses, i.e. the first day of each period, so that you keep in tune with your body and your hormonal cycle.  For peace of mind, you can still do a pregnancy test  -  the home kits should always be done in the morning and preferably before 10h00, as the human chorionic gonadotrophin (HCG) hormone in urine, is only raised in the morning should a pregnancy be indicated.  Alternatively, you can have a pregnancy test done at the Kloof Clinic at our Wellness Warehouse store in Cape Town  -  please just make an appointment to have this done.  Good luck  -  I am certain that you are fine, but just check to make 100% sure anyway.  Take care until next time!  Kind regards, Angela, Nursing Practitioner.

It is possible for Triphasil to cause alopecia. In fact all oral contraceptives can potentially cause alopecia. Each different contraceptive contains different hormones at different doses so it is important to find the one that works best for you. While one may have side effects another will not. However, before attributing the alopecia to the Triphasil, it would be important to take a full history to confirm that there is no other cause. If the alopecia is caused by the Triphasil, then I would suggest chatting to your GP about the alternative options.

Kind regards

Dr Gabriell Prinsloo

It is possible for Triphasil to cause alopecia. In fact all oral contraceptives can potentially cause alopecia. Each different contraceptive contains different hormones at different doses so it is important to find the one that works best for you. While one may have side effects another will not. However, before attributing the alopecia to the Triphasil, it would be important to take a full history to confirm that there is no other cause. If the alopecia is caused by the Triphasil, then I would suggest chatting to your GP about the alternative options.

Kind regards

Dr Gabriell Prinsloo

What is the best contraception – a very good question and one for which I don’t have a clear answer. It is different for everybody. Yes I agree that it is not ideal to put synthetic hormones into our bodies for an extended period; however we need to weigh up the pros and cons of all the options to find the best one.

Each person will have a different experience using oral contraceptives and while some people do experience side effects, many do not. Unfortunately often what we expect to happen will happen – so if we expect to have side effects we will.

Minesse is the lowest dose oral contraceptive. This is good as you are putting the smallest amount of hormones into your body and so will have the lowest chance of side effects. However I prefer a slightly higher dose pill as I believe that it mimics the natural cycle more closely. Generally, I would recommend Melodene. Melodene contains the same kind of hormones as Minesse, but in slightly higher quantities. Yasmin contains a different form of progesterone as well as a higher dose of estrogen than Melodene. However, each individual is different – so Yasmin may be right for some people.

It is possible that your low libido is related to the low dose of hormones that you have been taking. However, it would also be important to check if there are any other factors that are having an impact on your sex drive such as stress, tiredness etc.

Now the question of what would be best for you. Options would be to use an oral contraceptive such as Melodene. Even though synthetic hormones are not ideal, often this is the best of the available options. I do believe that it is important to give the body a break from synthetic hormones every now and then, so if you haven’t taken a break in a while it could be a good idea to let your hormones find their natural balance for a few months. Do you smoke? If you do, you should not take oral contraceptives (for women above 35yrs). Another option that could be very good for you is Mirena which is a progesterone secreting intrauterine device. The main effect is directly on the uterus and there is little systemic absorption of hormones.

Unfortunately it is difficult to give specific advice without knowing all the details, so I would suggest visiting your gynae or GP to discuss the pros and cons of all the options, and then to work out which would be the best for you.

Kind regards

Dr Gabriell Prinsloo

The morning after pill is most effective when taken within 48 hours of intercourse having occurred, and definitely not later than 72 hours.  The after morning pill can almost "shock" the body into preventing conception, and prevents a fertilised egg cell from growing in the uterus.  Your abdominal pains with brown and light spotting are side effects from taking the after morning pill.  Your menses may take 3-4 weeks to settle down again.  It is important to be aware that you should not have the morning after pill more than twice in a life time, as it can induce cancer in the body due to the concentrated oestrogen levels in the pill. You are fully entitled to see your medical doctor should you be concerned, otherwise you are welcome to make an appointment with our well clinics so as to discuss any further concerns you may have.  Kind regards, Angela. Nursing Practitioner.

There are two types of contraceptive injections of which both can cause weight gain, although weight gain does not occur rapidly, it can happen steadily and over a period of time.   I do strongly suggest however, that you consult your general practitioner so as to determine if there is an underlying medical cause for your low body mass (weight).  Alternatively, our Well Clinics do a wellness assessment on a regular basis for our in house patients.  This is a non-invasive medical checkup for blood pressure, height, body mass, abdominal circumference, a body mass index (BMI) which measures what your weight should currently be for your height.  Inclusive is also a glucose test and cholesterol screening and a haemoglobin to check iron levels.  The approach is a holistic one, and it would be determined as to the cause(s) of your low body mass.  Should you not be able to visit our Cape Town and Cavendish Square Well Clinics, you can pop into a Clicks pharmacy near to you and request that the nursing sister measures your height, weight and body circumference and then e-mail me the results.  Kind regards, Angela, Nursing Practitioner.  

The fact that you are nauseous so often, and especially when you smell certain types of food and that this is the same experience you are having, similar to your first pregnancy, urges me to request that you have another B-HCG quantitative blood test for pregnancy within one week's time.  Your previous and most recent blood test could have been too early to read as positive (this can occur if done within one week of conception).  I would like you to do this so that you have peace of mind in this regard.  On the other hand, your body may be telling you to stay away from certain foods, e.g. because they may be too fatty etc. and or because not enough of the correct nutritional foods are taken in to fuel your body.  Please let me know how you do  -  my clinic landline on a monday, tuesday, thursday and friday is 021-4875420/5435, and on a wednesday 021-6737200 from 09h00 - 16h00.  I do hope that you feel better soon.  Kind regards, Angela, Nursing Practitioner.

All oral contraceptives require a prescription. The reason being the medication is a Scheduled item according to law.

However, as there are several brands available, it is in your interest to be examined and receive council either by your general practitioner or gynaecologist , who will then prescribe the most suitable one.

Yasmin is a relatively new one, and is very popular. There is a newer one,Yaz, from the same company. The difference being a lower dosage, yet as effective.

The price for Yasmin, dispensed from Wellness Warehouse Dispensary (KLOOF ST), is R111.30.

I trust this answers your question.Should you have any further queries, please contact me or our dispensary staff.

Regards, Felicia.(Senior Pharmacist & Integrative Health Practitioner) Kloof Street.Cape Town

While all oral contraceptives contain low doses of hormones, different pills contain different amounts as well as different kinds of estrogen and progesterone. The goal is to use the lowest possible dose that gives the required effect; this provides the benefit of the drug while reducing the side effects.

Minerva contains a higher dose of oestrogen as well as a different form of progesterone. Because of this, it is one of the pills that is particularly good for preventing acne. Yasmin contains lower doses of hormones. This would have been the reason that your Dr changed you to Yasmin.

It is normal to experience those side effects as you are now on a lower dosage of hormones and your body needs to find a new balance. In a short time your body will adapt to producing its own hormones to keep the hormonal levels optimal.

I would suggest that you stick it out for a bit as it is preferable to be on the lowest possible dose of contraceptive. Usually the symptoms will go away as your body adjusts to the new dosage. If however they are still bothering you after another month or two then go back to your Dr to chat about the best option of medication.

Kind regards

Dr Gabriell Prinsloo

Your period could occur at the usual time this month; however it can take up to several months for your hormones to return to their natural balance and your period to become regular. As your hormones are changing and finding a new balance you might experience mild symptoms, similar to when you started the pill, however these are very mild and should not last very long. If you are having symptoms such as ongoing nausea, go to see your Doctor.

What is the reason for stopping taking the triphasil? I recommend going to visit your Doctor to discuss contraception and develop the best plan for going forward. Your Doctor can answer many of these questions more easily after talking to you and doing any examination and tests that are required.

Kind Regards

Dr Gabriell Prinsloo

With you having been on the Nur-Isterate contraceptive intramuscular injection, you would have experienced your menses becoming much shorter, and possibly disappearing altogether for the 2 and a half years you were on it.  Did you change over to Triphasil of your own accord, or were you assessed properly by a medical doctor or a nursing practitioner so as to determine that this particular pill would be suitable for you?  A full personal medical history and family medical history needs to be done prior to commencing a contraceptive pill, as does a cervical (pap) smear need to be done.  Side effects of Triphasil should also have been discussed prior to commencing it.

It is great that your scan has been determined as normal by your gynaecologist, and that you made this responsible appointment to see him/her. 

The pattern of your burning abdominal pain for the last 2 months, and of alternating from the left to the right, could be due to one of the following:

1)  Dysmennhoroea  -  this is period pain which can vary in severity, depending on your pain threshold.

2)  An inflammatory process, which could be ovarian. 

3)  Constipation. 

4)  Appendicitis.

I suggest that you see your general practitioner so that you can be assessed and examined accordingly, so as to determine for sure, exactly what it is that is causing your burning pain. 

Kind regards, Angela, Nursing Practitioner.

Good luck, and I wish you all the best!  Kind regards, Angela, Nursing Practitioner.    

The general rule is that you need to take the pill for 7 days consecutively for adequate contraception. So if you start taking the pill now and take it every day until the 28th, you will have effective cntraception.

If you are ever in doubt, the package inserts in the pill boxes usually have very good and detailed instructions on what to do if you miss a pill at different times in the cycle.

Have a wonderful wedding and honeymoon!

Kind regards

Dr Gabriell Prinsloo

It definitely sounds like it’s time to change to a different form of contraception.

There is a tendency for women to gain weight on the depo provera injection, with the amount of weight increasing with the duration of use. Other options for contraception would include the oral contraceptive or an intrauterine device (IUD), especially one such as Mirena (a hormone secreting IUD).

Weight gain and headaches are less common with a low dose oral contraceptive. The main drawback is that it is necessary to take a tablet regularly every day. An intrauterine device has a very localised effect on the uterus so side effects on the rest of the body are rare. In addition, once they have been inserted, they can be in place for 5 to 10 years. This is very convenient, however if you would like another child soon then this wouldn’t be advisable.

I would suggest that you use additional contraception such as a condom for the moment and visit your Gynae or GP as soon as possible to discuss the options and work out which form of contraception would be best for you, as there are many factors which would impact the choice that you would make.

Kind regards

Dr Gabriell Prinsloo

The Loop is one of the names for an Intra Uterine contraceptive Device (IUD), which is a small device that is placed in the uterus to prevent pregnancy. It works by preventing fertilization. Sperm that have reached the uterus are killed or prevented from reaching the egg. In addition the mucous secretions of the cervix change so that it is harder for sperm to enter the cervix, and the lining of the uterus changes so that eggs are unable to implant.

IUDs are 97 to 99% effective and don’t have any negative effects on the rest of the body. Additional benefits of the IUD are that it works immediately, is convenient and lasts 5 to 10 years (depending on the kind), and you and your partner wont feel it.

Once the IUD is inserted there may be a little pain or bleeding for the first couple weeks. You might find that your period is a bit heavier and lasts longer than before. There are also a few possible complications when using an IUD, most occurring during or immediately after insertion. The IUD could damage the wall of the uterus or it might come out on its own. Infections are a little more common, again mainly in the first few weeks after insertion. There is also a very small chance of ectopic pregnancy (pregnancy outside the uterus). However these complications are not common.

It is important to have a regular check up and to go see your Dr straight away if you have unusual bleeding, an unusual or bad smelling discharge or severe lower abdominal pain. The IUD doesn’t provide protection from infections so it is still important to use condoms.

The reason that you were advised not to have intercourse was most likely to allow the IUD time to settle into place, as in the first few days the chance of it being expelled is much higher. However I have found mixed recommendations as to the length of time that one should wait before having sex, ranging from 24 hours to 2 weeks.

I hope this gives you all of the information that you require.

Kind regards

Dr Gabriell Prinsloo

Fortunately both Triphasil & Nordette require you to start taking the active tablet on the 1st. day of your menstrual cycle , so there is no need to take extra precautions. Even though, Triphasil has 3 different tablets, the last 7 tablets in both Nordette & Triphasil are placebos, so the efficacy is constant.

However, if weight gain is a concern, it would be best to change to a newer generation of oral contraceptives with a lower dose of hormones.This you need to discuss with your medical practitioner or family planning clinic, who will prescribe accordingly.

Best wishes, Felicia (Senior Pharmacist & Integrative Medicine Practitioner)

Mirelle is a very low dose pill so it is important to take it at a similar time each day, however there are a few hours of leeway. The ideal is to take the pill within 2 to 3 hours of the same time each day. Taking it 5 hours later than usual on the rare occasion should not be a problem; however it would be best not to do this too often. The main problem is completely forgetting to take the pill – then it would be necessary to use additional contraception. The package insert gives good detailed instructions regarding what to do if a pill has been forgotten at different times in a woman's cycle.

Well done for thinking about this!

Kind regards

Dr Gabriell Prinsloo

All your signs and symptoms as you have mentioned them, are all listed side effects of taking the Yaz contraceptive pill.  But, in your instance, they are to an extreme!  In addition to your headaches, weight gain (with possible fluid retention as well?), and terrible mood swings, the leg cramps could be as a result of an increasing mineral deficiency of magnesium in the striated muscles of the legs, due to taking this particular contraceptive pill. In short, you need to discontinue taking Yaz with immediate effect.  Each woman is unique, and a response to certain types of contraceptives varies  -  this pill is not for you.  Your outlook is a balanced and healthy one and I am glad you have listened to your body and asked for a second opinion. 

Ideally, I would prefer to see you, so as to do an assessment in person, which can quickly result in a decision as to which contraceptive would be best suitable for you.  A patient's medical history and family medical history should be taken in detail prior to suggesting a contraceptive alternative, including the Mirena intrauterine device. 

I suggest the following:  Discuss with your husband that you stay off the chemically based contraceptives for at least 1-2 months so as to release the chemical components in Yaz from all the systems of the body, and to use a barrier method like condoms, in the meantime.  There are always the natural family planning methods to consider as well, which are completely safe.  'Natural Family Planning Methods' can be googled from the internet, or alternatively see me  -  I do have couples making appointments with this request from time to time. 

Your husband could consider having a vasectomy, however I only recommend this procedure if you have completed having your family, or alternatively in extreme medical circumstances for a woman  -  other than a contraceptive not being agreeable.  

You are more than welcome to telephone me, should you not be able to attend our well clinics, due to your geographical location.  The Kloof Clinic in Cape Town:  telephone number is 021-4875435 from 09h00 - 16h00 on a Monday, Tuesday, Thursday and Friday;  and the Cavendish Clinic in Claremont:  telephone number is 021-6737200/7210 from 09h00 - 16h00 on a Wednesday.

You are not going crazy, and you will recover from all this!  Kind regards, Angela, Nursing Practitioner.