在加拿大如何更好地避孕？

奥巴马医疗在特朗普总统上台以后前途未卜，美国妇女为此比较担心，她们希望能获得一种长期的避孕方式。加拿大的妇女目前也面对这一窘境，不是因为特朗普的政策，而是因为在加拿大不稳定的就业环境。

在社交媒体上，很多妇女自发组织起来，一起要求获得IUD。这是一种体内节育器。体积小巧、是T型的形状，通常是用塑料或者铜制造的，由专业的医生植入体内。通常可以维持几年的避孕效果。

本网站（时光在路上，https://www.timezls.com，ｈｔｔｐs：／／ｗｗｗ．ｔiｍｅｚｌｓ．ｃｏｍ）采用BY-NC-SA协议进行授权，凡本网强调版权为本网所有的文/图，使用时必须注明文章来源，违者本网将依法追究责任。本网在文章中注明来源的文/图等稿件均为转载或经过编辑整理，本网出于传递更多信息之目的，并不意味着赞同其观点或证实其内容的真实性。如其他媒体、网站或个人从本网下载使用，必须保留本网注明的稿件来源信息，并自负版权等法律责任。如果您看到这两段隐藏文字，说明您在浏览器设置中关了JavaScript属性。关闭此属性后本站一些功能将会丢失，排版可能会导致错乱，请不要这样做。

在奥巴马医疗政策下，妇女们可以免费获取而不需要支付任何费用，同时还可以获得其他由FDA获准的节育手段。

但是，如果特朗普目前的行动成功了话，国会真的废除了“可负担医疗法”（Affordable Care Act），一个小小的 IUD就会花去美国妇女1000美元的费用。如果没有了这种生育控制手段，相当多的妇女就会很难、或者感觉压力很大去负担每个月的避孕药物的费用。

所以部分妇女转向宫内节育器。根据AthenaHealth编辑并由Vox出版的来自美国2,500个医生办公室的数据，民主党所在的州也好，共和党所在的州也好，去年10月至12月，所有诊所宫内节育器的使用飙升了19％。而2015年没有这种突然增加的现象。

专家说，类似的情况发生在加拿大。因为这里的妇女也面临失去自己的健康保险或福利的风险。

部分医疗福利是包括了避孕药和IUD的。比如说Sun Life, Great-West Life 和Morneau Shepell，不过这仍然要取决于雇主的具体财务安排。专家们说，当妇女们换工作，或者当自己年龄增长、不再由父母承担自己的医疗经费时，她们就会转到IUD。

由于加拿大缺乏国家药品管理系统，大约四分之一到三分之一的女性，没有稳定职业或是刚来到加拿大的新人，不能获得免费避孕，因为她们既没有工作单位提供的福利，也没有资格获取关于药物的社会福利。

这意味着她们经常选择不太有效的避孕方法，例如避孕套，这只有约82％的有效性，而不是去选择真正有效的方式，如宫内节育器，原因是因为其高额的费用。

在多伦多计划生育服务Planned Parenthood Toronto下，铜制的IUD花费63元，激素宫内节育器费用高达380元。有些女性会要求先让医生开具宫内节育器处方，以方便以后自己决定真的要安装。（该程序由OHIP承担。）

加拿大妇女使用的最常见的避孕方法仍然是避孕药，但是宫内节育器的使用已经在增加。避孕药约90％的有效，IUD是99％有效。

选择因人而异：铜制子宫内避孕器较便宜，比较适用于希望避免合成激素的女性使用，但是有可能导致月经期不适或者引起经期疼痛。激素宫内节育器，会释放称为左炔诺孕酮的孕激素，价格更昂贵，同时会产生类似于避孕药的副作用；不过对月经期的影响要小得多。

到底用哪种宫内节育器？

铜制和荷尔蒙宫内节育器都可以持续3-10年，通过子宫颈插入子宫。对于已经分娩过的和没有分娩过的妇女，两者都是可以使用的。上世纪70年代有另一种宫内节育器，和现在的这两种完全不同。但以前的那种装置却给宫内节育器带来了几十年不好的名声。

铜制节育器：99％的效果

通过将异物植入宫颈和子宫，创造一个敌对的环境来预防怀孕
在 Planned Parenthood Toronto 下$54-$63

优势：

可逆和可被忘记非激素
可能适合不能服用雌激素的女性
减少子宫内膜癌的风险

缺点：

可能增加月经期间的血流量，疼痛和痉挛
植入过程中的一些疼痛或不适
罕见的风险包括在植入或取出时子宫穿孔

激素宫内节育器：99％有效

通过释放左炔诺孕酮而发挥作用，这导致子宫内膜变薄并且子宫颈粘液变厚，使得精子难以进入
在 Planned Parenthood Toronto下$306-$380

优点：

可逆和可忘记
可能导致较轻的月经
改善子宫内膜异位症状
可能适合不能服用雌激素的女性

缺点：

可能导致滴血；
可能引起激素副作用，如腹胀，乳房压痛，痤疮，头痛和心情问题
植入过程中的一些疼痛或不适
罕见的风险包括在植入或取出时子宫穿孔

以下是加拿大环球邮报的一篇文章，供大家参考：

Should I use an IUD for birth control?

The question

I'm considering getting an IUD as a (non-hormonal) alternative to the pill. What are the pros and cons?

What are the pros and cons?

The IUD or intrauterine device, is a form of birth control that is available to woman of any reproductive age seeking long-term, non-hormonal, safe and effective contraception.

In Canada, there are two types of IUDs - the Nova-T and the Flexi-T. The IUD is a small (3cm in length) T-shaped device with plastic arms, a copper wrapped stem and a nylon string at it’s base.

Neither the plastic, the copper or the strings can be felt or seen outside of the vagina. IUDs are thought to work by interfering with sperm mobility and by irritating the lining of the uterus which makes it difficult for an embryo to implant.

Choosing a birth control option is a very personal choice and depends upon the potential risks, benefits and efficacy of each method. For the IUD, there are several pros and cons to consider:

Pros

1. It's one of the most effective forms of birth control: 96-98 per cent effective

2. It's hormone-free

3. It's convenient and reversible: After inserted, you do not have to do anything, there's no need to take a daily medication and it doesn't interrupt sex because it is always in place.

While it can remain in place for up to 5 years, it can be removed at any time.

4. It can be private: Because it can’t be felt or seen, it’s a woman's choice and her choice to share if she chooses to.

5. It's cost-effective: An IUD costs $90-160, so over five years - it is significantly less than the cost of birth control medication for the same amount of time.

Cons

1. It doesn't protect against sexually transmitted infections

2. It can cause irregular bleeding, and heavier, longer and more painful periods. Generally this will improve over a few months after insertion, but if it persists or continues in between periods - check in with your doctor to ensure that it is not related to infection. If you already suffer from severe period pain or heavy periods, an IUD may not be the best option for you.

3. There is a slightly increased risk of infection within the first month of insertion: In the past, there was a strong concern about pelvic inflammatory disease because of a design flaw in the IUDs used in the 1970s. This has changed and today's IUDs have a very low rate of infection. To minimize this risk - your healthcare provider would check for infection prior to insertion.

4. Insertion can be uncomfortable: For some it is an easy insertion, for others it can be very painful. There are some options to help decrease pain that your doctor can offer prior to insertion that may help.

5. If you have a copper allergy, this is not a safe option.

Complications associated with the IUD are rare but may occur. These include perforation (puncturing the wall of the uterus), bleeding, or it can fall out.

To decrease the risk, insertion should be done by a trained clinician and they should review these risks with you prior to insertion to ensure that this is a safe option for you.

It is important to mention a device similar to an IUD called Mirena - an intrauterine system or IUS which is also T-shaped and inserted in the uterus, but it contains a hormone. It works by thinning the lining of the uterus and making it difficult for sperm to fertilize an egg. This option is popular for those who want the convenience of not taking a pill daily and who do not mind having a hormonal method of contraception. The progesterone effect can reduce menstrual bleeding and for some - menstruation completely stops.

For this reason, Mirena is also used for those who suffer from heavy menstrual periods. Side effects can include similar risks as the copper IUD (apart from heavier, crampier periods) and also progesterone related effects such as change in mood and libido, and spotting after insertion. The Mirena is slightly more effective than the copper IUD (99%) and it costs approximately $350-400 which is covered by most private health insurance plans.

来源：环球邮报等媒体