We often think of birth control as a synonym for ‘condoms’ or ‘the pill’ — but contraception is far more expansive and diverse than just these common options.
Injections, intrauterine devices (IUDs), Mirenas, transdermal patches and subdermal implants are only a few among a wide range of effective contraceptive methods that act for an extended period of time without requiring user action.
Long acting reversible contraceptives are a particular area of interest for General Practitioner Dr. Alexandra Ames, MBBS, MRCP, MRCGP, DFSRH (UK). After 19 years spent in England, Dr. Ames returned to her homeland of Trinidad and Tobago in 2014 and opened her private practice in Woodbrook, West Trinidad.
A self-labelled “out-of-hospital disease specialist“, Dr. Ames focuses on Women’s Health, Chronic Disease Management and Family Medicine.
“We should all be getting regular check-ups and screenings depending on age and risk factors, but for some people a doctor’s visit can seem inconvenient, particularly women who may have to wait weeks to get an appointment with their gynaecologist,” says Dr. Ames.
“By offering many services such as fitting IUDs and Mirenas and conducting screenings, I aim to make it easier for patients to have that access to be able to maintain optimal health so that they are more likely to ultimately stay out of hospital.”
Dr. Ames has had an interest in science and biology from an early age, and soon gravitated towards a career in medicine.
“I’ve always thought that the human body is the most fascinating thing,” she says. “I also liked dealing with people, and having that human interaction.”
Today, she belongs to the Trinidad and Tobago Medical Association as well as the British Medical Association. She is doubly qualified as an Internist (MRCP – Member of the Royal College of Physicians UK) and as a General Practitioner (MRCGP), and she holds the DFSRH, Letter of Competence in Intrauterine Techniques, and Letter of Competence in Subdermal Implants.
These contraceptive methods, while commonly available at GPs in the UK where she trained, are significantly underused in Trinidad and Tobago and the wider Caribbean.
“One concern is patient education — patients may not know about these techniques, or may not know where they can have them done,” explains Dr. Ames. “On the other hand, they are not readily available. Doctors need to undergo special training to get qualification on these techniques, and also they must perform a certain quota each year in order to maintain accreditation.”
Even with the more common methods of birth control, they are often misused.
“In Trinidad, we only have the combined pill; not the progesterone-only,” she says. “With the combined pill, it is even more important to get regular check-ups to check one’s blood pressure and weight, for example.”
She notes that some women may get the pill without consulting a doctor. This is dangerous because not everyone can take the pill safely. Some women may also be unaware of what to do if they miss a pill.
“If they get it over the counter, or use someone else’s medicine, this can lead to serious problems,” she adds. “Some methods would not be recommended for those who have a family history of blood clots, or get migraines with aura. Everyone needs to have an individual assessment; contraception is not one-size-fits-all.”
Dr. Ames is also passionate about the prevention and early diagnosis of chronic diseases such as diabetes and cancer.
In the UK, she was on the Wandsworth Clinical Commissioning Group for Cancer and Cancer Screening — an undertaking to manage a jurisdiction of approximately 360,000 people, ensuring that all the screening programmes of the UK’s National Health Service were properly executed.
Today, she translates this background into her day-to-day interaction with her patients, encouraging screening to detect cancer at an early stage while it is still curable.
“At 45 a woman should have mammograms every 2 years and this should begin earlier if there is a strong family history of breast cancer at an early age,” says Dr Ames. “People should consider having a colonoscopy after the age of 50 for bowel cancer screening.”
Another core area of focus is diabetes screening.
“If you are overweight or your waist circumference is more than 102cm (40 inches) for a man and 88cm (35 inches) for a woman, you should do a fasting blood sugar test,” she says.
While this is recommended particularly for persons in their 30s, she notes that even children are becoming more and more susceptible to not only Type 1 or juvenile diabetes, but Type 2 diabetes or lifestyle diabetes, which is usually found in adults.
“Children are simply not running around as much as they used to,” she laments. “With more technological advancements and more junk food, it is the children who pay the ultimate price. Parents need to encourage healthy habits, and practice these in the home.”
Medicine & Corporate Involvement
Dr. Ames believes that the corporate world also has a key role to play in the health of employees.
“A healthy workforce is a productive workforce, and it is in everyone’s best interest to constantly promote a healthy lifestyle — stop smoking, do screenings, and enable access to the necessary exams,” she notes.
Alongside heart disease and cancer, another area that should be emphasised by companies for their employees is bone health.
“After menopause, osteoporosis is more common due to a lack of oestrogen as our ovaries slow down,” says Dr. Ames. “This is even more detrimental for women who have additional risk factors. For instance, after menopause, osteoporosis or thinning of the bones is more common in people who drink alcohol to excess, smoke or have coeliac disease which reduces gut absorption.”
The Fracture Risk Assessment Tool (FRAX), developed by the World Health Organization (WHO), uses several clinical risk factors to estimate risk and probability of fracture in the next 10 years in untreated patients ages 40 to 90 years of age.
“There are so many things we can do, and should do, in terms of preventative medicine,” says Dr. Ames. “From diabetes and cancer screening, to pap smears, to vaccines such as for HPV (Human Papillomavirus) to just a general check-up, it is important for us all to be more aware and do as much as we can to protect our health.”
What You Need to Know
- Women from the age of 26 should have pap smears every three (3) years, and every five (5) years from the ages of 50-69.
- In the lab that shares the building in which Dr. Ames’ office is based, liquid-based cytology is used for pap smears. This is a newer kind of test that allows testing for HPV on the same smear. This is a considerable benefit to women in terms of reducing uncertainty and the need for repeat tests, as blood or other matter smeared across the slide used for the standard pap smear can contaminate the sample and produce inadequate results.
- Some “birth control” methods are also used for other purposes. For example, while the primary purpose of Mirena is contraception, it is also used to counteract women who suffer from heavy bleeding; and to protect the lining of the womb from the oestrogen in hormone replacement therapy if using an oestrogen patch. The Mirena coil is licensed for 5 years for contraception and licensed for 4 years for the treatment of heavy bleeding or menorrhagia.
- Once a decision is made to stop using condoms, it is recommended that couples visit their doctor together, and have an open discussion about sexual history. This is important for STD screening which can cause infertility if not detected.
- Birth control patches and hormonal implants are not currently available in Trinidad and Tobago.