Contraception

Contraception, also referred to as birth control, encompasses various medicines, devices, or methods that individuals choose to utilise in order to intentionally prevent pregnancy when engaging in heterosexual intercourse.

When choosing contraception, consider these questions:

Effectiveness: How well does it prevent pregnancy for me?
User-friendliness: Is it easy for me to use in my daily routine?
Side effects: What potential side effects should I be aware of?
Fertility: How soon can I conceive after stopping this method?
Health risks: Are there any specific risks or contraindications for me?
Lifestyle suitability: Does it align with my preferences?
STD protection: Does it offer protection against STDs?

While it’s important to also consult with your healthcare provider to get answers specific to your situation, here’s a brief overview of the various contraception choices available:

BARRIER METHODS OF BIRTH CONTROL

The Male Condom: A condom is made of soft rubber or synthetic materials that can be worn on an erect penis. It works by creating a barrier that stops sperm from reaching a woman’s vagina and uterus. Not only are condoms highly effective, boasting an impressive 98% success rate when used correctly, but they are also incredibly accessible and affordable. Moreover, they provide an extra layer of protection against sexually transmitted diseases (STDs). It’s worth mentioning, though, that using condoms regularly and consistently is crucial to maintain their effectiveness and typical use success rates drop to 85%. Therefore, if you are seeking contraception for an extended period, it might be helpful to explore alternative options that suit your needs and are less user dependent. Latex condoms can potentially cause allergies for some individuals, but it’s important to know that there are latex-free alternatives available to ensure safe and comfortable use.
The Female Condom: It is a flexible plastic pouch inserted into the vagina to prevent sperm from reaching the uterus. The pros include wide availability, hormone-free use, and protection against STDs. However, they can be a bit noisy and may cause allergies for some individuals. There are however, latex-free alternatives but are not usually as available and can be pricier than the male condoms. They should be used consistently for the best results. The success rate can vary, with approximately 79% effective typical use reported.
Diaphragm And Cervical Cap: Diaphragms and cervical caps are specialised cups available in various sizes, designed to be inserted into the vagina and cover the cervix effectively blocking sperm from entering the uterus. These methods offer a typical effectiveness rate of approximately 84-94%. Reusability and affordability are definite advantages, and this method is better for the environment, but note that it does not provide protection against sexually transmitted diseases (STDs). Ensuring a proper fit, cleaning and regular check-ups are necessary to make it effective and the diligent application of spermicide before each sexual encounter also increases it’s success rates.

HORMONAL METHODS OF BIRTH CONTROL

Combined Hormonal Contraceptives (CHCs): Combining oestrogen and progesterone, hormonal contraceptives (CHCs) work by inhibiting ovulation, thickening cervical mucus, and modifying the uterine lining. These methods offer valuable benefits such as regulating the menstrual cycle, reducing cramps, and providing protection against certain cancers. However, it’s important to be aware of potential risks. Although rare, CHCs come with a slight increase in the risks of blood clots, stroke, and heart attacks. Moreover, oestrogen can impact on milk supply making CHCs not recommended during breastfeeding. Women who are over the age of 35 and who smoke or have a high BMI or women who have certain medical conditions, such as migraines, hypertension, or epilepsy other relevant factors, might be advised against using CHCs. Additionally, CHCs are not advised for with a strong family history of certain cancers such as breast or ovarian. Also CHCs can interact with other medications so it is important to check this with a professional. There are different types of oestrogens and progesterones, and consulting with an expert can help determine the best option for your individual needs.
Oral Contraceptive Pills (OCPs): These pills not only provide reliable contraception but can also offer additional benefits such as relief from acne and lighter periods. However, it’s important to emphasise the importance of daily intake, as missing a pill (including vomiting or diarrhoea within 3 hours of taking it) can reduce its effectiveness. Traditionally, women were encouraged to have a monthly bleed on this method, but this is not necessary and women can safely take two to three packs back to back and then take a 7 day break to have a planned bleed only 4-5 x a year or they can just take it continuously without a break but this may cause unplanned breakthrough bleeding. There are a few other potential options depending on a woman’s needs. If you have not been advised about this, please discuss with a healthcare provider before changing your regime because there are a few types of combined pills that cannot be used in this way. It’s worth noting that OCPs are exclusive to women, involve costs, do not protect against sexually transmitted diseases (STDs), and may have potential side effects (as mentioned above).
Contraceptive Patches: They are skin patches that release hormones, working similarly to combined hormonal contraceptive pills but without the need for a daily pill. This method offers convenience and peace of mind as it only needs to be applied weekly. It’s a great choice for women seeking a hassle-free and reliable form of contraception. However, some women develop allergies to the adhesive and there is a risk of forgetting to change the patch which can reduce its effectiveness.
Vaginal Ring: It’s a flexible ring that is worn inside the vagina for three weeks, releasing hormones that prevent pregnancy. This method offers convenience and ease of use, as there’s no need to remember a daily pill. It provides a reliable and discreet form of contraception. This is a very well tolerated form of combined contraception which is somewhat underused. The main challenge with its use is forgetting to change the ring and for some women to feel comfortable enough to insert it into their vagina.

Progesterone-Only Contraceptives

Progesterone-only contraceptives are a reliable option for contraception. These pills contain only progesterone hormone, working by thickening cervical mucus and sometimes suppressing ovulation. These contraceptives offer various benefits, including compatibility with breastfeeding and the potential for reduced menstrual symptoms. Furthermore, whilst it also slightly increases the risk of blood clots, breast and ovarian cancer but this risk is considered lower than that of the combined pill. It’s also worth noting that they are considered lower risk for smokers, and for people with other medical problems and they can usually be safely used by women up to menopause. The biggest challenge with this method is the risk of irregular bleeding. Whilst some women have no bleeding or lighter regular bleeding, a significant proportion of women on these methods may have irregular, unpredictable bleeding. Some of the methods are better than others for this issue and there are things that can be done to manage this but it is important to be aware of this. They also do not provide STD protection. They include:

Progesterone-only pills (POPs): Also known as mini-pills, they are daily contraceptive pills that contain only progesterone hormone, if taken perfectly (consistently and correctly, daily) effectiveness can be up to 99%. They can be taken safely by women up to menopause (into their 50s). It’s advisable to take POPs at the same time every day to maximise their contraceptive effectiveness. Additionally, they are considered a better choice for higher-risk women, as they do not carry the same increased risks associated with oestrogen-containing contraceptives. This makes them a suitable option for individuals with specific health conditions or predispositions. They are safe to use while breastfeeding and do not require invasive procedures or insertion. The bleeding pattern with Progesterone-Only Pills (POPs) can vary among individuals: some women may experience regular menstrual bleeding, while others may have irregular bleeding or even no bleeding at all.
Progesterone-only Injectables: It is given to a woman’s buttocks or upper arm once every two to three months, and the hormone is slowly released into the bloodstream. It is highly effective, can reduce painful or heavy periods and are administered just once every 2-3 months (only 4 times a year). Most people have no bleeding on this method although this can vary. However, it is a higher dose of progesterone compared to some of the other methods and there is a theoretical risk of reduced bone density with long-term use.

LONG-ACTING REVERSIBLE CONTRACEPTIVE (LARC) METHODS

Contraceptive Implant: The Contraceptive Implant is a small rod inserted under the skin of the upper arm that releases progestogen, preventing ovulation and sperm entry. It’s highly effective, long-lasting, and reversible. However, irregular bleeding is a common side effect although this usually settles after the first 6 months and there are strategies to manage this. it’s important to note that for some women, it can be the primary reason for removal and is therefore not advisable for women who cannot tolerate irregular bleeding. It’s essential to have the Contraceptive Implant inserted and removed by a trained healthcare professional. This ensures proper placement and helps minimise any associated risks. It’s important to remember that the Contraceptive Implant does not provide protection against sexually transmitted diseases (STDs).
IUDs (Intrauterine Devices): They are a highly effective and low-maintenance contraceptive option. They are placed in the uterus to provide long-term contraception. Copper IUDs release copper, which creates a toxic environment for sperm, offering reliable protection. They have a lifespan of up to 10 years, making them a convenient choice. They are an excellent choice for women seeking long-term contraception without hormonal interference but can significant increase menstrual bleeding and cramping so are not advisable for women who already suffer with this. They do not provide STD protection and there is a small risk of infection and perforation but this is less likely with a trained, reputable fitter.
IUSs (Intrauterine Systems): They are hormonal devices that release a specific progesterone into the uterus, offering effective contraception. They work by thinning the uterine lining, thickening cervical mucus, and sometimes suppressing ovulation. Unlike copper IUDs, IUSs provide non-contraceptive benefits. They can reduce bleeding, provide pain relief, and potentially improve symptoms associated with endometriosis. IUSs typically last for 3 to 5 years, making them a convenient long-term option. They can be inserted post-partum (although if not done within 48hours, women are advised to wait 4 weeks) and used safely whilst breastfeeding. They also do not provide STD protection and there is a small risk of infection and perforation but this is less likely with a trained, reputable fitter.

PERMANENT METHODS OF BIRTH CONTROL

Vasectomy and tubal ligation are permanent contraception options for those certain about not wanting children. Reversal success rate is low.

Tubal Ligation: Tubal ligation is a surgical procedure that involves blocking the fallopian tubes to provide permanent contraception. It is a highly effective method, with a 99% success rate in preventing pregnancy. Tubal ligation is considered a permanent form of contraception and may not be reversible. Additionally, it’s a more costly procedure compared to other contraceptive options. Remember that tubal ligation does not protect against sexually transmitted diseases (STDs).
Vasectomy: Vasectomy is a surgical procedure that involves blocking the tubes that carry sperm, providing a permanent form of contraception for men. It is an extremely effective method, with a 99% success rate in preventing pregnancy. Although, it is always advised to have a confirmatory sperm sample before relying on this method, post procedure. Unlike tubal ligation for women, vasectomy is generally considered a less invasive procedure. It offers a reliable option for couples who no longer wish to have children or have completed their desired family size. It doesn’t protect against STDs.

NATURAL METHODS OF CONTRACEPTION

Natural methods of contraception, also known as fertility awareness-based methods, involve tracking and interpreting various physiological signs and changes in a woman’s body to determine fertility and prevent pregnancy. These methods rely on understanding the menstrual cycle and identifying the fertile and infertile periods. These methods are unreliable and have a higher failure rate compared to other methods of contraception so they are not advisable for women for whom an unintended pregnancy would be catastrophic.

Basal Body Temperature (BBT) Method: This method involves taking the woman’s temperature every morning before getting out of bed. A slight rise in basal body temperature indicates ovulation has already occurred, signaling the start of the infertile period. It is natural, non invasive, causes deeper understanding of one’s menstrual cycle and fertility, but it can also be unreliable and create stress especially if one continues to try to use this method to predict fertility when trying to conceive. It also requires consistency and an accurate thermometer, factors such as illness, lack of sleep, alcohol consumption, and travel can impact BBT readings.
The Rhythm Method: The Rhythm Method calculates fertility based on past menstrual cycles, assuming ovulation happens at a similar time each month. The woman tracks cycle lengths and uses a calendar to estimate fertile and infertile periods, relying on historical data rather than current signs. It is natural and hormone-free. No side effects or health risks. No cost associated with contraceptive devices or medications. It is less reliable than other contraceptive methods and a regular menstrual cycle is required.

EMERGENCY CONTRACEPTION

Emergency contraception works shortly after sex to prevent pregnancy. It’s used when contraception wasn’t used, failed, or after sexual assault. Different types are available, including pills and a copper IUD. There are two main pills Levonelle (must be used within 72 hours of unprotected intercourse) or Ella One aka Ulipristal (must be used within 120 hours of unprotected intercourse). The earlier they are used the higher the effectiveness. The copper IUD can be used with 120 hours of unprotected intercourse and is considered the most effective choice plus, it can also then be used as longer term protection.

OPTIONS FOR OLDER WOMEN

In upcoming articles, we will delve into the topic of birth control methods and provide detailed information about contraception choices for older/perimenopausal women. However, it is important to note that the combination pill, patch, and ring may not be recommended for women who smoke, are significantly overweight and are over 35 years old. We will explore the reasons behind this and offer an analysis of alternative options for individuals in these specific situations in a later post.

MYTHS ABOUT BIRTH CONTROL

Birth control myths have persisted throughout history, but science has debunked some of the most widespread ones. Birth control myths have persisted throughout history, but science has debunked some of the most widespread ones.

Urinating or douching after sex can prevent pregnancy: Douching with any substance following sexual activity does not prevent pregnancy.
Non-medical spermicide: Putting toothpaste or seeds in the vagina or any formulation that is not medically approved as spermicide does not prevent pregnancy and should never be used as a contraceptive.
You cannot get pregnant while you are on your period: It is untrue that a woman cannot become pregnant while she is having her period. She may not be as fertile in the first days of her period, but sperm can survive for several days inside a female body, making conception still feasible.
You cannot get pregnant if you have sex in a hot tub: Sexual intercourse in a hot tub or swimming pool does not prevent pregnancy. There is also no sexual position that prevents pregnancy.
Sex without penetration, ejaculation, or orgasm is safe: Anytime the penis, or even sperm from foreplay, penetrates the vagina, pregnancy is possible. Regardless of orgasms, a woman is still capable of getting pregnant.
Breastfeeding protects against pregnancy: A woman can become pregnant while breastfeeding, although the chance is lower.
Using two condoms offers extra protection: It’s not more protective to use two condoms. Using two male condoms or combining the use of a male and female condom could lead to pregnancy because of friction increasing the risk of a tear.