Your Guide To Contraception Because It's More Than Just The Pill
When I was 19 I was put on the combination pill to regulate my periods––I used to “be on” for three weeks and off for one. Yes, you’ve read that correctly. It's not a typo. My periods would last three weeks and, quite frankly, it cost me a fortune with most of my university loan going toward sanitary pads. Around the same age my sister’s doctor also put her on the pill to ease her acne, while many of my friends were either on the pill or had an IUD because they didn’t want to get pregnant. My point is, there are various reasons why women use contraception, none of which are shameful. Our body, our choice, after all.
However, while there are a myriad of contraceptives out there, most of us are unaware of all our options. The pill is the most common form of contraception offered to women, but did you know you could get a small implant on the inside of your arm that covers you for three years? I didn’t either until last year, and took the latter alternative as it suited my lifestyle more. For a woman to be fully in control of her body she needs to know what choices are available to her. So, awkward period stories aside, it’s time to get serious. Here, in this ultimate guide to different contraceptives, Dr. Reeja Abraham from Medcare Women & Children Hospital talks us through each option, including the pros and cons for each. So, if we have to make a decision, let’s make sure it’s an informed one.
Contraceptive: Combined pill
The combined pill is one of the most popular methods of contraception. The word combined implies that the drug contains a combination of estrogen and progesterone, and is most commonly used in low dose pills. The pill must be taken every day for 21 days, before a seven-day break allowing for a period. Combined pills are not recommended in women who are heavy smokers, have a history of venous thrombosis, hypertension or breast cancer. They should also be avoided by women who are breastfeeding as it causes a significant decline in the milk volume.
Success rate: 92% to 98.2%
Advantages: It’s cost effective. Does not require participation of a male partner. It’s reversible, and it can be therapeutic in cases including PMS, menorrhagia and cycle irregularities.
Disadvantages: For those that suffer from gastric intolerance, it may lead to nausea, vomiting and bloating. It could cause irregular or breakthrough bleeding, and users may also notice breast changes such as heaviness and tenderness.
Contraceptive: Progestogen-only pill
Also known as the mini pill, this oral contraceptive only contains progesterone and must be taken at the same time everyday (without a break between packs).
Success rate: 90% to 97%
Advantages: It can be taken during breastfeeding from beyond six weeks postpartum.
Disadvantages: Mini Pills must be taken at the same time everyday. However, a Desogestrel-containing pill, like Cerazette, can be taken as long as 12 hours late without reducing effectiveness.
There are two types: Progesterone-only injectable contraceptives and combined. Both, as you can guess, are delivered as injections, releasing hormones into your bloodstream. They last between 8 to 13 weeks, and you can have the injection at any time during your menstrual cycle, as long as you're not pregnant.
Success rate (Progesterone-only injectable): 99.6% to 99.8%
Advantages: It’s so convenient as it’s a single shot once every two to three months, depending on the type of progesterone. It’s also the most suitable in lactating women, and it’s one of the best contraceptives for women with haemoglobinopathies such as sickle cell anaemia.
Disadvantages: It can cause changes in menstrual pattern such as irregular bleeding, spotting PV and cessation of menstruation. It may also cause weight gain as well as impaired glucose metabolism. Some users experience a delay in return of fertility after discontinuation.
Combined injectable contraceptives can be taken as once monthly injections. They contain combinations of estrogen and progesterone at higher concentrations than the pill.
Success rate (Combined injectable): 99.6% to 99.8%.
Advantages: Menstrual irregularities are generally lower than progesterone-only injectables.
Disadvantages: Regular monthly injections are required by trained service providers.
This is a recent contraceptive method containing a combination of estrogen and progesterone in the form of transdermal patches, which when applied releases the hormones through the skin. A woman wears a patch for one week before replacing it on a different part of the body for three weeks, followed by one week of no patch during which a withdrawal bleed occurs. The patch usually adheres to the skin well allowing for daily regular activities, including swimming, bathing, and exercising, without interruption–even in warm, humid climates.
Success rate: 91% to 93%
Advantages: When used correctly the patch is highly effective. As the hormones from the patch are not absorbed by the stomach it can be used when women have gastrointestinal disturbances such as nausea and vomiting.
Disadvantages: Skin irritation or rash at the site of application is the most common side effect. The patch falls off in about 2% of cases.
These are progesterone-only implants that release a very small amount of hormones at a steady and controlled dose to achieve a good contraceptive effect. Depending on the brand, and the concentration of progesterone, the number of implant rods to be inserted varies. The insertion is made under the skin in your upper arm.
Success rate: 100% to 99.5%.
Advantages: It is a highly effective form of contraception. The contraceptive effect is easily reversible, and no aftercare is required. Some have long-term efficacy for up to five years.
Disadvantages: It requires insertion and removal by a doctor. Some experience side effects like irregular and prolonged bleeding, while amenorrhea (no period) affects 60% to 100% of users. It may cause headaches. There is a small chance of infection, hematoma and bruising during removal or insertion.
Contraceptive: Hormonal rings
These are soft vaginal rings containing a combination of estrogen and progesterone. Women insert the ring into the vagina themselves, keeping it in for three weeks before removing it for one week during which they have withdrawal bleeding. A new ring is needed for each four week cycle.
Success rate: 92% to 99.7%.
Advantages: It contains lower doses of hormones and lower side effects. There’s less chance of gastrointestinal disturbances, and the return to ovulation after discontinuation is rapid. The ring is also easy to remove.
Disadvantages: Expulsion without knowledge of the user can occur on rare occasions, resulting in pregnancy. Excessive vaginal discharge and vaginitis may also occur.
Contraceptive: Male condom
It is the oldest and one of the most widely used methods of contraception. There is now a plethora of condom options available varying in shape, color, lubrication, latex, non latex, thickness, with or without spermicide.
Success rate: 88% to 97%.
Advantages: There’s no need for a prescription or medical help for use. It’s the most harmless method of contraception and, if used carefully, is reliable. Using a condom also provides good protection against sexually transmitted diseases (STDs).
Disadvantages: They rarely produce hypersensitisation and may cause a reduction in sexual pleasure.
Contraceptive: Female condom
The “femi-dom” is a disposable barrier contraceptive for women consisting of a soft loose fitting polyurethane sack prelubricated with a silicone-based lubricant. They're worn inside the vagina to prevent semen getting to the womb. Spermicides may or may not be used along with the female condom.
Success rate: 79% to 95%.
Advantages: It’s a woman-controlled method. It’s effective in preventing STDs if used properly, and can not be damaged by oils or other chemicals unlike male condoms.
Disadvantages: It’s expensive. It requires a high level of motivation from the woman, and slippage can occur for one in 10 users.
Contraceptive: Diaphragm with spermicide
The diaphragm is a type of occlusive cap. Occlusive caps do not act as sperm proof mechanical barriers but are used as a means to retain spermicides in contact with the cervical os (the part of the cervix in the lower part of the uterus). The diaphragm should be inserted a few minutes to two hours before intercourse. Then users must wait at least six hours after intercourse before removing. This is very important.
Success rate: 72% to 82%.
Advantages: There are no major medical side effects and the control of fertility is entirely in the hands of women. It can also prevent STDs.
Disadvantages: Allergy to rubber or spermicidal agents may occur. There is increased incidence of a urinary tract infection if left behind for a long time. Also, on rare occasions may cause toxic shock syndrome.
Contraceptive: Intra Uterine Devices (IUD)
An IUD is a safe, cheap and convenient method of contraception involving neither repetition nor interference with sexual activity. It is the second most commonly used method of contraception after voluntary female sterilization. However, the insertion is not entirely pleasant. The IUD is inserted through the cervix and into the womb, and once inserted will need to be checked after three to six weeks by the doctor.
Also, an IUD also has two thin small threads that hang from your womb into the top of your vagina. Your health practitioner will instruct you on how to feel the threads so you can check they are in place. You should check after each period or a few times a month. Your IUD can be removed at any time by a trained doctor or nurse.
There are three categories of IUD:
Inert IUD: These are devices inserted into the uterine cavity to change the intra uterine environment by causing a sterile inflammatory response caused by a minor tissue injury, which is sufficient to be spermicidal. Most commonly used in this category is Lippes Loop.
Copper releasing IUD: These IUDs act in a similar way as inert IUDs by producing an inflammatory foreign body reaction. However, they produce a more intense inflammatory reaction and are more toxic to the sperms. These are non hormonal IUDs. Commonly available brands are Monalisa and Nova-T.
Hormone releasing IUD: These contain progesterone, which has a local effect by changing the nature of the mucus in the genital tract preventing transport of sperm and systemically by maintaining high progesterone levels and consequently low estrogen levels. Commonly available brands are Progesterone-containing Progestasert and Levonorgestrel-containing Mirena, Kyleena, Liletta and Skyla.
Both inert and copper containing IUDs have no hormonal or systemic side effects.
The hormone releasing IUDs mentioned differ in the type and amount of progesterone in them and the rate of release, which reflects on the lifespan of the IUD.
Success rate: Hormone-containing IUD 99.6% to 99.9%. Copper-containing IUD 99.2%.
Advantages: Requires only one time motivation. Cost effective considering its lifespan of three to five years depending upon the type. No systemic side effects. Return of fertility is immediate upon removal. It can be inserted soon after delivery or loss of a baby. Hormone containing IUDs are also therapeutic in cases of menstrual irregularities such as heavy flow or irregular cycles.
Disadvantages: Requires trained personnel for insertion and subsequent follow up. Insertion may be painful. Some women may not be able to tolerate IUDs due to complications like bleeding, pain and vaginal discharge.
It's so important to weigh up the pros and cons before choosing the right contraceptive for you. And remember, it is for you–it’s your body, and your lifestyle. There’s no harm in trying something new, but it is advised to discuss your options with a professional, and once you’ve chosen a method keep track of how your body reacts. Be in charge of your body, and treat it kindly.