Contraception

Image by Reproductive Health Supplies Co

This topic was originally published on Ferne Health.

What is contraception?

Contraception, or birth control, is a method for preventing pregnancy.

How to choose a contraception method?

There are many factors to consider when choosing a birth control method such as:

- age

- lifestyle

- pre-existing medical conditions

- cost.

You should talk to your doctor so that he or she can suggest a method that is suited to your needs.

Types of contraception

The options can be broadly categorised according to reversibility:

Reversible:

- Long-acting methods - hormone injections, subdermal implants, intrauterine devices

- Short-acting methods - patches, rings, pills, and condoms

Irreversible options:

- male and female sterilisation

Long-acting methods

Pros: can last up to 5 years, do not require you to take them every day to be effective, can be removed any time, may be cheaper in the long run

Cons: do not prevent sexually transmitted diseases

Hormone injections

A hormone called progesterone is injected into your buttocks and can last up to 3 months. Progesterone works by preventing ovulation (a process that allows your eggs to be released every month), thickening up the mucous membranes of your cervix and thinning out the lining of your womb so that fertilised eggs cannot be implanted into your womb.

Pros: highly effective, can be used during breastfeeding, may reduce heavy and painful periods.

Cons: often causes irregular bleeding [1], most women often experience infrequent or no bleeding.

Side effects: Hormonal contraception may also cause some side effects such as acne, headaches, and decreased libido.

Subdermal implants

A subdermal implant is a rod that is about 4cm in length and is inserted under the skin of your arm. The implant works by slowly releasing progesterone. As mentioned before, this hormone prevents ovulation by thickening up the mucous of your cervix and thins out the womb lining. It also prevents ovulation.

Pros: can last up to 3 years and is highly effective, may be used during breastfeeding, may reduce heavy and painful periods.. Relatively quick and painless procedure (done under local anaesthesia), implant can be removed anytime.

Cons: may cause irregular bleeding or infrequent or no bleeding

Side effects: as above - may cause acne, headaches, decreased libido

Intrauterine contraceptive device

Intrauterine contraceptive devices (IUCDs) are tiny T-shaped devices that are inserted into your uterus and can be categorised to hormonal and copper IUCDs. Both IUCDs can last at least 5 years and are highly effective.

For the hormonal IUCD, it works by slowly releasing the hormone progesterone into the uterus.

Pros: may be used during heavy and painful periods and during breastfeeding

Cons and side effects: as above

For the copper IUCD, it works by preventing sperm from reaching the egg as copper is highly toxic to sperm. It does not contain hormones.

Pros: no hormonal side effects

Cons: may cause longer and heavier periods

Very rarely, IUCDs may also perforate into the uterus, fall out, or cause ectopic pregnancy. You will also require a doctor to remove them.

Short-acting methods

Short-acting methods can last from a day to a week. They are commonly in the form of pills or patches. They are the most widely known options on the market.

Pros: ease of administration, may not require a doctor's appointment, do not require a doctor to remove

Cons: may be inconvenient, may be more expensive in the long run

Birth control pills

Birth control pills usually contain two kinds of hormones – progesterone and oestrogen. However, the progesterone-only pills are also available. Like other hormonal contraception, they work by thinning out the lining of the womb, thickening the cervix and preventing ovulation. These pills are taken every day. They usually come in a 21-day course, where you will have to take one every day with a one-week break (where you will have your menses). They can also come in a 28-day course with 7 of the pills being placebo.

Pros: reduce the risks of endometrial and ovarian cancer, regulate the menstrual cycles

Cons: inconvenient (have to take daily)

Side effects: acne, mood swings, decreased libido etc.

Contraindications: smokers aged 35 and above, past history of clotting, high blood pressure etc.

It is highly advised that you speak to a doctor before taking these pills. If you are a smoker above 35 or have a pre-existing metabolic condition, you might want to consider the progesterone-only pills.

Contraceptive patches

These patches last up to a week. Like birth control pills, they contain both hormones oestrogen and progesterone.

The advantages and disadvantages of these patches are the same as birth control pills, except that these patches are applied weekly instead of daily.

Other options

Male condoms

Widely available on the market, male condoms do not require a prescription and are relatively inexpensive. They also protect against STDs. There are also none of the hormonal side effects associated with most female contraceptive options. However, there is still a chance of condoms breaking or slipping off. Your partner will also need to know how to put it on and correct sizing is required.

Male or female sterilisation

This is an irreversible option and is done surgically to ensure that the vas deferens (in men) or the fallopian tubes (in women) are clipped or cut. The vas deferens, which are the tubes that connect the testicles to the penis, prevents the sperm from leaving the body. The fallopian tubes, when clipped, prevents the eggs from travelling to the uterus. The advantage is that contraception is no longer required. With every operation, there are small risks involved. Please speak to your doctor about this as risks vary with every individual.

As this is a permanent option, you or your partner should be sure that you do not want any more children.

You might want to speak to your doctor about contraceptive options so that they can tailor according to your lifestyle, needs, and preferences. Please also note that most contraceptive options, apart from male condoms, do not prevent against STDs. If you are sexually active with multiple partners, please stay safe and healthy by wearing condoms, having open and honest conversations with your partners and get tested before you have sex with a new partner!

[1] Irregular bleeding – bleeding that does not occur at regular intervals; most women experience menstruation every 28 days (but varies according to individuals) – your menses may be irregular if you experience bleeding outside of your normal cycles