For You General

Birth Control – The Options

Contraception-Congratulations, you’re pregnant! . A source of joy to many, these words can strike terror in the heart of the woman who is not anticipating them.

Birth control is the term that describes actions taken to prevent a pregnancy, usually implying the use of contraceptives. If you don’t want a baby, there are only two options – use contraception, or don’t have sex at all. Abstinence is the only form of birth control that offers 100% protection from falling pregnant.

There are over 15 different forms of contraception available if you are sexually active, each with certain advantages and side-effects, and some contra-indicated for certain users.

 

Oral Hormonal

Introduced in the -60s, swallowing the Pill at the same time every day is the most widely used female contraceptive. It has the advantages of allowing uninterrupted sex and is reversible when you do want to fall pregnant. With strict adherence to instructions, the Pill is over 99% effective. Importantly, the Pill must be taken every day; missing even one day requires other precautions to be taken.

  • The Combined Pill contains two hormones: oestrogen and progesterone, which occur naturally in the body. Progesterone-based contraceptives work in 3 ways: by stopping egg production; by forming a barrier against sperm; and by preventing eggs that are produced from settling in the womb.

Women with a history of blood clots, high blood pressure, circulatory disease or heart disease are likely unsuitable candidates and should seek medical advice.

The combined pill is not suitable while breastfeeding.

Side effects are usually temporary: breakthrough bleeding and spotting can occur; as can headaches, nausea, breast tenderness and mood changes. Rarely, some women develop blood clots.

The Combined Pill has the following advantages: your periods might be more regular, lighter, and less painful; PMS symptoms can be reduced; acne symptoms might be controlled; and the risk of fibroids and ovarian cysts can be reduced. The Pill might also protect against ovarian, colon and womb cancers.

  • Containing only one hormone, the Progesterone-only Pill (the -Mini-Pill ) is particularly suitable for women who are unable to take oestrogen for medical reasons. Notably, the Mini-Pill is suitable while breastfeeding.

Women with a history of heart disease, liver disease, strokes or a breast abnormality are not suitable candidates. It is not allowed if pregnancy is suspected.

The Mini-Pill has the following side-effects: changes to your menstrual cycle; acne aggravation; decreased libido; breast tenderness and weight gain; and a cause of ovarian cysts.

Long-acting, reversible contraceptives (LARCs)

An alternative to the daily pill-taking chore, LARCs provide longer cover with minimum maintenance.  Fully reversible and allowing uninterrupted sex, LARCs unfortunately do not offer protection against STDs, and their insertion and removal must be undertaken by a trained doctor.

  • The Intrauterine Systems (IUS) – the -hormonal coil – is a small plastic device that slowly releases progesterone when inserted in the uterus. Fitted in 5 minutes by a doctor, it can remain in place up to 5 years.

This contraceptive is unsuitable for women who have active liver disease or unexplained vaginal bleeding, or have had womb or breast cancer. It should also be avoided by women with migraines, untreated STDs or pelvic infections, or cervical problems.

The hormonal coil’s effectiveness is affected by certain medications. Breast tenderness, acne and headaches are side-effects, and periods may be irregular in the first few months.

A suitable alternative for women with completed families and for breastfeeding mothers, the hormonal coil also causes lighter periods that might stop altogether. It’s effective immediately, and is removable at any time.

  • Unlike the other LARCs, the Intrauterine Copper Device (IUD) – -the coil – is non-hormonal.  Manufactured from copper or plastic, it works in 2 ways: copper is toxic to sperm; and the device causes difficulty for eggs to settle in the womb. It is inserted in the uterus by a doctor and then requires checking every 6 weeks. It can last between 5 and 10 years.

The coil is not suitable for women with unexplained vaginal bleeding, untreated STDs or pelvic infections, or cervical problems. It causes heavier, longer, irregular and more painful periods and carries a risk of ectopic pregnancies.

It is immediately effective, removable at any time and suitable while breastfeeding. If inserted after 40, it may stay in place until menopause.

  • Regular administration of the Injection protects up to 12 weeks, by providing a very slow release of progesterone.

The injection is not immediately reversible, and, as it can take time for fertility and regular cycles to return, alternatives should be considered for near-term pregnancy planning. Users under 18 or over 45 are at risk of osteoporosis. It can cause irregular periods, but can also reduce heavy periods.

Side-effects include headaches, acne aggravation, decreased libido, breast tenderness and weight gain.

The injection is suitable for breastfeeding mothers and women who cannot take oestrogen, and possibly offers protection against womb cancer.

  • The Subdermal Implant is a small flexible rod, placed under the skin of the upper arm, which slowly releases progesterone. It is fitted by a doctor and lasts up to 3 years.

It’s not suitable for women who have active liver disease, circulatory diseases or heart abnormalities, unexplained vaginal bleeding, or who have had breast cancer.

The implant’s side-effects are an increased risk of acne and headaches, moodiness and decreased libido and occasionally breast tenderness. It may cause irregular periods that might stop altogether, but it may also reduce painful or heavy periods.

The implant is immediately effective, and fertility normally returns to normal immediately upon its removal.

Other Hormonal Contraceptives:

  • The Patch is a small -plaster that allows absorption of oestrogen and progesterone through the skin. Each patch lasts 7 days. They are used for 3 weeks, followed by 1 patch-free week.

The patch is contra-indicated for smokers or recent ex-smokers, and women over 35. It’s not suitable for women with certain pre-existing medical conditions: circulatory disease or heart abnormalities; breast cancer; active liver or gallbladder disease; diabetes; migraines; obesity; or a history of blood clots.

The patch is not suitable while breastfeeding and does not protect against STDs. Unfortunately it is visible, and certain medications reduce its effectiveness. Side-effects can include skin irritation, increased blood pressure, breakthrough bleeding, increased breast tenderness, headaches, nausea, mood changes and blood clots.

On the upside, the patch is easy to use and causes regular, lighter and less painful periods. Fertility returns immediately when its use is discontinued. PMS symptoms may be reduced, and the patch may reduce the risk of fibroids, ovarian cysts and benign breast disease.

  • The Contraceptive Ring is a translucent plastic ring placed in the vagina, which releases low doses of oestrogen and progesterone upon contact with the vaginal wall. It is inserted monthly (usually on day 1 of the menstrual cycle) and remains in place for 3 weeks and is then removed for 1 week. This device provides protection for up to a month and fertility is restored as soon as it is no longer used.

Suitability for women over 35, recent ex-smokers, or women with high blood pressure, diabetes, migraines, obesity or a history of blood clots should be discussed with a doctor. It is unsuitable for women with a prolapsed vagina, as the ring will not stay in place.

The ring might be expelled upon straining.

This method causes tender breasts, headaches, nausea, mood changes and breakthrough bleeding, and may increase the risk of vaginal discharges or infections.

  • Natural family planning involves identifying fertile times in the menstrual cycle, and practising abstinence at those times. The Natural Method requires accurate scrutiny of the body’s natural signs and fertility indicators by: recording changes in body temperature; observing changes in cervical mucous; and accurately calculating the menstrual cycle. Initially, accurate identification and recording might be improved with the assistance of a professional.

There are no -unsuitable candidates, as such, but the overall efficacy of this method depends on age, discipline and regularity of menstrual cycle. It normally takes 3 to 6 menstrual cycles for the process to be learned, and requires daily record-keeping. Fertility is under the control of the couple, allowing pregnancies to be either planned or prevented.

This method is natural and chemical-free, lacking side-effects, inexpensive and convenient, but offers no protection against STDs.

 

Non-hormonal contraceptives

Used only during intercourse, these latex barriers prevent sperm from entering the cervix, and are thus not suitable for women with allergies to latex or the chemicals used. All provide protection against STDs.

  • The Female Condom is a once-off barrier against sperm entering the vagina. It is a very thin layer of latex shaped with a closed end with a flexible ring, which fits inside the vagina, and an open end, which remains outside of the vagina. This condom can be used with water or oil-based lubricants.

The condom can be inserted anytime prior to intercourse. Unfortunately, it can be difficult to insert and requires practice to be effective. It can also be displaced or torn during intercourse.

This method requires no prescription. It offers protection against HIV.

  • The Diaphragm or Cap is a reusable thin circular cap that fits over the cervix, and is used with a spermicide (a chemical that kills sperm). Its size and type must be determined in consultation with a doctor.

It’s inserted any time prior to intercourse, but must stay in place for at least 6 hours after intercourse. A new application of spermicide is required for each act of sexual intercourse.

With this method, cystitis can be problematic for some women.

  • Also a once-off barrier against sperm entering the vagina, the Male Condom is a thin layer of latex fitted over an erect penis. Easily available, they are dispensed at clinics and sold by a variety of vendors. They are available in many different sizes, shapes, textures, colours and flavours.

Unfortunately, condoms are difficult to use without practice. They are easily damaged, and are rendered ineffective when used with oil-based products like Vaseline or body oils.

They offer protection against HIV.

This article has detailed the options: their side-effects, their advantages and their suitability. Your choice is which would most suit you, and fit in with your lifestyle.

 – Tracy

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