CONTRACEPTION (Birth Control)

Pregnancy occurs when a man's sperm reaches a woman’s egg. A woman’s ovaries usually produce an egg every month. After a man ejaculates, the semen that is released contains millions of sperm; only one is needed to fertilize a woman’s egg to begin a pregnancy. Contraception or Birth control tries to prevent pregnancy by: 1) keeping the egg and sperm apart, 2) by stopping egg production, or 3) by stopping the combined sperm and egg (fertilized egg) from attaching to the lining of the uterus.

According to the WHO, “a woman’s ability to choose if and when to become pregnant has a direct impact on her health and well-being”. The WHO has also acknowledged many advantages to contraception; some include:

• Contraception allows persons to attain their desired number of children and determine the spacing of pregnancies. (Contraception can prevent closely spaced and ill-timed pregnancies and births, which contribute to some of the world’s highest infant mortality rates.)
• Contraception prevents unintended pregnancies, including those of older women and adolescents who face increased risks related to pregnancy.
• Contraception is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and development efforts.

Some of the more common methods of contraception are described below.

*Remember, no matter what contraceptive you choose, you still need to use a condom to protect you from Sexually Transmitted Infections. 

 
LONG-ACTING METHODS

 
Reversible

These contraceptives can last from 3 to 10 years. There are two long-acting, reversible methods available, the IUD and the Implant.  Because these methods are ‘Reversible’, a woman can become pregnant once she stops using them. These methods also do not interrupt sex.
 
A) Intrauterine Device (IUD)

There are 2 different types of IUDs available.

1) The Copper T Intrauterine Device (IUD) is a small, flexible, plastic that is shaped in the form of a “T”; it has copper wire wrapped around it.” It is placed inside the uterus to prevent pregnancy (fertilization), and can stay in for up to 10 years.

2) The Levonorgestrel Intrauterine System (LNG IUD) is also a small, plastic, T-shaped device that is placed inside the uterus. It releases a small amount of progesterone hormone each day to prevent ovulation. The LNG IUD stays in your uterus for up to 5 years.

Advantages

• Prevents pregnancy very effectively (992 to 994 of every 1,000 women using IUDs will not become pregnant)
• Private (no else can know that you are using contraceptives)
• Little required of the woman once the IUD is in place
• Widely available

Disadvantages

• Bleeding changes are common:

 

• IUD Copper device (typically, longer and heavier bleeding and more cramps or pain during monthly bleeding, especially in the first 3 to 6 months, which gets lighter afterward)
• LNG IUD (typically, lighter and fewer days of bleeding, or infrequent or irregular bleeding)

B) Implant

The implant is made up of small, plastic rods about the size of a matchstick. The rods are put under the skin in the inside of the arm and they slowly release a hormone called progesterone, which prevents ovulation (the release of an egg from the ovary). They work for up to 5 years.

Advantages

• Prevent pregnancy very effectively (999 of every 1,000 women using implants will not become pregnant)
• Little required of the woman once the implant is in place.

Disadvantages

• May initially cause a change in bleeding pattern (typically, prolonged irregular bleeding over the first year, and then lighter, more regular bleeding, infrequent bleeding, or no bleeding)

PERMANENT

Permanent contraception, also called sterilization, prevents all future pregnancies. It is very difficult or impossible to reverse. (You must be sure that you do not want any more children before choosing sterilization as a form of birth control!)

C) Female sterilization

Female Sterilization also called Tubal ligation or “tying tubes” is an operation to permanently prevent pregnancy. The Fallopian tubes are blocked or sealed to prevent the eggs from reaching the sperm and becoming fertilized. The procedure can be done in a hospital or in an outpatient surgical center.

Advantages

• Prevents pregnancy very effectively (995 of every 1,000 women relying on female sterilization will not become pregnant)
• No need to worry about getting pregnant or contraception again
• Hormone free
• Do not interfere with sex
• Widely available

Disadvantages

• Not reversible/ Permanent
• Requires surgery
  
  

D) Male Sterilization

Male sterilization or Vasectomy is a form of Permanent contraception for men who will not want more children. It involves an operation to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg.

Advantages

• Prevents pregnancy very effectively (998 or 999 of 1,000 women whose partners have had vasectomy will not become pregnant)
• Does not affect male sexual performance
• Do not interfere with sex
• Widely available

Disadvantages

• Non-reversible/permanent
• Requires surgery

REGULAR ROUTINE METHODS

These contraceptive methods need to be remembered between once a day and once every 3 months. All of them are reversible, do not interrupt sex, and are methods that contain hormones.

E) The Pill

There are two types of pills available. The Combined Oral Pill (COP) contains the hormones estrogen and progesterone. The Progesterone-only Pill (The POP or Mini Pill) only contains progesterone.

A doctor usually prescribes these pills. The hormones inside them block pregnancy by preventing the ovaries from releasing an egg every month (ovulation). A pill is taken at the same time each day for 21 days, and then afterward there is a seven-day break when no pill is taken. During that week you would have a “period-type” bleed, and then you start taking the pill again after those seven days. (Some pills come in “every-day packs”; these packages have 28 pills. There are 21 active pills and seven inactive/dummy pills in a pack; one pill is taken each day without any break.)

Advantages

• Highly effective (less than 1 pregnancy per 100 women using COCs over the first year)
• Widely available

Disadvantages

• Need to think about it daily/ A pill is taken everyday
• May cause changes in bleeding pattern (Typically, there is irregular bleeding for the first few months and then lighter and more regular bleeding)
• May cause side effects (Headaches, dizziness, nausea, breast tenderness)
• May be less effective during severe vomiting and diarrhea

F) The Patch

The contraceptive patch is a small sticky patch that releases hormones into the body through the skin to prevent pregnancy. This skin patch is worn on the lower abdomen, buttocks, or upper arms. It releases the hormones progesterone and estrogen into the bloodstream, and blocks pregnancy by preventing the release of an egg from the ovary. A new patch is placed once a week for three weeks. During the fourth week, a patch is not worn, so you can have a menstrual period.

Advantages

• Highly effective (93 of every 100 women using the combined patch will not become pregnant)

Disadvantages

• Its visible
• May come loose or fall off
• Patch must be changed every week
• May cause changes in bleeding (typically, irregular bleeding for the first few months and then lighter and more regular bleeding)

 
G) Hormonal Vaginal Contraceptive Ring

The vaginal ring is a small, soft, plastic ring that you place inside your vagina. It releases a continuous dose of the hormones estrogen and progesterone (or progesterone only) into the bloodstream to prevent pregnancy. The hormones prevent the ovaries from releasing an egg.  The ring is worn for 3 weeks, (every day and night), and is taken out for the week you have your period, and then you put in a new ring after 7 days.  

Advantages

• Highly effective (93 of every 100 women using the hormonal vaginal contraceptive ring will not become pregnant)

Disadvantages

• Can cause vaginal discomfort or irritation
• New ‘vaginal ring’ must be placed every month
• Can cause changes in bleeding effective (Typically, irregular bleeding for the first few months and then lighter and more regular bleeding)

H) Injection

The contraceptive injection steadily releases hormones, which prevents the release of an egg each month (ovulation). There are two types, monthly injectables contain two hormones, (estrogen and progesterone) and are given once per month.  There are also Progestin-only injectables (contain only progesterone) and are given every 3 months (eg. Depo-Provera).

Advantages

• Highly effective (about 96 of every 100 women using injectables will not become pregnant)
• Widely available

Disadvantages

• It may initially cause a change in bleeding patterns
• New injection must be given every 1 or 3 months
• Gradual weight gain is common (averaging 1–2 kg per year)
• Return of fertility is often delayed. (It takes several months longer on average to become pregnant after stopping contraceptive injections than after stopping other method)

 
SINGLE USE METHODS

These methods have to be used every single time that you have sex. They are hormone free, inexpensive and are widely available. However they may interrupt sex and are not as effective as the previous methods.

I) Spermicides

Spermicides are sperm-killing substances inserted deep in the vagina, near the cervix, before sex. They work by causing the membrane of sperm cells to break, killing them or slowing their movement; this keeps sperm from meeting an egg. They are available in several forms (foam, gel, cream, film, suppository, or tablet). They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse.

Advantages

• Increase vaginal lubrication
• Can be inserted ahead of time and so that sex is not interrupted

Disadvantages

• Less effective (16 pregnancies per 100 women using spermicides over the first year)
• Irritation in or around the vagina or penis

J) Diaphragm
 
A diaphragm is a soft latex cup that covers the cervix (plastic and silicone diaphragms may also be available). The rim contains a firm, flexible spring that keeps the diaphragm in place. It is usually used with spermicidal cream or foam to improve effectiveness. Most diaphragms come in different sizes and require fitting by a specifically trained provider.
 
Advantages

• Increase vaginal lubrication

Disadvantages

• Less effective (79 of every 100 women using spermicides will not become pregnant)

 

CONDOMS

K) Male Condoms

Male condoms are Sheaths, or coverings, that fit over a man’s erect penis. They work by forming a barrier that keeps sperm out of the vagina, preventing pregnancy. Condoms keep infections in semen, on the penis, or in the vagina from infecting the other partner. Condoms can only be used once. They can also be used with water-based lubricants.

Advantages

• Help protect against both pregnancy and STIs, including HIV

Disadvantages

• Less effective (87 of every 100 women whose partners use male condoms will not become pregnant)
  
• Require correct use with every act of sex for greatest effectiveness.

L) Female condom

The female condom is a sheath or lining that fit loosely inside a woman’s vagina; it is made of thin, transparent, soft film. It has flexible rings at both ends. One ring at the closed end helps to insert the condom; the ring at the open end holds part of the condom outside the vagina. They work by forming a barrier that keeps sperm out of the vagina, preventing pregnancy. It can be inserted up to eight hours before sexual intercourse.
 
Advantages

• Help protect against both pregnancy and STIs, including HIV
• Have a soft, moist texture that feels more natural than male latex condoms during sex
• Are not tight or constricting like male condoms
• Do not dull the sensation of sex like male condoms

 
Disadvantages

• Less effective (79 of every 100 women using female condoms will not become pregnant)
• Require correct use with every act of sex for greatest effectiveness.

 
Tip#1:

Anyone can use contraception! A woman can use birth control even if:

• She is under 16 years old
• She is over 40 years old
• She had an abortion, miscarriage, or ectopic pregnancy before
• She is single, married or divorced
• She does not have spouse or husband’s permission

Tip#2:

The Pill

• The Pill must be taken around the same time everyday, for it to be most effective. If you miss 1 or 2 pills, take another pill as soon as possible (there is no risk of pregnancy). If you miss 3 or more pills in a row, take another pill as soon as possible, but for the next 7 days, you should use a condom if you have sex.
• The Combined Oral Pill (COP) can protect women from ovarian and endometrial cancer.
• Women who have irregular and extremely heavy periods can use the pill as well.

Tip#3:

The IUD:

• Does not cause discomfort or pain for the woman or the man during sex. It also significantly reduces the risk of ectopic pregnancy.
• Pelvic inflammatory disease (PID) could occur if a woman has chlamydia or gonorrhea at the time of IUD insertion.

Tip#4:

Female Sterilization:

• Only involves the fallopian tubes; the surgery does not remove a woman’s uterus or lead to a need to have it removed.
• Does not cause heavier bleeding or irregular bleeding or changes a woman’s menstrual cycles.
• Does not change women’s sexual behavior or sex drive.

Tip#5:

Injectables
Injections are best given into the hip, the upper arm, the buttocks, or the front of the thigh.
Contraceptive injections, (like many other forms of birth control that use hormones):

• Do not make women infertile.
• Do not cause early menopause.
• Do not cause birth defects or multiple births.

Tip#6:

Condoms

(Cannot get lost in the woman’s body)

Don’ts

• Do not use lubricants with an oil base on condoms, because they can damage latex. (Water based lubricants are best)
• Do not reuse condoms
• Do not use more than one condom at the same time
• Do not use both a male and female condom at the same time

After sex

• (Male condom) Immediately after ejaculation, hold the rim of the condom in place and withdraw the penis while it is still erect.
• (Female condom) After the man withdraws his penis, hold the outer ring of the condom, twist to seal in the fluids, and gently pull it out of the vagina.

 

I hope these tips on CONTRACEPTION were helpful; Remember, your health is invaluable.

By Dr. J. Lawarna Matthew
 
Acknowledgements
World Health Organization Contraception Guidelines
National Health services
Visit https://www.nhs.uk/conditions/contraception/what-is-contraception/ for more information