contraception

Choosing a method of birth control is a highly personal decision based on individual preferences, medical history, lifestyle, and other factors. Each method carries with it a number of risks and benefits of which the user should be aware.

Each method of birth control has a failure rate. Sometimes the failure is due to the method and sometimes it is due to human error, such as incorrect use or not using it at all. Each method has possible side effects, some minor and some serious. Some methods require lifestyle modifications, such as remembering to use the method with each and every sexual intercourse. Some methods cannot be used by individuals with certain medical problems.

The following list provides a range of options that I see most frequently in my practice.

Male Condom

 Condoms have a birth control failure rate of about 15%. Most of the failures can be traced to improper use. They have also been shown to be highly effective in helping to prevent STDs providing a good barrier to even small viruses such as human immunodeficiency virus and hepatitis B.

Combined oral contraceptive pill (COCP)

This is the most commonly used contraceptive pill. It contains both oestrogen and a progestagen that together prevent ovulation. It gives regular bleeding once a month but can be used continuously for a number of cycles to stop periods. The failure rate is 1 – 2%.

Combination oral contraceptives offer significant protection against ovarian cancer, endometrial cancer, iron-deficiency anemia, pelvic inflammatory disease (PID), and fibrocystic breast disease. Women who take combination pills have a lower risk of functional ovarian cysts.

The decision about whether to take an oral contraceptive should be made only after consultation with a health professional. Smokers over 35 years old and women with certain medical conditions should not take the pill.

Vaginal Ring

An alternative way of administering the same hormones as the COCP is the vaginal ring. The benefit is that the dose is reduced and you do not need to remember to take the pill every morning. The ring is inserted with the aid of an applicator on the first day of your period and is left in place for three weeks. You will not feel it once it is inserted correctly. You take it out yourself and replace a new one after a break of one week, exactly the same as the pill-free break with the COCP. The ring is very well tolerated and more and more women are using this as contraception.

Progesterone-only pill (POP or mini-pill)

POP is taken by breastfeeding women or by women who cannot use the COCP. It is taken continuously and works by making the cervical mucus thick. It also makes the womb lining thin and can stop ovulation. Women may get irregular light bleeding or no periods at all. The failure rate for POP is 1% to 3%.

When stopping the POP and starting the COCP (for example when finishing breastfeeding), simply stop the POP and start taking the COCP the following day.

Both methods of hormonal contraception, when used properly, are extremely effective.

Intrauterine Devices (‘coil’)

IUDs are small, plastic, flexible devices that are inserted into the uterus through the cervix. This can be performed at a normal consultation and takes only a few minutes. Ideally the procedure is performed when you are having your period so that there is no chance of unexpected pregnancy and at this time the cervix is soft and open. A few cramps can be experience for the following 24 hours that respond well to an anti-inflammatory such as Ibuprofen 400mg x3 per day.

Copper IUDs contain no hormones. They may give periods that are heavier, longer or more painful than before but are a good choice for those women wishing to avoid hormones and who already have light and short periods.

Hormone IUDs (Mirena, Levosert) contain the hormone progesterone that is released at an extremely low dose. These IUDs are better suited to women who have heavier or painful periods. Around 40% of women with hormonal IUDs will have no periods and the remainder usually have hight and short periods. For the first month or two after insertion the user will experience bleeding most days (‘Spotting’) but this settles with no treatment. Both forms of IUDs are highly effective and last for 3-5 years. One of the great benefits is that once inserted, you do not need to think about contraception – it is there when needed. Satisfaction rates are very high. Side effects are reversible and fertility returns immediately when the device is removed.

Surgical Sterilization

Surgical sterilization should be considered permanent. Tubal ligation seals a woman’s fallopian tubes so that an egg cannot travel to the uterus. Vasectomy involves closing off a man’s vas deferens so that sperm will not be carried to the penis.

Vasectomy is considered safer than female sterilization. It is a minor surgical procedure that usually takes less than 30 minutes. Minor post-surgical complications may occur. I do not perform vasectomies but am happy to direct you to a doctor who will help.

Tubal ligation is an operating-room procedure performed under general anesthesia. The procedure is performed by telescopes (laparoscopy), allowing you to go home the same day and resume normal activities after only a few days. Further information can be found here  (Filshie Clip Sterilisation).

Major complications are rare in female sterilization but include infection, hemorrhage, damage to the intestines and problems associated with the use of general anesthesia. The failure rate (future pregnancy) is very low at around 3 in 1000 lifetime risk.