As you may have seen, last week I did a post on contraceptive options, and focussed on the different types of contraceptive pills available, and gave lots of information about them too! If you haven’t seen that yet, you can have a look here: Contraceptive Options Pt 1: The Pill
This week I am talking about all the other contraceptive options out there, to make people aware of what their options are, and perhaps outlining some of the benefits and drawbacks of them. However, since writing my last post, I listened to a podcast from Oprah's Super Soul Conversations with Melinda Gates, co-founder of the Bill and Melinda Gates foundation. Melinda was talking about the work the foundation does, and how when she went to developing countries to speak to the people there about vaccines, women constantly asked her about contraceptives and if they could be provided. All that was provided to them were condoms, and they had no options, choices, and no way of deciding which contraceptive they could use, especially not without their husbands knowing, which was not always acceptable for their circumstances. I think it is important to be aware of the privilege of the choices that we have, which women around the world are not as fortunate to have. We should educate ourselves about our contraceptive options, because we are so lucky to have them, and to be able to choose if, and when, we have our families, as well as to protect ourselves against sexually transmitted diseases. I thought that this was so important for us to consider, in light of this discussion, and having heard something so recently about the topic I have been writing about. It brings some perspective.
I will start by talking about non-hormonal methods, which would include condoms. They are widely used, very effective when used correctly, and also are a great method to use as a second method of contraception, which is often referred to as ‘doubling up’, e.g. where you take a contraceptive pill and also use a condom as extra cover. Condoms are also essential for STI/STD prevention, and I would strongly recommend using them. An instance where it would be okay not to use condoms is where you are in a long-term relationship and both partners have tested negative for STIs. This is in the interest of both parties, and there are plenty of different types to choose from, and they are really widely available. Usually, if you are a student, you can get them for free from your student union’s office, and they may also be available for free from your family planning clinic, so there is no real reason not to practice safe sex! There are also female condoms available, which provide another option for STI prevention, as well as contraception.
Other 'barrier' methods (physically blocking sperm from entering the womb), include the diaphragm, and the cervical cap. These methods are great options for women who can't, or do not want to, use hormonal methods. While they do have lower rates of effectiveness than most of the hormonal methods, they work well for a lot of women, and it is all about what is right for you at any particular moment in time, and to be aware of the benefits and risks of the options that are applicable to you personally, and which you prefer, and which are accessible to you. Condoms are available widely, cheaply, and even for free, and without prescription, so they are a great contraceptive, once they are used correctly.
2. The Copper Coil:
The copper coil is a small T shaped plastic frame with copper wire. This is put into the woman’s womb to prevent pregnancy. The copper is toxic to both the sperm and egg and the copper coil can also be used as a form of emergency contraception.
- It is suitable for women in whom hormonal methods are not suitable or not preferred (E.g. for medical reasons, due to breastfeeding, family history etc)
- It can be used as emergency hormonal contraception if used within 5 days of unprotected sexual intercourse
- It can be removed . at any time and fertility will return to normal
- It is a reliable long-term method, as it does not require any thinking about contraception on a regular basis and does not depend on how you use it in order to work
- This has to be fitted by a trained doctor
- It is quite an invasive procedure
- It does not protect against STI's
- It can cause cramping, like period cramps, upon insertion
- It may cause heavier and more prolonged periods
Hormonal methods: (Other than the pill)
1. The Patch
What is it?
This is a pill which contains an oestrogen and a progestogen (combined hormonal contraception). If the combined pill is not suitable for you due to being over the age of 35, smoking, family history of heart disease, obesity or other reasons, as mentioned in my post on the pill, then this will also not be suitable. However, if combined hormonal contraception is . suitable for you, if you find it difficult to remember to take a pill every day, or would just prefer a once-weekly patch application, then this is an option you could discuss with your GP. The . hormones are absorbed through the skin, so it is important that the patch remains in contact with the skin for the full calendar week, as is directed.
How is it used?
A contraceptive patch is applied once weekly, then replaced on the same day the following week. The patch is applied like this for three weeks in a row, followed by one week patch-free, and then the cycle repeats, putting on the first patch of the next cycle one calendar week after the last one was removed. It may be easier to remember to replace this as it is only once-weekly, so you can choose a day that best suits you to start your cycle on.
The patch should be applied to clean, dry, hairless, intact healthy skin on the buttock, abdomen, upper outer arm or upper torso, in a place where it will not be rubbed by tight clothing. Do not apply it on the breasts or on skin that is red, irritated or cut. Each consecutive transdermal patch should be applied to a different place on the skin to help avoid potential irritation, but this can mean to just a different patch of skin on the same part of your body - e.g. a different patch of skin on your torso, you do not have to apply the next one to a whole other body part.
Benefits: 99% effective when used perfectly (i.e. when it stays in contact with the skin for the full week, is changed properly, the break is no longer than 7 days, no other medications interact with it).
It can be easier to remember to use than the pill
It does not interrupt sex
The protection it gives is rapidly reversible - if you did want to become pregnant, it does not affect fertility once you stop using it.
It may not be suitable for some patients, due to age, other medical conditions, smoking status, family history, etc.
It does not provide protection against STI's.
It has to be used correctly in order to be effective.
It is more expensive than the pill
2. The 'Ring'
This is a vaginal ring, which a flexible ring. Women who use a vaginal ring put it in their vagina for three weeks every month to help prevent pregnancy.
How does it work?
The oestrogen and progesterone released from this ring into the bloodstream stop ovulation from occurring, just like how the combined pill does.
Benefits of the Ring:
- It only requires once-monthly insertion (followed by removal after 3 weeks)
- This is a good option if you forget to take the pill daily, or your routine does not allow you . to take a pill at the same time every day
- You insert it yourself
- It cannot injure you or get lost up there
- 99% effective when used correctly
- It is another option for you if the pill is not working for you due to remembering when to take it, or due to side effects! It is great to have choice, and to be able to go with your personal preference in this instance.
Drawbacks of the Ring
- As mentioned with the patch, it will . not be suitable for use in all patients, this will be covered . in your conversation with your doctor
- It does not protect against STI's
- It is more expensive than the pill
3. The Injection
This injectable form of contraception contains progesterone only, and provides longer-lasting protection than the methods outlined above. Usually, it provides protection for up to 12 weeks, and is injected by a healthcare practitioner, such as a nurse or doctor. The drug is slowly . released from the muscle it is injected into over the period of 12 weeks (or a period otherwise specified by the healthcare professional who administers it to you). Your doctor will help you to decide if this is suitable for you, if it is an option you would like to consider.
Benefits of Injectable Contraception
- It is useful for women who cannot commit to taking contraception as regularly as daily or weekly, or even monthly
- It may be suitable for patients in whom the combined hormonal contraceptive methods (combined pill, patch, ring) are not deemed suitable for, as this method is progesterone-only so there is less risk of clotting events occurring due to no oestrogens being present
Drawbacks of Injectable Contraception:
- Not everyone is comfortable with needles and injections and would rather avoid this
- it has to be given by a healthcare professional - this is not necessarily a negative, as it gives you an excuse to see your doctor or family planning nurse every 12 weeks so if you have any health queries or concerns, it would be a good time to address them!
- It may cause irregular bleeding at first - but then this can happen with other methods such as the pill also
- it cannot be immediately reversed if you have side effects or if you decide you’d actually like to become pregnant - it will continue to be released for the 12 weeks - once it is injected here is no going back basically!
- It can actually take 6-12 months to regain fertility and regular periods once you stop getting it
- It does not protect against STI’s
4. The Implant:
This is 99.9% effective. It is a small, flexible rod-shaped device, which is inserted under the skin of the upper arm. It can be felt but you cannot be seen. It slowly releases a form of progesterone called Etonogestrel (progesterone-only, therefore can be used once women in whom combined methods containing oestrogen are not appropriate). It stops ovulation from happening and also thickens the mucus at the entrance to the cervix so that sperm cannot enter.
Benefits of the implant:
- Once inserted, this can provide contraceptive efficacy for up to 3 years
- It may reduce painful periods
- It can be taken out if you have side effects, or have decided to conceive, and natural fertility returns very quickly
- It may cause irregular bleeding, amenorrhea (no bleeding), or acne
- The bar can interact with other medications, just like the pill and other medications can interact, so be sure that your prescriber is aware of any other medications you may be taking
- Insertion and removal can only be carried out by a trained doctor
- It does not protect against STI's
5. IntraUterine System (IUS) - Hormonal as compared to copper coil (IUD)
This is a small, soft, plastic device which is inserted into the womb by a trained medical doctor. This contains the hormone progesterone only. This is a reversible method of contraception as it can be removed and fertility will return to normal. This lasts for about 3-5 years,. A small dose of the progesterone hormone is released into your body daily while it is inserted, to prevent . conception.
Benefits of IUS
- Over 99% effective and is not dependant upon user compliance
- Reliable long-term option - you do not even have to think about it once it is inserted
- Suitable for women of all ages and whether you have had children or not, and an option to consider for women in whom oestrogens are not suitable
- Suitable and safe to use during breastfeeding
- Can be removed at any time and fertility rapidly returns to normal
- Can last for either 3 or 5 years, depending on which one is used
- Lighter and shorter periods
Drawbacks of IUS
- Must be inserted by a trained medical doctor
- May experience irregular bleeding for the first few months, but this usually settles down
- As with other hormonal contraceptives, you may experience some hormonal-related side effects, such as breast tenderness, mood changes, headaches and abdominal discomfort, but this could be included under drawbacks of most of the hormonal methods, so this is important to remember also.
- Does not protect against STIs
To Sum It All Up
As I mentioned at the start, if you are reading this and are lucky enough to be able to have a . choice about contraceptives, and to be able to partake in family planning, then you should be as educated as you possibly can be about your options. While I may not have been able to include full details on every single option out there, and every benefit and drawback of each one, I wanted to provide at least enough information for you to know . what options are out there, and to engage you enough to find out more about the options that do interest you, and which you would like to . discuss further with your doctor, pharmacist, or with a healthcare professional at your local family planning clinic. I think this notion that we need to take responsibility for our own health is really important. If you're on a pill . and you just have not felt right since you started on it, you do not have to stick with it. It is your life, and your health and wellbeing, be informed such that you can make the best possible choices in your best possible interests. I have included some really helpful links below, where you can find out more information.
I plan on following this post up by talking about Emergency Contraception in Part 3!
If you have any questions, message, email, contact me, or speak to your doctor or pharmacist. I hope this has been helpful!
Love as always,