Contraception
Introduction
Contraception is also known as birth control or fertility control. It refers to methods or devices used to prevent pregnancy.
All the methods of contraception discussed below are effective. However, it should be kept in mind that no method is 100% reliable. In absence of any contraceptive method, more than 80 in 100 sexually active women become pregnant within one year.
Combined oral contraceptive pill (COCP)
This is a very efficient approach to prevent pregnancy. Its efficiency is such that 1 woman in 300 using the pill correctly will become pregnant each year. It contains oestrogen and progestogen. It works mainly by stopping egg production (ovulation). There are several different types of pills and they are advised depending on each woman’s requirements and health issues if any.
Condoms help to protect from sexually transmitted infections. Condoms are widely available. However, they are not as reliable as other methods. Male condoms occasionally split or come off
The pills containing only progestogen hormone are called as ‘the mini-pill’. It is commonly taken if the COCP is not suitable, such as in breast-feeding women, smokers over the age of 35 and some women with migraine. It works mainly by causing a plug of mucus in the neck of the womb (cervix) that blocks sperm.
Some advantages – it is very effective. Side-effects are uncommon. It helps to ease painful and heavy periods. It reduces the chance of some cancers. There is less risk of serious problems with mini pill.
Some disadvantages – there is a small risk of thrombosis (blood clots). It can’t be used by women with certain medical conditions, such as uncontrolled high blood pressure. Mini pill can cause irregular periods.
Contraceptive vaginal ring
This also contains the same hormones as the COCP. It is a flexible, see through ring which is just over 5cm in diameter. It sits in your vagina for 3 weeks and then you have 1 week without it. After exactly 1 week, you put a new ring into your vagina. It is about as effective at preventing pregnancy, as the COCP.
However, some women (and their partners) may feel it during sex. It may irritate the vagina and cause soreness or discharge.
Barrier methods
These include male condoms, the female condom, diaphragms and caps. They act by preventing sperm entering the uterus. If used properly, about 2 women in 100 will become pregnant. There are no medical risks or side-effects. Condoms help to protect from sexually transmitted infections. Condoms are widely available. However, they are not as reliable as other methods. Male condoms occasionally split or come off.
Contraceptive injections
These contain a progestogen hormone which slowly releases into the body. It is very effective. Fewer than 4 women in every 1,000 using it will become pregnant after two years. It works by mechanism of preventing ovulation and also has similar actions as the POP. An injection is given every 8-12 weeks. It is a very effective method. The woman does not have to remember to take pills.
Periods may become irregular or may stop altogether. Even after stopping, there may be a delay in your return to normal fertility for several months.
Contraceptive implants
An implant is a small device placed under the skin. It contains a progestogen hormone which slowly releases into the body. It works in a similar way to the contraceptive injection. It requires a minor operation using local anaesthetic. Each implant lasts for three years.
Periods may become irregular or may stop all together. It tends to settle after the first few months.
Intrauterine contraceptive device (IUCD)
A plastic and copper device is put into the womb. It is effective for five or more years. Fewer than 2 women in 100 will become pregnant with five years of use of this method. It works by stopping the egg and sperm from meeting. It may also prevent the implantation of embryo to the lining of the uterus. The copper also has a spermicidal effect (kills sperm).
The periods may become heavier or more painful. There is a small risk of serious problems.
Natural methods
This involves fertility awareness. This treatment requires commitment and regular checking of fertility indicators such as body temperature and cervical secretions.
The lactation amenorrhea method is suitable for the first six months after having a baby, if the woman does not have a period.
Sterilization
It is a permanent method of contraception. Vasectomy (male sterilization) stops sperm transfer from the testes. Female sterilization prevents the egg from travelling along the Fallopian tubes to meet a sperm. Vasectomy is easier as it can be done under local anesthetic. These methods are usually used after completion of family.
The couple does not have to think further about contraception after this operation. It is very difficult to reverse. Female sterilization usually needs a general anesthetic.
Emergency contraception
This can be used if you had sex without using contraception. Or, if you had sex but there was a mistake with contraception. Also it is useful in case of a split condom or if you missed taking your usual contraceptive pills.
Emergency contraception pills are usually very effective if started within 72 hours of unprotected sex. An IUCD also can be inserted for this purpose up to five days after unprotected sex.