02—FEB—2021 18:56 GMT
B
irth control (aka contraception) has been around since ancient times. However, effective and safe methods of contraceptives have only become available in the twentieth century. There are many forms of contraceptives nowadays, and when finding a method that’s best suited for you, there are a few factors to consider.
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There are two main categories of contraceptives: reversible and irreversible. Reversible contraceptives include barrier methods (condoms) and hormonal methods (oral, injectable and implantable contraceptives). Irreversible contraceptives involve sterilisation of the male or female sexual organ.
We will start by looking at the most popular form of contraception - barrier methods.
Barrier Methods:
External Condom
The external condom (aka male condom) is made of a polyurethane or nitrile polymer.
How it works
It is placed over an erect penis and acts as a physical barrier that prevents the sperm from meeting the egg.
Some advantages are:
- only used when having sex
- protect both partners from STI
- no serious side effects
Some disadvantages are:
- it may split or tear if not used properly
External condoms are suitable for most people. They can also be used when engaging in anal sex to protect against sexually transmitted infections (STIs). Make sure you are looking for latex-free condoms if you are latex allergic!
They come in different sizes and shapes. They look something like this.
Image shot by Deon Black.
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Internal Condom
The internal condom (aka female condom) is made of a polyurethane or nitrile polymer.
How it works
It is placed inside the vagina and acts as a physical barrier that prevents the sperm from meeting the egg.
Advantages:
- only used when having sex
- protect both partners from STI
- no serious side effects
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Disadvantages:
- may split or tear if not used properly
- not as widely available as male condoms, can be expensive
Internal condoms are also suitable for most people although they are harder to find than external condoms. They can also be used when engaging in anal sex to protect against STIs.
Hormonal Contraceptives:
Moving on to the next form of contraception – hormonal contraceptives.
To start off, we need to familiarise ourselves with two key hormones: oestrogen and progesterone. These hormones are responsible for the development and release of the egg. They also thicken the uterine lining for the egg to implant when it is fertilised (egg + sperm). If the egg is not fertilised by the end of the cycle, the lining of the uterus will shed, and the women will go through what is commonly known as the ‘bleed’.
Most hormonal contraceptives contain oestrogen and/ or progesterone that prevent the release of the egg.
Combined Oral Contraceptive Pill (COCP)
The COCP contains both oestrogen and progesterone hormones.
How it works
It prevents pregnancy by inhibiting the release of the egg from the ovaries, thickens the cervical mucus (making it harder for the sperm to get into your uterus) and thins the lining of the uterus. The pills need to be taken at the same time every day for 21 days.
There are many types and brands of COCP available on the market. Most COCPs are designed to give you a 7-day pill-free period or they can contain 7 days of placebo pills (dummy pills with no hormones) during which you can expect a withdrawal bleed in this period.
A withdrawal bleed happens because you are not taking hormones during that time.
Starting the combined pill
You can start taking the pill at any point of your menstrual cycle. If you take it within the first 5 days of your period, you will be protected against pregnancy straight away. If you take it after the 5th day of your cycle, you will need additional contraception, such as barrier method, until you have taken the pill for the first 7 days.
Not everyone can take the COCP. If you have the following conditions, it may not be suitable for you and your healthcare practitioner might suggest using alternative forms of contraception
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- 35 years old or older and smoke
- pregnant
- very overweight
- taking certain medications
- history of blood clots
- migraine with aura
- liver or gallbladder disease
- history of stroke or heart disease
- breast cancer
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Some advantages are:
- makes your bleeds regular, lighter and less painful
- reduce acne in some people
- reduces the risk of ovarian, uterine and colon cancer
- relieves symptoms associated with polycystic ovarian syndrome
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Some disadvantages are:
- does not protect against STI
- can’t be taken it if you are breastfeeding
Common side effects
- headache, mood changes and breast tenderness
- breakthrough bleeding or spotting (in the first few months of taking the pill)
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Rare but serious side effects
- increased risk of developing blood clots in the veins
Literally an image of a woman taking a pill because we couldn't possibly be more creative than that. Image shot by Elsa Olofsson.
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Progestogen Only Pill (POP)
The POP only contains progestogen, which is similar to the progesterone hormone that is produced naturally by your body.
How it works
It prevents the release of the egg from the ovaries, thickens the cervical mucus and thins the lining of the uterus. It is important to take the pill at the same time each day.
The pills come in a pack of 28 and there is no pill-free week or placebo week. When taking the POP, the effect on periods can vary from person to person. Some women continue to have regular normal periods. However, some can experience irregular periods, more frequent periods, or no periods at all. If you develop irregular bleeding while taking the POP, you should inform your doctor.
Starting the progestogen only pill
You can start taking the pill at any point during your menstrual cycle. If you take it within the first 5 days of your period, it will work straight away, and you will be protected against pregnancy. If you take it after the 5th day of your cycle, you will need additional contraception, such as barrier method, until you have taken the pill for the first 2 days.
Most people can take the POP. If you have the following conditions, it may not be suitable for you and your healthcare practitioner might suggest using alternative contraceptive methods:
- unexplained bleeding in between periods or after sex
- taking certain medications
- history of blood clots
- liver disease
- history of stroke or heart disease
- breast cancer
Some advantages are:
- good option for people who cannot take oestrogen
- can be taken while breastfeeding
- can be used by women who smoke and over 35 years
Some disadvantages are:
- doesn't protect against STI
- period patterns may change which may be unacceptable for you
- headache and breast tenderness
POPs are quite safe and any serious side effects are rare. Some women may develop fluid-filled cysts in their ovaries, but they are not dangerous normally. Some women may experience pain and will need treatment if that occurs.
Additional Resources
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You should be able to find most contraceptive options at GPs, clinics, sexual health clinics, and pharmacies and be able to speak to a healthcare provider to discuss your options. Here are some resources if you're looking for more information.
US:
UK:
https://www.sexwise.org.uk/contraception/which-method-contraception-right-me
https://www.nhs.uk/conditions/contraception/which-method-suits-me/
Malaysia:
http://www.myhealth.gov.my/en/contraception/
New Zealand:
https://www.familyplanning.org.nz/advice
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References
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How Effective Is Your Contraception? - Family Planning. (2021). Retrieved 25 January 2021, from https://www.familyplanning.org.nz/news/2014/how-effective-is-your-contraception
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If You're LGBTQIA, This Safer Sex Guide Is For You. (2021). Retrieved 25 January 2021, from https://www.healthline.com/health/lgbtqia-safe-sex-guide#condoms-and-barriers
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If You're LGBTQIA, This Safer Sex Guide Is For You. (2021). Retrieved 25 January 2021, from https://www.healthline.com/health/lgbtqia-safe-sex-guide
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Which method of contraception is right for me? | Sexwise. (2021). Retrieved 25 January 2021, from https://www.sexwise.org.uk/contraception/which-method-contraception-right-me