Methods of contraception: which is best for you?

How do they work and which should you choose?

Qualified Nutritionist (BSc, MSc, RNutr)
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24 October 2016

What is there to consider?

Choosing a method of contraception isn’t straight forward, there are often many factors to be considered and there are so many options available: where do you even start!?

There is free confidential advice available to you from local GP practices, pharmacies and sexual health clinics. However, not everyone makes use of these and added pressure or feeling embarrassed can result in rash and uninformed decisions.

Before jumping in with both feet there are a number of factors you might want to consider. First, why do you want to use contraception in the first place? The obvious reason is to avoid pregnancy but actually there can be other reasons too, for example to help correct a hormone imbalance and some of the associated problems such as problem periods or skin breakouts. In many cases it is necessary to protect against sexually transmitted diseases (STD’s) too, for example if you’re aren’t in a relationship and are meeting new people. A combination of all of these reasons isn’t unheard of either!

It is also important to consider your age and circumstances, what you feel comfortable with (for example in terms of putting physical methods into use) and whether or not you mind what happens to your period going forward – many methods can have an effect; some women don’t mind having no period at all whereas other would prefer to have them! It’s all very personal. Also, are there any risk factors to consider and how effective is each method?

So, now I’ve got you thinking about some of these questions, let’s talk through some of your options: from physical barrier methods to hormonal methods, I talk about what is involved with each and some of the pros and cons that they have – you have a number of options allowing you to choose exactly what’s right for you!

Let’s discuss the options!

1. Natural methods

So there are some more ‘natural’ methods of contraception out there that you might want to consider. This means your menstrual cycle is left alone and can continue as nature intended, although, often these aren’t as fail safe when it comes to avoiding failing pregnant. With the right amount of effort and attention though they can be very effective.

  • Family planning – Also called the rhythm method this is when a women pays close attention to her menstrual cycle so that she can determine when she’s ovulating and therefore when would be safe (or not!) to have unprotected sex. This often requires some degree of training and getting used to and the women really needs to have fairly regular periods for it to work – irregular periods can me more problematic. There are some important considerations involved, example the fact that sperm can survive inside a female for days after a sexual encounter – therefore it’s quite complicated and not the simplest of methods!
  • Breastfeeding – Did you know that breastfeeding is an effective method of contraception? However to work effectively it has to be done a certain way and often hectic modern lives means it isn’t always 100% reliable. Breastfeeding keeps levels of a hormone called prolactin high which can suppress other sex hormones responsible for maturing and releasing your eggs. However in order to work effectively you need to be breastfeeding continuously, approximately every 2 –  3hours and this includes during the night, so if your baby is sleeping for most of the night, breastfeeding isn’t so likely to prevent you from falling pregnant and not such a reliable method

2. Barrier methods

Barrier methods as the name suggests – create a physical barrier between sperm and the egg, it is only when these two come into contact you need to worry – they are fine close by in the same vicinity! Barrier methods don’t upset the female menstrual cycle as they aren’t hormonal – for this reason they are often favourable for someone who doesn’t have sex very often. However, on the down side they are often trickier and take more effort to put into practice: this is often around the time of sex which can be uncomfortable of inconvenient. Let’s talk through some of the options:

  • Male condom – The male condom is one of the most popular and effective barrier methods (if used correctly). The male condom can be readily purchased, and has the benefit of protecting the uses against STD’s too. They are disposable are and only required at the time of sexual intercourse – they can be worn just before and disposed of straight away afterwards. Condoms are often made of latex – this can be problematic for anyone who is allergic or when using oil-based lubricants as this can degrade the latex, so this is something to be aware of. Price is an important consideration too though as this can add up if used continually over some time. Other than that, condoms are really accessible, quick and easy to use and effective.
  • Female condom – The female condom is a less popular barrier method. Similar to a male condom the woman inserts the condom into her vagina before having sex. Again, this method does have the benefit of protecting against STD’s if used correctly. Female condoms are slightly more risky than male condoms as the position is harder to control and they are often more expensive and less readily available, however, the bonus being the woman is more in control!
  • Cervical Caps and diaphragms – Similar to the female condom, cervical cup and diaphragms are physical device a woman must insert prior to having sex. The idea is this blocks the opening to the cervix so sperm cannot pass through. The plus sides are that a woman can insert this several hours before sex and it doesn’t have much impact on the sexual experience much. The downsides are they can be slightly trickier to insert and remove (they should be kept in for several hours after sex) and they must be used alongside spermicides in order to increase their effectiveness.  If the cup isn’t inserted properly you are at risk of it not working properly and it is thought to be less effective in woman who has given birth vaginally previously
  • Birth control sponge – The birth control sponge is a more unusual method of contraception and involves a sponge soaked in spermicide being inserted into the vagina prior to sex – the spermicide immobilises the sperm and the sponge also acts as physical block. This has no effect on hormones although user experience can vary a bit in terms of comfort and convenience it isn’t everyone’s cup of tea!
  • Intrauterine device (IUD) also called the coil – The ‘coil’ is a type of intrauterine contraception (IUC) and the IUD is the barrier or ‘sperm deterring’ variety! The coil is a small ‘T’ shaped device that is inserted by a medical professional into the neck of the uterus (this can be painful for women who haven’t given birth) and contains copper which acts prevents sperm from entering. This is an effective method of contraception that can work for up to ten years in many cases, and if inserted correctly, you shouldn’t notice it is there! However, many women find it being painful as it is notoriously difficult to insert

3. Hormonal methods

Hormonal methods of contraception are often used to prevent pregnancy but also, in many cases, to keep troublesome symptoms of PMS under control, for example skin problems or particularly heavy or painful periods. It is important to note that high levels of synthetic hormones can have their own side effects too though so this is also something to be aware of! It is important to look out for potential hormone imbalances.

Hormonal methods of contraception generally work in two ways in order to prevent pregnancy – they can prevent an egg from being released each month, prevent a fertilized egg from implanting in the uterus, or both. Hormonal methods of contraception often have less room for human error, (although not always: for example relying on you to remember to take your pill!). However, if taken properly these are amongst some of the most reliable methods. They do however disrupt a woman’s menstrual cycle – although in some cases these changes are favourable!

  • The contraceptive pill – Up there with condoms, the contraceptive pill is one of the most popular methods of contraception and with good reason; it can be up to 99% effective if taken correctly. The pill contains synthetic versions of the female sex hormones oestrogen and progesterone, although there are a number of different types and brands available. Generally these can be split into two types; firstly you have the combined pill – this contains levels of both oestrogen and progesterone. The combined pill is taken for three weeks on, one week off and during this week a woman will have a period (although this isn’t a true period more of a withdrawal period as ovulation doesn’t actually happen). The other type of contraceptive pill is the progesterone-only pill, also called the mini pill. The mini pill is a progesterone-based pill which stops ovulation (although not consistently) which impairs the ability of the womb to support implantation of an egg (in the event ovulation takes place). As ovulation is inconsistent, so is a woman’s period. You may not have your period at all or in some cases you might have some irregular bleeding or spotting. Generally, the pill helps to reduce symptoms of PMS but you may still have some degree of symptoms around the time of your period. The effectiveness of the pill can be greatly reduced if you forget to take it each day though or if you are suffering from sickness or diarrhoea. If this is the case you may need emergency contraception or be required to take extra precautions, such as using condoms, for up to seven days afterwards. There is also a small increase in the risk of developing blood clots or certain types of cancers whilst on the pill, however always speak to your doctor for more information on this if you are worried. You can stop taking the pill at any time and your menstrual cycle should regulate within a few months, although watch out for any hormone imbalances throughout this time which can easily crop up as your body tries to readjust: it can often take some time for your periods and the associated symptoms to calm down! Herbal remedies such as Agnus castus or soy isoflavones can be useful during this time, although not when you are on the pill. Click the following link to watch a short video on the effects of hormone imbalances and how herbal remedies can be used to help
  • The contraceptive patch – The contraceptive patch works in a similar way to the pill, it is a sticky patch that you physically apply to your skin which release hormones over the course of a month. You apply a new patch each week for three weeks and then go without patch for a week which will result in you having a period – much like the pattern of events when on the combined pill. This has the upside of the user not having to remember to take a pill every day, but the look of the patch can take some getting used to and there is the risk the patch can fall off without you noticing!
  • Vaginal rings – Vaginal rings are small, soft plastic rings that you insert inside your vagina. You leave them in there for 21 days and it releases a steady stream of hormones similar to those found in the pill during this time. After the 21 days are up you can remove the ring which will give you a period. Insertion of the ring is easy, it is normally very comfortable and provides contraception for the full month ahead. The vaginal ring has benefits over the pill as its effectiveness isn’t affected during times of sickness or diarrhoea and it often allows for light, less painful periods. However, there is the risk the ring can work itself outside the body – in this case you can put it back in yourself but emergency contraception may  be required
  • The contraceptive implant – As with the mini-pill, the contraceptive implant is a progesterone-based method of contraception. This means ovulation and periods generally stop but it can take a while to get to this stage and in the meantime you might have irregular and unpredictable periods. On the plus side, once inserted there is no room for error such as with the pill, and the implant can protect you against pregnancy for up to three years if need be, although, you can have it removed sooner if your circumstances change. A general anaesthetic is used when inserting and removing the implant in the upper arm and it sits just underneath the skin
  • Intrauterine system (IUS) a hormonal version of the coil – This is a hormonal IUD also called the Mirena coil. The device is inserted into the womb, where it releases a steady stream of progesterone. Similar to the implant it is invasive although in a different area and can remain in place, releasing hormones for up to 5 years. Again, it can be removed at any time if necessary. With the Mirena coil there is the risk and uncertainty of what is to happen with your periods, generally over time your periods should become shorter, lighter and in many cases stop but sometimes in the meantime periods can become heavier and more unpredictable

4. Permanent methods

Depending on your age, personal circumstances or just through choice; you might not want to ever fall pregnant. If this is the case you can have a permanent procedure done, also called sterilisation, that means you don’t need to worry about bothering with any shorter-term methods of contraception as these procedures are generally very effective. Sterilisation physically impairs your reproductive function. In rare cases permanent methods of contraception can be reversed if requested although it may not always be successful.

  • Tubular occlusion – Also known as female sterilisation, tubular occlusion involves a procedure in order to cut and seal the fallopian tubes. This means eggs can no longer travel into the uterus to meet sperm
  • Vasectomy – A vasectomy is the male sterilisation procedure. During this procedure the tubes that carry sperm out of the male testicles (vas deferens) are cut and tied or sealed which means sperm cannot enter the semen for transport outside of the body. Vasectomies are more easily reversed than tubular occlusions in females but it isn’t advisable to go through with the procedure if you are in any doubt .

5.  Emergency methods

Emergency methods are available if you weren’t previously using any contraception or if you fear the method you are using has failed. Emergency methods of contraception should be used as such and shouldn’t be used on an ongoing basis

  • The emergency contraceptive pill (morning after pill) – The morning after pill should be taken as soon as possible after unprotected sex and acts to delay ovulation. If ovulation has already occurred the morning after pill might not be so effective
  • IUD – Having the IUD coil inserted within 5 days of unprotected sex means it can act as a means of emergency contraception (it can then be left in after this for ongoing contraception.)

I hope this page has been useful! It’s important to make an informed decision in order to find the method of contraception that suits you and your partner best.

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