Birth control is important to the majority of the population in their lives. Effective contraception brings both health and economic benefits to women, their families and wider society. The avoidance and management of unplanned pregnancies is a key issue for our society today.
According to the World Health Organisation, approximately 214 million women of reproductive age in developing countries who want to avoid pregnancy, are not using a modern contraceptive method. This may be due to unavailability of resources, knowledge or concerns of its short and long-term side effects. Common short-term side effects of hormonal contraception include:
- breast tenderness,
- irregular menstrual bleeding, and
- changes in mood.
Some are concern over its long-term effects such as irreversibility of fertility or risk of malignancy. This negative images and concepts perceived regarding contraception in some religion and social arenas are the major factors responsible for non-compliance and meagre usage of both contraceptive methods in many areas of the world.
There are many types of contraceptives available today to allow individuals to choose the type of birth control that best fits their lifestyle and budget.
Contraceptive methods can be divided into reversible and irreversible types. Reversible methods are Hormonal methods (combined hormones or progestin-only in the forms of pills, patch, implants and injections), Intrauterine Device (copper and hormonal), Barrier methods (physical either as condoms, diaphragms and cervical caps or chemicals delivered as foams, gels and sponges), Natural methods (using ways of abstinence, fertility awareness method, lactational amenorrhea method and withdrawal) and Emergency Contraception (morning after pill). Irreversible methods include sterilization with tubal ligation or vasectomy.
Generally, the effectiveness of Hormonal method and use of Intrauterine Device is more than 99% if used perfectly. The effectiveness is more than 99% for male and female sterilization as well but only more than 80% in actual use of condoms alone or combined with spermicides. Natural methods offer only effectiveness of more than 70% in perfect use. All these methods provide significant protection against pregnancies if compared with not using any methods at all which is only 15% of effectiveness.
For example, a well-organised person with a reasonably regular routine has a wide choice of contraception because the chance of forgetting about taking a pill or reapplying a patch is less. An individual can choose between the method that is used only when one has sex, such as the male or female condom, or a method that needs to be taken every day, such as the pill. Methods such as the patch, injection or implant do not need to be used every day or each time during sex. Some contraceptives can affect periods; they may make periods lighter or more infrequent such as the pill, contraceptive patch or injection and intrauterine system. Those who are smokers and over 35 years old may not suit contraceptives such as the combined pill, patch or the vaginal ring. A person’s weight would not affect most types of contraception, and most contraception would not make one put on weight. However, the contraceptive injection has been linked to a small amount of weight gain if used for two years or more which is usually due to water retention rather than fat gain.
“Those who are smokers and over 35 years old may not suit contraceptives such as the combined pill, patch or the vaginal ring.”
Some contraceptives work by using hormones that are similar to the hormones that women produce naturally. These hormones are oestrogen and progestogen. Contraceptives that contain these hormones aren't suitable for some women, such as those who have medical conditions, including breast cancer. Therefore, the choice of contraceptive methods are only Intrauterine device or barrier methods for them.
Contraceptives that contain oestrogen aren't suitable for women who are over 35, who smoke, are very overweight, take certain medicines or have certain medical conditions, such as problems with blood circulation or migraines with aura. Options available for this group of women include intrauterine device, intrauterine system, contraceptive implants, contraceptive injections and progestogen-only pill.
There are questions on to whether emergency contraception should be used regularly. The morning after pill was developed for use in emergencies - for example if the pill has been forgotten or a condom rips. It contains a much higher dose of hormones than the normal contraceptive pill, which means that it should not be used regularly. As it was not designed for continued use, medical trials only assessed its safety when used as advised. The morning after pills effectiveness is lower than the contraceptive pill or the condom. Having unprotected sex and taking the emergency contraceptive pill is riskier than using contraception. Unprotected sex also puts one at risk of sexually transmitted diseases. Using this pill several times in the same month will also cause changes in the menstrual cycle.
“Concerns on long-term side effects of contraception on women’s fertility should not arise as all methods of reversible contraception can be stopped if pregnancy is planned”
Concerns on long-term side effects of contraception on women’s fertility should not arise as all methods of reversible contraception can be stopped if pregnancy is planned. Fertility can be resumed quickly after stopping contraception if these methods such as contraceptive implants, intrauterine device, progestogen-only pill or the barrier methods are used. For hormonal injections, fertility normally resume 3 to 6 months later after discontinuation.
On the other hand, hormonal and intrauterine system methods do have some beneficial on women’s health such as the ability to regulate menstrual cycle and reduce menstrual flow; hence less issues of anaemia. These methods also reduce incidents of ovarian cysts, pelvic infections and uterine cancer. Use of barrier methods such as condoms also can reduce the risk of sexually transmitting diseases.
As a conclusion, consulting a gynaecologist or family physician for proper evaluation of the women’s individual reproductive desires, medical complications and other health concerns is a necessary step. These healthcare professionals will give careful consideration to patient’s lifestyle and preference regarding form and route of administration and will recommend the best form of contraception to suit each individual.