Contraception – What are the options?

Having some fun in the bedroom maybe shadowed often by a fear of unwanted pregnancy but actually, it doesn't need to be so, especially now that there are a variety of contraception options to fit a variety of needs. Contraception, also known as birth control, can be used to prevent pregnancy and, in some cases, will also protect you against sexually transmitted infections.

When determining what kind of contraception is best for you, there are various factors to consider, such as safety, efficacy, acceptability, and availability. So, let us help you explore your options.

Birth control methods can be divided into the following:

• Reversible birth control methods
• Irreversible or Permanent birth control methods

Reversible Birth Control Methods

1. Barrier Methods

Barrier methods are the only form of contraception that prevent cross-transmission of STDs along with preventing pregnancy. They consist of various options which form an impenetrable barrier between the male & female genital parts so as to prevent the exchange of any fluids (for eg semen, vaginal secretions, saliva etc) or infective organisms between the sexual partners. Barrier methods of contraception can be of different types:

• Condoms: Condoms are available in both male and female forms. The male condoms are spread over an erect penis, whereas the female condom is inserted into the vagina before intercourse.
• Effectiveness: If used properly, male condoms are 85-98% effective, while female condoms are 80-95% effective.

Pros:

• They are free from hormones and thus do not have any hormonal side effects on the body.
• Provide protection against STDs.
• Do not have any long-term effects on fertility.
• Easy to use and widely available without any medical prescription.
• Do not require any expert advice or training once you understand how to use them.

Cons:

• If not used properly, it can tear or slip off during sex.
• One needs to be very particular about wearing a condom before initiating any genital contact or penetration.
• It has the potential to reduce spontaneity & some people feel that it interferes with sexual pleasure (although that is highly debatable).
• Diaphragm and Cervical Cap: They are dome-shaped silicone caps that need to be inserted into the vagina before sex. The diaphragm and cervical caps. act as a barrier and stop the sperms from entering the cervix & uterus. It is better to pair it with a sperm-killing gel (spermicide) to increase the efficacy. After sex, the diaphragm must remain in place for at least six hours and be removed after that. In any case, you should always remember to remove it within 24 hours of intercourse Once removed, the diaphragm should be removed and cleaned thoroughly. Because diaphragms and cervical caps come in varying sizes, see your doctor for a good fit.
• Effectiveness: 85-95%.

Pros:

• It is not hormonal.
• Can be used more than once.
• If you take proper care & handle it judiciously, it can last up to two years.

Cons:

• Using a diaphragm takes some practice & one needs to learn how to insert it properly to get a good seal.
• The spermicide used can cause some irritation.
• Contraceptive Sponge: The spermicide-containing contraceptive sponge is required to be inserted into the vagina. It can be put in right away or up to 24 hours prior to sex. After sex, it is required to be left in the vagina for at least six hours.

Pros: It provides a hormone-free birth control option.

Cons:

• The spermicide can cause vaginal irritation
• Prolonged use can cause dryness

2. Hormonal Methods

• Oral Contraceptive Pills: Oral contraceptive pills are hormonal tablets and they prevent pregnancy by inhibiting ovulation, altering the uterine lining & cervical mucus to prevent implantation. They are of three types:
• Combined oral contraceptive pills,
• Progestin-only pills, and
• Emergency contraceptive pills.

The combined pill contains a combination of the hormones estrogen and progesterone preparations, while the progestin pill contains only progesterone preparation. Both the pills need to be prescribed by a doctor and need to be taken regularly daily as advised, at the same time every day.

The emergency contraceptive pill needs to be taken once within 72 hours of unprotected intercourse & helps prevent pregnancy in case of a broken condom, missed pills, or having sex without a condom/diaphragm in a woman who is not using any other regular form of contraception. So far, in India, the emergency pill can be bought over the counter without any prescription.

Effectiveness: 98% efficacy if used properly.

Pros:

• They allow for sexual spontaneity.
• They are easy to use, well-tolerated by most women.
• One does not need to undergo painful injections or procedures for using them.
• They are easy on the pocket & economical to purchase.
• Combined pills may even help with heavy and painful periods and/or acne when prescribed for specific cases by a doctor.
• The effect is easily reversible & one resumes fertility once they discontinue the use of pills if they desire pregnancy.

Cons:

• One needs to remember to take the combined pills at the same time every day to maintain efficacy as irregular use may increase the failure rate and cause irregular bleeding.
• Additional contraceptive techniques may be required as a backup if pills are forgotten.
• Emergency pills need to be taken within 3-5 days ( depending upon the type of pill) of unprotected intercourse. They are not effective if taken after this duration.
• Some people may have adverse effects of the hormonal preparations including nausea, headache, vomiting, allergic reactions stomach upset etc.
• Some people may have serious side effects like the formation of blood clots in the veins, increased incidence of migraine headache & occasionally, high blood pressure.
• Implant: This contraceptive method includes a single, thin rod that is implanted beneath the skin of the upper arm of a woman. The rod contains a certain fixed amount of progestin hormone, which is delivered into the body over a three-year period and provides birth control for that duration. A minor procedure done under local anaesthesia is performed by a doctor to insert the rod in the arm and remove it after 3 years. Effectiveness: >99%.

Pros:

• Long-lasting protection against pregnancy.
• Does not interfere with sex.
• Does not require daily intake of any tablet or before/after every sexual act hence chances of failure due to missed doses are lesser.

Cons:

• Requires trained medical staff for insertion and removal.
• Can cause irregular bleeding in some women.
• Can lead to formation of blood clots, worsening of migraine, hypertension in susceptible women.
• Do not give any protection against STDs and an additional use of condoms is recommended to prevent STDs.
• Contraceptive Injection: In this method, you get an injection of progestin hormone shots into the buttocks or arms every three months.
• Effectiveness: 99%.

Pros:

• Protection Lasts up to three months.
• Allows sexual spontaneity.
• Does not require daily intake of any tablet or before/after every sexual act hence chances of failure due to missed doses are lesser.

Cons:

• Can cause irregular bleeding.
• May result in weight gain and reduced bone density.
• Can cause irregular bleeding in some women.
• It needs to be given by a trained medical staff.
• Does not provide protection against STDs.
• Contraceptive Patch: It is a skin patch that can be worn on the upper body (except breasts), buttocks, or lower abdomen. The hormones progestin and estrogen are released into the bloodstream through this patch. Each patch is good for one week. For three weeks, you change the patch every week, then take a week off without one.
• Effectiveness: 99% if used correctly.

Pros:

• It can help in case of heavy or painful periods.
• Doesn’t interfere with sex and allows for spontaneity.

Cons:

• Requires changing every week.
• It can be visible.
• Can cause skin irritation, soreness, or itching.
• Vaginal Contraceptive Ring: The contraceptive ring is a flexible plastic ring that is placed inside the vagina by the woman. The ring constantly releases small doses of estrogen and progestin hormone. Wear the ring for three weeks, then remove it for the week of your period and replace it with a fresh one.
• Effectiveness: 99% if used correctly.

Pros:

• Does not require medical staff to place the ring.
• Can aid in the regulation of the menstrual cycle.
• May help in reducing period pains and PMS.

Cons:

• Not recommended for women who are unable to use estrogen-based contraception.( eg those who have high blood pressure, blood clotting disorders, migraine, certain forms of cancer).
• Expensive compared to other methods of contraception.
• Do not provide protection against STDs.

3. Intrauterine Contraception

• Intrauterine Devices: It is a small, T-shaped device that is placed within a woman's uterus by a trained healthcare professional. It is composed of material containing progesterone hormone or copper incorporated in a plastic device. Depending on the type, these devices can stay in place & be effective for up to three to ten years.
• Effectiveness: Copper IDUs provide 99% efficacy. Hormone containing IUDs provide 99.8% efficacy.

Pros:

• Long-lasting method of contraception.
• Cost-effective in the long run.
• Hormonal devices also help control heavy or irregular periods.

Cons:

• Requires trained medical staff for insertion.
• Can lead to irregular bleeding for the first few months.
• Can predispose to pelvic infections & Ectopic pregnancy in some cases.
• Do not provide protection against STDs.

4. Lactational Amenorrhea Method

This method of contraception is quite effective when the following three conditions are met:

• You have given birth to a baby less than six months ago.
• Your menstruation has not commenced after delivery (amenorrhea).
• You are solely breastfeeding your infant.

However, remember that this is a temporary method of contraception. Always use some other method of birth control if you don’t meet any of the conditions mentioned above.

5. Fertility Awareness – Based methods

These methods are based on your knowledge of your fertility days. The fertile window or the fertile period refers to the days when your chances of pregnancy are at their peak. You are at your most fertile state one- or two days following ovulation. However, because sperm can live for several (4-5) days inside the female body, you can become pregnant in the days leading up to ovulation. If you do not wish to get pregnant, you either don't have sex on your fertile days or use a contraceptive. However, the failure rates of these approaches differ.

Permanent Birth Control Methods

Sterilization

It refers to the procedure of entirely removing the body's ability to reproduce. Sterilization requires an open or minimally invasive surgery that is performed under general anesthesia. It can be done for both men and women.

• Male sterilization / Vasectomy: This procedure prevents a man's sperm from reaching his penis. This way, his ejaculate never contains enough sperm to fertilize an egg. One can go back home on the same day of surgery. It takes less than a week to recover. The failure rate of a vasectomy is around 0.15%.
• Female sterilization / Tubal Litigation: Both fallopian tubes are blocked or severed during this procedure. In most cases, the woman is discharged from the hospital on the same day of operation. Following the surgery, you will continue to have regular periods and can have sexual intercourse as before. The failure rate of this procedure is around 0.5%.

Remember that both these surgeries are permanent methods of birth control. Therefore, you must be absolutely sure about your decision of not to have kids.

Are all these options getting you overwhelmed? Don’t be. Talk with your partner and with your doctor to try and choose the method of birth control that is most suitable for both of you.