Contraceptive Options – Pros, Cons, and Side effects

It wasn’t until the early 1990s that the World Health Organization (WHO) recognized the need for evidence-based contraceptive guidance. To date, the number of available contraceptive options has reached over a dozen. A quick online search will give you at least 15 types of contraception (Gasp!). It could be confusing to decide which method is right for you.

What is contraception?

Simply put, contraception is a method that protects you from getting pregnant (provided that it is used correctly). There are many different types of contraception to choose from, but not all types are appropriate for all cases. Contraceptive methods are broadly classified into temporary and permanent methods. Temporary or reversible contraception is for those who want to postpone or space births. Permanent methods or sterilization are one-time procedures that prevent a woman from getting pregnant or a man from releasing sperm. Birth control methods can also be categorized as either natural or artificial. Abstinence and withdrawal are types of natural contraception. On the other hand, artificial or modern contraception can be further classified into four categories:

• Long-acting reversible contraception (LARC)
• Barrier methods
• Hormonal methods
• Emergency contraception
• Permanent methods

How do contraceptives work?

Contraceptive products are designed to prevent the union of the sperm and the egg so that pregnancy can not occur. But how do they do that? Contraceptives work in three basic ways, either by:

• blocking the sperm
• disabling the sperm so it doesn’t reach the uterus
• inhibiting ovulation

Some contraceptive options work in multiple ways. For example, hormonal intrauterine devices (IUDs) release the hormone progestin to thin the lining of the uterus (partially suppressing ovulation), while also keeping the cervical mucus thick to make it harder for the sperm to reach the waiting egg. You see, some methods are better than others in preventing pregnancy. However, no single product works for everyone.

Natural Contraception

As the name implies, it involves pregnancy-preventive strategies without the use of medications, surgeries, or other physical devices. While highly-motivated and disciplined couples can benefit from natural contraception (after all, it’s cost-free!), it has a high failure rate of about 25% from typical use. The good news is that it has no physical side effects and is acceptable to all faiths and cultures.AbstinenceNot having sex or engaging in non-penetrative sex work for some people. The method is simple: if you don’t want to get pregnant, then don’t have sex. But sex isn’t always black and white; that’s why we have a gazillion contraceptive options. It is no surprise that abstinence is the only 100% effective contraception. Any additional benefits? Well, abstaining from oral, vaginal, and anal sex protects you from sexually transmitted infections (STIs).WithdrawalIn the scientific world, this method is called coitus interuptus. Unlike abstinence, it does not prevent the transmission of STIs. Penetrative sex, including oral, can spread STIs. Note that some infections like herpes and genital warts can also be acquired through skin-to-skin contact. The efficacy rate of the “pull-out” method is only 78-80%. About 1 out 5 women will get pregnant each year during this method. How does it work? The male partner takes his penis out and ejaculates outside the vagina when he feels that he is about to cum. While it’s better than nothing, this method is not very effective. There’s a possibility that your partner will fail to predict the exact timing of ejaculation. What’s even worse is that the pre-ejaculate or pre-cum (the liquid that seeps from the penis before ejaculation) can pick up sperm from the urethra (the tube that carries urine and semen out of the body) and lead to an unplanned pregnancy.

Barrier Contraception

Barrier contraceptives are non-hormonal products that you use every time you have sex to prevent the meeting of the egg and the sperm. These contraceptive methods are removable and may be a good option if you cannot use hormonal methods. They typically don’t require a visit to a healthcare provider. In terms of effectiveness, it depends on the method being used. The common problem with vaginal barrier methods is that they can cause vaginal irritation, which increases STI risk.

Male Condom

Condoms are cheap, easy to carry, available without a prescription, and prevent most types of STIs including HIV. They are 98% effective when used correctly. A male condom is a flexible covering made of rubber latex (lambskin or synthetic versions are also available) that is worn on a man’s erect penis before intercourse. One disadvantage of condom use is the lack of spontaneity. If you or your partner have latex allergies, you can use synthetic condoms instead.

Female Condom

Female condoms are a vaginal barrier made of polyurethane sheath with a ring on either end. The upside of the female condom over the male condom is it can be inserted before sexual activity, and left in place for a longer time after ejaculation. It is safe for those with latex allergies and offers great protection against certain STIs, particularly genital herpes. Female condoms or internal condoms are about 95% effective when used correctly.

Diaphragm

Diaphragm is a dome-shaped barrier with a firm, flexible rim made of silicone or latex. It is coated with spermicidal gel (a sperm-killing substance), folded, and placed deep in the vagina before intercourse. It should cover the cervix in order for it to work. The efficacy rate of the diaphragm is 88% during actual use.

Cervical Cap

The thimble-shaped cap is similar to a diaphragm, only smaller. It can also be left in place longer. It covers the cervix to prevent the sperm from getting into the uterus (womb) to fertilize an egg. Both diaphragm and cervical cap do not protect you from STIs. They are about 92-96% effective when used correctly with spermicide.

Sponge

The sponge is a one-size-only cervical cover that is not commonly used nowadays. It has a high failure rate and limited availability. It contains 1 g of nonoxynol-9, the active ingredient in most spermicides. It is only 76-88% effective in preventing pregnancies. Prior to insertion, you must add two spoonfuls of liquid to the central indentation to create a spermicide foam. No wonder it has gone out of vogue.

Other Contraceptive Options

Injection

Contraceptive injectables (Depo Provera) are one of the most effective methods in preventing pregnancy with about 99% effectivity rate. Your doctor will inject an artificial hormone into your arm or upper thigh every three months. It does not protect you against STIs so you still need to use a condom.Intrauterine

Device (IUD)

IUDs are known as the “fit and forget” contraception, IUD is a small, plastic T-shaped object that is placed inside the uterus by a doctor. It is highly effective and can last up to 10 years. There are two types of IUD: hormonal IUD and copper IUD. As mentioned above, hormonal IUD contains progestin (levonorgestrel), which causes thickening of the cervical mucus. On the other hand, the copper wire coiled around copper IUDs is toxic to the sperm and egg. Both hormonal and copper IUD has an efficacy rate of over 99%.

Contraceptive pill

Oral contraceptive pills or birth control pills are the most widely used hormonal contraceptive method. It has more than a 99% effectivity rate when taken correctly. The combined oral contraceptive pill (COC) contains synthetic versions of female hormones estrogen and progestogen. It prevents ovulation and makes the cervical mucus thick, thus inhibiting sperm penetration. Another type of oral contraceptive pill is the progestogen-only pill (POP) or minipill. It does not contain the hormone estrogen. Unlike COC, you don’t need to take a break after taking a pack of mini pill. Oral contraceptives must be taken consistently around the same time each day in order to be effective. Possible side effects include spotting, breast tenderness, weight gain, nausea, and mood change. The use of estrogen-containing contraceptive methods is linked to an increased risk of blood clot formation (but so is pregnancy!).

Patch

The patch is a hormonal contraceptive involves the application of a sticky patch to the skin of the abdomen, upper arm, upper torso, or buttocks. It is replaced every 7 days for three weeks followed by a no-patch week on the 4th week. The patch is about 91% effective during typical use.

Vaginal Ring

Similar to birth control pills and transdermal patch, the vaginal ring releases hormones for three weeks. It is then removed on the fourth week and a new ring is inserted into the vagina after 7 days. Nine out of 100 women per year may get pregnant using vaginal rings, which means it is 91% effective in preventing pregnancy.

Implant

This flexible, plastic rod (about the size of a matchstick) is surgically inserted under the skin of your upper arm and lasts up to 3 years. It only takes a few minutes to insert and remove. It has a high efficacy rate of over 99%. You get immediate protection if it is implanted during the first 5 days of your menstrual cycle. If implanted on any other day, you need to use other forms of contraception (condom) for seven days.

Permanent Contraception

Permanent contraception prevents all future pregnancies. It is almost impossible to reverse. If you still wish to have kids later on or if you think you might change your mind about getting pregnant, there are other alternative contraceptive options to explore. Sterilization does not protect you against STIs or HIV.

Tubal Ligation

Tubal Ligation (having your tubes tied) is a surgical procedure that involves cutting, tying, or blocking of the fallopian tubes to prevent pregnancy. The egg reaches the uterus from the ovary via the fallopian tubes, thus tubal ligation blocks the egg from travelling into the womb and the sperm from reaching the egg. Both fallopian tubes need to be cut or blocked during surgery. Though it’s a rare occurrence, the tubes may reconnect or unblocked after sterilization and pregnancy can happen. Should you get pregnant after tubal ligation, it will most likely be an ectopic pregnancy. It is a very dangerous condition that must be treated with medications (to stop the fertilized egg from growing) or surgery.

Tubal Implant

This method is ideal for those who prefer a non-surgical sterilization method. Using a thin catheter or tube, the implants are inserted into the fallopian tubes without anesthesia. The metal and fiber coils of the implants create scar tissue and block the fallopian tubes.It could take three months for the implants to take effect, so you need another form of birth control during this period. Reported side effects include pelvic pain, allergic reactions, infection, and perforation of the uterus or fallopian tubes.

Vasectomy

Male sterilization is a minor operation that blocks the sperm from reaching the ejaculate or semen. The testicles still produce sperm but they are absorbed by the body. The procedure does not affect the volume of the ejaculate. Couples will need another form of contraception for three months after a vasectomy. What to do if contraceptive options don’t work for you? There are many reasons why a contraceptive option might fail. Condoms can break. It’s easy to miss a pill. To make matters worse, you don’t have a backup method. Such scenarios would require emergency contraception. Talk to your doctor if you had unprotected sex. You may be given a morning-after pill or an IUD. The pill should be taken up to three days after unprotected sex. The IUD can be fitted within five days of unprotected sex. These methods are not 100% effective and they are more likely to work the sooner you have them.

Conclusion

While there are many forms of contraception, not all options may suit you. In choosing a contraceptive method, you need to consider your lifestyle, overall health, future pregnancy plans, risk of sexually transmitted infections, as well as the cost and the side effects associated with these methods. According to the FDA, the most effective contraceptive methods—or those with less than 1 pregnancy per 100 users per year of typical use—are sterilization, IUD, and implants. The male condom is the only form of contraception that has been proven to reduce the transmission of STIs. The female condom may also protect you against STIs and HIV but more research is needed to confirm this.

Sources:

1. https://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/pdf/Contraceptive_methods_508.pdf
2. https://onlinelibrary.wiley.com/doi/book/10.1002/9781444342642
3. https://www.researchgate.net/publication/321549805_The_Handbook_of_Contraception_A_Guide_for_Practical_Management
4. https://www.nhs.uk/conditions/contraception/
5. https://www.crcpress.com/Contraception-Today/Guillebaud/p/book/9781498714600
6. https://www.fda.gov/media/99605/download
7. https://www.elsevier.com/books/yen-and-jaffes-reproductive-endocrinology/strauss/978-1-4557-2758-2
8. https://www.hhs.gov/opa/pregnancy-prevention/index.html