But in the first place, why do people use contraception?
People choose to use contraception for various reasons, but the majority of them are due to:
- Wish not to have children or to delay parenthood;
- Require contraception to help space the timing of the births of their children; or
- They may feel their family is complete and to guard against the possibility of becoming pregnant again.
The choice of methods of contraception can be broadly divided into:
Hormonal
- The combined pill (micropill)
- The progestin-only pill (mini-pill)
- Intrauterine system (IUS)
- Implant
- Injection
- Contraceptive patch
- Vaginal ring
- Emergency pill
Barrier
- Intrauterine device (IUD, coil)
- Male condom
- Female condom
- Diaphragm plus spermicide
- Cervical cap plus spermicide
Alternative
- Male sterilisation
- Female sterilisation
- Withdrawal (Coitus Interruptus)
- Natural family planning (Fertility awareness)
Hormonal contraception
Most hormonal methods of contraception contain a combination of estrogen and progestin, which act by preventing an egg from a woman being released each month and thickening the mucus at the entrance of the womb, thus making it difficult for man’s sperm to get through. Other methods contain progestin only, which also work by thickening the mucus but also by changing the lining of the womb. In some women, it may also prevent ovulation. The methods are:
The combined pill - Contains estrogen and progestin. The woman is given one pack for each 28-day cycle. There are a number of different types of combined pills available. But please note that fertility will quickly return to normal when the pill is no longer taken.
The progestin-only pill - Only contains progestin. The woman takes one pill every day. Suitable for women who cannot tolerate estrogens. Further, it can be used while breastfeeding.
Intrauterine System (IUS) - A small plastic-shaped device with a cylinder containing progestin is inserted into the cavity of the womb. The tiny dose of progestin is released slowly. Suitable for women who prefer not to think about birth control on a daily basis. Can also be used by young women.
Implant - A small plastic rod containing a progestin reservoir is inserted in the upper arm. The progestin is released in tiny doses. Implant is particularly suitable for women who want long-term contraception, women who are breastfeeding and those who do not tolerate estrogen.
Injection - The injections contain progestin only or a combination of estrogen and progestin. It is given either once every month or once every three months. Suitable for women who are breastfeeding and those do not tolerate estrogen.
Contraceptive patch - Contains estrogen and progestin and is affixed to the abdomen, thigh, buttocks or upper arm. The hormones are released continuously and the patch has to be changed weekly.
Vaginal ring - Contains estrogen and progestin combination and is inserted into the vagina. It is replaced once a month.
Emergency pill - Works by delaying or inhibiting ovulation. Can contain either a combination of estrogen and progestin, or progestin only. Do note that emergency pill should not be used regularly.
Advantages of hormonal contraception
- Hormonal methods are the most reliable form of protection against unintended pregnancy.
- Hormonal methods are easy to use.
- Hormonal methods are a reversible form of contraception; a woman can get pregnant again once she stops using it.
- There are a number of options available to suit different needs, for example, different mixes and doses of hormones, and different application forms.
- Added health benefits e.g. women may see noticeable improvements in their skin and hair condition, lighter and shorter periods too.
- Hormonal methods do not protect against sexually transmitted diseases (STDs).
- Some women may experience side-effects.
Barrier methods are designed to stop sperm from entering the womb. The methods include:
Male condom - Latex or polyurethane sheath that fits over the penis when it is erect. It is closed at one end with a 'teat' at the top to hold the sperm when the man ejaculates. Provides protection against STDs if used properly.
Female condom - A polyurethane sheath which fits inside the vagina. The closed end covers the cervix and the open end is positioned at the entrance of the vagina. Provides protection against STDs if used properly.
Intrauterine device (IUD) - A small plastic and copper (usually T-shaped) device is inserted in the cavity of the womb. Prevents pregnancy by preventing sperm and eggs from meeting. Not recommended for women who have not given birth or for women with anaemia. Regular use is also not recommended.
Diaphragm plus spermicide - A dome-shaped circle made of rubber or silicone that is inserted into the vagina to form a barrier between the sperm and the entrance of the womb. It is important to have the diaphragm checked every 6 months.
Cervical cap plus spermicide - Cap made of rubber or silicone, similar to the diaphragm. Not recommended for women who have already given birth.
Advantages of barrier contraception
- The condom is the only form of contraception that offers protection against STDs if used properly.
- Barrier methods is most suitable for women who cannot or do not want to use hormonal contraception.
- The IUD is a long-acting method which means it does not interfere with spontaneity.
- Barrier methods offer protection against unintended pregnancy without acting on the natural hormone and fertility cycle, thus avoid the risk of pharmacological side effect.
- Some methods need practice to be used correctly and effectively.
- Some methods such as the male and female condom can interfere with spontaneity, sensation and pleasure.
- Barrier methods are less reliable at preventing unintended pregnancy compared to hormonal methods.
Alternative methods are less reliable than hormonal and barrier methods, particularly for inexperienced individuals. This is by:
Withdrawal method - When having sex, the man has to remove his penis from the vagina before ejaculation. The reason behind is to stop sperm from entering the vagina.
Advantages of alternative contraception
A natural alternative to barrier methods and hormonal methods.
Disadvantages of alternative contraception
- Requires a high level of control from the man
- Frequently fails because small drops of sperm can escape from the penis into the vagina before the man ejaculates
- Causes impairment of sexual climax
These methods involve some means of finding out when a woman is at her most fertile, so that she can be extra careful or to avoid sex altogether at these times. The women should practice to keep a daily record of their body temperature by using a special fertility thermometer.
Advantages of natural contraception
It is a natural alternative to barrier methods and hormonal methods based on the natural hormone and fertility cycle.
Disadvantages of natural contraception
- This technique requires a significant level of motivation and a clear understanding of how to monitor fertility.
- Natural methods of contraception do not take into account fluctuations in the cycle.
- Many circumstances in everyday life can influence the rhythm of a woman menstrual cycle, making reliable calculation of the fertile and infertile days difficult and sometimes impossible.
This method is only for people who have decided they definitely do not want children, either presently or in the future. It is very important to be aware that this is a permanent, non-reversible method of contraception. This can be performed by a surgical procedure to cut or block the fallopian tubes (female sterilisation) or the tubes that carry sperm (male sterilisation).
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