Who Let The Doc Out?! #010: Understanding birth control

Contraception, also known as birth control, is the deliberate use of drugs, devices, techniques, or medical procedures to prevent pregnancy. Pregnancy occurs if an ovum is fertilized by a sperm. Different methods of contraception try to keep this from happening by one of the following methods:

  • Blocking the sperm from accessing the ovum
  • Stopping ovum production
  • Preventing implantation of the fertilized ovum in the lining of the womb

This article will explore what methods of contraception are available to you, and what benefits and adverse effects come with each method.

Birth control methods are typically classified under four broad categories as follows:

  • Barrier methods
  • Hormonal methods
  • Fertility awareness methods
  • Permanent contraception

Barrier methods

These methods function by blocking the sperm from reaching the uterus. The most common kinds are:

  • Condoms: These prevent both pregnancy and sexually transmitted infections. There is a male condom, which is up to 98% effective if correctly used, and a female condom which is about 95% effective.
  • Diaphragms: These are dome-shaped rubber cups which fit over the cervix. They’re a great cost-effective option because they can be washed and re-used, and are 94% effective. However, they need to be inserted before intercourse and must remain in place for at least 6-8 hours after but not more than 24 hours.
  • Cervical caps: These work similarly to diaphragms but are more rigid and must be used with spermicide.
  • Vaginal spermicides: These are foams, creams, and suppositories which contain chemicals that kill sperm. They are about 81% effective and should be used together with another contraceptive method for better efficacy.

Barrier methods are the preferred option for many because they don’t have long-lasting systemic effects and are easy to access and use.

Hormonal methods

These function by using exogenous hormones like estrogen and progestin to block production of ova and to make conditions for pregnancy in the body unfavorable.

Oral Contraceptives

Also known as birth control pills, these contraceptives can contain either progestin alone, or a combination of estrogen and progestin – combined oral contraceptives (COCs).

COCs are taken for 21-24 days, with 4-7 days taken off when you are having your period. During these 4-7 days, you take daily placebo pills, which are usually iron supplements. These durations may vary depending on your menstrual cycle and your corresponding conversation with your healthcare provider.

Progestin-only pills are taken daily without any time off for the period.

If used correctly, this method has a 99.7% efficacy rate. However, many women are shying away from oral contraceptives as they are commonly accompanied with side effects like:

  • Nausea
  • Weight gain
  • Acne
  • Headaches
  • Risk of developing hypertension
  • Increased risk of developing blood clots
  • Increased risk of cervical cancer with prolonged use.

Contraceptive injections

The commonly used brands of contraceptive injections like Depo Provera and Sayana Press contain a hormone known as medroxyprogesterone. It works by preventing the production of an egg from your ovary during your menstrual cycle, and is injected once every three months.

This is a preferred method for many women because it doesn’t need to be taken daily. However, it comes with certain side effects that may include:

  • Weight gain
  • Irregular or no period
  • Headaches
  • Delayed return of fertility after cessation. It can take women up to 18 months to successfully conceive after stopping medroxyprogesterone injections.

Implants

These contain progestin and slowly release into the bloodstream over a period of 3-5 years, depending on your brand of choice. They are 99.95% effective, and a fantastic option for women. The side effects are usually similar to those associated with contraceptive injections.

Other methods of hormonal contraception include contraceptive skin patches and vaginal rings, which work in a similar manner as other hormonal contraceptives.

IUDs

Intrauterine devices (IUDs) are a contraceptive method that has slowly gained popularity among women over the years. They are placed in the uterus where they prevent pregnancy by one of two mechanisms:

  • Hormonal IUDs: These release small amounts of progestin into your bloodstream, preventing the release of eggs during your menstrual cycle and also blocking sperm from traveling up the cervix. They can last for 3-7 years depending on the brand.
  • Copper IUDs: The copper wire on these IUDs prevents sperm from reaching the ovum and fertilizing it. They can last 8-12 years.

The side effects associated with IUDs vary depending on if they are hormonal or copper. Hormonal IUDs more typically cause symptoms similar to those in other hormonal contraception methods. Copper IUDs on the other hand may be associated with more painful and heavier periods. Generally, IUDs also come with an increased risk of pelvic infections.

Permanent contraception

This is the process of disrupting or blocking the tubes that carry sperm or the ovum. This ends the person’s ability to reproduce. In men, this is known as vasectomy. In women, this is known as tubal ligation. These are both surgical procedures, although vasectomies are significantly less invasive than tubal ligations.

However, they both come with the usual risks associated with minor and major surgery. Additionally, although these procedures are reversible, rates of conception after reversal are relatively low, and as such, permanent contraception should only be approached as an option for people who have little or no desire to reproduce in the future.

Innocent Immaculate Acan is a medical doctor and writer. She won the Writivism Short Story Prize in 2016 and has published an illustrated children’s book titled The Pearl Trotters in Black, Yellow, Red. She was part of the 2018 class of the Young and Emerging Leaders Project.

Innocent Immaculate Acan