Contraception: The pill and beyond

Condoms are the most widely used contraceptive method, as they effectively prevent sexually transmitted infections (STIs). However, many monogamous couples would like to eventually stop using this method. Many then turn to the pill as the obvious choice, but people often forget – or don’t realize – that there are many other safe, convenient and effective methods that in many cases may more suitable.

The pill

The most commonly used hormonal method Combined oral contraceptives contain two types of hormones: an estrogen and a progestin. The pill prevents the ovary from releasing an ovum, helps thicken the cervical mucus, and alters the coating of the uterine wall, which makes embryo implantation difficult. The advantages of hormonal contraception are that it is effective and reversible, it regulates the menstrual cycle, and does not interfere with sexual relations. However, it does not protect against STIs.

The pill may have some generally minor adverse effects such as irregular bleeding, breast tenderness, nausea and headaches. These effects usually abate after a few weeks.

As with any medication, hormonal contraception involves some risk and is not suited to every person. These contraceptives slightly increase the risk of venous thrombosis and stroke. To give a concrete example, in a 10-year study of women between the ages of 25 and 29, the average risk of having a stroke was 2.7 women out of 10,000. The risk increased to 4 out of 10,000 women among those using hormonal contraceptives.

The risk of complications associated with the use of hormonal contraceptives is further increased by the presence of other risk factors such as migraine with aura, cardiovascular disease, uncontrolled hypertension, breast cancer and smoking, especially in women above the age of 35. These women should avoid using hormonal contraceptives.

The pill is not the only hormonal contraceptive. Here are some others:

Contraceptive patch

The contraceptive patch (Evra®) sticks to the woman’s skin in order to release continuous levels of progestin and estrogen. The way it works is similar to the pill. Each patch is worn on the skin for 7 days and is replaced on the same day of the week for three weeks. No patch is applied on the fourth week, which triggers menstruation.

Vaginal ring

The ring is placed in the vagina and continuously releases hormones. It is held in place by the vaginal walls. It works the same way as the pill and is just as effective. Most men and women cannot feel its presence, and those who do are rarely bothered by it.

The ring is kept in place for three weeks, followed by a one-week hormone-free break. It is discreet and very convenient, especially for women who have trouble taking a daily pill at a regular time.

Mini-pills

Mini-pills are contraceptives that only contain a progestin. When taken correctly, this method is as effective as the traditional pill. Unlike the latter, however, it can be used in smokers above the age of 35.

Progesterone injections

This contraceptive is injected in the buttock or arm every three months. It is very effective, but requires a doctor’s appointment every three months for the injection. After this contraception is stopped, it takes an average of nine months for the woman’s fertility to return. It may also have an effect on bone density.

Intra-uterine system (IUS)

This is a small, T-shaped device inserted into the uterus. The device has a cylinder that contains the hormone levonorgestrel. It can remain in the uterus for up to five years. Its effect reverses as soon as it is removed. It is an excellent option because it is reliable and worry-free. It requires a doctor’s appointment for insertion and removal.

An IUS can reduce the amount of menstrual bleeding and cramping. In 20 to 30 percent of users, menstruation stops completely. Women who have never had children can also use an IUS without any problems. It is a good choice for women who often forget to take their pills.

There are also several non-hormonal options available:

Male condom

In addition to protecting against pregnancy, this is the method that provides the best protection against STIs. When used correctly and consistently, condoms are 97 percent effective. They are inexpensive, easy to use and effective. There are also polyurethane condoms on the market, for individuals with a latex allergy.

Female condom

This is the only woman-controlled contraceptive that protects against pregnancy and STIs. It must be inserted into the vagina prior to intercourse. It is available in drugstores, but is a little bit more expensive than male condoms.

Copper IUD

This little T-shaped device is inserted into the uterus, with an attached copper thread that changes the uterine chemistry in a way that destroys sperm. The device can be left in place for up to 5 years. It has no negative impact on fertility and does not alter the user’s regular menstrual cycle. It is a good option for women who cannot use hormonal methods and who have had failed attempts with other methods. However, it can increase menstrual bleeding and cramping.

Cervical cap and diaphragm

Diaphragms can be made of latex or silicone, while cervical caps are always made of silicone. The woman must see a doctor to have a gynecological exam in order to determine the proper device size for her body. The cap and diaphragm are used with a spermicide, a product that kills sperm.

A diaphragm must be inserted up to six hours before intercourse and remain in place for six to eight hours after intercourse. A cervical cap, for its part, must be inserted up to 30 minutes before intercourse and must remain in place for at least eight hours after intercourse.

Natural methods

With these methods, the woman must identify the days in her cycle where she is most fertile (about 7 to 10 days), by observing her cervical mucus or body temperature. To prevent a pregnancy, she must avoid all sexual activity during her fertile days. This method is effective 75 to 88 percent of the time. It requires a lot of discipline and commitment from both partners.

The lactational amenorrhea method (LAM) is used by new mothers who exclusively breastfeed their babies. The LAM method is effective for the first six months after childbirth if the woman is breastfeeding her baby every four hours during the day, every six hours at night, and if she is still not menstruating.

For more information on sexuality and contraception, speak to your pharmacist or visit www.sexualityandu.ca.