Here’s All You Need to Know About Choosing the Right Contraceptive Method!
What are the types of contraception available?
There are many different forms of contraception available and picking one can often be confusing. Contraception can be divided into a few types as detailed below. For the purpose of this article, we will focus more on hormonal contraception and long acting reversible contraception.
- Hormonal contraception
- Oral pills taken daily – either the combined oral contraceptive pill (COCP) which contains both a synthetic estrogen and progestin hormone, and the progesterone only pill (POP), also known as the “mini pill”.
- Contraceptive patch (Evra), which contains both estrogen and progesterone, which is stuck onto the skin and changed once a week
- Contraceptive injection, Depo-Provera, a progesterone-only injection administered in clinic, which lasts 12 weeks
- Long acting reversible contraception (LARC)
- Contraceptive implant (Implanon/Nexplanon), a flexible small plastic rod which is inserted beneath the skin of the upper arm. It contains a progesterone hormone which is slowly released over time and lasts 3 years
- Intrauterine device – a T-shaped device that sits in the cavity of the womb uterus. It can either be copper (non-hormonal) or hormonal based. The lifespan of the IUD is anything between 3-10 years.
- Barrier methods
- Condoms or diaphragms
- Emergency contraception
- Oral emergency contraceptive pill (“Plan B”) or copper IUD
What sort of considerations should I keep in mind when selecting a form of contraception?
The wide variety of contraception methods available can be intimidating and you may be wondering what suits you best. There are various considerations that will help guide you in selecting the best form of contraception for yourself.
- Patient factors
One of the considerations is age, for instance, women above the age of 50 should not take the combined hormonal contraception because their risk of complications like venous thromboembolism (dangerous blood clots in the veins), strokes and cardiovascular disease.
Smokers above the age of 35 should also avoid combined hormonal contraception for similar reasons.
For breastfeeding mothers, progesterone-only contraceptives are preferred. This includes the mini-pill, Depo-Provera injection, Implanon and the hormonal IUD.
- Pre-existing medical conditions
If you have pre-existing medical conditions, some forms of contraception may not be suitable.
Estrogen-containing contraceptive methods should be avoided in women with previous medical conditions including a personal or family history of venous thromboembolism, strokes, heart disease, migraines with aura, smoking over the age of 35, high blood pressure. Individuals with a history of breast or any female hormone related cancers, or genital bleeding with no diagnosed cause, should avoid hormonal contraception.
Certain medications can also interact with some forms of contraception, for instance, some anti-epileptic medications may interact with the combined oral contraceptive pill.
Speak to your doctor if you have pre-existing medical conditions or regular medications you take to ensure that the choice of contraception is compatible.
- Duration of contraception
Another consideration would be how long you wish to take contraception for. If you are certain that you do not wish to conceive in the next few years then long acting reversible contraception like Implanon or the IUD may be suitable for you.
Otherwise, shorter acting hormonal methods may be a better choice. However, you should note that even with shorter acting forms of contraception like the pill or Depo Provera injection, while you can get pregnant the moment you stop taking these, some women may find that their periods take several months before the return to normal.
- Lifestyle or practicality
The type of contraception you choose should also be something that suits your lifestyle.
If you are able to consistently adhere to taking medication on a daily or weekly basis then hormonal methods like the pill or patch will be suitable for you. However, if you are likely to miss doses, then these will not be the best choice as multiple missed doses will greatly reduce the efficacy of contraception.
If you pick the Depo Provera injection, then you will have to ensure you are able to make a trip down to the clinic every 12 weeks.
- Concern about side effects or complications
All forms of contraception come with benefits and side effects.
Contraception can affect your menstrual cycle. For women with menorrhagia (heavy menses) and dysmenorrhea (painful menses), hormonal contraception can help in reducing these symptoms. The copper IUD causes heavier and more painful periods, so if you are already suffering from these, you should stay away from it. You may not get your period altogether with some forms of hormonal contraception, like the hormonal IUD. Some women may like this but others may prefer to still regularly get their period.
If you have skin concerns, certain forms of combined oral contraceptive pills can be helpful in reducing acne.
If weight gain is of paramount concern to you, then certain progesterone only forms of contraception like the Depo Provera injection may not be ideal although research has largely shown that there is no significant weight gain from most forms of hormonal contraception.
Long acting reversible contraception like the implant and IUD are slightly more invasive as they involve insertion and eventual removal of the device, and these procedures, while simple and can be done in clinic, do come with risks which your doctor will be able to tell you about.
Ultimately, selection of contraception should be individualised to each patient. Feel free to speak to your doctor to find out what might best suit your health and lifestyle needs.