Contraception

Why we need contraception

The use of contraception means that becoming pregnant is a choice, and with some forms of contraception, you lower your risk of contracting a sexually transmitted infection (STI).

Different types – barrier methods vs. hormonal methods of contraception

There are roughly 15 different methods of contraception that allow you to enjoy having sex without the risk of getting pregnant, with each having various pros and cons. You can differentiate between types of contraceptives depending on how they work: barrier methods, hormonal methods, intrauterine devices and sterilization.

Hormonal contraceptives contain a small amount of oestrogen and synthetic progesterone (called progestin), which inhibit or augment the natural cycle of hormones, often preventing ovulation or thickening cervical mucous to create a physical barrier to the uterus (or both), and thus preventing pregnancy. Some hormonal contraceptives may also change the lining of the uterus to make it difficult for an egg to be implanted.

Barrier contraceptives prevent sperm from entering the uterus and fallopian tubes, which may be via chemical or physical means, but the most common is the male condom. Barrier methods do not have many side effects, but do have the possibility to fail through human error, ranging from accidents to damage to the device itself either in manufacturing, degrading after the use-by date, or accidentally (or indeed on purpose!) in the moment.

Your options – list of different types of contraception and how they work

There are several different options when it comes to contraception, with some more reliable than others. Options include:

  • The oral contraceptive pill (hormonal, combined pill or mini (progestin-only) pill)
  • Contraceptive injections (hormonal, long-lasting)
  • Vaginal ring (hormonal)
  • Contraceptive patch (hormonal)
  • Contraceptive implant (hormonal)
  • Male condom (barrier, very common and now very safe)
  • Female condom (barrier, available and safe, but not used as much)
  • Diaphragm (barrier)
  • Cervical cap (barrier)
  • Intrauterine device (IUD) (can be hormonal or non-hormonal, changes uterine lining)
  • Contraceptive sponge (barrier only)
  • Spermicide (chemical – often used with diaphragms or condoms)

The oral contraceptive pill (OCP)

The pill is ranked as one of the most commonly used types of contraception after being invented in 1960. The pill prevents pregnancy 95 per cent of the time, and comes close to providing 99 per cent protection if taken as prescribed.

The pill comes in two forms: the combined contraceptive pill that contains both oestrogen and progestin, or the so-called ‘mini-pill’ that only contains progestin. In the case of the mini-pill, it is important to take it every day at the same time and not be late by more than three hours. The pill does not provide protection against STIs and a doctor prescription is required for both types of pill

Male condom

The male condom is one of the most often used effective contraceptive methods, as it is easy to use, affordable and offers protection against STIs and pregnancy.

Condoms are usually made of latex and can cause a reaction in those who are allergic, however, some brands specialise in condoms made of other substances. Non-latex condoms are compatible with all types of lubricant, whereas latex condoms are only compatible with water-based lubricant. You must use a new condom every time you have sex.

Female condom

The female condom offers 95 per cent protection against pregnancy and protection against most STIs. Female condoms tend to be more expensive than male condoms, but have less chance of breakage, and can be inserted up to eight hours before sex. The female condom has not been a popular choice despite it being a barrier form that women can be in control of.

Diaphragm

The diaphragm is placed inside the vagina, up against the cervix, to prevent sperm from reaching the uterus. This barrier method does not protect against STIs. The diaphragm is usually manually coated with spermicide before sex, and a doctor must show you how to use it. You need a prescription to get a diaphragm.

The diaphragm needs to be inserted no more than six hours before sex, and removed about six hours afterwards for cleaning. Diaphragms are typically designed to be reused.

Cervical cap

A cervical cap is a thimble-shaped latex cup, which has been likened to a smaller version of a diaphragm and also needs to be used with spermicide. The cervical cap has to remain in place for at least six hours after sex and be taken out within 48 hours.

The cervical cap has roughly 93 per cent protection rate against pregnancy and does not offer protection from STIs.

Intrauterine device (IUD)

There are two types of IUDs: hormonal or copper-based devices. Both types are long-term solutions and can be used for up to five or ten years respectively. The effectiveness rate for IUDs is over 99 per cent, but they provide no protection against STIs.

Contraceptive implant

A contraceptive implant is another long-term contraception option lasting roughly three years. Implants do not protect against STIs. The implant contains synthetic progesterone, which is also in the contraceptive pill. The hormone is released at a steady pace for three years and has the same effect as the pill.

These implants are inserted into the upper arm by a healthcare professional and must be taken out after three years. The implant has an effectiveness rate of about 99.99 per cent.

Contraceptive sponge

The sponge is a small, round piece of foam made of polyurethane that is placed inside the vagina. It contains spermicide so sperm cannot reach the uterus. The sponge should be left inside the vagina for at least six hours after sex and removed within 24 hours.

The sponge does not protect after the 24 hours and does not provide protection against STIs. Sponges can be used as a backup for other contraceptive methods and does not need a prescription to be bought. Real sea sponges found at some pharmacies or supermarkets in some countries can also be used, after being moistened and then inserted deep into the vagina, up against the cervix.

Spermicide

Spermicide is often used in conjunction with other types of contraceptives. By itself spermicide does not always offer the best protection against pregnancy, which can be due to inconsistent use of the product. There are very few associated side-effects, but it does not protect against STIs. Spermicide does not require a prescription.

Contraceptive injections

One shot of these hormones lasts for eight to twelve weeks and has the same effect as the pill. Injections have about 99 per cent effectiveness. The shot cannot be reversed once it has been given. It does not protect against STIs.

Vaginal ring

The vaginal contraceptive ring is a small, transparent ring that is inserted into the vagina and kept there for three weeks. It is removed for one week out of every four to cause what’s known as breakthrough bleeding, which mimics a menstrual period (but is not a true period, because ovulation has not occurred). The ring is then replaced with a new one. The ring contains hormones and provides the same protection as the pill. The ring does not protect against STIs and needs a doctor’s prescription to buy it.

Contraceptive patch

The contraceptive patch is the same as the pill but in the form of a patch and provides the same protection against pregnancy with the same side effects. It does not protect against STIs.

The patch should be worn for three weeks and taken off for one to allow for breakthrough bleeding (not a real period, but generally looks the same) before starting a new patch. There is a risk for skin irritation and a slim chance of it falling off.

Emergency contraception

Emergency contraceptives exist to stop you getting pregnant if you have unprotected sex. This method is best for one-time occasions and not recommended for daily use (which would then become more like the pill). It can be used if a condom broke or if a contraceptive pill is missed.

It should be taken within 24 hours, which offers over 95 per cent protection. The effectiveness drops the longer you wait. After 72 hours, the effectiveness drops below 50 per cent. You must take another pill if you vomit within three hours of taking the original.

Permanent contraception

Another method of permanent contraception is sterilisation and is an option for both men and women.

The male version is called a vasectomy and consists of tying off and cutting the tubes that carry sperm, with the need for a scalpel or stitches. There is no downtime needed after this procedure. This method of contraception provides no protection against STIs and is a permanent solution. In very rare cases, the tubes can regrow and join back together, making pregnancy possible.

Female sterilisation is also a simple operation with no downtime. You can choose between surgical or non-surgical sterilisation. Surgical sterilization requires the fallopian tubes to be cut and tied so the ovaries are no longer linked to the uterus. The effects are permanent.

Non-surgical sterilisation consists of placing a coil in each fallopian tube so that scars appear and eventually block each tube, though this method has come under scrutiny recently after serious complications in some women. The scars may take up to three months to fully block the tube so another form of contraceptive will need to be used in the interim.

Both options offer more than 99 per cent protection against pregnancy but no protection against STIs.

How do I know what sort of contraception is best for me?

You should discuss all option with your doctor to figure out what types of contraceptive is best for you depending on your needs. Side effects from any methods must be addressed, and measured against the risks of pregnancy or infection.