Choosing the type of contraception can be overwhelming as there are many options available in the practice.
Pills, injections or implants are hormonal contraception.
Hormonal contraception works by thickening up the fluid at the neck of the womb (prevent sperm and egg meeting), making the inner lining of the womb thinner, and by preventing ovulation. The hormones in contraception are very similar to women’s natural hormones, but the levels are steady.
Hormonal methods either use low levels of two hormones (estrogen and progesterone) or just one (progesterone).
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After giving birth and if you are breastfeeding, it is best to avoid combined hormonal contraception because estrogen dries up breast milk. Choose progesterone-only hormone or non-hormonal contraception.
If you are a well-organized person and less likely to forget then you may choose the progestogen-only pill. You have to take daily without break for 28 days.
Progestogen-only pill will only be efficient if taken at about the same time every day with forgiving 12-hour or 3-hour window depending on the brand use. It has 91% efficacy in preventing pregnancy.
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Contraceptive injections or depot (progesterone only hormonal) need to be taken every 2 or 3 months.
If you wish to have a baby in the near future, injections might not be a suitable option as there can be a delay in fertility return for about 1 year after the injection wears off. Injections are about 97% efficient in preventing pregnancy.
Progesterone only hormonal contraception gives a lighter and less painful period every month but is associated with irregular bleeding or no period in many users.
It can also be associated with temporary side effects at first, such as headaches, nausea, breast tenderness, mood swings and decrease sexual drives. Progesterone only hormone reduces the risk of womb cancer.
Most women don’t put on weight when on hormonal contraception. However, weight gain is fairly likely (3kg in 2 years) for women who choose contraceptive injections.
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The progesterone-only hormonal implant can last about 3 years, is very convenient and extremely efficient in preventing pregnancy by about 99%. However, its side effect of irregular bleeding (for 1 in 5 women) can be a nuisance and troublesome for some women.
If irregular and unpredictable bleeding are unacceptable side effects to you, then progestogen-only pills, injections and implant are not suitable methods for you. Choose non-hormonal contraception instead such as copper coil and barrier method.
Once you have stop breastfeeding, then you may consider combined hormonal contraception pills which give you regular and predictable monthly bleeding. (For women who are over 35 years old and smoking, obese or have certain medical conditions; combined hormonal contraception are to be best avoided due to extremely rare complication of blood clots in legs or lungs about 2 in 10000 users.)
Barrier contraception (male and female condom) is the only type of contraception that can both prevent pregnancy and protect against sexually transmitted infections with correct and consistent usage.
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However, some couples may find that using condoms interrupts sex and reduce pleasure. The condom needs some skill-knowing how to stop condoms from breaking and slipping off. If a condom breaks or comes off, emergency contraception (morning after pill or copper coil) might be needed.
For average typical users, condoms are about 79% effective (21 out of 100 people can have unplanned pregnancy).
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Copper coil (non-hormonal) can last up to 5 to 10 years, depending on the type. It is 99% effective in preventing pregnancy. It does not contain the hormone, thus does not have any effect on the regularity of menstrual cycle. Women do have monthly periods but the menstrual flow tend to be prolonged, heavy and more painful.
Having the copper coil fitted in your womb can be painful for some women. It can come out (1 in 20 women) for first 3 months of insertion. Sexually transmitted infection needs to be check before putting in.
It can be associated with rare risks of intrauterine device migrate through the wall of the womb (fewer than 1 in 1000 women) and pregnancy outside the womb (ectopic pregnancy). For women who have a previous history of ectopic pregnancy is best to avoid the intrauterine device.
There are many options of contraception with added benefits that may be suitable for you depending on what criteria is important to you. However, some are associated with extremely rare risks which are better be avoided in certain specified women.
Please consult your doctor for risk assessment before deciding on which method is right for you. Nevertheless, for healthy women, all methods of contraception are safer to be taken than going through pregnancy and childbirth.
Source: This article is written by Dr Haslinda Binti Mohd Daud, Obstetrics and Gynaecology (O&G), Pantai Hospital Ampang
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