Types of Contraceptives
Contraceptives and their types:
A woman can get pregnant if a man’s sperm reaches one of her eggs.
Contraception tries to stop this happening by keeping the egg and sperm apart, or by stopping egg production, or by stopping fertilization attaching to the lining of the womb. Contraception is almost free for most people in the UK.
With 15 methods to choose from, you can find one that suits you best.
Barrier methods such as condoms are a form of contraception that helps to protect against sexually transmitted infections and pregnancy. You should use condoms to protect both your sexual health and that of your partner, no matter what the other contraception you’re using to prevent pregnancy.
What methods of contraception are available?
There are different methods of contraception:
- long-acting reversible contraception,
- hormonal contraception
- barriers methods,
- fertility awareness
- emergency contraception
- permanent contraception
There are about 15 methods of contraception. Don’t worry if the first type you used isn’t quite right. You still many ample options.
- ¨ Caps
- ¨ Combined pills
- ¨ Condoms- female
- ¨ Condoms- male
- ¨ Contraceptive implant
- ¨ Contraceptive injection
- ¨ Contraceptive patch
- ¨ Diaphragms
- ¨ Intrauterine devices
- ¨ Intrauterine Systems
- ¨ Natural family planning
- ¨ Progestogen-only pills
- ¨ Vaginal ring
- ¨ Female sterilization
- ¨ Male sterilization
Over years the number of contraceptive methods has greatly increased and the methods differ by how they work. There are
- ¨ Barrier methods- condoms or cervical cap
- ¨ Hormone methods- pills
- ¨ Intrauterine devices & sterilisation
Most types of contraceptives work by:
- a) Prevent an egg from being released every month (hormones)
- b) Prevent sperms from reaching the egg (barrier and some IUD methods)
- c) Block the reproductive function – in men or women (sterilization)
- d) Prevent a fertilized egg from implanting in the uterus (hormones)
What is long-acting reversible contraception?
A long-lasting reversible contraception usually last for a long time, you need to remember it every day or month.
There are two types of LARC:
- anintrauterine device that lasts five or more years
- animplant under the skin that lasts either three or five years.
These types of contraception last longer so are more effective at preventing pregnancy because you don’t have to worry about forgetting pills or a condom breaking or coming off.
They are “fit and forget” contraception.
Hormonal methods of birth control use hormones to regulate or stop ovulation and prevent pregnancy. Ovulation is the biological process in which the ovary releases an egg, making it available for fertilization. Hormones can be introduced into the body through various methods, including pills, injections, skin patches, transdermal gels, vaginal rings, intrauterine systems, and implantable rods. Depending on the types of hormones that are used, these methods can prevent ovulation; thicken cervical mucus, which helps block sperm from reaching the egg; or thin the lining of the uterus.
- Injectable birth control:
This method involves the injection of a progestin, given in the arm or buttocks once every 3 months.5 This method of birth control can cause a temporary loss of bone density, particularly in adolescents. However, this bone loss is generally regained after discontinuing use of DMPA. Most patients using injectable birth control should eat a diet rich in calcium and vitamin D or take vitamin supplements while using this medication.
- POPs progestin-only pills:
In this, a woman takes one pill each day probably at the same time. POPs may interfere with ovulation or with sperm function. POPs thicken cervical mucus, making it difficult for sperm to swim into the uterus or to enter the fallopian tube. POPs alter the normal cyclical changes in the uterine lining and may result in unscheduled or breakthrough bleeding. These hormones do not appear to be associated with an increased risk of blood clots.
- Contraceptive patch:
It is a thin plastic patch which sticks to the skin and releases hormones into the bloodstream. The patch is placed on the lower abdomen, buttocks, outer arm, or upper body. A new patch is applied once a week for 3 weeks, and no patch is used on the fourth week to enable menstruation.
- Vaginal ring.
The ring is thin, flexible, and approximately 2 inches in diameter. It delivers a combination of Ethinyl estradiol and a progestin. The ring is inserted into the vagina, where it continually releases hormones for 3 weeks. The woman removes it for the fourth week and reinserts a new ring 7 days later. Risks for this method of contraception are similar to those for the combined oral contraceptive pills. A vaginal ring may not be recommended for women with certain health conditions, including high blood pressure, heart disease, or certain types of cancer.
EMERGENCY CONTRACEPTIVE PILLS:
ECPs are hormonal pills that are taken as a single dose or 2 doses, 12 hours apart. They are intended to use in the event of unprotected intercourse. If taken prior to ovulation, the pills can delay or inhibit ovulation for at least 5 days to allow the sperm to become inactive. They also cause thickening of cervical mucus and may interfere with sperm function. ECPs should be taken as soon as possible after semen exposure and should not be used as a regular contraceptive method. Pregnancy can occur if the pills are taken after ovulation or if the woman has unprotected sex in the same cycle.
In this article, we will mainly focus on the 3 main types: IUD, Vasectomy (male contraception) & tubectomy (female contraception)
An intra-uterine device (IUD) is a small T-shaped birth control device which is usually made of plastic and wrapped with copper or hormones. This device is inserted into the women’s uterus to prevent pregnancy. A plastic string is tied to the end of the IUD that hangs down the vagina through the cervix. One can check if the IUD is in place by feeling this string. This string is also used by the doctors to remove the IUD.
TYPES OD IUDs:
There are 2 types of IUDs that are usually preferred. They are:
- ¨ Hormonal IUD
- ¨ Copper IUD
The hormonal IUD releases a form of progestin hormone called as levonorgestrel. This type of IUD is found to be the most effective form of contraception than the copper IUDs. They can prevent pregnancy for 3 to 5 years.
The copper IUD is the most commonly used IUD. A copper wire is wound around the stem of the T-shaped device. This can prevent pregnancy for 10 years.
Insertion & working of IUDs:
The insertion of IUD into the uterus is done with help of a specialized doctor. An IUD can be inserted anytime into a women’s body provided she is not pregnant or have a pelvic infection. The insertion procedure takes only a few minutes and sometimes an anesthetic may be given in the area around the cervix.
The main function of the IUD is to prevent the fertilization of the egg by killing or damaging the sperms. The hormonal IUD prevents the fertilization of the egg by killing or damaging the sperms. It makes the mucus in the cervix thick and sticky so that the sperm can’t get through the uterus. It also weakens the uterine lining so that it becomes a poor place for the fertilized egg to implant and grow. The hormone in this IUD also reduces the menstrual cramping and bleeding.
Copper is toxic to the sperm. The copper enables the fallopian tube and uterus to produce a fluid that consists of copper ions, enzymes, white blood cells and prostaglandins that kill the sperms.
When can it be done?
Women can undergo an IUD if she fits into one of the below categories;
- Do not have a pelvic infection at the time of insertion
- If a woman is breastfeeding
- If she is not prone to sexually transmitted diseases
- If she do not want to use birth control pills
- If she prefers a long-acting method of birth control
Advantages of IUDs:
The advantages of IUDs include:
- ¨ It is cost-efficient
- ¨ Less time-consuming method of contraception
- ¨ Lowers risk of ectopic pregnancy
- ¨ Reduces menstrual bleeding and cramps by 90%
- ¨ It may prevent endometrial cancer
- ¨ Do not cause weight gain
Disadvantages of IUDs:
- The hormonal IUD may give rise to non-cancerous growth such as ovarian cysts.
- It may cause hormonal side effects as that caused by oral contraception.
- The side effects include breast tenderness, mood swings, headaches, and acne.
Menstrual problems: the hormonal IUD reduces menstrual cramps and bleeding whereas the copper IUD increases menstrual cramps and bleeding. Some may also experience spotting between the periods.
Perforation: one out of 1000 women will strike in perforation. It almost occurs during insertion. The IUD should be removed if the uterus perforate.
Expulsion: about 1 out of 100 women may experience expulsion. The IUD may be expelled out of the vagina.
Tubectomy, also called as tubal ligation is solely meant for women. It is a surgical procedure of permanently preventing pregnancies. It is commonly called as, “getting your tubes tied” is a surgical sterilization technique for women. This procedure involves closing the fallopian tubes thereby stopping the eggs from traveling from the ovary to the uterus. It also prevents the sperms from entering the fallopian tube to fertilize the egg.
This surgical procedure is 99.5 % effective as birth control and works immediately. In the tubal ligation, the fallopian tubes are either cut or burned or blocked with clips. It does not protect against sexually transmitted diseases including HIV & AIDS.
The tubectomy can be carried out in 2 ways; one is by open surgery that is cut opening the abdomen and the other is a minimally invasive surgery using laparoscopic techniques. In this, the tubes are cut and tied or a clipped at a particular point so as to stop the motion of egg from the ovary to the uterus. This prevents the chances of getting pregnant.
Can the procedure be reversed?
As mentioned earlier this is a permanent technique but it can be reversed by undergoing major surgery. However, the results of that surgery are not at all guaranteed and reversals are more difficult and expensive. Performing tubectomy by microsurgery or laparoscopic techniques have higher chances of reversal but the chances of getting pregnant after the reversal are very minimal.
Women can enjoy sex as earlier even after tubal ligation. There are no noticeable changes in their menstrual cycle and hormone levels. The ovaries release eggs as earlier they are not pushed down the fallopian tube but are reabsorbed by the body itself.
Who should not get this procedure?
It is a complex surgery and is performed under general anesthesia. Certain people who suffer from the following should not undergo this procedure.
- Women who already have undergone surgeries in the abdomen
- Women who have heart and lung diseases
- Women who are allergic to general anesthesia.
Why is it more complex than a vasectomy?
It is definitely considered to be more complex than a vasectomy because women undergoing this surgery are prone to have more complications because it is a major abdominal surgery. In a vasectomy, the semi vesicles are cut. These tubes are much closer to the skin and do not require a major surgery. Also, these tubes can be accessed easily and be done under local anesthesia.
Women undergone tubectomy may develop bladder infections and abnormal bleeding. Some may have post-tubal sterilization syndrome. This includes irregular and painful periods, mid-cycle bleeding or no periods at all. Women who get pregnant after the reversal surgery have more chances of ectopic pregnancy.
- Immediately effective method of contraception
- Permanent birth control
- It is cost-effective in long run
- Allows sexual spontaneity as well
- Does not require regular attention
- Does not protect against Sexually transmitted diseases
- Requires major surgery
- There are complications associated with the surgery
- May not be reversible in some cases
- It is more complicated than male sterilization
Tubal ligation is permanent sterilization and one has to be mentally prepared before making a decision. A woman undergoing tubectomy is susceptible to have more complications since it is considered to be a major abdominal surgery. So one has to think wisely and consult a doctor before making a decision.
A vasectomy is a surgical procedure that is considered as a permanent birth control method. It is solely meant for men and makes him permanently unable to get a woman pregnant. It prevents the release of sperms when the man ejaculates. This procedure involves cutting or blocking the two tubes called as vas deferens. This makes it impossible for the sperm to enter the semen.
How is vasectomy performed?
During a vasectomy:
- The testicles and scrotum are shaved and cleaned with antiseptic.
- You will be given an oral or IV medicine that makes you sleep. So that you will not feel the pain.
The surgical procedure takes about one hour and you will be provided a local anesthesia to numb your scrotum. Once the area is numbed, the doctor makes a small hole on one side of the scrotum and pulls the vas deferens on the other side. The hole made is very small in size so that it heals by itself without stitches. A small portion of the vas deferens is removed and is sealed with clamps. This prevents the sperms from entering into the semen which then ejaculated through the penis. The testicles produce sperms continuously but it is reabsorbed by the body. The eggs cannot be fertilized if there are no sperms in the semen. The doctor then performs the same thing on the other side.
No-scalpel vasectomy is a technique that uses small clamps with pointed ends instead of a scalpel. These clamps are used to cut open the skin of the scrotum. This method is more beneficial as it causes less bleeding, only a small hole is made that heals by itself without stitches, and has fewer complications. This method is as effective as traditional vasectomy.
Vasclip implant procedure: In this procedure, a device called vasclip is used to lock the vas deferens. In this technique, the vas deferens is not cut which reduces the pain and complications of the surgery. However, studies show that clipping is not that effective compared to other methods of sealing the vas deferens.
How effective is vasectomy?
It is the safest and effective method of birth control. About 1 or 2 out of 1000 people might give rise to pregnancy after vasectomy.
Can a vasectomy be reversed?
Some vasectomies can be reversed but the surgery is very difficult and is more expensive. So, one should not undergo vasectomy unless he is sure not to have children in the future.
After the surgery;
Most men will return to the doctor to have a sperm count check but these days there is also home test available. A vasectomy will not interfere with the sex factor, ability to have an erection, sensation of orgasm, etc. one may have mild itching in the testicles during sexual intercourse for few months after the surgery.
Possible risks of the surgery: The complications are very minimal. It includes
- Bleeding under the skin which may cause swelling
- Infection at the site of the incision. In rare cases, the infection may enter into the scrotum
- Inflammation of the tubes that move the sperms from the testicles
- It is a permanent method of birth control
- It is safer, cheaper and also has fewer complications
- It is only a one-time cost and is usually covered with medical insurance
- It cannot prevent sexually transmitted diseases.
- There are complications associated with the surgery
- May not be reversible in some cases.
Vasectomy reversal is possible but is very difficult and expensive. The results of reversal are not guaranteed at all. So before one makes a decision, you will have to think wisely about the risks and complications of vasectomy as well as the benefits. You may also consult your doctor for a second opinion. So far there are no new methods with relatively lesser side effects and risks for male sterilization.
What are the natural methods of contraception?
Natural methods are typically very inexpensive compared to other methods of birth control unless a woman chooses to purchase ovulation test kits.
Advantages of natural birth control
- A woman does not need to take medication or use hormonal manipulation.
- No procedures or fittings by a physician are required.
Disadvantages of natural birth control include
- It can be difficult to estimate or know precisely when a woman is fertile, allowing increased chances for unplanned conception.
- Natural methods are not as effective as some forms of contraception.
- Ovulation test kits are used by some couples using natural methods of contraception, and the cost of these kits is another potential disadvantage.
- Being unable to have intercourse at certain times of the month is a disadvantage for some women.
Calendar rhythm method:
The calendar rhythm method to avoid pregnancy relies upon calculating a woman’s fertile period on the calendar. Based upon her 12 previous menstrual cycles, a woman subtracts l8 days from her shortest menstrual cycle to determine her first fertile day, and 11 days from her longest menstrual cycle to determine her last fertile day. She can then calculate the total number of days during which she may ovulate. If a woman’s menstrual cycles are quite irregular from month to month, there will be a greater number of days during which she might become pregnant.
The calendar method is only about 80% effective in preventing pregnancy and when used alone, it is considered outdated and ineffective.
Basal body temperature method:
The basal body temperature (BBT) method is based on the fact that a woman’s temperature drops 12 to 24 hours before an egg is released from her ovary and then increases again once the egg has been released. Unfortunately, this temperature difference is not very large. It is less than 1 degree F (about a half degree C) when the body is at rest.
The basal body temperature method requires that a woman takes her temperature every morning before she gets out of bed. A special thermometer that is more accurate and sensitive than a typical oral thermometer must be used, and the daily temperature variations carefully noted. This must be done every month. Online calculators are available to help a woman chart her basal body temperature.
To use the basal body temperature as a birth control method, a woman should refrain from having sexual intercourse from the time her temperature drops until at least 48 to72 hours after her temperature increases again.
Mucus inspection method:
The mucus inspection method depends on the presence or absence of a particular type of cervical mucus that a woman produces in response to estrogen. A woman will generate larger amounts of more watery mucus than usual (like raw egg white) just before the release of an egg from her ovary. This so-called egg-white cervical mucus (EWCM) stretches for up to an inch when pulled apart. A woman can learn to recognize differences in the quantity and quality of her cervical mucus by examining its appearance on her underwear, pads, and toilet tissue; or she may gently remove a sample of mucus from the vaginal opening using two fingers.
She may choose to have intercourse between the time of her last menstrual period and the time of change in the cervical mucus. During this period, it is recommended that she have sexual intercourse only every other day because the presence of seminal fluid makes it more difficult to determine the nature of her cervical mucus. If the woman does not wish to become pregnant, she should not have sexual intercourse at all for 3 to 4 days after she notices the change in her cervical mucus.
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