Contraception.. What's my options?
One of the most common things I get asked in clinical practice is, “okay, apart from the pill - what are my options?”
I get it - It can be overwhelming with all the options and knowing which one is the right fit for you. From the oral contraceptive pill to condoms to the fertility awareness method, there are many different contraceptive options. Here’s how they each prevent pregnancy, the pros & cons and how they each affect your hormones.
The Combined Oral Contraceptive Pill (OCP)
The combined OCP commonly referred to as “the pill” is a combination of synthetic estrogen and progesterone (progestins). These synthetic hormones shut down the communication between the brain and the ovaries, which inhibits the signal for the ovaries to mature and release an egg, ultimately preventing ovulation. Without ovulation, the ovaries do not produce their normal amounts of estrogen and progesterone and therefore pregnancy is prevented.
Pros:
It can reduce severe period pain in conditions such as endometriosis
A reduction in severe menorrhagia (heavy bleeding)
Reduced acne breakouts (only while on the pill, will return post-pill and may surge)
Cons:
Mood alterations - Anxiety/Depression
Lowers libido
Depletes nutrient stores (B vitamins, folate, vitamin C, vitamin E, magnesium, selenium, zinc)
Other potential side effects:
Hair loss
Headaches
Blood clots
Weight gain/changes in insulin
Breakthrough spotting and/or bleeding
Breast tenderness
Elevated blood pressure
Increased risk of cervical and breast cancer
Non-Hormonal/Copper IUD
The intrauterine device (IUD) is a plastic T-shaped copper-coiled device that is inserted into the uterus by a doctor. It is the copper itself that prevents pregnancy as it creates an inflammatory response in the uterus, it is a spermicide & deteriorates eggs. The copper also decreases the sperms ability to freely move in the uterus, which in turn prevents it from reaching the ovum/egg in the fallopian tubes.
Pros:
Lasts longer than other forms of contraception
No need to remember to take a pill every day
Does not contain synthetic hormones or suppress ovulation
Cons:
Insertion can be painful
Can cause heavy bleeding
May increase dysmenorrhea (period pain) for the first few months
Increases the risk of bacterial vaginosis
Can interact with zinc levels
The IUD can migrate to other areas of the body which can cause organ perforation (the chance of perforation is 0.1 percent but more likely if during breastfeeding)
Mirena/Hormonal IUD
Hormonal IUDs are different from all types of hormonal birth control in that they do not completely suppress ovulation. Compared to contraceptive pills and implants, the hormonal IUD delivers a lower dose of the contraceptive drug - levonorgestrel. The blood level of levonorgestrel in Mirena-users is about a tenth of pill-users. Unfortunately, even that low dose can cause side effects.
Pros:
After insertion, you don’t need to do anything or take anything
Mirena lasts 5 years and Skyla lasts 3 years
Hormonal IUDs reduce menstrual flow by at least 90 percent
Helpful for heavy menstrual bleeding and those with endometriosis
Cons:
Insertion can be painful
Suppresses ovulation some of the time
Can cause irregular bleeding and spotting for the first three to six months of use
Changes the vaginal microbiome and may increase the risk of yeast infections and bacterial vaginosis
Can cause ovarian cysts (5 percent of users)
Hormonal IUDs can cause pelvic inflammatory disease (PID) but only during the first three weeks after insertion, and only if you have a pre-existing infection with gonorrhea or chlamydia
Hormonal IUDs cannot protect against sexually transmitted infections
Other side effects due to the release of the drug levonorgestrel:
Headaches
Yeast infections
Weight gain
Anxiety/Depression
Acne
Hair loss or hirsutism
Contraceptive Implant
The contraceptive impact is a plastic stick that is inserted under the skin on the inside of the upper arm. It works by slowly releasing synthetic hormone (progestin) into the bloodstream which thins the uterine lining and impairs cervical fluid, they also inadvertently suppress ovulation.
It’s important to be aware that progestin has no resemblance to our amazing natural hormone progesterone.
Progesterone is a beneficial hormone for our thyroid, skin, mood, hair and metabolism to name a few. Unfortunately, there is no progesterone in any type of hormonal birth control. Instead, implants contain the progestin steroid drugs levonorgestrel or etonogestrel.
Progestins can cause mood problems, ovarian cysts, irregular menstrual bleeding and weight gain.
Pros:
Inexpensive long term contraception
Requires very little maintenance or effort
Stops bleeding or causes very irregular bleeding
Cons:
Requires insertion and removal by a doctor
Can cause side effects such as:
Erratic bleeding (breakthrough bleeding)
Irregular bleeding
Anxiety and/or depression
Hair loss
Weight gain/ increases insulin sensitivity
Barrier method - Condom
Strangely, overlooked as a form of contraception is the humble ol’ condom. A condom prevents the possibility of pregnancy by providing a barrier to prevent sperm from entering the uterus. There is no effect on male or female hormones and it does not affect ovulation.
Here’s a chemical reduced, low-tox, eco-friendly condom - Jonny.
Pros:
Does not affect male or female hormones
Create a shared responsibility of contraception
Dosen’t affect or shut down ovulation
Provides some protection against sexually transmitted diseases
Minimally-invasive
Cons:
Requires diligence in the heat of the moment
Reduced sensations
Latex allergies
Environmental impact
In the rare case of condom breakage or slippage, the morning-after pill is a reasonable course of action
Fertility Awareness Method (FAM)
Finally, the Fertility Awareness Method (FAM!).
There are roughly only six to nine days of the menstrual cycle where pregnancy can occur, this includes the day of ovulation, the day after ovulation and the five days leading up to it, as this is how long sperm can survive in the uterus.
The fertility awareness method refers to cycle tracking that identifies signs of fertile and non-fertile times. A period tracking app isn’t quite enough as they are based on an “average” 28-day cycle that predicts ovulation occurs on day 14, which is not the case for most women. FAM uses calendar tracking with the addition of recording individual symptoms such as basal body temperature and cervical fluid to identify your fertile windows.
Once the fertile window is identified you are then able to use barrier methods (condoms) or abstinence to avoid pregnancy during your fertile window,
FAM takes a few cycles to learn before you can rely on it as a contraceptive method.
Pros:
Can be used to prevent and plan pregnancy
The least invasive method
Cultivates cycle & body awareness
Doesn’t interact negatively with hormones
Doesn’t stop your cycle or shut down ovulation
Cons:
It requires consistency in tracking signs & symptoms (temperature tracking etc).
Often arousal is highest during times we are most fertile and therefore barrier method would be indicated
If you are experiencing side effects of your contraception or are seeking to discuss alternative options please book an appointment for individualised support.
