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.