If You Do Not Want to Become Pregnant, How Do You Prevent It?

Chapter 5 of Your Fertile Years is about contraception. It is recommended that everyone who is sexually active should use contraception if they want to avoid a pregnancy.

There are currently sixteen methods of contraception; two specifically for men (male condom and male sterilization), thirteen for women (female condom, combined pill, mini pill, implant, injection, patch, vaginal ring, diaphragm, intrauterine system, intrauterine device, natural family planning, emergency contraception and female sterilisation). There is also the withdrawal method. The ‘right’ method of contraception may depend on age, smoking, weight, and medical and family history and is likely to vary at different times of your reproductive life.

If a woman needs contraception, I recommend she visits her health professional or a sexual and reproductive health or family planning clinic to discuss her individual circumstances and decide which method is most suitable. Several methods have side effects and if they become an issue, women should not suffer in silence. There are alternatives.

However, appointments to discuss contraception are usually short and do not give sufficient time for all methods to be explained. My colleague, Professor Judith Stephenson and her team have developed an amazing interactive website, called Contraception Choices which will help you decide which is the best method for you.

In this chapter of my book I will explain each method of contraception, the advantages and disadvantages and how effective they are. For most methods, there are two levels of effectiveness; the first for optimum use and the second for the average user ‘allowing for the ups and downs of life’.

Condoms; male and female
Condoms are only effective if used properly and must stay in place throughout intercourse, as sperm can be released from the penis at any time. If used properly, the male condom is 98% effective, but they are often not used correctly, which reduces their effectiveness to 85%. The female condom is 95% effective if used correctly but this reduces to about 79% for the average user.

The two biggest advantages of condoms are: they do not have any effect on a woman’s body; and they are the only method of contraception which also protects against STIs which I cover in chapter 6.

Hormonal methods of contraception
The advantages of hormonal contraceptives are that they can be very effective at preventing a pregnancy; they do not interrupt the moment; they are easy to use; and, for some women; they make periods more regular and lighter; reduce premenstrual syndrome (PMS); and they help acne.

The disadvantages of hormonal contraceptives are that they do not provide any protection against STIs and some women experience side effects.

These can be separated into two groups; those that administer oestrogen and progestogen and those that just deliver progestogen. They all have different advantages and disadvantages and can be highly effective if taken correctly.

Hormonal contraception that administers oestrogen and progestogen includes:

Combined hormonal pill. There are many different types of combined pill, with varying levels of hormones. Ideally, the pill should be prescribed by a health professional who will also take into consideration the patient’s family history, blood pressure, weight and height. If a woman does not get on well with one brand of pill, her health professional can change her to a different one. The pill can be 99% effective, but for the average user is 91% effective.

Contraceptive patch. This is a small adhesive patch, 5 centimetres by 5 centimetres, like a much stickier version of a plaster, placed on the skin that works in the same way as the combined pill. It releases progestogen and oestrogen and is changed every week. It is 99% effective for optimum use but for the average user is 92% effective.

Vaginal ring. This is a small, flexible plastic ring that is inserted into the vagina and releases progestogen and oestrogen. It is easy to insert and does not need to be put over the cervix. With optimum use it is 99%, but for the average user is 92% effective.

Progestogen only hormonal contraception includes:

Progestogen-only pill (the mini-pill; POP). This contains only progestogen and needs to be taken at the same time each day, 365 days a year, without a break, to be effective. It can be 99% effective, but for the average user is 92% effective.

Contraceptive implant and contraceptive injection. The implant is a small 4 centimetres long and 2 millimetres wide rod that is inserted under the skin, usually on the inside of the upper arm and it releases progestogen. The injection contains progestogen and only lasts for 8-13 weeks, depending on the brand used. The implant is the most effective at 99% and is not affected by the user. The injection is 99% effective but needs to be topped up on time so overall we say on average it is 97% effective.

Intrauterine systems (IUS). The IUS, or hormonal coil, is a small plastic T-shaped device that is inserted into the womb and releases low dose progestogen. The most common IUS is the Mirena coil which is 99% effective and is not affected by the user.

Non-hormonal Methods of Contraception
The non-hormonal methods include:

Intrauterine device (IUD). An IUD, or copper coil, is a small plastic and copper T-shaped device that is inserted into the womb and stays in place for 5-10 years. The IUD is 99% effective and is not affected by user error.

Diaphragm and cap with spermicide.  The diaphragm is a soft dome made of silicone or latex and the cap is a circular dome of soft silicone which covers the cervix. It can be 94% effective but for the average user is only 84% effective.

Other methods of contraception
Natural family planning. If used properly, it can be as high as 93-99% effective, but most reports say it is about 70% effective. Any woman considering this method needs to be trained by a family planning expert to understand when she is ovulating and her fertile window. Period trackers that just look at menstrual cycle dates are totally unreliable at predicting ovulation and the fertile window and should never be used for natural family planning.

Permanent methods of contraception; male and female sterilisation, The Fallopian tubes or the tubes leading from the testes to the urethra are cut, tied or blocked. Both are 99% effective. Men undertaking this may wish to freeze some sperm in case they change their minds. For women, they could undergo IVF if they change their mind. Reversal of both male and female sterilisation can be attempted.

Withdrawal. The withdrawal method is highly ineffective and really should not be considered a form of contraception. The withdrawal method is when a couple have sexual intercourse but the man removes his penis before ejaculation.  If used perfectly, it is about 96% effective but the average user can expect it to be about 73% effective.

Emergency contraception. This is used if the method of contraception has failed or if a couple have had sex without using contraception. There are two methods; the IUD or oral emergency contraception (morning-after pill). Their effectiveness vary depending on how soon they are administered after unprotected sex.

Read more
Your Fertile Years is available to pre-order on Amazon now. Contact joyce.harper@ucl.ac.uk if you would like Joyce to give a talk to any group or at any event.

Blogs
Chapter 1: Knowing Your Body; Understanding Your Menstrual Cycle And Fertile Window
Chapter 2: The biological clock, female fertility decline
Chapter 3: Optimising your reproductive health
Chapter 4: Everything you should know about sex

And videos to accompany the blogs on my YouTube Channel
Why I wrote Your Fertile Years
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5:

9 things you should know if you want kids in the future