Let’s talk about contraceptives

Contraceptives have for long been surrounded by myths and misconceptions which have influenced their uptake.

Research shows that women are most comfortable and likely to continue to use contraceptives if they are well informed and their choice is supported by doctors. Here are answers to concerns that most women about contraceptives.

What contraceptive options do I have to choose from?

Contraceptives can be classified under two categories; non-hormonal and hormonal. Non-hormonal contraceptives include male and female condoms, cervical caps, or diaphragm, copper IUD (coil), natural birth control and sterilisation. Sterilisation is tubal ligation in women and vasectomy in men.

Hormonal methods of birth control are pills, injections, contraceptive patches, implants and the hormonal IUD or coil.

Natural birth control work primarily based on understanding the female reproductive cycle and the fertile window. It offers a choice for couples not willing, or not able to use other contraceptive options. These methods require a very predictable, regular cycle, partner co-operation and a lot of consistency.

Their typical failure rate fluctuates significantly and can be quite high. Condoms have the advantage of being widely available, especially for the male condom, as well as being able to help prevent both pregnancy and sexually transmitted infections (STIs).

Implants are small flexible plastic rods about the size of a matchstick embedded with hormones that are implanted under the arm skin. They can last three or five years. They are amongst the most effective contraceptive methods preventing pregnancy more than 99.9 percent of the time.

The commonest contraceptive injection is the three-month ‘depo’ injection. It is related to the implants in hormone content but is slightly less effective. The contraceptive patch is a good substitute for those who may wish to take contraceptive pills but are unable to sustain daily taking. A woman sticks the small adhesive patch on her skin and changes it every seven days. If fixed on dry skin it will withstand taking a bath and even swimming.

Male and female sterilisation is a permanent birth control option for couples who do not wish to have more children. They entail a small cut to block the fallopian tubes in women or semen passages in men. Both can be performed in an outpatient clinic.

Emergency contraceptive pills (e-pills) are among the most misunderstood and hence abused contraceptives in the Kenyan market. There are several emergency contraceptive pill choices.

However, the most commonly used e-pill contains the hormone levonorgestrel. It is 98 percent effective in preventing pregnancy if taken at the earliest but within 72 hours of sexual activity.

The e-pill is more likely to fail if taken after 72 hours of sex, in obese women, or if taken repeatedly over short durations.

Unknown to the majority of people the copper coil is an alternative emergency contraceptive that is more than 99 percent effective and works if fitted up to five days after unprotected intercourse.

What are the pros and cons of the options listed above?

A major concern amongst women is weight gain for those considering hormonal birth control. Truth is that there is no consistent effect of contraceptives on weight gain. Other factors such as genetic potential, variation in activity level, alteration in diet, or change in metabolism are more likely to result in variations in weight. The level of effectiveness, health, age, side effects, cost and lifestyle are some of the basic concerns looked into before deciding on a contraceptive.

What myths surround contraceptives?

There has been a lot of speculation about the effects of birth control methods on women’s libido. At present scientific evidence is conflicting as to whether contraceptives affect sex drive.

Although the majority of women on hormonal contraceptives report no change in libido a small proportion may report a reduction.

Another common myth is that women using coils are more prone to pelvic infections. Research evidence confirms that the insertion of a coil does not increase the risk of acquiring pelvic infections.

However, if a coil is inserted into a womb with ongoing, often asymptomatic infection, the infection will flare. This may lead to the mistaken assumption that the coil caused the infection. Sterilisation has been surrounded by many misconceptions. The commonest is that tubal ligation diminishes a woman’s libido, causes excessive lubrication during sex, or causes menopause. For vasectomy, men express fear that it will diminish their ‘maleness’ and libido. None of these is true.

On average what's the likelihood of a contraceptive failing?

Contraceptive methods are safe, provide good protection against pregnancy but nothing is perfect; failure rates are low and depend on the method used. For example, instances of women conceiving while on the contraceptive coil are very rare but have received the most coverage. A reason can be a downward displacement or even expulsion of the coil due to contractions of the uterus during menstruation. As a preventive measure, women usually receive instruction on how to check for the position of the coil.

Can I discontinue contraceptive use when I want to have children?

Yes. Contraceptives can be discontinued at any time if the couple would like to conceive, would want to change methods, are concerned about side effects or just take a break. Contraceptives are a tool meant to empower couples to achieve their desired spacing and number of children.

Can contraceptive use delay subsequent conception?

Ovulation and fertility resume immediately or within one or two months after contraceptive use depending on the method. We advise couples to be patient and tailor their expectations appropriately.

At least eight in 10 couples with or without out prior contraceptive use conceive within a year.

Couples with, or without a history of contraceptive use are advised to have a check-up just to be sure all is well if they have not conceived after a year of regular unprotected intercourse.

Dr Mwaniki is an assistant professor and consultant Obstetrician Gynaecologist at Aga Khan University Hospital in Nairobi