Myths around birth control

What myths and misconceptions do most women have about contraceptives?

There are many women who are misinformed. That coupled with controversies gives birth to myths around contraceptive use. I will touch on some of the commonest encounters in my practice.

Weight: Women are increasingly very conscious about changes in their weight. No wonder weight gain is a major concern for those considering a hormonal birth control. Stories from friends may deter you.

A lot of research has gone into this and has not demonstrated a consistent effect of contraceptives on weight gain. But in general people may tend to gain weight over time whether or not they are on a contraceptive. Factors such as genetic potential, activity level, diet and metabolism are the biggest contributors to this.

Coils and pelvic infections: Women using or considering coils have often asked me if they are more prone to pelvic infections. Insertion of a coil does not increase the risk of acquiring pelvic infections.

However, it is important to be confident there is no ‘silent’ infection of the womb at the time of insertion. Otherwise, the infection will flare leading to the mistaken assumption that the coil caused the infection.

Libido: Research shows that majority of women on hormonal contraceptives report no change in libido. A small proportion may report a reduction. Other factors that may influence libido are emotional connection with the partner, level of stress and hormonal fluctuations.

Infertility: “Will this method make me infertile?” or “will it delay conception once I have stopped using it?” are the two most common questions. No contraceptive method other than sterilization causes infertility.

Ovulation and fertility resumes soon after discontinuing a contraceptive. It is helpful for a couple to understand that even without prior contraceptive use, conception may take even a year.

All couples with or without history of contraceptive use are advised to seek medical review if they have not conceived after a year of regular unprotected intercourse.

Contraceptive coils have high failure rates: Instances of women conceiving while on the contraceptive coil have received wide coverage. A common reason is downward displacement, or even expulsion of the coil due to contractions of the uterus during menstruation leaving the uterus conducive for conception.

As a preventive measure, women usually receive instruction on how to check for position of the coil at insertion. If there is any doubt if the coil is well positioned a visit to the clinician is advised.

Emergency contraceptive pills are among the most misunderstood and hence abused contraceptives in the Kenyan market. This is partly due to the lack of information on other emergency contraceptives.

The copper coil is an alternative emergency contraceptive that is more effective and works up to five days after unprotected intercourse.

What are pros and cons, side effects and failure rates of various contraceptive options?

Contraceptive methods are fundamentally safe and go through stringent review before being recommended for use. However, each option has its benefits and drawbacks.

Although natural methods have good effectiveness in ideal circumstances, hardly have any side effects and enhance couple cooperation, they have high failure rates in real-world aka typical use due to natural variability of cycles, very stringent application criteria, poor understanding of how they work and lack of partner cooperation.

This causes a wide variability in their effectiveness. Out of 100 women using these methods anywhere from 2 to 25 of them may conceive in a year.

The hormonal methods share potential for some common side effects. These include nausea, headache, breast discomfort, bloating and mood variations. However, these may not occur in all women and may even vary widely among various methods.

They mostly settle on their own. Hormonal methods are based only on the progesterone hormone, that is the progesterone-only pill, Depo-Provera and implants may affect menstrual regularity to varying degree. The combined hormonal pill and patch are suitable for regularising the menstrual cycle.

The hormonal coil is very useful in controlling heavy menstrual flow. In terms of effectiveness, the shorter duration options, such as pills and 3-monthly injection, have a huge gap in effectiveness when used correctly and consistently, and when used in real-life conditions. For example, only 1 in 100 women will conceive in a year with ideal use of a pill but in typical use, 8 in 100 will.

This is mainly due to delayed or skipped pills. The failure rate of implants and hormonal coil is less than 1 in a 100 in a year under both conditions since they do not depend on user habits once started.

The non-hormonal methods have little influence on the menstrual regularity. Male and female condoms are convenient over the counter options with hardly any side effects. They protect against pregnancy as well as most sexually transmitted infections including HIV.

However, without correct and consistent use, their effectiveness drops drastically. Copper coils are gaining popularity due to their long term effectiveness of up to 12 years. The failure rate is less than 1 in 100 women in a year.

However, for some women, an increase in the amount or duration of menstrual flow may be observed. Sterilization is very effective with minimal side effects for couples who are sure they do not want more children.

Both bilateral tubal ligation for the woman and vasectomy for the man require a small surgery with just a few days recovery period. Their failure rate is negligible.

Can I discontinue a contraceptive choice when I want to have children before the stipulated duration?

Absolutely. It is a couple’s right and choice of what contraceptive to use and for what duration. 

Dr Mwaniki is an assistant professor and consultant obstetrician gynaecologist at Aga Khan University Hospital Nairobi