Many women want to know what the best contraceptive in the market is. There really isn’t a contraceptive that can be described as the ‘best’. Each has its own benefit and risk profile. Every woman is different and they have different needs.
How do you choose a contraceptive?
The type of contraceptive you choose depends on your overall health, your desire to have children in the future, how often you have sex, the number of sex partners you have and your need to prevent sexually transmitted infections. It is also important to note that some birth control methods work better than others at preventing pregnancy.
It is also important to discuss possible side effects of each contraceptive before making a decision. You must also be realistic about your ability to be compliant to therapy. For example, will you remember to swallow your birth control pill every day? You also need to take into account your partner’s needs and their ability to comply with the chosen birth control method. For example, will your partner accept to use a condom every time you have sex?
Types of birth control methods
These are listed in order of most effective to least effective at preventing pregnancy:
Options for women: Tubal ligation or tubal occlusion.
In tubal ligation, you have a minor surgical procedure to cut the fallopian tubes. In tubal occlusion, small coils are inserted into the tubes through the vagina. This blocks the tubes by causing fibrosis (tissue growth) around the coils. No surgery is required for tubal occlusion). This method prevents the egg from reaching the uterus after being released from the ovary. You will, however, continue to ovulate and have monthly periods. Tubal ligation does not trigger menopause or reduce libido.
Option for men: Cutting the vas deferens. Vasectomy can be reversed if a man wishes to have children later on in life. However, conception after reversal of vasectomy is harder than usual. Although the vas deferens is cut during vasectomy, you will continue to have orgasms and ejaculate.
These include intrauterine devices (popularly referred to as coils) and hormonal implants (the ones typically implanted into the arm). Most of these offer protection for anything between three-10 years, depending on the method. They offer the advantage of not having to remember to regularly take a pill or go to hospital for an injection.
Short-acting reversible contraceptives
These are usually hormonal methods and include the pill, injection, patch and vaginal ring). Most pills require you to take them daily. The patch can last up to three weeks whilst the injection needs to be given every three months. The time taken to conceive after cessation of these contraceptives is relatively short.
Tip: Hormonal methods usually affect your normal reproductive cycle and you will not ovulate. Some women even stop having menses. (For this reason, some doctors prescribe them to women with abnormally heavy menses). Usually these effects are reversed once you stop taking the medication.
These include male and female condoms, cervical caps, diaphragms and sponges. These are inserted each time you have sex. With the exception of the male condom which can only be inserted at intercourse, women can insert the others several hours before intercourse. Barrier methods can be combined with sperm killing agents (spermicides).
Rhythm method: This involves avoiding sex or using other forms of birth control on the days when you are most fertile (most likely to get pregnant).
Withdrawal method: This involves removing the penis from the vagina just before ejaculation. The natural methods are the least effective methods of contraception.
Pros and cons of different contraceptive methods
• More regular and lighter periods which reduces the chances of having iron deficiency anaemia.
• Reduced menstrual cramping.
• A lower risk of ovarian, endometrial (uterus) and colon cancers.
• Some women report improvement in the appearance of their acne.
•Increased risk of getting clots in the veins of the legs (deep venous thrombosis)
•Increased risk for development of hypertension
• Increased risk of breast and cervical cancers: this was particularly true for older hormonal contraceptives which had higher amounts of hormones than the current regimens.
• Weight gain (usually due to fluid retention)
• Mood changes
Women who are over 35 years of age and smoke should not ideally use hormonal contraceptives because they are at a much higher risk of getting complications (especially the leg clots and hypertension which increases their risk for stroke and heart attack).
Intrauterine devices (coils)
There is a small risk of getting an ectopic pregnancy or infection whilst having a coil. (In an ectopic pregnancy, the fertilised egg implants itself somewhere outside of the uterus— usually in one of the fallopian tubes. This type of pregnancy cannot be carried to term and is a risk to the mother’s life).
Spermicides (gels that contain sperm killing agents)
These can irritate the vagina and increase the risk of getting sexually transmitted infections (including HIV). Use of other vaginal suppositories and gels e.g those used to treat thrush can make the spermicides less effective.
How about outercourse?
Outercourse refers to any sexual activity that does not include penetrative intercourse. Outercourse provides sexual satisfaction without the risk of pregnancy. However, the risk of getting infections is still present especially when having oral sex.