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  • Vivien Wamalwa

So Many Types Of Contraceptives: Which One Is Best for You?

Key facts (WHO)

  • Among the 1.9 billion Women of Reproductive Age group (15-49 years) worldwide in 2019, 1.1 billion have a need for family planning; of these, 842 million are using contraceptive methods, and 270 million have an unmet need for contraception (WHO, 2020)

  • The proportion of the need for family planning satisfied by modern methods, Sustainable Development Goals (SDG) indicator 3.7.1, was 75.7% globally in 2019, yet less than half of the need for family planning was met in Middle and Western Africa (WHO, 2020)

  • In choosing a method of contraception, dual protection from the simultaneous risk for human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) also should be considered. Only one contraceptive method, condoms, can prevent both pregnancy and the transmission of sexually transmitted infections, including HIV.

  • The use of contraception advances the human right of people to determine the number and spacing of their children.

  • It is possible to get pregnant after having a baby if you have sex and do not use birth control. Some women can get pregnant even before their menstrual period returns. Starting a birth control method immediately after you have a baby can help you avoid an unintended pregnancy. (ACOG, March 2018)

  • Implants, IUD, Vasectomy, and Tubal methods have shown 99% effectiveness in preventing pregnancies but they do not offer protection against STIs/HIV. It is important to discuss contraception options with a Medical doctor or an Obstetrician /Gynecologist for professional guidance.

  • Emergency contraception can be oral medication (most commonly oral UPA or LNG or a combination - which is more effective and can be used 3 to 5 days after unprotected intercourse) or IUDs. IUDs have been shown to be more effective than emergency contraception with the option of LNG 52 mg IUD which contains progestin.

The percentages indicate the number out of every 100 women who experienced an unintended pregnancy within the first year of typical use of each contraceptive method.


Contraception methods are not always 100% effective in preventing pregnancies. These methods can be divided into the following subgroups:



Permanent methods

These include tubal ligation and vasectomy. These methods are irreversible and prevent you or your partner from getting pregnant.


Tubal Ligation


If you're sure you won't want to get pregnant, you may be ready for permanent birth control. The operation for women is called tubal ligation, or "having your tubes tied." A surgeon closes off the fallopian tubes. This prevents eggs from leaving the ovaries.


Vasectomy


Other than condoms, a vasectomy is the only birth control option for men. A doctor surgically closes the vas deferens, the tube that carries sperm from a testicle. This prevents the release of sperm but doesn't affect ejaculation.


Long-acting methods

These methods allow you to prevent pregnancy for years at a time which includes Intrauterine Devices (IUDs) and implants.


Intrauterine Devices (IUDs)


These include two types of devices: Copper-containing IUDs or Progestin-containing IUDs. These IUDs are placed inside a woman's uterus. Copper-containing IUDs (ParaGard) last for 10 years after insertion with less than 1% at risk of pregnancy in the first year of use. The side effect of Copper containing IUDs is heavier menses which may last longer than usual. Progestin IUDs (Levonorgestrel) may have more benefits than Copper-containing IUDs as they may decrease menstrual bleeding and pain as they thin the uterine lining as a result. There are several brands of Progestin IUDs that are removed at different times. The Mirena and Liletta Progestin IUDs can stay in place for up to six years, Kyleena can stay in place for up to five years, and Skyla can stay in place for up to three years

Implants

Nexplanon is a matchstick-sized rod that a doctor places under the skin of a woman's upper arm. It contains the hormone etonogestrel, a progestin, which is slowly released into the body which mainly stops ovulation. It usually offers protection for 3 years and within 7 days of insertion, however, if it is inserted more than 5 days from the start of your period, backup birth control such as condoms should be used for seven days. Your ability to conceive returns upon immediate removal of the implant.


Hormonal methods

These methods usually release hormones mainly estrogen and progestin that prevent ovulation (the release of an egg from one of the ovaries) and prevent pregnancy. These hormones can be released in various forms such as pills, injections, patches, and vaginal rings. These key hormones also prevent pregnancy by also thickening mucus in the cervix to prevent sperm from getting through or thinning of the uterine lining to prevent implantation. There are various hormonal methods that include the following:


Combined Oral Contraceptives


The most common type uses estrogen and progestin to prevent ovulation. It's very effective if taken right. About 9% of women who use it get pregnant but with perfect use the risk of pregnancy is lower. It is important to note that the use of the combined birth control pill is safe for most women, however, there is a small increased risk of deep vein thrombosis (DVT), heart attack, and stroke. The risk is higher in some women, including women older than 35 years who smoke more than 15 cigarettes a day or women who have multiple risk factors for cardiovascular diseases, such as high cholesterol, high blood pressure, and diabetes; a history of stroke, heart attack, or DVT; or a history of migraine headaches with aura. You should not use combined hormonal methods during the first 3 weeks after childbirth because the risk of DVT is higher in the weeks after childbirth.


As such for birth control pills you’ll need to have a doctor prescribe it so as to ensure you are not at risk of DVT, heart attack, and stroke. (ACOG, March 2018)

Lastly, it is common that on being on oral contraceptives you may experience breakthrough bleeding as your body adjusts to the change in hormonal levels. This is usually temporary and resolves on its own.


Birth Control Patch


Women who forget to take daily pills may want to use birth control patches. You wear it on your skin and change it once a week for 3 weeks. During the fourth week, a patch is not worn, and you will have your period. After week 4, a new patch is applied and the cycle is repeated. You apply the patch on the same day of the week even if you still are bleeding.


To use the patch as a continuous-dose form of birth control, apply a new patch every week on the same day without skipping a week. (ACOG, March 2018)


Vaginal Ring


The vaginal ring is a soft plastic ring that goes inside the vagina. It releases the same hormones as the pill and patch, which are absorbed into the body. The vaginal is prescribed by a medical professional.

You fold the ring and insert it into the vagina. It stays there for 21 days. You then remove it and wait 7 days before inserting a new ring. During the week the ring is not used, you will have your period. To use the ring as a continuous-dose form of birth control, insert a new ring every 21 days with no ring-free week in between. (ACOG, March 2018)


Birth Control Shot


It's called Depo-Provera, and it's a hormonal shot that protects against pregnancy for 3 months. The injection is usually injected in the buttock or upper arm or under the skin. Depo injections work in the same manner as other hormonal methods. They are very effective if given during the first injection during the first seven days of your menstrual cycle. The most common side effect on the use of Depo-Provera is irregular or prolonged bleeding and spotting, particularly during the first few months of use.


Barrier methods


This involves the use of male or female condoms which is the only method that can offer protection against sexually transmitted infections and pregnancy. For the female condom, This is a thin plastic pouch that lines the vagina. A woman can put it in place up to 8 hours before sex. To do that, they would grasp a flexible plastic ring at the closed end and guide it into position.


Precoital methods


These methods include use every time you have sex. These include diaphragms, sponges, and spermicides.


Cervical Cap

A cervical cap is a plastic dome that fits tightly over the cervix and is always used with a spermicide. It must be prescribed and placed by a healthcare professional. The cap does not protect against HIV or other STIs.

A cervical cap is a plastic dome that fits tightly over the cervix and must be prescribed and placed by a healthcare professional. The cap does not protect against HIV or other STIs. The cervical cap is less effective in women who have given birth. You should wait 6 weeks after giving birth to use the cap, until the uterus and cervix return to normal size. (ACOG, March 2018)


Diaphragm

This is a rubber dome that women place over their cervix before sex. You should also use a spermicide. This method does not protect against STIs, including HIV. Of 100 women who use it, 24 are at risk of getting pregnant in a typical year for those who are multiparous (have been previously pregnant and delivered) and 12 for the nulliparous. There are two types of diaphragms:

  • Individually sized diaphragm, which must be fitted by a healthcare professional,

  • One-size diaphragm, which fits most but not all women.

You should wait 6 weeks after giving birth to use a diaphragm, until the uterus and cervix return to normal size. The diaphragm must remain in place for 6 hours after sex, but for no more than 24 hours total. If you have sex again within this time frame, apply more spermicide without removing the diaphragm. You then need to wait another 6 hours before taking out the diaphragm. (ACOG, March 2018)


Birth Control Sponge


The sponge is a round device made of soft foam that contains spermicide. It is inserted into the vagina to cover the cervix and keeps sperm from entering the uterus. The spermicide also inactivates sperm. The sponge does not protect against STIs, including HIV.

The sponge can be put in up to 24 hours before sex and should be left in place for at least 6 hours after sex. The sponge should be worn for no longer than 30 hours total. If you have sex again in this time frame, you do not have to replace the sponge. Throw the sponge away after use. The sponge is less effective in women who have given birth.

If you want to use the sponge after having a baby, you should wait 6 weeks after giving birth until the uterus and cervix return to their normal size. (ACOG, March 2018)


Spermicide


A spermicide is easy to use, inexpensive. It is a foam, jelly, cream, or film that goes into the vagina before sex it contains a chemical that inactivates sperm. For spermicide for every 100 women who use this method, 28 women are at risk of pregnancy.

Spermicide can be used alone or with all other barrier methods except the sponge, which already contains a spermicide. When used alone, a spermicide should be inserted into the vagina close to the cervix. You need to wait 10–15 minutes after insertion for the spermicide to become effective. Read the label carefully to see how long before sex you need to insert the spermicide into your vagina. Keep in mind that spermicides are effective for only 1 hour after they are inserted. You must reinsert spermicide for each act of sex. Do not douche or try to remove the spermicide for at least 6 hours after insertion. (ACOG, March 2018).


Vaginal pH regulator gel


Vaginal pH regulator gel containing lactic acid-citric acid-potassium bitartrate (Phexxi) is a non-hormonal birth control gel that can be used in place of spermicide. It has 12 prefilled applicators that are inserted in your vagina up to 1 hour before sex. The gel creates an acidic environment that immobilizes sperm. There is limited data on the effectiveness of this method of contraception in preventing pregnancy. It may cause vulvovaginal irritation and itching post-application in some people.


You can speak to our doctors via the Byon8 app for advise on finding the right contraceptive for you.

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