Dr Michelle O'Driscoll: Contraception... know your options

In her weekly column Dr Michelle O'Driscoll talks about the different options when it comes to contraception
Dr Michelle O'Driscoll: Contraception... know your options

"Thankfully, there is a huge range of options available in terms of contraception," says Dr O'Driscoll.

A WOMAN’S menstrual cycles can begin at any time from the age of eight to 18, and from that point until we reach menopause, our bodies are prepared to conceive.

Due to current societal norms, we have for the most part decided to delay starting our families, space out our pregnancies, and put a limit on the number of children that we have.

Understandably, we often want to finish our education, to become established in good jobs, and financially be able to afford a good quality of life. For these reasons, to name just a few, most of us are required to think about contraception at some point during our reproductive lives.

Thankfully, there is a huge range of options available in terms of contraception. Choosing the right form can be a minefield however, as every woman’s cycles, needs and bodies are different. So many types, so many modes of action, so many brands to choose from!

Today’s article offers a general overview of the types of contraception available, and some of the factors to consider with your doctor as part of the decision-making process.

Condoms are the most commonly used form non-hormonal contraception.
Condoms are the most commonly used form non-hormonal contraception.

Contraception can be divided into two main types; hormonal and non-hormonal, the most commonly used type of non-hormonal being male condoms. While they are crucial for protecting against most Sexually Transmitted Diseases (STDs), they are not enough if you want to be assured pregnancy will not occur. They are in fact considered to be one of the least reliable forms of contraception available, due to their potential to be used incorrectly.

Other non-hormonal options include spermicides, and the diaphragm, which is inserted lengthways into the vagina and springs open to block the entrance to the womb. This is now available in a one-size version, without the need for measurement.

When it comes to hormonal contraception, it is important to understand that the body goes through a vastly complex cycle in order to release an egg for fertilization. This cycle is driven by the rise and fall of particular hormones at very specific time-points in order to create optimal conditions for conception. For that reason, hormones can be used either locally or systemically to create a contraceptive effect.

Hormonal contraception can be further divided into two types; those that contain both oestrogen and progesterone, and those that contain progesterone only. They are available in a wide range of forms, listed below:

Pill - These are available either with both oestrogen and progesterone, or with progesterone only, and are taken on a daily basis, with the option of a pill-free period of up to a week for those on a combined oral contraceptive.

Patch – Oestrogen and progesterone is released into the body through the skin. The patch is changed on a weekly basis for three weeks, followed by a week of not wearing any patch.

Vaginal ring – This is inserted into the vagina, where it releases oestrogen and progesterone for three weeks, followed by a week where the ring is removed.

Injection – This contains progesterone only, is given by your doctor and lasts for 12 weeks.

Implant – also known as the “bar”, which is inserted by the doctor under the skin of the upper arm and releases progesterone. It’s effective for three years.

Intrauterine options – These are inserted by your doctor into the womb, and are available either as a hormonal method using progesterone, or non-hormonal using copper. Its duration of action varies from three to ten years, depending on the type chosen.

As is evident from the extensive list above, there are many things to consider when choosing the right contraception for you. Some factors to think about include:

Side effect profile:

Contraceptives inevitably come with side-effects, which vary greatly from woman to woman. These side effects have the potential to settle down after a few months of use, but may prompt review of the contraceptive choice if not. In general, oestrogen can cause headaches and/or sore breasts, it may improve acne for some women and worsen it for others.

Progesterone can lead to irritability and low mood, bloating, and other PMS-type symptoms. Copper intrauterine devices may lead to heavier periods.

Know there will be side effects with some contraception.
Know there will be side effects with some contraception.

Other factors include whether you’re currently breastfeeding, or if you have any history of blood clots or migraine with aura, in which cases the use of oestrogen would not be recommended at all.

The good news is there are so many different types and strengths available that it is still very possible to find the right one for you.

Duration of action:

Are you happy to have to remember to take a pill daily or change a patch weekly, or would you rather a “fit and forget” type of contraception that lasts for a longer duration?

The likes of the implant and the injections certainly reduce the risk of human error, but some women don’t like the invasiveness of them, and prefer the idea of having that daily control over their contraception.

Reversibility:

All of the above contraceptive choices are considered to be reversible. The injection is the only one that requires a significant amount of time for fertility to return to baseline after use (approximately 12 months).

The others allow the body’s natural fertility levels to return as soon as you stop using them. This should be taken into consideration if you think that you may wish to conceive in the future, as you should factor this lag-time associated with the injection into your plans.

Benefits other than contraception:

There are other potential benefits to be considered besides the obvious contraceptive effect with many of these products. Some are fantastic for women with heavy periods to reduce the thickness of the womb lining, some greatly improve acne, and others may be used to treat conditions like endometriosis or polycystic ovarian syndrome (PCOS).

The intrauterine devices that release progesterone are also suitable for protecting the wombs of women who are on oestrogen Hormone Replacement Therapy (HRT) for menopausal symptoms.

Knowing the types of contraceptives available to you and the different factors to be considered in your choice provides a starting point upon which to base your conversation with a GP, pharmacist or family planning clinic. At least you’re then in a position to learn more about each one, based upon your own situation, health and personal preferences.

Choosing the right form can be a minefield, as every woman’s cycles, needs and bodies are different.

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