A Guide to Birth Control: 5 Different Methods You Should Be Aware Of
Birth control is a contraceptive tool that is utilised to prevent the occurrence of unwanted pregnancies. It has gained momentum as societies recognise the importance of female’s having autonomy over their body, and being able to practise positive sexuality. In this article, the term “woman” refers to all individuals with the following anatomical organs: a vagina, uterus, and/or fallopian tubes.
The prevalence of contraception amongst women has increased, and in order to proceed with any method of birth control, consent must be sought, and individuals must have ample time for discernment. The most popular and effective birth control methods that are currently available in Asia have been discussed below.
1. Permanent Contraception (Tubal Ligation and Vasectomy)
Tubal ligation and vasectomies are considered permanent and the most widely used methods of contraception. Tubal ligation is a surgical procedure that prevents pregnancy by occluding the fallopian tubes, while a vasectomy is a procedure where the vas deferens (tubes carrying sperm) are cut so sperm cannot travel out of the body. The following factors may affect the frequency with which these two methods of contraception are chosen:
- Increasing age of population
- Increasing parity
- Reported cognitive disabilities among people of the younger population
- Public insurance or lack thereof
- Lower income
- Lower level of education
There are no absolute medical conditions to contraindicate these contraceptive methods, however, the age of consent is an important regulatory measure. Tubal ligation has been associated with post-ablation tubal sterilization syndrome (PATSS), hysterectomy, and possible decreased rates of endometrial cancer. However, no links have been found between permanent methods of contraception and menstruation, onset of menopause, sexual function, or breast cancer. Complications following vasectomies are uncommon and no correlation has been found in terms of reduced sex drives, or the occurrence of cancer and heart diseases.
2. Intrauterine Device
An Intrauterine device (IUD) is a small, T-shaped device that is inserted in the uterus and is an effective method of birth control, it may also be referred to as a ‘copper coil’ or ‘coil’. IUDs are effective because they either illicit hormonal changes which prevents the movement of sperm beyond the cervix or prevents an egg from being released from the ovaries. This method of contraception is rapidly reversible, cost effective (lasts 5 to 10 years), has few side effects and reduces the risks of cervical cancer, endometrial cancer, and ovarian cancer. While the incidence rates are low, some disadvantages of IUD placement include pelvic infection, displacement in the uterus, and damage to the womb. Additionally, IUDs do not protect the user from sexually transmitted infections (STIs).
3. Oral Contraceptive Pills
Oral contraceptive pills prevent pregnancy by releasing hormones (estrogen and progestin) to either inhibit the process of ovulation so an egg is not released by the ovaries or by modifying the cervical mucus to make it difficult for the sperm to travel beyond the cervix.
Individuals with the following conditions are contraindicated for use of oral contraceptive pills and have been labeled as “unacceptable risks” by the Centres for Disease Control and Prevention (CDC) and World Health Organisation (WHO) in 2015:
- Aged 35 and above, and smoking at least 15 cigarettes a day
- Arterial cardiovascular disease (older age, smoking, diabetes, hypertension)
- Valvular heart disease (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis)
- Ischemic heart disease
- Stroke history
- Breast cancer
- Severe cirrhosis
- Hepatocellular adenoma or malignant hepatoma
- Migraine with aura
- Diabetes mellitus of more than 20 years with nephropathy, retinopathy, or neuropathy
Contraceptive pills can be about 91% effective and offer high reversibility, regulation of menstruation, management of dysmenorrhea, and they reduce the risk of ovarian and endometrial cancers6. However, contraceptive efficacy is reduced when they are combined with anticonvulsants, antibiotics, antifungals, or antiretroviral drugs. Some patients may experience other side effects such as nausea, breast tenderness, and bloating during the early stages of taking oral contraceptive pills. No studies have conclusively proven that weight gain or weight loss are associated with oral contraceptive pills. However, the potential for additional risks such as venous thromboembolism and cardiovascular disease should be thoroughly discussed with patients.
A direct method of preventing pregnancy is abstinence and may be the method preferred by women who have health, personal, or religious considerations. Abstinence is also the method with the least medical cost and side effects. However, this is not usually recommended to women with irregular menstrual cycles or those who are unable to reliably track their menstrual cycles. This method of contraception does not offer protection from STIs. Due to high failure rates, this method of contraception requires rigorous patient education and is one of the least effective methods of birth control.
5. Other Contraceptive Methods
Some other contraceptive methods have been listed as follows:
- Etonogestrel Implants – a single-rod progestin is placed subdermally in the upper arm. This is a long-acting, reversible, non-invasive contraceptive method and is approved for three to five years of use
- Injectables – release hormones into the bloodstream and can be administered every 12-13 weeks
- Transdermal Patches – highly effective, reversible, and non-invasive method
- Diaphragm, female condom, spermicides – pericoital contraception, non-hormonal, immediately reversible, can be used at the time of intercourse, relatively inexpensive and has substantially higher failure rate
- Male condom – male-controlled pericoital contraception, also offers protection against STIs
- Withdrawal or Coitus Interruptus – removal of penis from the vagina before reaching ejaculation
Emergency contraception (EC) methods can be utilized when other methods of contraception were either not used during intercourse, or used inappropriately. EC prevents fertilization and can be administered through a device (IUD, or levonorgestrel IUD) which is the most effective. EC can also be administered orally by prescribing ulipristal acetate (UPA), levonorgestrel (LNG), mifepristone, the Yuzpe method (combining oral estrogen and LNG contraceptive pills) and does not affect future fertility.
Birth Control Counselling
Special populations should be considered for birth control counseling such as adolescents, breastfeeding mothers, post-abortion, women with chronic medical conditions (including substance use disorders), and women with intellectual or physical limitations. Women in child-bearing ages should be given thorough information on the various contraceptive methods available as well as their benefits, risks, costs, immediate and long-term side effects.
While some individuals value shared decision making with their doctors, patient autonomy is important and physicians should be information providers only. It is the duty of physicians to promote health equity, avoid bias, and to be informed about any factors that may affect their patient’s decision making abilities.
It is important to note that the medical information stated above is not a substitute for medical consultation or advice.