Birth control

Contraception is a way to prevent an unplanned pregnancy. Different methods are used to achieve this, with some contraceptives (barrier methods) preventing sperm from reaching the uterus, while others change the conditions in the female reproductive system to make pregnancy impossible.

Contraception can be roughly divided into three categories: hormonal contraceptives, non-hormonal contraceptives, and permanent contraception (sterilisation).

The birth control pill, commonly known as "the pill," is one of the most widely used contraceptives. It works by using hormones to prevent ovulation. Most pills are "combination pills," containing both oestrogen and progestogen. These hormones stop the release of an egg and also alter the uterine lining, making it difficult for sperm to reach the uterus or for a fertilised egg to implant.

What types of contraceptive pills are there?

There are different types of birth control pills, which can sometimes cause confusion. The main types include: 

• Single-phase pill: Each tablet in the pack has the same composition, with a consistent dosage of active ingredients. Pills with less than 30 mg of oestrogen are known as sub-30 pills, while those containing 30 to 50 mg are sub-50 pills. Lower oestrogen content can reduce the likelihood of side effects. 
• Multi-phase pill: The hormone levels vary across the tablets to mimic the natural hormonal cycle, with different pill colours indicating the dosage changes. 
• Mini pill: This contains only progestogen, making it lighter and less likely to cause side effects. It can also be used during breastfeeding. 

Birth control pills are highly effective when used correctly. Typically, one tablet is taken daily for three weeks, followed by a seven-day break during which withdrawal bleeding occurs. During this break, protection against pregnancy continues. Some pills do not require a break; you simply start the next pack right away. 

The contraceptive effects wear off quickly after discontinuation, with fertility returning almost immediately.

Some women take the pill for reasons other than birth control, such as managing heavy periods, menstrual pain, or irregular cycles. The pill can replace natural menstruation with lighter, regular withdrawal bleeding, helping alleviate these issues. It can also be used to delay periods for convenience.

The morning-after pill is different from regular birth control and is used to prevent pregnancy after unprotected sex. It contains hormones that delay ovulation or prevent a fertilised egg from implanting. It should be taken as soon as possible, ideally within 12 hours, but no later than three to five days after intercourse.

• Contraceptive injection: Provides protection for 12 weeks with one injection. 
• Contraceptive implant: A small device placed under the skin releases hormones for up to three years. 
• Contraceptive patch: The patch is worn on the skin and replaced weekly, with a break after three weeks. 
• Vaginal ring: Inserted into the vagina for three weeks, releasing hormones locally. 
• Hormone coil (IUD): This intrauterine device releases hormones and protects against pregnancy for up to five years. 

Non-hormonal contraceptives are an alternative for those who prefer to avoid hormones. They include barrier methods and devices like the copper coil. 

• Condom: The only non-permanent male contraceptive, also offering protection against STDs. 
• Female condom: A bag-like device inserted into the vagina before intercourse. 
• Pessary: A cap placed over the cervix, used with spermicide for added effectiveness. 
• Copper coil (IUD): This device releases copper, which deactivates sperm, providing protection for five to ten years. 

Permanent contraception is achieved through sterilisation, a surgical procedure meant for those who do not wish to have children in the future. 

• Male sterilisation (vasectomy): Involves cutting the vas deferens to prevent sperm from entering semen. 
• Female sterilisation: Seals off the fallopian tubes to stop eggs from meeting sperm. 

This method involves avoiding intercourse during the fertile period, using techniques to predict fertility. 

• Temperature method: Tracks slight temperature changes around ovulation. 
• Cervical mucus method: Observes changes in vaginal mucus consistency. 
• Calendar method: Monitors cycle patterns to predict fertility. 

Each contraceptive carries its own risks and side effects.

Hormonal methods may cause side effects like breakthrough bleeding, headaches, breast tenderness, weight gain, fluid retention, and mood swings. There is a slight increased risk of more serious conditions, such as blood clots and certain cancers.

What if you miss a dose of hormonal contraceptive?

Missing a dose, vomiting, or losing a patch may reduce the effectiveness. Follow instructions in the product leaflet for guidance.

Can you breastfeed when using hormonal contraceptives?

Hormonal contraceptives are not always suitable for breastfeeding women. Oestrogen-based contraceptives can reduce milk supply, so it is preferable to avoid them in the first six weeks postpartum. A mini pill containing only progesterone does not affect milk production and can be used while breastfeeding. Coils can also be used from four to six weeks after childbirth. Hormones may pass into breast milk, but this is not necessarily harmful.

What are the risks and side effects of non-hormonal contraceptives?

Non-hormonal options generally have fewer risks. The copper coil may cause heavier periods, and sterilisation carries typical surgical risks. Improper use of condoms or pessaries can reduce their effectiveness.

What are the risks and side effects of alternative methods of contraception?

Alternative methods like periodic abstention are less reliable than other contraceptives and require careful tracking.