There are a variety of options when it comes to birth control and sexual protection. In this blog, we will discuss the potential risks and benefits of the various types of birth control to narrow down what may be more suitable for you. Your choice is personal and not every form of birth control is right for everyone. Consult with your GP or OBGYN to find out which birth control method is appropriate for you. No form of contraception is 100% effective, however, some are more effective than others. Because of this, it is a delicate balance between the overall risks and benefits for each patient so an individualised approach is necessary.
It is also notable that the only form of contraception that both prevents pregnancy and STIs are condoms. Please consider your options carefully and think about using a condom in conjunction with other forms of birth control to protect yourself against STIs.
IUDs
An Intrauterine Device is a small device that is placed inside the uterus through the cervix by a doctor. An IUD works in two ways: it stops sperm from being able to penetrate an egg, and it stops the egg from attaching to the uterine wall. Both steps are crucial in progression to a pregnancy, and at 99.4% effectiveness, the IUDs are found to be highly effective forms of long-acting reversible contraception.
Two forms of IUDs are available in Australia:
Copper: The copper device is placed inside the uterus releasing copper ions that cause the production of a fluid that inhibits sperm from fertilising eggs. While it has been found to make some women’s periods heavier, it may be the best form of hormone free contraception. This device lasts for 5-10 years depending on which form you choose, making it a great choice for people not looking to fall pregnant in the near future.
Hormonal: These devices releases a synthetic type of progestin hormone that causes the cervix mucus to thicken, which prevents the sperm from fertilising the egg. It is just as effective as the copper IUD, and it is known to either cause much lighter periods or stop periods altogether while the device is active. The hormonal IUDs lasts for 5 years, and does release very low doses of hormones into the body. Women who have hormone issues, sensitivities or any contraindications should discuss this form with their doctor.
Oral Contraceptives and Vaginal Rings
Oral contraceptives, otherwise known as “the pill,” are 99.7% effective when used correctly and taken at the same time every day. The combined oral contraceptive pill is made up of a combination of oestrogen and progestogen: naturally found hormones that work synergistically to inhibit ovulation and increase the thickness of cervix mucus, making it harder for sperm to penetrate and fertilise an egg.
The pill has other non-contraceptive benefits and has been used to help stop periods, minimise period pain and acne, relieve symptoms of PCOS and endometriosis, and further, has shown to reduce the risk of uterine, ovarian, and bowel cancer. The pill is widely available in various forms and doses, is non-invasive, and relatively inexpensive. This may sound like a perfect form of contraception preventing pregnancy but there may be risks and side effects associated with the pill which need to be individually assessed for each woman prior to prescribing.
A small number of women may experience blood clots, mood changes, depression, weight gain, and migraines to name a few of the side effects. Another downside is that if you forget to take a combined oral contraceptive pill, or experience vomiting or diarrhoea, the effectiveness reduces to 91 percent. The pill may not be for you if you have trouble remembering to take a daily tablet or your lifestyle would make it hard to take a pill every day at the same time.
A vaginal ring is a device that is inserted into the vagina and is replaced every 3 weeks and is identical to how the pill works releasing oestrogen and progestogen into the body to prevent ovulation and fertilisation. The added advantage of using a vaginal ring is the hormone release is local and therefore minimises systemic absorption of side effects which may occur through the oral route. Another advantage is improved compliance where many women may prefer to or find it easier to remember to replace the ring once every 3 weeks rather than take a pill every day. All other benefits of the pill apply to the vaginal ring, but the hormones released come with the same potential side effects. The decision to choose this dosage form is personal and should be made by weighing the options and speaking to your doctor.
Implants & Injections
A hormonal implant is a plastic rod inserted sub-dermally into a female’s upper arm by a doctor. It slow-releases the hormone progestogen into the bloodstream and works by stopping your ovaries from releasing eggs each month, and thickens the cervical music making it harder for sperm to fertilise an egg. The only implant available in Australia is Implanon NXT and it is 99.95% effective (the most effective form) in preventing pregnancy for 3 years, making it one of the best choices for women looking for long term birth control. The implant is able to be just as easily removed if your plans change with fertility returning back to normal immediately.
Hormone injections are another long acting form or progesterone which is given by intra-muscular injection every 12 weeks. It prevents ovulation and also thickens the cervical mucus, preventing sperm from fertilising any eggs. The injection is known as “depo” and comes in two forms in Australia: Depo-Provera and Depo-Ralovera. It is slightly less reliable than the implant with 1 in 6 women falling pregnant while receiving the injections, and is not reversible if there are any side effects that may be experienced during that time given it is a once off injection. Upon cessation, fertility does not return back to normal immediately and can take up to 9 months. This may also not be appropriate for some women who are predisposed to osteoporosis or are at risk of having weak bones. This needs to be discussed with your doctor.
Both the implant and the injections are safe to use while breastfeeding and both may cause changes in your period or stop your period completely.
Surgical methods for men and women
Tubular ligation is the formal term for “getting your tubes tied.” With this method of birth control, a doctor performs keyhole surgery to seal the fallopian tubes, preventing eggs from leaving the ovaries. This procedure is permanent and has limited success in reversal. The good news is that if plans change, IVF is still an option. There are few risks associated with this surgery.
A vasectomy is a procedure that males can have where the vas deferens is cut and the ends are sealed, making it impossible for sperm to leave the penis upon ejaculation. Men will still produce sperm and will still form erections, but will not be able to impregnate a female. This procedure is 99.9% effective and is reversible through another surgery. Men with vasectomies can still have children through IVF with a partner by extracting sperm from the testicles via a needle.
Condoms
A male condom is a latex covering that is placed over an erect penis before sex and physically blocks sperm from entering the vagina. They also come in non-latex forms for those with latex allergies and are readily available in grocery stores and chemists. They are 98% effective in preventing pregnancy and STIs when used correctly. They can be used during oral, anal, and vaginal sex.
A female condom works in much the same way but is less reliable because the penis could accidentally insert under or around the condom opening.
It is not a good idea to use these methods together as the friction could cause breakages in the material and ruin the effectiveness of both condoms, resulting in pregnancy or an STI.
While the forms of contraception discussed above are effective in preventing pregnancies, they don’t protect against sexually transmitted infections (STIs). Whichever form of contraception you choose that is right for you, we still recommend adding a condom to your safe sex plan to protect against STIs.
Natural Methods
While we may not count these as the most reliable methods, they have been used by some women with some success and ultimately, it is a personal and drug free preference.
Tracking ovulation through a calendar or period tracking app and abstaining from sex during your fertile windows can help prevent pregnancy. This is not a foolproof method, and is likely more successful when used as an adjunct or when trying to fall pregnant. Fertile windows are highly individualised and can vary from woman to woman based on her usual cycle and sperm can remain active and live inside the female reproductive tract for up to 5 days. We also know that despite planning, anything can happen, and there is no guarantee that intercourse will not occur during or close to this time parameter.
A woman can observe her cervical mucus changes and record her basal body temperature every morning to see if she is ovulating. This additional information can then be used to either abstain from sex (or plan for intercourse) if the woman suspects ovulation. These methods require knowing the subtle differences between usual and ovulating cervical mucus, and the ability to discern a 1 degree drop in body temperature when ovulating.
We hesitate to even mention the pull out method, where a male attempts to withdraw his penis from the vagina just prior to ejaculation. Pre-ejaculate contains viable sperm and is released from the penis as part of lubrication, and because it is difficult to be precise in the heat of the moment, can we just say…this probably isn’t a viable form of birth control and should be avoided as there are more successful methods to prevent pregnancy.
Emergency Birth Control
The emergency contraceptive methods consist of the “morning after pill” and copper IUDs. Emergency contraception has about an 85% effectiveness rate. It is imperative to use these forms of birth control as soon as possible after intercourse. Neither of these cause abortions or will hurt you or the foetus if already pregnant.
Since copper is toxic to sperm, a copper IUD can be inserted within 5 days of sex. It will disrupt sperm movement, making it unlikely that a sperm can fertilise an egg. It may also help to stop a fertilised egg from attaching to the uterine wall.
The emergency contraceptive pill must be taken within 24 hours following intercourse, and can be taken up to 5 days later, depending on the type of emergency contraceptive pill used or readily available. It will prevent or delay ovulation, however, if ovulation already occurred, the emergency pill will not be effective.
Conclusion
We hope that this information has given you more knowledge about the different types of contraception available to you. As a sexually active person, it is important to have a plan that works for you. Consult your doctor for more information and do your research! If you don’t feel comfortable with a prescription or advice given, get a second opinion and listen to your body! Birth control and sexual wellbeing is a personal and unique decision for any person.
As always, our WholeLife Pharmacists would be happy to discuss any of the options or provide counselling, advice and detailed information following provision of a prescription to help you make an informed decision.
Be well,
The WholeLife Team