It is every woman’s right to avoid unwanted pregnancy and plan one whenever she is ready. Contraceptives are also used to regulate the interval between pregnancies.

 

The best contraceptive for you is one that is safe, effective, easily available, long-acting and requires little or no medical supervision. Do ask your doctor about non-hormonal benefits associated with each option while making your choice.
While abstinence is one way to prevent unwanted pregnancies, it is not the most practical method. Natural means of contraception like cycle tracking and the pullout method are the least effective methods of birth control and they do not protect against sexually transmitted diseases or illness.

 

Barrier Protection

What it is: Condoms (male and female)
Condoms prevent pregnancy by hindering the sperm from meeting the egg. The male condom is most effective when worn before intercourse begins. Female condoms work in the same way, with the exception that they are more cumbersome and costly. Female condoms should not be used along with the made condom.

Protection against STDs: Numerous studies show that with the correct and consistent use, latex condoms are highly effective in providing protection against sexually transmitted diseases.

Word of caution: Condoms should be used correctly, following the instructions on the box, otherwise the failure rate is high. There is a risk of slippage and rupture therefore it is better to use them with other methods of contraception.

 

The Pill and Vaginal Rings Containing Hormones

What it is: Combination pills (The Pill) and progesterone-only (Mini Pill)
Birth control pills are a combination of hormones estrogen and progesterone. One pill needs to be taken a day with a pill-free period between packs. The pill works by preventing ovulation. There are lots of myths surrounding the pill but its advantages outweigh the risks.
The mini pill is a progesterone-only pill. This pill contains small doses of the hormone progesterone. This pill also needs to be taken daily without a break. It is good for breastfeeding mothers and older women who can’t take the usual pill as most side effects of estrogen are avoided (risk of heart disease and stroke). It is also a safer option for women who smoke.
 

Protection against STDs: Birth control pills do not provide protection against STDs
 

Word of caution: Side effects of birth control pills include acidity, breast pain, headaches, changes in mood, and vaginal dryness amongst others. The pill is ideal for young women as fertility returns immediately after stoppage. It is avoided in women who have hypertension, diabetes, heart disease, breast cancer or liver disease. The pill increases your chances of blood clots (in susceptible individuals with comorbidities) and is not suitable for smokers especially after the age of 35.

 

Advantages of the birth control pill

• Regulates the menstrual cycle
• Reduces period flow and pain
• Reduces acne and unwanted facial hair
• Protects against functional ovarian cysts.
• Treatment of endometriosis
• Protects against endometrial and ovarian

 

What it is: Vaginal Rings
Vaginal contraceptive rings have been around for a long time but are not very popular. It is a transparent, soft flexible ring that contains both estrogen and progesterone. Like the pill, it prevents ovulation but the hormones are absorbed through the vagina. The woman can insert it herself but it has to be removed after every three weeks to be replaced with a new ring after one week. The cycle comes during the one-week gap before the new ring is inserted.
 

Protection against STDs: It does not protect against STDs
 

Word of caution: The vaginal ring may be felt by the partner and it may cause vaginal irritation.

 

 

Long-Acting Reversible Contraceptive(LARC)
These include the intrauterine device (IUD), implants and injectables. These are extended methods of contraception that work for years.
 

What it is: IUD
These are placed inside the uterus. There are two types available: those containing progesterone which is released daily over a period of 5 years and those that contain copper. A trained professional has to insert these after the patient’s period ends.
These serve as foreign bodies inside the uterus, thereby preventing implantation of the embryo. Copper T also functions as a spermicide. Hormone IUD makes the lining of the uterus very thin while increasing the thickness of the cervical mucus, which makes the period lighter. These require a one-time insertion and work for three to five years. Hormonal IUD reduces menstrual pain and bleeding. These are recommended for women who are perimenopausal and those who experience heavy bleeding and pain during their periods.
 

Protection against STDs: It doesn’t protect against STDs.
 

Word of caution: IUDs that contain copper can increase menstrual bleeding and pain. There is also an increased risk of infections if the IUD is not inserted under strict asepsis (environment free from disease-causing micro-organisms). Therefore, these are not recommended for women with recurrent infections.

What it is: Contraceptive Implant
This is a discreet, progesterone-filled soft, flexible implant that is placed under the skin of the upper arm. Implanon is recently available in India.
It makes the cervical mucus thick and causes atrophy of the uterine lining. It works for two to three years. This is a highly effective method of contraception and is best suited for women who want to delay their pregnancy by two or three years. It is often recommended to breastfeeding mothers and young women.
 

Protection against STDs: It doesn’t protect against STDs.
Word of caution: Only a trained professional can insert or remove the implant after administering local anesthesia. The implant can cause spotting in between your menstrual cycle.

 

What it is: Injectable

These are long-acting up to one year but you need to take the shot every three months. Depo-Provera shots are available in India.
The shot works by thickening the cervical mucus and prevents implantation. It is ideal for women who forget to take the pill regularly. It is recommended to breastfeeding mothers, women who have heavy periods and anaemia. There is a chance that menstrual bleeding may stop completely during its use.
 

Protection against STDs: It doesn’t protect against STDs.
 

Word of caution: It is not recommended in women under 20 years as it may cause bone loss. Fertility and menstrual cycles can take a few months (up to 9 months) to return. Some patients also report a slight increase in weight after two or three injections. Other side effects include acne, breast tenderness, and depression.

 

Emergency Contraception
 

What it is: The morning-after pill
The morning-after pill is used when no contraception was used or when the contraceptive used has failed, ruptured condom for instance or if there has been a lapse in the use of the usual method of contraception. It is also used in the case of sexual assault.
Chances of pregnancy are reduced if used within 72 hours and it is more effective when taken within 24 hours.
 

Protection against STDs: It doesn’t protect against STDs.
 

Word of caution: These should not be used as a routine method of contraception. When used regularly it can disrupt your menstrual cycle and can cause abnormal bleeding. Some women do get pregnant despite using the morning-after pill. Changes of an ectopic pregnancy (a medical emergency where the fertilised egg attaches itself outside the uterus) also increase.

Permanent Methods of Contraception

Tubectomy is a surgical procedure performed under anesthesia where fallopian tubes are tied or cut to prevent the transport of the egg. It is recommended only for couples who do not want any more children. It can be done along with a cesarean section or after a normal delivery. The reversal of the procedure is difficult and involves another surgery.
 

Vasectomy is a surgical procedure for permanent contraception in males. It is less invasive and takes less time to perform. Back-up method of contraception should be used after the first three months till the absence of sperm is documented by semen analysis.