When getting pregnant is not in the plan, maybe due to not being ready to start a family, taking a break in between growing a family, or not wishing for more children; a sexually active woman should be on a form of birth control. There are different methods of birth control with their upsides and downsides, levels of effectiveness, suitability and associated side effects.
Hormonal birth control is one of the different options used for preventing pregnancy, and may also help regulate menstrual cycles, and relieve menstrual cramps. This method of birth control uses oestrogen and progesterone hormones either in a combination, or progesterone only; administered as shots, injections, insertions, or patches applied to the skin. The choice of which to use would depend on individual circumstances, medical history and preference.
Hormonal contraceptives work by affecting the levels of oestrogen and progesterone hormones in the body, and the natural menstrual cycle. This results in stopping the release of eggs, thereby preventing ovulation; blocking the sperm from reaching the egg by thickening the mucous of the cervix (neck of the womb), and preventing implantation from occurring by making the lining of the uterus thinner than it should be.
1. The Contraceptive Injection/ The Shot
This is an injection that contains the hormone progesterone, example Depo-Provera®, and is administered once in every 3 months in the arms or buttocks. It increases the amount of progesterone in the body to prevent pregnancy from occurring by stopping ovulation, thickening the cervical mucous to block sperm from reaching the egg, and thinning the wall of the uterus. If done following instructions, it is usually >99% effective.
Pros: One benefit of the shot is that it’s safe to use while breastfeeding. It is also a good alternative for women who for some medical reason cannot use oestrogen-based contraception. Each shot lasts up to 12 weeks, so there is no need to take a pill daily. In addition, the shot may help prevent cancer of the womb and pelvic inflammatory disease, and its effectiveness is not affected by other medication.
Cons: On the down side, it may not be the best option for a woman that wants to get pregnant within the next year, due to the fact that its effect on fertility takes some time to wear off even after it’s been stopped. It may cause irregular or no menstrual period, nausea, weight gain, spotting, low libido, headache, acne, moodiness and depression. Some studies have linked this birth control option with thinning of the bones/decreased bone density; though there’s recovery after the shot is stopped. Finally, the shot does not protect against HIV and other sexually transmitted infections.
2. Birth Control Pills
A. The combined oral contraceptive pill
The combined pill as the name implies, uses a combination of both oestrogen and progesterone hormones to stop pregnancy from occurring. It works by preventing ovulation, thickening the mucous of the cervix, and thinning of the lining of the womb. It is taken each day for 21 days, followed by a 7 day break , and then continued. If used correctly, it is 99% effective.
Pros: The good thing about the combined pill is that fertility/ ability to conceive is restored faster after the pill has been stopped. It is also known to improve acne, make periods more regular, lighter and less painful, as well as improve PMS symptoms. The risks of ovarian, uterine, colon cancer and pelvic inflammatory disease are much lower when using the combined pill, in addition to a reduced risk of fibroid, ovarian cyst and non cancerous breast disease.
Cons: The combined pill is not suitable for every woman, such as: women breastfeeding a child under 6 months, women over the age of 35, women who smoke, women with a history of blood clots, a history of migraines, high blood pressure and heart diseases, and a history of breast, liver, endometrial cancer. The effectiveness of the combined pill may be affected by certain medications eg antibiotics. There are some minor side effects associated with the combined pill, including spotting in the first few months, nausea, weight gain, spotting, breast tenderness, low libido, headache, and depression. It may also increase blood pressure, and does not protect against HIV and STIs
B. Progestin-only pills (POP)
Also known as the ‘mini pill’, because this pill only contains progestin. Progestin is a syntesized form of the natural progesterone hormone. It prevents pregnancy from occurring by thickening the cervical mucous, and thinning the lining of the uterus; some types can stop ovulation. For it to work, it has to be taken at the same time everyday. There’s no break when taking the POP. It is usually >99% effective
Pros: On the upside, it is suitable for breastfeeding mothers, women who can’t use oestrogen-based contraceptives, women aged 35 and above and women who smoke. Also, your fertility/ability to conceive is restored faster after the pill has been stopped, in addition to helping improve PMS symptoms.
Cons: As with most hormonal birth control, there’s the possibility of weight gain, nausea, headaches, acne, depression, low libido. You may also get spotting between periods, as well as irregular periods. The effectiveness may be affected by certain medication, and it does not protect against HIV and other STIs.
3. The Patch
This is a 5 x 5cm contraceptive stuck to the skin to release the oestrogen and progesterone hormones. An example is Ortho Evra®. It works like the combined pill, and stops pregnancy from occuring by preventing ovulation, thinning the lining of the uterus and thickening the cervical mucous. A fresh patch is used every week, for 3 weeks and then none is worn in the 4th week. Used according to instruction, it is usually 99% effective.
Pros: The patch is easy to use and convenient for people that don’t like pills and injections. Fertility/ability to conceive is restored faster after the pill has been stopped. It has the added benefit of make periods lighter and less painful, and may also help with PMS symptoms. The patch may protect you from ovarian, endometrial and colon cancer, in addition to reducing the risk of fibroids, ovarian cysts and non cancerous breast tissue.
Cons: It may not be suitable for women above 35 years, or women who smoke. A few minor side effects are that it can irritate the skin at the site of application, may cause spotting in the first few months of using it, may result in nausea, headaches, moodiness, breast tenderness. It can be affected by certain medication, and doesn’t protect against HIV and other STIs.
4. The Ring
This is a soft, flexible and transparent ring inserted into the vagina to release oestrogen and progesterone hormones. An example is Nuvaring®. It is to be inserted by the woman herself and worn for three weeks, after which there’s a break before another is inserted. It works like the combined pill and stops pregnancy from occurring by preventing ovulation, thinning the lining of the uterus and thickening the cervical mucous. It is >99%effective when used correctly.
Pros: The advantages of the ring are that fertility and ability to conceive is restored faster after the pill has been stopped; periods become more regular, flow less and are less painful, in addition to improved PMS symptoms; it’s easy to use, no doctor’s visit required; it may reduce the risk of ovarian, endometrial and colon cancers, as well as the risks of fibroids, ovarian cysts and non-cancerous breast tissue.
Cons: There are temporary side effects like increased vaginal discharge, headaches,tender breasts, nausea, and spotting in the first few months of using it. Also, it is not suitable for women above 35 and women who smoke. It can be affected by certain medication, does not protect against HIV and other STIs.
5. Progestin IUS
This is a T-shaped plastic intra uterine system which contains the hormone progestin. Examples Mirena®, and Skyla®. It can only be inserted or removed by a health care provider. It works by slowly releasing progestin into the uterus, which thins the uterine lining and thickens cervical mucous . It can also stop eggs from being released. It is >99% effective.
Pros It can be used by breastfeeding moms. You will be able to get pregnant quickly after it’s removed. There’s no need to worry about pills or injections because they can prevent pregnancy for a long time (5 to 7 years). There’s also the added benefit of less painful and lighter periods. It is not affected by other medication.
Cons There’s the possibility of having spotting, irregular periods or even no periods at all. Some mild cramping may be felt for a few days after it’s been inserted. It is not suitable for women with pelvic inflammatory disease, cervical, vaginal or uterine abnormalities. It does not protect against STDs.
6. The Implant
The implant is a matchstick-sized flexible rod containing the hormone progestin, which is placed under the skin of the upper arm by a healthcare provider. An example is Nexplanon®. This releases progestin into the body to stop the release of eggs, thicken the cervical mucous and thin the lining of the uterus. It is usually >99% effective.
Pros: It is suitable for women who are breastfeeding, and women who can’t use oestrogen- based contraceptives. It is long lasting (up to 3 years), and can make periods lighter and less painful. Fertility is quickly restored after the implant is removed. In addition, there may also be some protection against womb cancer and pelvic inflammatory disease.
Cons: temporary side effects like nausea, acne, headaches, moodiness, loss of sex drive. It may make periods irregular or no periods after 1 year. It doesn’t protect against STDs