Birth control pill and other contraception choices

The most popular options for planned birth control are the pill and the ‘Copper T’ in India.  Both of these are excellent choices for some women and not so good choices for another set of women.  Read below make a choice suited for you!

The most important aspect of birth control is indeed family planning, that is, for how long do you want  contraception: for a few months or for many years

Contraception choices that a woman would like to make also depend on her age, physical status, marriage status, habits such as smoking etc.

Another important aspect is the convenience  of the birth control method. This includes: how it has to be used and what side effects can it have?  Some methods have to be used every day, some monthly or quarterly and some can be left in place for a few years. Also, some can cause issues such as mild weight gain, mood changes etc. which you might be very sensitive towards.

In India context, secrecy of the method is important, with often, other people controlling or at least unduly influencing women’s choices in family planning or birth control

Different types of birth control include medicines, devices, and procedures. Some types of birth control are used by women, and others are used by men. Some types need to be used every time a person has sex. Other types can prevent pregnancy for long periods of time

Four broad categories exist:

  1. Barrier methods, such as condoms: These need to be used in every act, but  have very important added benefit of helping in prevention of STD (Sexually Transmitted Diseases). Condoms are a must for people who have sex with more than one partner or whose partners may have had sex before with others. We would advise women in such situation to use condoms every time they have oral, anal, or vaginal sex, in addition to using whatever contraceptive method they choose. If you use condoms properly, the chances of pregnancy in the next year are 2%, but if the use is not perfect the chances increase to 18%. Read on how to use condoms perfectly
  2. Hormonal short term birth control: Hormonal birth control can be of following types : OC (Oral Contraceptive) pill, injections, skin patches or vaginal rings. All these methods may contain either a combination of the hormones estrogen and progestin or only progestin. Some such as the pills have to be taken everyday and others such as injections, patches or rings need to be replaced/ topped up every three weeks or a few months. The return of fertility is soon after you stop using these methods with these methods
    • Pills – Most birth control pills contain estrogen and progestin but there is one that contains only progestin. Birth control pill packets usually include 4 to 7 days of hormone-free pills each month. It is during these hormone-free days that women get their period.The chances of conceiving despite the pill are only  0.1% when pills are taken perfectly (same time every day, no missed pills, startng the next cycle on time), but many times women forget to adhere to perfect use, in which case, the actual failure rate is 9% .Pills can cause some side effects, which mostly improve in 2-3 months. But, pills or hormonal contraception is not for high risk women, especially women over 35, who smoke, have heart disease or blood clotting disease themselves or in family. Check out the complete list of women who should be wary of OCP . If you have any doubt about whether you should go for them, consult your doctor before startingMinor side effects of the pill include feeling of vomiting, breast tenderness, bloating, mood changes and Irregular vaginal spotting

      However, The OCP also has benefits other than contraception. It helps in lessening cramps during periods and makes them regular. Also, the blood loss is less so chances of iron deficiency anemia are less. It also leads to less incidence of  acne, cancer of the uterus and ovaries.

    • Injections: You can also get contraceptive injections either every three weeks or once in 2-3 months depending on the individual choice you make. There are Combined hormonal injections and progestin only injections, just as there are pills. Their advantage over pills is their less often use and potential secrecy. Some injections (Depot Provera) have a prolonged period of nearly ten months after one stops using them, before one can conceive
    • Vaginal rings: Women have to place the ring inside the vagina after every menstrual cycle and keep them for next three weeks. They can be washed for hygiene but have to be put back within three hours to be effective. These are not very popular currently and hence not readily available
    • Skin patches: These also have to be worn for three weeks and off for next one week for periods to occur.
  3. Long Acting Reversible Contraception: The main benefit of long-acting birth control is that you do not have to remember to do anything or take any medicines on a regular basis.The main downside of these methods is that unlike condoms, they do not protect against infections you can catch during sex .
    • Under skin hormonal implants: Hormonal under skin implants (common one is Norplant) provide long term contraception for a period of 3-5 years once in place. They contain progestin only, so have lesser side effects than combined hormonal methods. But, they can lead to spotting/ irregular bleeding at the beginning of use and then periods usually stop till they are in place.
    • Intrauterine implants: It is a small, T-shaped device that a doctor or nurse puts in your uterus by going through your vagina and cervix .This also provides long term contraception, they can be hormonal IUCD such as Mirena or copper containing such as Copper T. They need to be inserted under aseptic conditions in hospital/clinic of doctor . Women need to keep checking for the thread of the IUD in their vagina. IUDs are very good for women who are in single partner relationships with low risk of infections. They can cause some pain and increased bleeding for a few months initially which settles down soon. But for women who have chances of sexually transmitted infections or have had PID (Pelvic Inflammatory Disease) in the past, its not a very good option.
  4. Permanent sterilization: 
    • Male sterilization: It is a good option for people with willing partners
    • Female sterilization: Tubectomy is a surgical procedure requiring hospitalization. This is a good option if you are sure about not wanting any more children. Although there are chances of successful reversion of the surgery, it is not certain that you will be able to conceive in reverting the procedure. The arrival of long term contraception such as hormonal IUD etc. has expanded women’s options beyond permanent sterilization

Most effective – Long-Acting Reversible Contraception (LARC: IUCD and under skin implants) are most effective

Effective – Hormonal contraceptives are very effective if used perfectly, but women often make mistakes in their use. It is important to start them on time each cycle and use them consistently.  and know what to do if some dosage are missed. Injections  have the highest effectiveness in this tier, better than pills, vaginal rings and skin patches

Least effective – Other methods of contraception, including natural methods such as using the ‘safe period’ withdrawal etc. and barrier methods such as male and female condoms are associated with higher pregnancy rates in real life. This is because often their use is far from perfect!

Two things:

  1. In most cases, you have to use emergency contraception and barrier method/usual contraception till next cycle. If you use OCPs and have forgotten one dose, take it as soon as you remember. IF you have forgotten two or more doses, take emergency contraceptive dose of the same pill. Also use condoms ill your next period. If the condom broke, then also take emergency contraception and use condom as usual
  2. Test yourself for pregnancy by UPT (Urine Pregnancy Test) within one week of expected menstrual period

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