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Halina Tomaszczyk, MD
Halina Tomaszczyk, MD | GMC licence number: 3125964
Contraception
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Contraception – effective pregnancy prevention methods

Contraception is a group of measures and methods to prevent pregnancy. It is also known as birth control or fertility control because it is used for family planning. Contraception methods have been known and used since ancient times, but they became safe and effective only in the 20th century.

Contraception methods

Contraception methods include natural, hormonal, chemical, and mechanical measures.

Natural contraception methods

Natural contraception methods are aimed at precise determination of fertile days within the female monthly cycle and refraining from sexual intercourse on those days. Natural contraception requires that a woman has a profound knowledge of her own body and sticks to certain rules. However, even if we determine fertile days with the utmost precision, it does not guarantee 100% effectiveness. Known methods allow confirming ovulation, but are unable to predict it several days in advance. It should be remembered that sperm can survive in a woman’s body more than 48 hours. 

Natural contraception methods include:

  • Thermal method
  • Billings method – also known as cervical mucus method
  • Rötzer's sympto-thermal method
  • Calendar-based method (Knaus–Ogino method)
  • Portable microscope (Easyfertile – the device allows determining fertile days based on saliva sample examination)
  • Electronic calendar
  • Fertility tests
  • Among natural contraception methods, also measured using the Pearl index, there are fertility computers. These are certified medical devices intended for precise determination of woman’s fertility phases and ovulation. Using a fertility computer does not require any specialist knowledge. Fertility computers can be used for supporting natural methods of pregnancy prevention (sympto-thermal method).

    Hormonal contraception

    Hormonal contraception is a method of pregnancy prevention that involves administration of preparations containing synthetic counterparts of hormones. The substance acting as female sex hormones is responsible for inhibiting ovulation and changing the consistency of cervical mucus so that it does not allow sperm to pass through. Some hormonal contraceptives contain two ingredients – estrogen and progestogen, others contain a single ingredient – only progestogen. 

    Types of hormonal contraceptives:

  • Contraceptive pills (combined pills and progestogen-only pills)
  • Contraceptive patches
  • Contraceptive rings (vaginal rings)
  • Intra uterine devices (IUD, contraceptive coil)
  • Contraceptive implant
  • Hormonal injections
  • Morning-after pill
  • Hormonal contraception features high effectiveness and comfort of use, it leads to better menstrual cycle regularity, and reduces the symptoms of premenstrual syndrome. However, using contraceptive pills and other hormonal contraceptive methods is not neutral for the body. Hormonal contraception should always be discussed with a doctor, while specific products ought to be selected individually.

    Contraceptive pills

    Oral contraceptive pills belong to the most popular hormonal contraception methods. Contraceptive pills include:

  • Progestogen-only pills, the so-called minipill
  • Combined contraceptive pills.
  • Progestogen-only contraceptive pills, also known as minipills, contain a small dose of one hormone – progestogen. They thicken cervical mucus, which makes it impossible for sperm to pass through to an egg cell. Minipill sometimes inhibits ovulation. 

    Progestogen-only pills are recommended for:

  • Very young women due to the low hormone content
  • Breastfeeding women
  • Women suffering from thrombosis
  • Women who cannot use pills containing estrogen
  • Women who cannot use coils
  • Women approaching menopause
  • Women who smoke cigarettes
  • Women in the stroke risk group
  • Women over the age of 35
  • Combined contraceptive pills contain two types of female sex hormones: estrogen and progestogen. Hormones contained in the pill inhibit the growth of an egg cell in the ovary and prevent ovulation. They also thicken cervical mucus so that sperm cannot pass through. 

    Combined hormonal pills are divided into:

  • Monophasic pills – all the pills in a package have the same composition
  • Biphasic pills – there are two types of pills in a package with different hormone doses
  • Triphasic pills – there are three types of pills in a package with different hormone doses.
  • Considering the estrogen content, combined contraceptive pills are not recommended for all women at all ages. In many cases, a gynaecologist may recommend progestogen-only pills (without estrogen) or monophasic combined pills (low estrogen content). The use of hormonal contraceptive pills is always consulted with a doctor.

    Contraceptive pills – how to take them?

    Using contraceptive pills is simple and convenient, but remember to follow certain guidelines carefully. Ways to take pills depend on their type. 

    When it comes to progestogen-only pills, their package contains 28 pills, which have to be taken every day at the same time of day. The difference in the time the pills are taken may be up to ca. 3 hours. There is no interval between taking consecutive packages. 

    Combined contraceptive pills should be taken from the first day of a monthly cycle and should continue to be taken for the subsequent 21 days. Then, there is a seven-day interval and bleeding occurs. It is similar to menstrual bleeding, but is usually shorter and lighter. Besides packages containing 21 pills, there are combined pills on the market packed 28 pills per package. However, seven of the pills do not contain hormones and have no effects while they are taken, bleeding should occur. The placebo makes it simpler, but one should be careful not to confuse the pills and take the right ones on the proper days of a cycle.

    Contraceptive pills – side effects

    Taking contraceptive pills, as any preparations containing artificial hormones, may lead to side effects. Usually, they do not constitute any threat to health and occur mainly at the beginning of contraception – when the body is getting used to the hormonal changes. However, no abnormal symptoms should be ignored and, when they exacerbate, you should consult a doctor. 

    Potential side effects of contraceptive pills:

  • Lower libido
  • Body weight gain
  • Headaches, migraines
  • Nausea and vomiting
  • Acne
  • Abnormal bleeding and spotting
  • Higher arterial hypertension
  • Bad mood
  • Nipple pain
  • Vaginal yeast infection
  • Thrombosis
  • Over-the-counter contraceptive pills

    Contraceptive pills and other hormonal contraception methods are not available on the Polish market without doctor’s prescription. Due to the specific effects of hormones on the body, using such a type of contraception requires doctor’s examination and consultation. Over-the-counter contraception is available in the form of mechanical and chemical contraceptives.

    Contraceptive patches

    Contraceptive patches are one of the methods of hormonal contraception. They contain the same hormones as contraceptive pills and have the same effects. A patch applied to the skin continuously releases hormones, which permeate to the circulatory system and prevent ovulation. This make contraceptive patches very convenient, as you do not have to remember about them every day and the active ingredient does not end up in the digestive tract, which helps avoid any additional gastric problems. 

    How to use contraceptive patches? The package contains three patches, each for one week. After three weeks, there is an interval and bleeding occurs. 

    The patch can be applied to:

  • the arm
  • the back
  • the buttocks
  • the bikini areas
  • Under no circumstances should you apply the patch to your breasts. Skin under the patch should be healthy and free from any marks.

    Contraceptive rings (vaginal rings)

    Contraceptive rings are one of the methods of long-term hormonal contraception. The small ring contains progestogens in lower concentration than contraceptive pills, but still able to inhibit ovulation. A woman puts the ring in her vagina by herself for the period of three weeks. After that time and ring removal, there is a seven-day interval and bleeding occurs.

    Intra uterine devices (IUD, contraceptive coil)

    Intra uterine devices, also known as contraceptive coils, are another method of hormonal contraception. They are recommended for women who have already given birth and do not intend to have any more children in the near future, and they do not want to or cannot use oral contraception. The coil is designed to prevent pregnancy for a period from two to six years.

    Contraceptive implant

    Contraceptive implant is one of the latest contraception methods and belongs to the group of long-term hormonal contraception methods. It only contains progestogen, which allows more wider use than preparations containing estrogens. An implant inserted under the skin on the inner side of the arm can work for a period from six months to five years. It is recommended for women who, due to different reasons, cannot use contraceptive pills or patches.

    Contraceptive hormonal injection

    Contraceptive hormonal injection is one of the contraception methods with long-term effects. It contains only one ingredient – progestogen – the release of which inhibits ovulation, thickens cervical mucus, and changes the uterine cavity, making egg cell implantation impossible. Hormonal injection is made once in three months.

    How much does hormonal contraception cost?

    Prices of contraceptives depend on the type, duration of effects, and producer. Prices of contraceptive pills range on average from PLN 5 to PLN 50, contraceptive patches will cost us several dozen PLN, while a contraceptive implant means spending around PLN 1,000.

    Chemical contraception methods

    Chemical contraception methods do not belong to the most effective pregnancy prevention methods. Chemical contraception relies on thickening cervical mucus so that it becomes an impenetrable barrier for sperm and retards sperm motility. 

    Chemical contraception methods include:

  • Spermicide gels
  • Contraceptive foams
  • Vaginal globules
  • Spermicide creams
  • Vaginal sponges
  • Mechanical contraception methods

    Mechanical contraception methods create a barrier making it difficult for sperm to reach an egg cell. Measures used in this method are designed both for women and men. The most popular and the most common mechanical contraception measure is condom. The methods also include vaginal diaphragm and cervical cap. Apart from protecting against unwanted pregnancy, mechanical contraceptives prevent the spread of sexually transmitted diseases.

    Effective contraception – the Pearl rate

    Contraceptive method effectiveness is measured using the Pearl rate, also known as the Pearl index. It constitutes a ratio of the number of unwanted pregnancies arising from regular sexual intercourse in a year in hundred couples using the exact same contraceptive method during that time. The lower Pearl rate, the more effective a contraception method is. 

    Different sources provide different Pearl rate values. This is because the effectiveness of a particular contraception method determined in clinical trials differ from the effectiveness of the same method in the everyday life setting. For example, this applies to contraceptive pills, which sometimes women forget to take, or women might be under the influence of drugs that suppress the effects of contraceptive pills.

    How to read the Pearl index?

    The most effective contraception methods are those with the Pearl index of up to 2. This means that there were two unplanned pregnancies per hundred couples who regularly have sex. 

    The average effectiveness of contraception methods ranges from 2 to 5. 

    Ineffective contraception methods are considered those above 5. When no contraception is used whatsoever, the Pearl rate amounts to 80–90, which is the number of couples out of hundred couples that can expect a baby.

    Contraception methods in terms of the Pearl rate

  • Monophasic contraceptive pills 0.2–0.5
  • Tetraphasic sequential contraceptive pills 0.2–1.4
  • Fertility computer: 0.64
  • Vaginal ring: 0.65
  • Biphasic contraceptive pill: 0.7
  • Contraceptive patch: 0.9
  • Progestogen-only minipill: 1-3
  • Rötzer's sympto-thermal method: 1-3
  • Intra uterine device (coil): 1-3
  • Condom: 3-7
  • Vaginal spermicides: 8-36
  • Rejected sexual intercourse: 10-35
  • No contraception: 80-90
  • The Pearl index, just as other similar studies, cannot precisely and accurately determine the effectiveness of a given contraception method. We should make allowances for the fact that statistics are kept on a specific population group and in specific conditions, while the results should be treated only indicatively. 

    Furthermore, the effectiveness of contraception methods depends mostly on the awareness, knowledge, and skills of those who use them. For example, contraceptive pills should be taken in accordance with specific guidelines, while condoms should be used in a proper manner. Contraception methods help prevent an unplanned pregnancy, but are never 100% effective. The only method that can be fully trusted is sexual abstinence.

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