Contraception is essentially prevention of pregnancy by halting conception and/or implantation. Contraception gives a woman control over her reproductive cycle so that she may be able to plan if and when she falls pregnant.
Numerous methods of contraception are available and include barrier or hormonal method, withdrawal, natural family planning, abstinence, and male and female sterilisation (surgery). Some of these methods are confined for women and others for men and some of the methods are reversible and some are permanent.
Natural family planning method
Natural family planning (NFP) or fertility awareness does not require medication, physical devices, or surgery to prevent pregnancy. This method relies on the woman’s body physiology to know the time of ovulation. This method involves monitoring different body changes such as basal body temperature or cervical mucus variations. The woman then abstains from unprotected sex for approximately 7 to 10 days when she may have ovulated. This is often referred to as the Billings Method of Contraception.
Barrier methods
Barrier methods form a physical barrier to obstruct the sperm from entering a woman’s uterus thereby preventing conception. The most common barrier method is the condom. Condoms have the added benefit of providing increased protection from sexually transmitted infections including HPV, chlamydia, gonorrhoea, Hepatitis B and C and also HIV. The female diaphragm is another example of barrier contraception.
Hormonal methods
There are numerous types of hormonal contraception options available.
The combined oral contraceptive pill (COCP) which contains oestrogen and progesterone is the most well-known contraception on the market. Another is the progesterone only pill (often called the “mini-pill).
Other progesterone only contraception options include;
- Depo provera – a 3-monthly injection
- Implanon – otherwise known as “the rod” which is placed under the skin in the upper arm
- Mirena – an intrauterine device
The Nuvaring is another combined hormonal contraception option. It is a small ring that is placed into the vagina monthly.
Hormonal contraception works by various mechanisms – generally, they prevent ovaries from releasing an egg for fertilisation. They also thicken the mucus around the cervix, making it difficult for sperm to penetrate, finally they also thin the lining of the womb decreasing its ability to accept a fertilised egg. The intrauterine device (IUD) is a small device made of copper or impregnated with progesterone (Mirena IUD) that is inserted into the uterus. It works by thickening the mucus around the cervix and by thinning the womb’s lining, making it difficult to accept a fertilised egg.
Surgical options
Often called “permanent” contraception or “sterilisation”.
Female sterilisation involves a tubal ligation, a surgical procedure that blocks the fallopian tubes which carry the eggs from the ovaries to the uterus. Historically this was achieved using Filshie clips to mechanically occlude the tube. More recently, women opt for bilateral salpingectomy (removal of both fallopian tubes) as this results in a decreased failure rate and has the added benefit of decreasing risk of epithelial ovarian cancers.
Male sterilisation involves vasectomy, a surgical blocking of the vas deferens, the tubes through which sperm pass into the semen.
In summary
The choice of contraception method is an individual or a couple’s choice. Your choice will be affected by frequency of sexual activity, number of sexual partners, future pregnancy wishes, and certain medical conditions.
It is important to remember that ALL methods of contraception have a known failure rate with abstinence being the only method to guarantee protection from pregnancy!
There are added benefits and risks for all of the options listed above that may affect your decision, therefore always discuss with your doctor about the choice of birth control method.
