Contraception

Contraception is a crucial aspect of reproductive health, enabling individuals and couples to prevent unintended pregnancies and plan their families effectively.

Various contraceptive methods are available, each with its own advantages, limitations, and suitability for different needs and lifestyles.

Types of Contraception

Barrier methods prevent sperm from reaching the egg. They are typically used at the time of sexual intercourse and offer protection against sexually transmitted infections (STIs).

  • Condoms: Available for both men and women, condoms are made from latex, polyurethane, or lambskin.
    • Symptoms: Potential allergic reactions to latex, reduced sensation.
    • Risk Factors: Incorrect usage can lead to breakage or slippage, reducing effectiveness.
    • Treatment Options: Non-latex condoms for those with allergies.
  • Diaphragms and Cervical Caps: These are inserted into the vagina before intercourse to cover the cervix and block sperm entry.
    • Symptoms: Vaginal irritation, increased risk of urinary tract infections (UTIs).
    • Risk Factors: Must be fitted by a healthcare professional, and effectiveness depends on correct placement.
    • Treatment Options: Proper fitting and use, combined with spermicide to enhance effectiveness.

Hormonal methods regulate a woman’s hormonal cycle to prevent ovulation, thicken cervical mucus, or thin the uterine lining.

  • Oral Contraceptives (The Pill): Combined (oestrogen and progestagen) and progestagen-only pills taken daily.
    • Symptoms: Nausea, breast tenderness, weight gain, mood changes, breakthrough bleeding.
    • Risk Factors: Smokers over 35, those with a history of blood clots, heart disease, or certain cancers.
    • Treatment Options: Different formulations or switching to another contraceptive method if side effects persist.
  • Contraceptive Patch  (not available in Australia): A skin patch worn on the body that releases hormones.
    • Symptoms: Skin irritation at the application site, nausea, headaches.
    • Risk Factors: Similar to those for oral contraceptives.
    • Treatment Options: Rotate application sites, or consider alternative methods if side effects are significant.
  • Progestagen-Only Pills: Progestagen-only pills are a contraceptive option for women who prefer or require methods without oestrogen. In Australia, two types are available:
    • Traditional Mini Pills: Contain levonorgestrel (Microlut) or norethisterone (Noriday). Must be taken at the same time every day, with a 3-hour window for effectiveness.
    • Drospirenone: A newer option with drospirenone (Slinda), offering a 24-hour window and a 24+4 regimen that may regulate bleeding patterns.
    • Symptoms: Irregular bleeding, breast tenderness, headaches.
    • Treatment Options: Education on proper timing for traditional pills or using Slinda for more flexibility.
  • Contraceptive Injection (Depo-Provera): An injection of progestagen given every three months.
    • Symptoms: Weight gain, delayed return to fertility, bone density loss with long-term use.
    • Risk Factors: History of osteoporosis, unexplained vaginal bleeding.
    • Treatment Options: Monitoring bone health, switching to another method if long-term use is a concern.
  • Vaginal Ring (NuvaRing): A flexible ring inserted into the vagina releasing hormones.
    • Symptoms: Vaginal irritation, increased discharge, nausea.
    • Risk Factors: Similar to oral contraceptives.
    • Treatment Options: Proper insertion technique, considering alternative methods if issues persist.
  • Implants (Implanon): A small rod inserted under the skin of the arm, releasing progestagen.
    • Symptoms: Irregular bleeding, weight gain, headaches.
    • Risk Factors: Similar to other hormonal methods.
    • Treatment Options: Monitoring and managing side effects, considering removal if problematic.

IUDs are small, T-shaped devices inserted into the uterus to prevent pregnancy. They can be hormonal or non-hormonal.

  • Hormonal IUDs (Mirena, Kyleena): Release progestagen to thicken cervical mucus and thin the uterine lining.
    • Symptoms: Irregular bleeding, cramping, hormonal side effects similar to other methods.
    • Risk Factors: Uterine abnormalities, history of pelvic infections.
    • Treatment Options: Managing side effects, checking placement if discomfort occurs.
  • Copper IUDs : Release copper ions that are toxic to sperm.
    • Symptoms: Heavier periods, increased cramping.
    • Risk Factors: Wilson’s disease (copper allergy), heavy menstrual bleeding.
    • Treatment Options: NSAIDs for pain relief, considering removal if side effects are intolerable.

Emergency contraception is used to prevent pregnancy after unprotected intercourse or contraceptive failure.

  • Emergency Contraceptive Pills (ECPs): Levonorgestrel (Postinor) or ulipristal acetate (Ella) taken within 72-120 hours.
    • Symptoms: Nausea, fatigue, headache, changes in menstrual cycle.
    • Risk Factors: Limited to occasional use, effectiveness decreases with delay.
    • Treatment Options: Anti-nausea medication if needed, consulting a healthcare professional for repeated use.
    • Are available without prescription

Take 2 combined oral contraceptive pills (must contain oestrogen and progestagen) and repeat 12 hours later.

  • Symptoms: Nausea, fatigue, headache, changes in menstrual cycle.
  • Risk Factors: Limited to occasional use, effectiveness decreases with delay.
  • Treatment Options: Anti-nausea medication if needed, consulting a healthcare professional for repeated use.

Can also be used as emergency contraception if inserted within five days of unprotected sex.

  • Symptoms: Similar to those of regular copper IUD use.
  • Risk Factors: Same as for regular copper IUD.
  • Treatment Options: Ensuring timely insertion and monitoring for side effects.

Permanent methods are surgical procedures intended for individuals who are certain they do not want more children.

  • Tubal Ligation: A surgical procedure to block or seal the fallopian tubes.
    • Symptoms: Surgical risks, potential for regret.
    • Risk Factors: Those uncertain about future childbearing desires.
    • Treatment Options: Counselling to ensure informed decision-making, considering less permanent methods if uncertain.
  • Vasectomy: A surgical procedure for men to cut or seal the vas deferens.
    • Symptoms: Surgical risks, potential for regret.
    • Risk Factors: Those uncertain about future childbearing desires.
    • Treatment Options: Counselling and considering alternatives if not fully decided.

Causes of Contraception Failure

  • Incorrect Use: Not following instructions, inconsistent use.
  • Interaction with Medications: Certain medications can reduce the effectiveness of hormonal contraceptives.
  • Health Conditions: Conditions like vomiting or diarrhoea can affect the absorption of oral contraceptives.
  • Product Defects: Rare manufacturing defects in barrier methods like condoms.

Symptoms of Contraceptive Side Effects

  • Hormonal Effects: Mood swings, weight changes, nausea, breast tenderness.
  • Physical Discomfort: Cramping, irritation at application or insertion sites.
  • Menstrual Changes: Irregular bleeding, heavier or lighter periods.

Risk Factors for Choosing Contraception

  • Medical History: History of blood clots, heart disease, or cancer may limit options.
  • Lifestyle: Smoking, alcohol use, and adherence to daily routines.
  • Age and Reproductive Plans: Age-related fertility concerns, desire for children in the future.
  • Personal Preference: Comfort with usage, potential side effects, and partner involvement.

Treatment Options for Contraceptive Side Effects

  • Switching Methods: Trying different contraceptive methods if side effects are intolerable.
  • Managing Symptoms: Using medications or lifestyle changes to alleviate side effects.
  • Consultation: Regular consultations with healthcare providers to adjust and monitor contraceptive use.
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