WOMEN ACROSS THE WORLD USE SOME FORM OF CONTRACEPTION TO REDUCE THE RISK OF PREGNANCY, BUT WHY DO SO MANY OF US FEEL AWKWARD DISCUSSING IT?
Image: Gabriela Sanda
You’re browsing the internet. There are so many articles, so much information available. How do you make the decision? You read one woman’s experience of a contraceptive pill that made her “fat and spotty”. Okay, maybe the pill is not for you. How about the implant? Maybe not, one of your friends had the implant and it gave her a womb infection. Is it even normal to pump your body full of hormones anyway? You read there’s a new app available that can tell you your fertile days and non-fertile days just by taking your temperature. Sounds interesting. But do you really want to rely on an app for contraception? What about the old-fashioned way, condoms. You read someone’s horror story when her boyfriend’s condom split, and she ended up pregnant at 16. Maybe not.
Exasperated, you turn away from the internet. Who else can you get information from? Obviously, the doctor, but that could be awkward talking to someone you don’t know about the different contraceptives available. Maybe your friends, but then everyone’s body is different, and they’re not actually qualified to give you that advice. You definitely don’t want to talk to your Mum about it, that would come with a bombardment of questions and judgement.
The thing is, talking about contraception shouldn’t be this taboo. The wealth of information on the internet and your doctor should allow you to make an informed decision. We need a contraceptive overhaul. It’s time to talk about your options.
The contraceptive pill is one of the most widely used forms of contraception and is prescribed for free under the NHS. 70% of 16-19-year-olds use some form of the pill. 66% of 20-24-year-olds and 58% of 25-34-year-olds also use this form of contraceptive. Pretty popular, right? There are many available pills with different concentrations of two hormones – oestrogen and progesterone. While most pills contain a mix of these two hormones, known as combination pills, there is a type known as the mini-pill which contains progesterone only. The pill you are prescribed will depend on several factors; if you have a history of high blood pressure or migraines, if you have a family history of blood clots, if you have acne, and many other things.
When taken correctly, the pill is up to 99.9% effective. Lucy*, a 21-year-old commercial administrator, found that the pill helped with her acne. “I was prescribed Lucette after a bad experience with the implant,” she says. “Lucette contains different hormones to the normal pill, so it helps with your skin. I’ve been on this pill for two years with no problems and my skin is better than it’s ever been before”. Amongst other benefits, the pill can also reduce cysts in the breasts and ovaries, the effect of PMS, anaemia and period pains.
However, it’s not all sunshine and rainbows! There are many side effects to the pill; some people have no problems, some people face all the problems, and some people take the pill for years before side effects start to rear their ugly heads. Headaches, bloating, weight gain, spotting, and nausea are all side effects, and obviously the fact that the pill does not protect against STIs. Georgia*, a 22-year-old full time student, says “I was on a combination pill for two years until I started getting headaches. I went to the doctor and we discussed what other options I had. We decided on a mini-pill because the lack of progesterone is supposed to help headaches. I haven’t had any problems since”. While there are side effects of the pill, there are many different types of pill that you can try. If you think you’d like to try the pill, have a discussion with your GP. Being on the pill can be trial and error; remember, you don’t need to stick to one pill forever, there are many different types to try that may or may not suit your body.
The pill is not for everyone. The combination pill is not suitable for people who have/had following health problems; blood clots, breast cancer, heart attack or stroke, migraine headaches, uncontrollably high blood pressure or diabetes. Using the pill can slightly increase your risk of health problems including liver tumours, heart attack, stroke and blood clots. This is nothing to scare too much from – the risk is extremely low, although it is something to consider when making your contraceptive choice.
Struggle to remember your keys let alone to take a pill every day? Fear not, the implant may be your new best friend. The contraceptive implant is a small plastic rod that’s inserted into your upper arm and releases the hormone progestogen. Again, like the pill, it’s free on the NHS. The implant can last up to three years but can be removed anytime if it’s not for you. The implant is over 99% effective, so like the contraceptive pill, the risk of pregnancy is really low.
Benefits of the implant include its longevity – three years is a long time to not have to worry about contraception! This method is suitable for breast feeding women and women that can’t use oestrogen-based contraception (if you’re not sure if you can or not, check with your doctor). You may experience irregular, longer, lighter, or heavier periods – sometimes they stop completely. If you are worried about fertility, it will return naturally after the implant is removed.
Like all medication, there are side effects. Lucy, who we met earlier, struggled when she was on the implant before she started taking Lucette. “I was fine for a couple of months until I started getting really bad mood swings and feeling nauseous a lot,” she explains. “Then on New Years Eve I felt really awful. I laid down and I could not stop shaking, I felt like I couldn’t move. I thought my body was going to shut down. My friends had to call the paramedics, it was terrifying. I got my implant taken out two weeks later and the symptoms disappeared”. While this may not be the case for you, it is important to remember that your body may react badly to any of the contraceptive methods you choose. Again, it is important to trial and error until you find what works the best for you. Other negative side effects include acne, having to have a procedure to insert and remove it, and the fact that it doesn’t protect against STIs. Isabelle*, a 21-year-old student who’s travelling on her industry year at University, has been on the implant for four years. She says: “the implant is a really easy and effective method of birth control. As a forgetful individual, any other form of birth control may be risky for me, so the implant is a good way to ensure I avoid pregnancy”.
Not everyone is 100% happy with the idea of pumping their body with hormones. Luckily, there are non-hormonal alternatives. Condoms, specifically here male condoms as they are the more popular choice, are the only contraceptive that protects against both STIs and pregnancy. They can also be used in conjunction with other birth control, which reduces the risk of pregnancy even more. Male condoms are 98% effective when used correctly. However, we are not perfect; due to the likelihood of human errors, condoms are more like 85% effective. You can get condoms for free from sexual health clinics and some GP surgeries, or you can buy them from supermarkets. There are many different types of condoms, so again, and I know you’re sick of hearing this, it’s a trial and error until you find what suits you and your partner best. Even if you are allergic to latex, there are latex-free condoms on the market.
A couple of things to watch out for though; condoms can come off or break during sex, which will mean you will have to use emergency contraception to reduce your risk of pregnancy. Emergency contraception is available at pharmacies and GP surgeries, and should not be relied on for regular contraception. Condoms can also become out of date, so if you or your partner finds a box underneath the bed that’s quite dusty, it’s best to double check the date on it. Some often complain as well that condoms feel less intimate, especially when you’re with a long-term partner. However, if you decide to use condoms or their own or in conjunction with birth control, you have every right to do so! If someone pressures you into having sex without a condom, you need to think of your own safety. Even if you’re on other birth control, condoms prevent transmission of STDs, so if it “feels better for them without one” or “they forgot to bring some”, leave it for next time.
Another form of non-hormonal birth control is an intrauterine device (IUD). This is a small, T-shaped device made up of plastic and copper that’s placed in your womb. Sounds a bit strange, but this non-hormonal method releases copper instead to prevent pregnancy and can last between five and ten years – not too bad! The IUD, like most other forms of birth control, is over 99% effective at preventing pregnancy. It can also be taken out whenever if you don’t get on with it anymore, like the implant. There are a couple of negatives, as always. The IUD can cause your periods to change, and there’s also a small risk of infection after it’s been placed. This device can sometimes move or try to push out your IUD, but the doctor or nurse will give you instructions on what to do if this does happen.
Would you ever trust an app to prevent you from getting pregnant? If you love your phone and are well organised, this method may be for you. Natural Cycles is a smartphone app that uses a thermometer to measure your fertility each day. The combination of your body temperature and what day you are in your cycle tells the app whether you are at high or low risk of pregnancy; if you’re at high risk, you should probably use condoms that day. If you are at low risk, you can have unprotected sex with a low likelihood of pregnancy. A Swedish study found that, out of 4’000 women using the app, 5 in 1’000 will become pregnant accidentally, and 7 in 100 will become pregnant from not using the app properly. It’s assumed that the risk of pregnancy using this app is higher than the risk of pregnancy with typical birth control methods like the pill or condoms. However, if you are very organised with measuring and logging your temperature, or you’re with a long-term partner and maybe you want to know the days your most fertile to try and get pregnant, then this app may be for you.
We’ve covered a range of birth control methods here, but believe it or not, there are still other forms of contraceptives available to you. Now you know the most popular forms of birth control, you can go to the GP with your new-found knowledge and discuss in depth what you think will work best for you. Let’s open a conversation! Women shouldn’t be ashamed or embarrassed to talk about or ask for birth control. It’s a completely natural part of life and if it reduces your risk of unplanned pregnancy, it’s definitely something to talk about.
*names have been changed for anonymity.