All you need to know about modern contraception.
While the whole science of contraception is still quite revolutionary – modern contraception has only been around since the 1960s – not many of us give much thought to the various options that are available. Dr Sarah Jackson,
specialist obstetrician and gynaecologist at Park Lane Hospital in Joburg, says that when choosing the best form of
contraception, the following has to be taken into consideration: the patient’s contraceptive needs, the duration that
contraception is needed, their risk of acquiring STIs, and whether they have other medical issues or complications.
‘Ideally, gynaecologists should counsel patients towards long-acting, reversible contraceptives,’ she says, ‘and these
include intrauterine devices/systems (IUDs/IUSs) and implants.’
Although the pill kick-started the whole movement where a woman could control her reproduction cycle and choices
about having children, medical and technological advancements since then have allowed other options to flourish on
the market. There is now a contraceptive method that can work for each and every individual woman, depending on
The following are the most common options available in South Africa, their pros, cons, and why they’ll work for you.
Hormonal contraceptives use either progesterone alone, or the combination of oestrogen and progesterone to prevent a pregnancy by sending signals to the brain to stop ovulation.
Progesterone-only contraception takes the form of pills (often referred to as the mini-pill), injectables, implants, and
intrauterine systems. ‘Bleeding patterns on progesterone-only contraception can be unpredictable,’ says Sarah.
‘Some people may have no period at all, known as amenorrhoea, while others have regular periods, and some have very erratic bleeding.’
Each pill contains a small amount of synthetic progestin, which thickens cervical mucus and thins the lining of the uterus to prevent fertilisation and implantation. They may also suppress ovulation, but not consistently.
- A good alternative for women who cannot take oestrogen.
- A downside to the mini-pill is that, unlike a combination oral contraceptive, it must be taken at the same time each day in order to be effective in preventing pregnancy.
Shaped like a bobby pin, an implant is placed under the skin of the upper arm. It works by releasing synthetic progesterone, which tricks your body into preventing ovulation.
- Long-lasting and works for three years before it needs to be replaced.
- Ideal for women who cannot tolerate oestrogen and for those who require long-term contraception.
- ‘The one disadvantage of the implant is that it may cause irregular bleeding and can interfere with some ARVs,’ Sarah advises.
An intrauterine system, such as Mirena, is a small, plastic T-shaped device with a cylinder around its stem that’s inserted into the uterus by a doctor. The cylinder releases synthetic progesterone, called levonorgestrel, into the uterus, preventing fertilisation of the egg and implantation.
- An IUS is an effective and long-lasting contraceptive, which can work for up to five years before it
- Ideal for women who suffer from heavy periods as it reduces menstrual bleeding and pain. Some
people are fortunate and don’t even have a period on Mirena.
- ‘Even though IUSs are excellent contraceptive devices,’ notes Sarah, ‘some women do experience
irregular bleeding for the first three to six months after insertion. A small number complain of negative skin
changes, and fluctuations in mood, including high levels of anxiety.’
Injections are administered every two or three months. They contain a synthetic progesterone that prevents ovulation.
- Safe for women who are oestrogen intolerant. Can also lead to periods ceasing, especially after use for more than a year.
- ‘Injections have been known to cause abnormal bleeding, and we recommend using it with caution
in teenagers and pre-menopausal women as it can reduce bone mineral density,’ says Sarah. For those
looking to have children, it can also take up to a year to get your cycle back.
Combined oestrogen and progesterone
With combined contraceptives, oestrogen is added for cycle control. ‘This allows for regular withdrawal bleeds,’ explains Sarah. ‘This can be given either in the form of an oral pill, a patch, or a vaginal ring.’
Transdermal patches are placed directly onto the skin and release both hormones into the body to prevent
pregnancy. They can be placed on the buttock, abdomen or thigh (never on your breast) on the first day of the menstrual cycle. This is repeated weekly for three weeks before having a patch-free week during which menstruation occurs.
- ‘Unlike taking a pill every day, a patch only needs to be applied weekly – great for people who travel frequently and across different time zones,’ says Sarah.
- Benefits are similar to taking combined oral contraception pills – periods can be lighter and more regular, and it can aid with clearing skin and decreasing PMS symptoms.
This plastic ring-shaped device is inserted into the vagina for three weeks before being removed for the fourth week for withdrawal bleeding. The hormones are released into the vaginal wall to prevent ovulation, thicken vaginal mucus and thin the lining of the uterus.
- Simple and easy to use and doesn’t need to be removed during sex. Unlike oral contraceptives, it won’t be affected by certain medications, vomiting or diarrhoea.
- Disadvantages include discomfort in inserting and removing the device, as well as increased vaginal
discharge, headaches, nausea, breast tenderness and mood changes during the first months of use.
Combined hormonal pills allow women to skip the placebo and time a withdrawal bleed when it’s convenient for them. ‘It’s a misconception that women need to bleed every month,’ says Sarah. ‘Unless you have something such as polycystic ovary syndrome, “tricycling” or skipping your placebo pills for two or three months to bleed in your next cycle is more than fine. You could even skip every month’s placebo pills and wait until your body bleeds naturally before starting a new pack after four or seven days, depending on which pill you’re using.’
Combined hormone oral contraceptives
‘Contraceptive pills work well, as long as you take them!’ acknowledges Sarah. ‘They have great benefits, including:
- regulating periods
- reducing the amount that you bleed
- reducing period pain
- improving acne
- reducing risk of ovarian cancer.’
With regards to disadvantages of combined hormone oral contraceptives, the main risk is thrombosis (blood clot).
‘This risk is highest in the first three years that you take the pill,’ clarifies Sarah. ‘If you don’t get a clot in the first
three years, you’re extremely unlikely to develop one with continued use of the pill. However, if you stop the pill
for a short while for a “break from the hormones”, once you go back on the pill, you return to that first three years
of increased risk. I never recommend to my patients to take a break from the pill; the only reason to go off it is to have a baby. Otherwise I would suggest finding a more suitable contraceptive option.’
Sarah does not always recommend the pill for teenagers due to the high rate of missed pills, leading to
teenage pregnancies. Rather opt for a long-acting, reversible contraceptive. However, if their skin is a problem, an oral pill does work best. It’s essential, however, to explain the dangers of not taking it correctly.
Hostile lady parts?
For women with endometriosis, Sarah recommends Mirena. ‘You can also use a combined pill but skip the placebo to prevent withdrawal bleeding,’ she says. If you suffer from polycystic ovary syndrome, a state of chronic anovulation and high oestrogen levels that cause cysts to develop on the ovaries, ‘it’s very important to protect the lining of the womb (endometrium). This is best done by causing a withdrawal bleed with the combined oral pill or Mirena insertion,’ explains Sarah.
Did you know?
According to a study by the United Nations, 64% of married or in-union women of reproductive age worldwide,
are using some form of contraception.
If you struggle with side effects on hormonal contraceptives, don’t despair, there are other options available that don’t use hormonal manipulation.
A small copper and plastic device inserted into the uterus by a doctor, it works by inhibiting implantation by affecting the sperm’s movement to the egg. ‘Copper is spermicidal, in other words it kills sperm, and the IUD acts as a foreign body in the uterus, preventing a pregnancy from implanting,’ says Sarah.
- Lasts 5-10 years.
- Can make periods heavier with more severe cramping at the beginning (depending on which type is
- Can be removed at any time with quick return to normal fertility.
These include cervical caps (a silicone cap that fits over the entrance of the cervix), as well as diaphragms and condoms, which act as a barrier to prevent the egg and sperm from meeting.
Sterilisation or vasectomy
This is permanent, and for all intents and purposes, irreversible, and will require surgery. While there is no law in South Africa on the age at which you can be sterilised, Sarah would counsel patients against this under the age of
35. ‘I would rather encourage them to opt for a long-acting, reversible contraception as you never know what
your future might hold, and whether you may want to revisit having more kids down the line.’
Sarah recommends a progesterone-only contraception if you’re breastfeeding. This can either take the form of the mini-pill, injections, implants or Mirena, and even a copper IUD can be used. ‘Anything containing oestrogen will decrease the quantity of breast milk and should be avoided while breastfeeding.’
Oestrogen a problem?
If there’s a history of thrombosis/pulmonary embolism, or you suffer from migraines with aura, speak to your medical practitioner about oestrogen-free options.
FEATURE: TARYN DAS NEVES PHOTO: FOTOLIA.COM
The advice contained here is strictly for informational purposes. The content is not intended to be a substitute for professional advice, diagnosis, and treatment. Always consult your GP or a doctor for specific information regarding your health.