Contraception For Women: Pros And Cons Of Hormonal Pills, IUDs And Female Condoms

Universal access to high-quality and affordable contraceptive services is a fundamental human right and helps to prevent the harmful effects of unintended pregnancies and abortions.

For women, contraceptive options are available in form of physical barriers, oral pills, injectables, implants, intrauterine devices, and surgery.

Oral contraception

Oral contraception is one of the most popular methods of contraception. It means birth control methods taken orally to delay or prevent pregnancy. It is a highly effective method if taken correctly and consistently. It is estimated that approximately 8 per cent of all married women are currently using OCPs globally. However, in India, the use of oral contraception is low (4 per cent)

A combined oral contraceptive pill (COC) contains both estrogen (Ethinyl Estradiol) and progesterone. They act by inhibiting ovulation. Many different formulations and brands of COC are available commercially; most are designed to be taken over a 28-day cycle. The user is required to take hormonal tablets for the first 21 days of the cycle and the last 7 days are hormone-free days where no pills or placebo pills are given. A woman can start using COCs any time she wants if pregnancy can be ruled out with certainty. The failure rate with typical use is 8 pregnancies per 100 women a year and with perfect use is 0.3 pregnancies per 100 women a year.

Pros: It has non-contraceptive benefits:

? Decreased risk of endometrial, ovarian, and colorectal cancer

? Regularization of menstrual cycles

? Treatment of menorrhagia, dysmenorrhea, Premenstrual Syndrome (PMS)

? Treatment of pelvic pain of endometriosis

? Treatment of hirsuitism and acne.

Cons: irregular bleeding, nausea, dizziness breast tenderness, weight gain, ineffective if pills missed

Progesterone only Pills (POPS)/ Mini Pills

Oral contraception is one of the most popular methods of contraception.

These pills contain a very low dose of synthetic progesterone. The progesterone dose in these pills is less than that in COCs. They have to be taken every day at the same time without delay, for maximum effectiveness. These are safe and effective methods of contraception and can safely be used in breastfeeding women even before 6 weeks. They act by thickening cervical mucus thus preventing fertilization by preventing sperm from reaching the ovum. They may also suppress ovulation but not consistently. The failure rate with typical use is 1-10 pregnancies/100 women a year and with perfect use is 0.3-0.9/ 100 women a year.

Cons: Strict timings for pill intake, irregular bleeding

Pros: can be taken by breastfeeding women, where estrogen is contraindicated

Centchroman (Ormeloxifene)

Ormeloxifene is a nonsteroidal non-hormonal once-a-week OCP. It is safe and effective contraception and can be taken during breastfeeding. It exerts its contraceptive action by causing asynchrony in the menstrual cycle between ovulation and development of the uterine lining; however exact mechanism is not well defined. Its failure rate with perfect use is 1-2 pregnancies/100 women a year.

Pros: Once a week administration, nonhormonal, safe for breastfeeding mother

Cons: scanty bleeding during periods, absent menses

Emergency Contraceptive Pills (ECPs)

These are used to prevent pregnancy after unprotected sexual intercourse, contraceptive accidents like condom rupture or missed pills, and in cases of sexual assault. They are also known as the morning-after pill or the post-coital contraceptive pill.

Pros: Can be used in an emergency, single-dose

Cons: the higher possibility of failure as compared to other methods and high incidence of menstrual irregularity, nausea, and vomiting.

Injectable contraceptives

These are intramuscular injections available in various combinations and dosages.

Pros: long-acting, improvement in anaemia and dysmenorrhea, safe for breastfeeding mother

Cons: The major problem associated with the use of this method is irregular bleeding and amenorrhea. Return of fertility is delayed up to 9-10 months after stopping the contraceptive drug weight gain, headache, and dizziness, decrease in bone density but fully reversible

Implants are devices put subcutaneously, releasing hormonal contraceptives over a long period (1-3 yrs or more).

These implants consist of hormone-filled capsules or rods which are inserted under the skin of the upper arm.

Pros: Long-acting

Cons: Irregular menstrual cycle is common and most distressing to the patients, especially in the first year of use. Other side effects include GI side effects, weight gain, and breast pain. Rarely there are complications related to implant insertion or removal. No major effect on bone density. The implants need to be inserted and removed through a minor surgical procedure performed by trained personnel. Implants do not provide protection against sexually transmitted infections (STIs).

Intrauterine devices

These implants consist of hormone-filled capsules or rods which are inserted under the skin of upper arm.

CopperT, Mirena is a highly effective, long-acting reversible contraceptive method.

Cons: menstrual irregularity in the first 4 months after insertion followed by light and short menses, breakthrough bleeding. Overall, complications with IUDs are uncommon and include expulsion (incidence 2-10% within the first year), method failure, and perforation

Transdermal Patches

Transdermal contraceptive patches mimic the oral pills and deliver a combination of estrogen and progesterone to the user. They are different from pills in dosing frequency, which is weekly for 3 weeks as compared to daily intake.

Pros: It avoids the first pass through the liver thus causing fewer side effects. It can be applied on the lower abdomen, upper outer arm, buttock, or the upper torso excluding the breast.

Cons: breakthrough bleeding, spotting, skin reactions at the application site

Barrier methods

The female condom, cervical cap, diaphragm, spermicidal jelly all act as physical barriers and avoid sperm entry.

Pros: Safe, prevents Sexually Transmitted Infection, can be used where hormones contradicted

Cons: needs training, high failure rate, not easily available

Female sterilisation

Tubectomy or tubal occlusion procedures

Pros: Permanent, highly effective

Cons: Invasive procedure, anaesthesia complications, low success rates of reversal

Dr Deepika Negi is a Consultant Obstetrician and gynaecologist at Samarpit Mediclinic, Noida

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