Birth control methods: what are the options?

Photo by Giorgio Trovato on Unsplash

Photo by Giorgio Trovato on Unsplash

Have you ever been told to take the oral contraceptive pill (OCP) “to regulate your hormones”? The OCP suppresses our hormone production, it doesn't regulate them 🤷🏽  ⁣⁣⁣⁣⁠

Birth control pills maintain a high concentration of oestrogen and progesterone in the bloodstream. This then prevents the production and mid-cycle peak of these hormones and subsequently blocks the release of FSH and LH from our pituitary gland, preventing ovulation. ⁣⁣⁠

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Don’t get me wrong, the invention of the OCP was REVOLUTIONARY. Access to the OCP has enabled women to control childbearing, increase their education level and earning capacities, and so much more. However, this form of contraception is not without its drawbacks and may not be for everybody. 

So that leaves the question… if we don’t use the OCP, what other forms of contraception are out there? What are some of the pros and cons for each method? 

HORMONAL BIRTH CONTROL

Oral contraceptive pill: maintains a high concentration of oestrogen and progesterone in the bloodstream to suppress ovulation.

PROS:

  • Can prevent menstruation - if that can be seen as a positive! 

CONS:

  • Suppresses ovulation. No ovulation = no progesterone. 

  • Causes nutrient depletion: folate, B2, B6, B12, vitamin C and E, magnesium, selenium and zinc.

  • Interferes with thyroid function by elevating thyroid binding globulin and depleting the above nutrients needed for thyroid function.

  • Side effects can include weight gain, increased risk of blood clotting, depression, gastrointestinal symptoms, low libido, hair loss, post pill PCOS and post pill acne.

  • No protection against STDs.

Implanon: arm implant that releases progestogen or progestin (levonorgestrel or etonogestrel).

PROS:

  • Prevents menstruation - if that can be seen as a positive! 

CONS:

  • Suppresses ovulation. No ovulation = no progesterone.

  • Weight gain and erratic bleeding - anovulatory bleeds or breakthrough bleeds which occur when uterine lining has been exposed to oestrogen, but not progesterone.

  • Levonorgestrel is derived from testosterone, so can cause side effects like hair loss, acne and weight gain, along with ovarian cysts, anxiety and depression.

  • No protection against STDs.

Photo by Nadine Rupprecht on Unsplash

Photo by Nadine Rupprecht on Unsplash

Depo-Provera injections: contains high dose progestin medroxyprogesterone acetate, which completely suppresses both oestrogen and progesterone.

PROS:

  • Prevents menstruation - if that can be seen as a positive! 

CONS:

  • Completely suppresses ovulation. No ovulation = no progesterone.

  • Side effects: weight gain, temporary bone loss, increased breast cancer risk. 

  • No protection against STDs.

Mirena IUD: contains progestin only. The mirena works by thinning the uterine lining, and impairs cervical fluid to inhibit sperm survival.

PROS:

  • Permits ovulation: the mirena shuts down ovulation in 85% of cycles in the first year, but only shuts down ovulation in 15% of cycles afterwards.  

  • Unique in that it suppresses a menstrual bleed but permits ovulation and hormone production. 

  • Can reduce menstrual flow by 90%, so can be helpful in flooding, adenomyosis and endometriosis.

CONS:

  • Side effects can include depression and reduced ability to cope with stress. 

  • No protection against STDs.

NON HORMONAL BIRTH CONTROL

Copper IUD: Copper ions impair sperm motility. It’s presence changes the uterine lining so that a fertilized egg cannot implant.

PROS:

  • Does not alter hormones and permits ovulation.

  • Has the highest rate of user satisfaction of any method.

CONS:

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  • Can increase heaviness of periods by 20-50% in the first 12 months. 

  • Bad for the balance of bacteria in the vagina, doubling the risk of bacterial vaginosis. 

  • There is a risk it can be expelled. 

  • Small risk of uterine perforation. 

  • Can cause copper excess.

  • No protection against STDs.

Fertility Awareness Method (FAM): women are only fertile for 6 days a month! This method teaches you to determine which fertile days to abstain from intercourse or simply use a barrier method. For more information on how to use this method, see https://fertilityfriday.com/22-fertility-awareness-websites-you-should-know-about/

PROS:

  • Encourages body literacy by learning the objective signs of body temperature, cervical fluid, or cervix changes (or all three).

  • Does not alter hormones and permits ovulation.

CONS:

  • Requires effort.

  • No protection against STDs.

Condoms: a barrier method.

PROS:

  • Simple, effective and protect against STDs.

  • Readily available.

CONS:

  • Can split or tear if not used correctly.

Diaphragm: latex or silicone dome that seals against the vaginal wall, preventing sperm from entering the uterus.

PROS:

  • Does not affect ovulation or hormone production.

CONS:

  • No protection against STDs.

Tubal ligation: keyhole surgery to clamp the fallopian tubes to prevent eggs traveling to the uterus. 

Vasectomy: cauterising of the vas deferens to prevent sperm in ejaculate.

PROS:

  • Effective long term contraception. 

  • Tubal ligation does not affect ovulation or hormone production.

CONS:

  • Risks of surgery and general anesthetic. 

  • Tubal ligation is basically permanent, whereas vasectomy reversals can be successful. 

  • Women who have undergone tubal ligation are more likely to go on to suffer heavy and irregular periods.

So is it time to rethink your birth control?

*Please note this is not an exhaustive list or how to guide - speak to your health professional for tailored advice and more information. Some information courtesy of Lara Briden’s The Period Repair Manual.

Hayley Brass