Contraceptive Pills

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Five Major Categories of Contraceptives - Everybody should Know

Birth control or contraception is a method or process or device that is used to prevent pregnancy. Every woman resorts to some form of contraception during her life to prevent pregnancy. Predominantly birth control methods interfere with the normal physical process of ovulation, fertilization and implantation. Barrier method of contraception involves prevention of sperm from entering woman's ovary thus preventing the formation of pregnancy.

Every month women goes through menstruation that is meant to facilitate pregnancy. When an egg inside her ovary matures, mucus is secreted which facilitates easy movement of sperm. Mucus secretion is kind of invitation for sperm as it makes women feel for sex. During this period a lining is formed inside the uterus walls in preparation to receive a fertilized egg. Any woman who wants to use a birth control must use a reliable one and that is suitable to her as most birth control methods are designed to interfere with her natural process.

There are numerous birth control methods are available and each one has its own risks and side effects. Birth control methods are grouped into few categories based on their functionality. Let us see each one of them in detail.

Different Types of Contraception

There are five major categories of contraception available right now including:
- Long acting reversible contraception (LARC)
- Hormonal Methods
- Barrier Methods
- Emergency Contraception
- Sterilization

Let us see each one of them in detail

I. Long acting reversible contraception (LARC)

As the name indicates, these are contraceptives that last for a long time, in true sense it will last for a few years. They are often referred to as 'fit and forget' contraception as you don't need to remember it every day or every month. LARCs are most effective types of contraception and are more than 99% effective in preventing pregnancy.

Further LARC contraceptives are subdivided into two categories

-          Intrauterine Methods - lasts for 5 to 10 years

-          Implants - lasts for 3 to 5 years

Intrauterine Contraceptive Methods

This involve inserting a small Intrauterine device (IUD) into the uterus to prevent conception. The IUD can be a coil, loop, triangle or T-shaped device. Only a healthcare professional can insert the device into the uterus through vagina and the IUD can remain in its position and function effectively for many years at a time. After the recommended period or when the woman wants to become pregnant again a healthcare provider is needed to remove the device or replace the device with a new one.

IUDs work in two ways. One type serves as a gate and prevents sperm and eggs from meeting by preventing sperm from entering fallopian tubes. The other type of IUD change the uterine lining so that fertilized egg cannot implant in uterine.

IUDs have the highest success rate compared to other methods. IUD is ideal and regarded as the safest for women who are on a monogamous and stable relationship and who have a low risk of infection. Let's see two types of IUDs:

Hormonal IUD or IUS

A hormonal IUD or IUS works by releasing progestin hormone (levonorgestrel) into the uterus. This hormone thickens the cervical mucus and thus inhibits sperm from reaching and fertilizing the egg. This also reduces the thickness of the uterine lining and prevents ovaries from releasing eggs. The success rate of IUS is 99% and it is the highly successful methods of contraception. Studies have confirmed that IUDs are effective even up to a year beyond their recommended usage period. For few women with heavy menstrual bleeding, IUDs are also used to contain the bleeding levels.

Copper IUD

A Copper IUD prevents sperm from reaching and fertilizing the egg that is released from ovary. Even in case of fertilization of the egg happens; the device prevents fertilized egg from reaching and implanting in the uterus lining.  Copper IUDs can remain safely inserted for upto 10 years. This is not recommended for women with pelvic infection or those with cervical cancer or uterus cancer, and those suffering from vaginal bleeding or pelvic tuberculosis.

Contraceptive Implants

Implants are small, match stick-sized, flexible implantable rods made of plastic. The insertion involves a small surgical procedure where a surgeon will insert the rod under the woman's upper arm skin. The implanted rod releases progestin hormone resulting in thickened cervical mucus. Thick cervical mucus prevents sperm from swimming and reaching egg. Implants come with 99% success rate.

II. Hormonal Contraceptive Methods

We all know that hormones play an important role in the formation of pregnancy. Hence hormonal methods of pregnancy control involve usage of specific synthetic hormones injected into our body to regulate or stop ovulation and prevent pregnancy. There are two types of hormonal methods of contraceptives.

  1. Short Acting Hormonal Methods
  2. Combined Hormonal Methods

Short Acting Hormonal Contraceptive Methods

Ovulation is the biological process that involves ovary releasing an egg during every menstrual cycle and making it available for fertilization and once the egg is fertilized, it will travel through fallopian tube and fall in uterus and gets implanted, which is pregnancy. This procedure involves injecting hormones into our body through various methods such as pills, injections, skin patches, transdermal gels, vaginal rings, intrauterine systems, and implantable rods. Depending on the type of hormone that is used, ovulation is prevented by thickening cervical mucus making it impossible for sperm to swim through and reach the egg or thickness of the uterus lining is reduced. Based on the physician's evaluation, a suitable hormonal contraceptive is recommended.

Short-acting hormonal methods (e.g., injectables, pills, patches, rings) are highly effective if used properly.  There are two types of methods in this category

Injectable birth control

This method involves injection of a progestin in the arm or buttocks once every 3 months. It is reported that this method brings about a temporary loss of bone density and patients can regain the bone mass once the injection is discontinued. Patients who are given a shot of injectable birth control should consume a diet rich in calcium and vitamin D.

Progestin-only pills (POPs)

This is a pill that a woman needs to take one pill every day regularly as long as she wants to avoid pregnancy. POPs will interfere with the natural ovulation process or with sperm movement. POPs thicken cervical mucus making it difficult for sperm to swim and enter fallopian tube. It will also change the uterine lining, thus preventing the possibility of pregnancy.

Combined Hormonal Contraceptive Methods

Combined hormonal methods contain a synthetic estrogen and an approved progestin. The hormones work together and inhibit ovulation and thicken cervical mucus. Thus it ensures pregnancy is prevented in all possible ways. The combined estrogen/progestin formulation is available as a pill, a patch or a vaginal ring. It is found that combined hormonal methods come with a medical risk such as blood clots. But these risks are not there in injectable birth control, POPs and LARCs. Your physician can decide on the best contraceptive method for you depending on your age, health condition and other factors.

Combined oral contraceptives (COCs, "the pill")

COCs come with a synthetic estrogen and a progestin, which functions together in unison to inhibit ovulation. The patient needs to take one pill every day, preferably at the same time each day.

Contraceptive patch

This is a new age, modern contraceptive method that involves sticking a plastic patch to the skin on the lower abdomen, buttocks, upper body or outer arm. A new patch is replaced once every week for 3 weeks and fourth week is left without any patch to allow menstruation to happen.

Vaginal ring

It is a thin and flexible ring that is inserted into the vagina and it continually releases progestin and estrogen hormones for 3 weeks and the patient should remove it on the fourth week to facilitate menstruation and reinsert it after 7 days. A vaginal ring has risks similar to that of oral contraceptive pill and it is not recommended for women suffering from high blood pressure, heart disease and certain types of cancer.

III. Barrier Methods

As the name suggests it is a method of contraception that prevents sperm from entering the uterus by creating a barrier. Barrier methods are removable and are ideal for women who don't want to use hormonal methods of contraception. Barrier methods have fairly good success rate and the success rate largely depends on the usage. Further, barrier methods do not require a trained healthcare provider to administer and it can be applied through simple 'do-it-yourself' options.

Male condoms

This needs no introduction. Condoms are thin sheath of latex or polyurethane that is worn over the penis and the ejaculated sperm is collected in the condom itself thus preventing the sperm from entering vagina. Condoms are not only effective in preventing pregnancy but also offer protection from sexually transmitted diseases.

Female condoms

Made for women, these condoms need to be inserted into the vagina before starting an intercourse. The condom collects the full load of the ejaculated sperm and thus prevents it from entering the uterus. Female condoms are also effective in reducing the risk of STDs. It allows women to take complete control over the consequences of sex.

Contraceptive sponges

These are small, soft, disposable and spermicide-filled foam sponges that are inserted into the vagina before intercourse. The sponge blocks the sperm from entering the uterus and the spermicide also kills the sperms cells. Unlike condoms, the sponge should be allowed to settle inside the vagina atleast for 6 hours after intercourse.

Spermicides

A spermicide is a medicine that can kill sperm cells on contact. Most spermicides contain a chemical called nonoxynol-9 (N-9). Spermicides are available in several forms including foam, jelly, cream, suppository, and even in the form of a transparent film. A spermicide should be inserted into the vagina at least 30 minutes before the start of the intercourse and left in its place 6 to 8 hours after intercourse to prevent pregnancy. Spermicides are effective in preventing pregnancy but cannot preventSTD transmission. Spermicides may also cause allergic reactions or vaginitis.

IV. Emergency Contraception

As the name indicates, it is a type of contraception that is used after unprotected sex or when a condom breaks during intercourse and results in sperm entering vagina.

  • Copper IUD. It is considered as the most effective method of emergency contraception and nearly 100% effective in preventing pregnancy. The device should be inserted within 120 hours of unprotected sex.
  • Emergency contraceptive pills (ECPs) are hormonal pills that need to be taken as a single dose or two doses 12 within 24 hours after the unprotected intercourse. The pills make mucus to thicken and thus interfere with the sperm function. If taken prior to ovulation, the pills can delay or inhibit ovulation for at least 5 days to make the sperm inactive. They also cause thickening of cervical mucus and may interfere with sperm function.  Point to be noted is that ECPs should be taken as early as possible after intercourse and should not be used as a normal contraceptive. Pregnancy can occur if the pills are taken after ovulation.

V. Sterilization

Sterilization is a permanent way of birth control that prevents women from getting pregnant permanently or men from releasing sperm during an intercourse. Sterilization involves a surgery to be performed by a trained physician. Sterilization procedures are generally not reversible.

  • A sterilization implant ensures permanent blockage of the fallopian tube. This is a non-surgical procedure and a physician sends a thin tube with a thread through the vagina and through this tube a soft and flexible insert is placed into each of the fallopian tube. After the insertion scar tissues from around the inserts and blocks the fallopian tubes permanently so that eggs and sperm never meet. It takes 3 months for the scar tissues to fully develop and completely block the fallopian tube. A back up contraception method is used during the 3 months until the fallopian tubes are fully blocked.
  • Tubal ligation is a surgical procedure in which a physician cuts and seals the fallopian tube to block the path between the ovaries and the uterus permanently. By this the sperm is prevented from reaching the egg and eggs can never reach the uterus.
  • Vasectomy is a surgical procedure that blocks the path between the testes and urethra. Because of this surgery, the sperm cannot leave the testes and there is no chance of sperm meeting the egg. It normally takes 3 months for this procedure to become effective.

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