Contraception is a topic that can fire people’s passions. Dr Joe talks about the ways in which we can prevent pregnancy, including measures for both males and females and barrier and hormonal contraceptive methods.
Contraception means things you do to not get pregnant. ‘Contra’ meaning against; ‘Ception’ meaning conceiving.
There’s contraception for males and for females – that’s one way dividing it up, the other way of dividing up contraception is into barrier methods and hormonal methods.
Let’s look at the males and females division first. For males it is fairly straightforward, there is either a barrier method of a condom or a barrier method of a vasectomy. Condoms have been around for about 100 years and for a period of time people weren’t that fussed or interested in condoms, particular in the 60s and 70s when the pill was all new and exciting, but the advent of things like HIV and more awareness of sexually transmitted diseases have brought the condom back. The other thing is technology evolved and today’s condoms, the manufacturing method is better than it was 20 or 30 years ago.
Essentially a condom provides a barrier between the sperm and the egg, it needs to be applied at the time and it is fairly straightforward. Having a vasectomy is a permanent procedure and obviously that would only be considered by males who don’t want to have any more children. It’s a small operation and it’s generally done under a local aesthetic. You hear about people having vasectomies reversed and that can be done but it’s generally recommended and this is quite important that if you’re thinking about having it reversed then you shouldn’t be thinking about having a vasectomy.
So what about for women? Again, it’s subdivided into two categories: barriers and, in this instance, hormonal. The best known form of contraception is of course the contraceptive pill, these days we have 25 or 30 different types on the market. They are all fairly similar, the combined contraceptive pill have all got some oestrogen and progesterone in them. These pills work by stopping the ovaries from releasing the egg. People will say it’s tricking the body into thinking it’s pregnant – that’s not quite the case though it is a way of thinking about it – but essentially it stops an egg from being released. If an egg isn’t released then it can’t be fertilised and you don’t get pregnant.
As mentioned before, there are number of different types. They are all similar but different women will find different ones work for them so don’t be concerned about trialling one, giving it a few months, seeing how you go, going back to your doctor and saying it doesn’t agree with you for whatever reason and trying a different one.
The other sort of pill is what’s called the mini pill though it’s not any bigger or smaller. It is a progesterone only pill, it works in a different way it stops implantation so the egg can still be released, it may be fertilised by sperm but it can’t implant in the uterus. With the mini pill, it’s particularly used for women after they’ve given birth and when they’re breast feeding and again for some women where oestrogen might not agree with them.
There are two other forms of hormonal contraception which are the injection and the implant. These are also progesterone only so they are similar in some respects in how they work to the mini pill. The advantage of the injection is that it lasts for up to 3 months and the implant can last for three years or more. Again, it doesn’t suit everybody, some women find these forms very agreeable and others prefer not. Another option for women is intrauterine devices. These were popular in the 60s and 70s and went out of fashion and there were some problems particularly in the 70s with one called the Dalkin Shield. Newer versions are much better and there are forms that release some hormones directly into the uterus and there are various coils that can be used. Generally that would be recommended for women after they’ve had children rather than before and it’s not suitable for everybody.
A bit like with males and a vasectomy, if a female decides they don’t want any more children then tubes can be tied. Again, not a great term – nobody puts a knot in them – it’s not like tying your shoelaces but there is a blockage put so the egg can’t get through between the ovary and the uterus. Same with males, it can be reversed but it is not a procedure that should be done if you are thinking that one day you will have it reversed.
To sum up, contraception is fairly straightforward if you think about it in the terms we’ve discussed. If you don’t want to get pregnant, then it is important to use some sort of contraception, people think “it won’t happen to me” but guess what, it can very easily happen to you. So, contraception can be for males or females and essentially we’re looking at some sort of barrier between the egg and the sperm or some sort of hormonal contraception. There are different forms and we are fortunate to have choice and it is about what works best for you.
For more information on contraception, including types of contraception, protecting against sexuallly transmitted infections, and contraception after childbirth, see Contraception (Birth Control).
For more information about pregnancy, including preconception advice, stages of pregnancy, investigations, complications, living with pregnancy and birth, see Pregnancy.