Contraceptive Pill

What Is Contraception?

Contraception is any method used to prevent pregnancy. Contraceptive methods can be used by both males and females, although females have a greater number of options available to them, particularly in Australia with the PBS. 

How Does Contraception Work?

Reproductive Biology 101

In order to become pregnant, a sperm cell must reach and fertilise the egg. The fertilised egg must then successfully attach to the uterus for pregnancy to occur. Contraceptive methods, such as the combined oral contraceptive and progesterone-only pills, aim to disrupt this process at various places in order to avoid pregnancy.

What are the Different Birth Control Options?

All people will have slightly different experiences with each contraceptive. One that is perfect for one person may not be viable for another. For this reason, there are many different methods, strengths of medicines, devices and ways to prevent pregnancy.

Female Contraceptives

Hormonal Contraception

Many of the female options for contraception are hormone-based birth control. All hormonal contraceptives are reversible contraceptives although the time before fertility returns can vary depending on the medicine. Hormonal treatments will not protect against sexually transmitted infections (STIs) and other methods like barrier contraceptives should still be used when the status of your partner is unknown.

What are the benefits of hormonal birth control?

Besides preventing pregnancy these contraceptives can be used to:

• Make your period less painful, lighter, and more regular
• Improve acne
• Improve medical conditions such as endometriosis and polycystic ovary syndrome (PCOS)
• Skip your period (Only some contraceptives, consult your GP)

Side effects for hormonal birth control

A small number of people may experience irregular changes in vaginal bleeding, nausea, mood changes, headaches, or breast tenderness. 

If you believe your hormonal contraceptive is causing side effects, you should speak to your doctor about a different strength or type of contraceptive method.

The Combined Oral Contraceptive Pill (COC)

Begin Assessment

What is the COC and how does the pill work?

The most well-known birth control pills are these pills. They are a combined pill of two hormones, estrogen and progestin. 

These hormones prevent pregnancy in three ways. They can prevent the release of an egg (ovulation) in some people. They thicken the mucus around the cervix making it more difficult for sperm to reach an egg. They thin the lining on the uterus to prevent an egg to attach to the uterus. 

How long does it take to work?

You must use the COC pill every day (within 24 hours of the last pill) and it can take up to seven days to work to prevent pregnancy depending on when it is first taken in the menstrual cycle. Its other benefits may take longer.

How effective are COC pills?

They are 99% effective at preventing pregnancy if taken properly. This is defined as 1 in 100 patients who use this treatment for one year will fall pregnant.

The Progesterone Only Pill (POP)

Begin Assessment

What is the POP and how does it work?

As the name suggests, the progesterone-only pills contain progesterone only and are often referred to as the “mini-pill”. They are mostly used if people cannot tolerate the oestrogens in the COC. They work by thickening the fluid around the cervix which doesn’t then allow sperm to pass. 

How long does it take to work?

The POP is taken once daily, however, it must be within three hours of the same time every day in order to prevent pregnancy. It will only take two days of taking the POP to become protected from pregnancy.

How effective are POPs?

They have the same effectiveness as the COC at 99% when taken properly. It’s worth noting that since this pill needs to be taken within a three-hour window every day, the risk of taking a pill late and not being protected is quite high.

Long-Acting Reversible Contraceptives (LARCS)

Contraceptive Implant

The contraceptive implant is a small flexible rod injected into the upper arm. It is often referred to as ‘the bar’ due to its shape and feeling under the skin. A steady amount of progesterone is slowly released, thickening the mucus around the cervix and potentially preventing ovulation.

This bar is left in the arm and effective for up to three years before needing to be replaced. It is extremely effective at 99.95% due to steady release and removing the potential for human error (forgotten pills).

Contraceptive Injections

The injections are what’s known as a depot preparation. These are slowly released progesterone based medicines much like the bar. This medicine is injected into the shoulder muscle of the upper arm every 3 months by a GP or nurse. Again this medicine works by thickening the mucus around the cervix and potentially preventing ovulation. 

This method is highly effective at 99.5% as it removes a lot of human error such as forgetting pills, although some people are daunted by the idea of an injection every three months.

Intrauterine Devices (IUD)

These devices are inserted inside the uterus through the cervix and are commonly referred to as IUDs. The devices come in two types, progesterone releasing IUD or copper IUD. 

The progesterone IUD works by thickening the mucus around the cervix and potentially preventing ovulation and can be left in place for 5 years before replacement is needed. It is 99.8% effective.

The copper IUD works by killing sperm before they are able to fertilise the egg. Copper is highly effective at killing sperm and the IUD is 99.2% effective. There are fewer side effects for this method as this treatment is not hormonal. However, some women may experience heavier periods and so it is not recommended if heavy menstrual bleeding is a pre-existing problem.

Other Methods of Birth Control

Vaginal Ring

This device is a flexible clear ring that inserted into the vagina for three weeks before being replaced one week later. It works by slowly releasing both estrogen and progesterone. These hormones work three ways, thickening the fluid around the cervix, thinning the uterus wall, and preventing ovulation. It is 91-99% effective when accounting for human error and the potential for the device to fall out.

Barrier Contraceptives

There are two barrier options for women, the female condom or the diaphragm. 

The female condom is a plastic sheath that is placed into the vagina before sex. This method is up to 95% effective when used correctly. This method is also effective in the prevention of STIs. The drawback for these is the same as male condoms, they can tear during use, which accounts for the last 5%.

The diaphragm is a silicone dome that is placed over the cervix which does not allow sperm to pass. These need to be fitted initially by a doctor or nurse to ensure it is a correct fit. When used correctly the diaphragm is up to 94% effective. 

Fertility Awareness Method

This method is centred around knowing where you are in your cycle and being aware of when ovulation is happening and avoiding sex around this time. If this method is going to be used it is recommended to seek specific education from family planning experts first. This method is around 75-88% effective however ovulation times can vary in some women making this method unreliable at times. Medically it is recommended to use a more reliable method if possible.

The Emergency Contraception Pill

If contraceptive methods should fail due to missed treatments or failed methods such as broken condoms, the emergency contraception pill can be effective in preventing pregnancy. There are two different types, one being most effective in the first three days after sex and the other being effective up to five days after sex. Both treatments work by delaying ovulation and therefore the chance of sperm fertilising the released egg.

The effectiveness of these medicines varies largely depending on how long after sex they are taken. They are up to 95% effective when taken within the first 24 hours reducing down in effectiveness to around 50% by day 5.

Surgical Contraception

This surgery is called tubal ligation, or more commonly known as getting your tubes tied and is a more permanent form of contraception. For this reason, it should only be used once a person is sure that they do not wish to have more children.

This is keyhole surgery where the surgeon blocks the fallopian tubes with a tie or clip to prevent sperm and eggs from meeting. This method is over 99% effective and is only ineffective if a tie or clip fails and a fallopian tube becomes unblocked.

Male Birth Control

Barrier Contraceptives

Perhaps one of the most well known contraceptive methods is the use of condoms. This involves placing a latex or latex-like sheath over the erect penis. This keeps the sperm inside the barrier preventing pregnancy and STIs. If used correctly condoms are up to 98% effective.

The Withdrawal Method

The method is where the man takes his out from the vagina before ejaculation. This method varies in success from 78-96%. The variance comes from a failure to withdraw before ejaculation or enough pre-ejaculate to cause impregnation. For this reason, it is only recommended as a secondary method of contraception.

Surgical Contraception

This surgery is known as a vasectomy. A vasectomy involves cutting or blocking the tube that carries sperm from the testicles to the urethra. This prevents sperm from being present in the ejaculate.

This method is one of the most effective methods of contraception at 99.98% effective. This method is close to permanent with reversal being possible in some cases although not ideal. This should only be used by men who are sure they do not want more children.