These are contraceptives for women and include oral contraceptives,
commonly known as the "pill", as well as hormonal injections, implants and
vaginal rings, all containing synthetic hormones. Their method of action is to
stop the ovaries from releasing an egg each month (ovulation) and/or to keep
the cervical mucus thick so that sperms cannot easily pass through it.
- Oral contraceptives are taken according to a
prescribed daily schedule. Injectable contraceptives are given as
intramuscular injection and prevent pregnancy for two or three months.
Implants and vaginal rings, which are not readily available in South
Africa, prevent pregnancy by delivering contraceptive hormones to the
body from their site of application. Implants are small, rubber-like rods
placed under the skin of the arm, while vaginal rings are placed into the
- Hormonal methods require visiting a doctor for
a prescription, injection, or placement of implants/rings.
Oral contraceptives (the
- Available as combination of oestrogen and
progestogen in dose regimens that suppress ovulation, or as
progestogen-only pill that thickens the cervical mucus.
- Highly effective if taken consistently, preferably at
the same time each day. If a pill is missed or vomiting occurs soon after
taking the pill, another form of contraception until the onset of the next
menstrual period should be used.
- Certain drugs may cause the pill to become less
effective. This is the reason why a doctor needs to be consulted for the
prescription. The doctor will ask about any medication used and will
find out whether there are any contraindications for the pill.
- An oestrogen containing pill can suppress or
diminish milk production and is not advised to breast feeding mothers.
The hormones are also excreted in the breast milk and can cause side-effects
in the newborn baby.
- If a woman wishes to have a baby, she should
switch from the pill to another form of contraception (for example barrier
method) three months before planning to conceive. The chance to fall pregnant
soon is greater after discontinuing barrier methods than after stopping the
- Using the pill carries a slight health risk which
increases with age and smoking. Oral contraception is usually not
recommended for women over 45, or those over 35 who smoke. Women suffering
from cardiac disease, thrombosis (blood clot formation in veins), breast
cancer, tumours of the liver or endometrial carcinoma (cancer of the lining
inside the womb) are also advised against the pill. A further, relative
contraindication exists for women with poorly controlled diabetes, obesity or
gall bladder problems.
- Oral antibiotics may decrease effectiveness - a
backup contraception method should be used while taking antibiotics until the
next menstrual period following the completion of the antibiotic.
- Women who experience unpleasant side-effects on one
type of pill can usually adjust to another. When starting the pill,
communication with the doctor needs to be maintained
for optimal matching of the type of
- Effectiveness: If the combination pill is
correctly used, the Pearl Index is less than 1.
- Very effective in preventing conception.
- Is used independently from sexual
- Can make periods more regular.
- Less: acne, iron deficiency anaemia,
premenstrual tension, dysmenorrhoea (period pain), rheumatoid arthritis.
- Reduces risk of: ovarian cancer,
non-cancerous breast tumours (cysts, benign dysplasia). The stronger progestogenic pills have a
protective effect against the development of endometrial (uterine) cancer.
- Reduces risk of ectopic pregnancies. This potentially life-threatening
condition occurs when the fertilised egg implants and begins developing
outside the uterus - usually in the fallopian tubes.
- Reduces risk of developing pelvic inflammatory
- Breast tenderness due to fluid retention. This
improves after a few months.
- Nausea. This also improves after a few
- Vaginal candida infection. This used to be more
common with pills having a higher oestrogen content.
- Pigmentation in the face (chloasma). This is
rare and improves after stopping the pill.
- Acne or oily skin. This is due to progestogens
with an androgenic (male-hormonal) effect.
- Weight gain. Due to increased appetite caused by
- Dyspareunia (painful sexual intercourse). Due to
dryness of the vagina.
- Headache. This may be due to progestogen
withdrawal during the pill-free days.
- Loss of libido (urge to be sexually active).
This is very rare.
- Contains a progestogen and no oestrogen -
alternative for women who desire contraception in pill form but are sensitive
to oestrogen, or are breast feeding.
- Should be taken daily like combined oral
contraceptives but at exactly the same time each day.
- Thickens the cervical mucus to prevent
sperms from reaching the egg, changes the motility of the
fallopian tubes to interfere with fertilisation, and makes the
uterine lining less receptive for implantation should an egg become
- Effectiveness: A Pearl Index of 2 which
means a slightly higher risk for pregnancy compared to the combination pill.
- No oestrogen - suitable for those unable to
take the combined pill because of adverse side-effects or personal medical
- May decrease risk of endometrial cancer and PID.
- Does not increase risk of heart disease (blood
- Women who are advised to stop taking the combined
pill at a certain age (for example, if they smoke)
can safely use
the progestogen-only pill.
- Can be used by diabetics - does not affect blood
- Can be used during breast feeding - no
effect on the baby or milk production. Together with the
contraceptive effect of breast feeding, the prevention of
pregnancy comes close to 100%.
- No delay in future fertility - it is possible to become pregnant very soon after stopping this type of pill.
- Requires strict pill-taking routine: This pill
needs to be taken at the same time each day and ideally not less than
three hours before intercourse because it takes two hours for the pill to be
effective on the cervical mucus.
- Some women experience scanty, irregular periods.
- Persistent spotting is another possible symptom,
but this should resolve after a few months' usage or by switching brands.
- Although the incidence of ectopic pregnancy
is extremely low, the ectopic/intrauterine ratio is higher than with
combined oral contraceptives or injectable progestogens.
When to call a doctor:
taking oral contraceptives should contact their doctor immediately when
suffering any of the following conditions:
- Severe or sudden onset of abnormal bleeding
- Severe headaches
- Sharp, stabbing pains in the chest
- Blood present in sputum
- Blurred vision
- Muscle weakness
- Severe abdominal cramping
- Progestogen injection deep into muscular
tissue of buttocks or upper arm.
- Although similar to the 'progestogen-only pill'
regarding the effect on cervical mucus, tubal motility and endometrium, the
additional effect of the injectables is inhibition of ovulation due to the
larger dose of progestogen.
- Single injection provides contraceptive
protection either for 12 weeks (Depo- Provera®, Petogen®) or for
8 weeks (Nur-Isterate®).
- Benefits similar to mini-pill. Side-effects
are also similar and can include irregular periods, weight gain,
and breast tenderness. Most women develop amenorrhoea (no periods)
and need to be adequately informed about this beforehand.
- Extremely effective (99%) as long as injection
is repeated at the correct intervals.
- Allows contraception independent of sexual
- Does not depend on high level of user compliance.
- Prevents ovulation - reduces risk of ectopic
- Reduces risk of ovarian cysts.
- Can be safely used while breast feeding.
- No oestrogen-related side-effects - mainly benefits
women unable to take oestrogen, or those over the age 35 who
- No effect on blood pressure and clotting. Does not
contribute towards developing thrombosis, and may be used under medical
supervision by patients with hypertension, previous thromboembolism, cardiac
disease, diabetes and obesity.
- Longterm side-effects. Women who
suffer side-effects may need to
endure them for the duration of the contraceptive's action.
- Several women may
gain weight when first using this method, although this usually stabilises.
- Effectiveness may be impaired by certain
medication (anticonvulsants, rifampicin, meprobamate) and also by alcohol.
The doctor may advise to shorten the interval between
- Becoming pregnant could be delayed by six months to
a year after stopping the injectable. It should not be the first choice of contraception if a pregnancy is planned fairly soon.
- Can cause menstrual irregularities which can be
treated with oestrogen containing tablets.
- Painful intercourse may occur because of a dry
vagina which can be treated with oestrogen cream.
ImplantsNone of the implants are available in South Africa at
present. Norplant®, which was available for a short time and then withdrawn from the market, consisted of 3 cm long silastic rods which were surgically implanted under the skin of the upper arm. Six rods protected against pregnancy for up to five years by steadily releasing a
contraceptive hormone (levonorgestrel). A newer single-rod device (Implanon®) may become available containing a contraceptive hormone (3-keto-desogestrel) which is slowly released over three years.
- Highly effective, reversible contraception.
- Needs to be administered only after long
intervals (three and five years).
- Does not depend on high level of user compliance.
- Return of fertility is quick after removal of
- Financial cost may be less than buying oral
contraceptives every month over the same time period.
- Insertion requires a small surgical procedure
under local analgesia by a skilled health professional trained in the
- May cause irregular bleeding.
- Possible removal problems.
The injectable contraceptive debate
Any questions? Ask our sexologist