If you’re a sexually active woman, contraception is a necessary part of life. And, since you’re likely to use it for several decades, it’s important to choose a method that suits your body, your needs and preferences, and your lifestyle.
In South Africa, an estimated 65% of women are currently on some form of contraceptive, according to the United Nations Population Fund (UNFPA). Because of this, the fertility rate is said to have decreased from 2.92 children per women in 2001 to 2.35 in 2011.
While the statistics show promise, there is still a lot of work that needs to be done in terms of reducing the transmission of sexual diseases and HIV and preventing unplanned pregnancies. 2013 statistics from the Department of Health indicate that there were 89 000 legal abortions in 2013 and teenage pregnancy contributes to 8% of all pregnancies.
For these reasons, it’s not surprising that companies and researchers worldwide are focusing on developing more effective methods that last longer and are less user dependent. In other words, they’re looking for solutions that require little effort or compliance on the part of the user.
Read: Teen pregnancy prevention
Long-acting reversible contraceptive methods
At the forefront of these developments are the new long-acting reversible contraceptive (LARC) methods. Dubbed “fit and forget”, LARCs include progestogen-only implants, progestogen injections as well as hormonal intrauterine contraception (IUC) and copper intrauterine device (IUD) contraceptive methods.
The new LARC contraceptives means women have the option of long-term birth control that’s virtually hassle-free for months, years or forever, comments Dr Christopher Estes, assistant professor of Obstetrics and Gynaecology at the University of Miami School of Medicine.
What are your options as a woman of the 21st century? Could it be time to ditch the Pill or the condoms in your drawer for something more effective? We bring you the lowdown on what’s currently available worldwide.
Read: Long-term contraceptives more effective
Hormonal and non-hormonal contraceptives
Contraceptives fall into two broad categories: hormonal and non-hormonal. There are also two main types of hormonal formulations, namely progestogen-only contraceptives and combined hormones.
Progestogen-only products include hormonal implants, IUCs, injectables (Depo- Provera®, Petogen®) or for 8 weeks (Nur-Isterate®) and the mini-pill.
Combined hormonal methods include the contraceptive patch, combined injectables, vaginal rings and oral contraceptive pills.
1.) Hormonal implants
What is it? This long-acting reversible implant comprises matchstick-sized rods containing synthetic progesterone that are implanted under the skin of the upper arm.
Implanon lasts up to three years and is 99.9% effective, making it one of the most effective contraceptive methods available.
How it works: Implanon prevents ovulation by releasing constant small amounts of progestogen via a single rod implant.
A doctor trained in this method uses a local anaesthetic to first numb the area before inserting the implant just under the skin on the inside of the upper arm. This is done via a sterile applicator in a quick, easy procedure only lasting a minute. When replacing the implant after three years, the doctor will remove it in just a few minutes.
• Convenient and 99.9% effective
• Quickly reversible
• Minimal side effects (may cause irregular bleeding or changes in menstruation, similar to progesterone-only oral contraceptive pills)
• Ideal for long-term contraception and for women who cannot tolerate oestrogen
• Long lasting (up to three years)
• Can be used during breastfeeding
• Effective immediately if inserted during the first five days of your menstrual cycle, which starts with the first day of bleeding
2.) Vaginal ring
What is it? This soft flexible plastic ring is conveniently inserted into the vagina and releases hormones in a similar way as the oral contraceptive pill. If used according to instructions, it’s 99.3% effective.
Some rings use a combination of oestrogen and progestogen and are inserted on a monthly basis. The progestogen-only NuvaRing, developed by the World Health Organisation, is currently available in Australia. This clear levonorgestrel-releasing ring has similar effects to the mini-pill and can be left continuously in the vagina for about five months.
How it works: The hormones in the ring are released directly into the blood vessels in the vaginal wall where they prevent the egg from leaving the ovary. NuvaRing doesn’t prevent menstrual cycles.
NuvaRing offers continuous protection for the lifespan of the device, usually five months. As with other progestogen-only methods, it may cause erratic bleeding in some women.
The combined hormonal vaginal ring is left in place for three weeks after being inserted into the vagina. The ring is then removed for a week to allow for a withdrawal bleed, with a new ring being inserted one week after removal.
A vaginal ring is inserted into the vagina in the same way you would insert a tampon. It’s designed to sit in the upper, more spacious part of the vagina, which is insensitive to touch. The ring is kept in place by the vaginal muscles, so it doesn’t have to be removed during sex or exercise.
- Immediately reversible
- Suitable for most women, particularly if you have a predictable regular bleeding pattern
- It may improve medical conditions such as acne, endometriosis, ovarian cysts and premenstrual symptoms.
- It alleviates heavy/painful periods, making them shorter, lighter, less painful and more regular.
- Fewer side effects because its hormone dose is lower than that used in the Pill
- Vomiting or diarrhoea don’t affect the hormones because they’re absorbed directly into the bloodstream.
- Popular alternative for women who prefer not having to take a pill every day
Read: Vaginal ring to prevent pregnancy, HIV and herpes
3.) IUCs and IUDs
Both hormonal and non-hormonal IUDs or IUCs are suitable for women of any age. They can be used by most women, even if they have existing health conditions.
3.1 Hormone releasing IUC/IUD
What is it? The hormonal IUC is a small plastic T-shaped device with a cylinder around its stem that’s inserted inside the uterus by a doctor or nurse who has been trained in this procedure.
It releases a synthetic form of progesterone hormone called levonorgestrel and lasts up to five years. It’s 99.8% effective.
How it works: This device continuously releases gradual doses of levonorgestrel from the sleeve around its stem. Two fine threads are attached to the IUC base to make removal easier. It prevents pregnancy by changing cervical mucus and preventing fertilisation and implantation.
Insertion and removal through the vagina has to be performed by a procedure-trained doctor or nurse. Some women may experience temporary discomfort during the insertion procedure.
- Long-term contraceptive protection (up to five years)
- Reduces the amount of bleeding, so is suitable for managing heavy menstrual bleeding.
- If inserted after age 45, it can be left in until after menopause.
- Immediately reversible on removal.
3.2. Copper intrauterine devices (non-hormonal IUD)
Copper T and Multiload
What is it? An intrauterine device (IUD) is a small plastic and copper device that’s inserted into the uterus by a doctor trained in the procedure. It doesn’t release hormones but is 99.2% effective. The copper IUD can remain in place for between five and ten years, depending on the specific device.
IUD brands available in South Africa include the Copper T and Paraguard.
How it works: Copper IUDs prevent fertilisation and inhibit implantation by affecting sperm movement to the egg.
- Suitable for women of all ages
- Easily reversible
- Safe for use during breastfeeding
- Long-acting contraceptive (Copper T is effective for ten years, while Multiload is effective for five years.)
- Inexpensive contraceptive method if used for the full effectiveness period
Read: IUD's don't impair future fertility
4. Progestogen-only injectables
Depo-Provera and Nuristerate
What is it? The contraceptive injectable Depot medroxyprogesterone acetate (DMPA) is an intramuscular injection of progestogen given every 12 weeks.
How it works: DMPA is usually injected into the buttock or upper arm and works by primarily preventing ovulation. It’s 99.8% effective, provided follow-up injections are regularly given at
- It can be used by most women even those with significant health issues.
- More convenient and longer lasting than the pill as it offers protection for three months.
- Good choice for women who don’t mind a delay of up to one year in the return of fertility after stopping.
- The injection is available by making an appointment with your doctor, community health clinic or Shine SA.
*Note: Some countries have a subcutaneous form of the injectable contraceptive, which is injected just below the skin. It’s less painful and the woman can administer it herself.
Ortho Evra transdermal patch
What is it? A small plastic flesh-coloured square patch that sticks firmly on the skin of the upper arm, abdomen or buttocks. It releases synthetic oestrogen (ethinyl estradiol) and progesterone (norelgestromin).
How it works: Each Ortho Evra transdermal patch is used for seven days at a time over a four-week period. One patch is used each week for three weeks, and removed for one week during which menstruation occurs.
• Highly effective
• Very convenient and easy to use
• Barely noticeable
6. Oral contraceptives (ocs)
Combined oral contraceptives and the mini-pill
There are two main types of oral contraceptives, namely combined oral contraceptives (COCs) and the mini-pill. Although oral contraceptives can be very effective, inconsistent use, misuse or discontinuation often results in unplanned pregnancies.
The good news is that most of the newer pills are highly effective and, with reduced oestrogen doses, may result in less troublesome oestrogen-related side effects such as nausea and breast tenderness. In addition, many new pills are in clinical trials and are aiming to have fewer side effects, enhanced safety and greater effectiveness when pills are missed.
Read: Contraceptive patch available in South Africa
6.1 Combined oral contraceptives (COCs)
These contain both oestrogen and progestogen. They’re at least 98-99% effective if taken according to instructions.
How it works: It prevents pregnancy by changing the hormone balance in your body to stop ovulation. The combined pill is taken every day at roughly the same time, for three weeks, followed by a break. It’s not reliable if taken over 12 hours late. When first starting the pill, it takes seven tablets before it offers contraceptive protection.
6.2 The mini-pill
The mini-pill contains small amounts of progestogen only. The mini pill must be taken every day. It’s not reliable if taken over three hours late.
How it works: It prevents pregnancy by changing the cervical mucus to restrict sperm movement and changing the lining of the uterus.
*Note: Several newer triphasic oral contraceptive pills (e.g. Linessa and Tri-Cyclen Lo) use a lower total hormone dose, while others (Seasonale and Mircette) use varying dose
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Image: IUD, contraceptive pills and condoms from Shutterstock
Sources: What contraceptive are you?; Shine SA; Australian Prescriber; Virtual Medical Care; Gynaecology Centres Australia; Medical Journal of Australia; BBC; Melbourne Institute; Pregnancy Birth & Beyond; CORE ARHP; Sexual Health and Family Planning South Africa; National Institute for Health and Care Excellence
- Philip Goldstone, et al. Factors predicting uptake of long-acting reversible methods of contraception among women presenting for abortion Med J Aust 2014; 201 (7): 412-416.doi:10.5694/mja14.00011