What is Contraception: Types and How They Work

Exploring contraception involves gaining practical insights into various methods and their functions. From condoms to pills, we'll break down each approach for easy understanding. Let's dive in and get clued up on contraception!

Understanding Contraception

Contraception, simply put, is a way to prevent pregnancy, and it has come a long way^[1]. Back in the day, our options were limited, but now we've got an array of choices tailored to our lifestyles and needs. This provides an extra layer of control in your life plan, empowering many to decide when they're ready for that next big step.

Types of Contraceptive Methods

1. Long-Acting Reversible Contraceptives (LARCs)

• Birth Control Implants

These inconspicuous rods are inserted under the skin of the arm, providing a steady release of hormones over several years^[2]. This hands-free approach eliminates the need for daily reminders, offering a highly reliable and convenient form of long-term contraception^[2].

• Hormonal IUDs 

Noteworthy for their versatility, hormonal IUDs also fall under the category of LARCs. They offer both intrauterine and long-term contraceptive benefits^[2]. This dual functionality makes them a highly efficient choice for individuals seeking a dependable method of contraception without the need for frequent maintenance^[2].

2. Short-Acting Reversible Contraceptives (SARCs)

• Oral Contraceptives

Oral contraceptives, colloquially known as "the pill," represent a monumental advancement in reproductive health. They function by regulating hormone levels, ultimately suppressing ovulation^[3]. This revolutionary approach grants individuals a heightened sense of control and responsibility over their reproductive choices, allowing them to plan their family on their terms.

• Birth Control Patches

Birth control patches offer a highly efficient contraceptive method characterised by convenient weekly application^[4]. These patches release hormones that effectively prevent pregnancy[4]. This approach particularly benefits individuals seeking a low-maintenance option that provides consistent protection against unintended pregnancies.

• Birth Control Injections

For those seeking a convenient and reliable contraception method without needing daily attention, birth control injections offer an excellent choice. These injections provide sustained protection over a period of weeks or months, depending on the specific type used^[4]. This means fewer daily concerns and a reliable method of contraception.

• Vaginal Rings

Initially met with scepticism by some, vaginal rings have emerged as remarkably effective contraceptive tools^[5]. Positioned within the vagina, they steadily release hormones throughout the month, ensuring reliable contraception^[5][6]. This method offers a convenient and discreet way to maintain consistent reproductive protection.

3. Other Methods

I. Barrier Methods

• Male Condoms

When employed consistently and correctly during sexual activity, male condoms boast a 98% effectiveness rate.^[7] They provide a reliable shield against unintended pregnancies by physically blocking sperm from reaching and fertilising an egg^[4]. Additionally, condoms offer an added layer of defence against sexually transmitted infections (STIs), making them a versatile and crucial tool for reproductive health[4].

• Female Condoms

Female condoms, made from materials like latex or polyurethane, are thin, flexible sheaths worn inside a woman's vagina.^[8] They provide a barrier that prevents sperm from reaching the egg and also helps protect against infections.^[8] When consistently and correctly used, they are effective at preventing pregnancy and reducing the risk of sexually transmitted infections, including HIV.^[8] 

With typical use, about 21 out of 100 women using female condoms won't become pregnant in a year.^[8] When used perfectly, this number drops to about 5 out of 100 women.^[8]

• Diaphragms and Cervical Caps

Diaphragms and cervical caps stand as reliable contraceptive tools designed to be inserted into the vagina^[4]. Their purpose is to cover the cervix, forming a physical barrier that impedes sperm from reaching and fertilising an egg^[4]. While these methods are effective, it is essential to ensure proper fitting and correct usage for optimal effectiveness^[9].

II. Sterilisation

• Tubal Ligation

Tubal ligation is a viable option for individuals certain they have completed their childbearing journey^[10]. This surgical procedure involves blocking or sealing the fallopian tubes, ensuring eggs cannot meet sperm^[4]. While permanent, this method provides a high level of confidence and certainty in reproductive choices^[10].

• Vasectomy

Often a decision made in partnership, a vasectomy is a minor surgical procedure for men. It involves blocking the tubes responsible for carrying sperm, providing a permanent form of contraception^[11]. This procedure offers an effective and long-lasting solution for couples who have completed their family planning^[11].

III. Fertility Awareness-Based Methods

• Calendar-Based Methods:

Standard Days Method(SDM): This method involves avoiding unprotected intercourse between days 8 to 19 of the menstrual cycle.^[12] It's reversible and suitable for women of all ages. It doesn't protect against STDs, so it's recommended to use condoms for that.^[12]

Calendar Rhythm Method: This is a natural family planning technique where a woman estimates her likely fertile days based on her past menstrual cycle length.^[13]

• Symptom-Based Methods:

Temperature Method: This technique monitors basal body temperature, which experiences a slight rise after ovulation.^[14] It necessitates the measurement of body temperature each morning before rising from bed.^[14] This should be done prior to consuming food, drink, or engaging in smoking, ideally at a consistent time each day.^[14]

Cervical Secretion Monitoring: Though it may sound clinical, cervical mucus monitoring is surprisingly intuitive. The consistency of cervical mucus changes throughout the menstrual cycle, offering valuable indicators about your fertility status.^[15] 

It's important to note that fertility awareness-based methods, including calendar and symptom-based methods, have a relatively higher likelihood of unintended pregnancy compared to other contraceptive methods. Therefore, using these methods entails a greater level of personal responsibility and awareness

IV. Lactational Amenorrhea Methods

The Lactational Amenorrhea Method (LAM) provides a safe family planning option for breastfeeding mothers, considering three main factors:^[16]

1) The return of menstrual periods

2) Breastfeeding patterns

3) The postpartum period

A woman can opt for LAM if:^[16]

1. Her menstrual cycle has not resumed since giving birth (Bleeding or spotting within the initial 56 days is not considered a period.) AND
2. She breastfeeds her baby on demand, both day and night, without regularly providing other foods or liquids (Although occasional tastes are acceptable, they should never replace a breastfeeding session.) AND
3. Her child is less than six months old.

The effectiveness of LAM is temporary and lasts up to six months. It diminishes if any of the three criteria change.^[16] Meeting all three conditions results in a less than two percent chance of pregnancy.^[16] Nonetheless, should any of these conditions change, it is advisable to transition to an alternative family planning method.^[16]

What is Emergency Contraception?

Acknowledging that unexpected situations may arise, emergency contraceptive pills serve as a protective measure.^[17]They can aid in averting pregnancy after instances of unprotected intercourse or contraceptive mishaps, offering a vital solution during urgent times.^[17] However, it's important to note that due to potential side effects, this method of emergency contraception cannot be taken regularly. It should be reserved for genuine emergencies.

Are All Methods Effective?

In order to make informed decisions about birth control, it's essential to understand the effectiveness of various methods. Below is a comprehensive overview of different birth control options, ranging from the most effective to less effective, along with their respective rates of pregnancy per 100 women in a year:^[18]

Empowering Choices!

Understanding contraception is an important step towards taking control of your reproductive health. Each method has its own strengths, and finding the one that fits your lifestyle is key. If you're ever unsure, don't hesitate to talk to a healthcare provider. Remember, it's all about what works best for you!

References

1. NCBI. “Contraception - StatPearls.” NCBI, 24 July 2023, https://www.ncbi.nlm.nih.gov/books/NBK536949/. Accessed 16 October 2023.
2. ACOG. “Long-Acting Reversible Contraception (LARC): Intrauterine Device (IUD) and Implant.” ACOG, https://www.acog.org/womens-health/faqs/long-acting-reversible-contraception-iud-and-implant. Accessed 17 September 2023.
3. NCBI. “Oral Contraceptive Pills - StatPearls.” NCBI, 24 November 2022, https://www.ncbi.nlm.nih.gov/books/NBK430882/. Accessed 18 September 2023.
4. CDC GOV. “Contraception - Contraception.” CDC, 2018, https://www.cdc.gov/reproductivehealth/contraception/index.htm. Accessed 17 September 2023.
5. Wieder, Devorah R., and Lynn Pattimakiel. “Examining the efficacy, safety, and patient acceptability of the combined contraceptive vaginal ring (NuvaRing®).” NCBI, 12 November 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990910/. Accessed 16 October 2023.
6. NPRA. “Nuvaring.” NPRA, https://www.npra.gov.my/index.php/en/consumer-medication-information-leaflets-rimup/item/nuvaring.html. Accessed 13 October 2023.
7. NHS. “Condoms.” NHS, https://www.nhs.uk/conditions/contraception/male-condoms/. Accessed 13 October 2023.
8. WHO. “FAMILY PLANNING.” Family Planning, https://fphandbook.org/sites/default/files/WHO-JHU-FPHandbook-2022Ed-v221115a.pdf. Accessed 13 October 2023.
9. “Contraceptive diaphragm or cap.” NHS, https://www.nhs.uk/conditions/contraception/contraceptive-diaphragm-or-cap/. Accessed 16 October 2023.
10. NCBI. “Tubal Sterilization - StatPearls.” NCBI, 5 September 2022, https://www.ncbi.nlm.nih.gov/books/NBK470377/. Accessed 16 October 2023.
11. NHS. “Vasectomy (male sterilisation).” NHS, https://www.nhs.uk/conditions/contraception/vasectomy-male-sterilisation/ Accessed 18 September 2023.
12. CDC. “Standard Days Method - US SPR.” CDC, https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/days.html. Accessed 13 October 2023.
13. NCBI. “Calendar rhythm efficacy: a review - Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.” NCBI, https://www.ncbi.nlm.nih.gov/books/NBK66578/. Accessed 13 October 2023.
14. NHS. “Natural family planning (fertility awareness).” NHS, https://www.nhs.uk/conditions/contraception/natural-family-planning/. Accessed 13 October 2023.
15. NCBI. “Cervical mucus patterns and the fertile window in women without known subfertility: a pooled analysis of three cohorts.” NCBI, 15 May 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8487651/. Accessed 16 October 2023.
16. WABA. “WABA.” World Alliance for Breastfeeding Action: WABA, https://www.waba.org.my/resources/lam/. Accessed 18 September 2023.
17. World Health Organization (WHO). “Emergency contraception.” World Health Organization (WHO), 9 November 2021, https://www.who.int/news-room/fact-sheets/detail/emergency-contraception. Accessed 19 September 2023.
18. ACOG. “Effectiveness of Birth Control Methods.” ACOG, https://www.acog.org/womens-health/infographics/effectiveness-of-birth-control-methods. Accessed 16 October 2023.

Disclaimer

The information provided in this article is intended for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. 

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