For any couple, family planning is an important milestone, which is best done when they are emotionally and financially ready to become parents. For those — married or otherwise — who are not ready to have a baby yet, there are many contraceptive options available. For women, especially, it may seem a bit confusing as to which option to choose, and why.
In addition to that, there are many myths about contraception, which people readily believe. On World Contraception Day today, therefore, Dr Aruna Muralidhar, senior obstetrician and gynaecologist, Fortis La Femme Hospital, Richmond Road, Bangalore, explains the different options available, and how one can choose whatever suits them best.
According to the doctor, contraceptives may be classified into five categories in the increasing order of effectiveness:
1. Natural methods such as avoiding fertile period, withdrawal, etc.
2. Barrier methods such as male and female condoms.
3. Hormonal contraceptives such as vaginal rings, patches, and combined oral contraceptive pills (birth control pills).
4. Long-acting reversible contraception like intrauterine devices (copper-T or hormone-releasing systems), implants, and injections.
5. Finally, permanent methods such as tubectomy or vasectomy (also called sterilisation).
“One may choose the type of contraception based on some factors: how effective it is, possible risks and side effects, plans for future pregnancy, personal choice, whether there is a medical problem that might affect the efficacy, and whether any current medication may cause drug interactions with the contraceptive,” says Dr Muralidhar.
Ask these questions:
* Do I need contraception occasionally and only during sex? These may include barrier methods such as condoms.
* Am I comfortable using contraceptives inserted in the vagina? These include vaginal rings, diaphragms.
* Will I be able to remember to take the contraceptive every day? These include oral contraceptive pills.
* What if I cannot use contraceptives containing estrogen? (These women include smokers above 35, obese women, those who take certain kinds of medication, or those who have certain types of conditions like poor circulation and migraines with aura). Their options would include condoms, copper-T, hormonal intrauterine system, implants, and injections that contain only progesterone hormone.
* I have completed my family and need long-term contraception. These include Intrauterine devices releasing copper or hormone and last for 3-5 years or permanent sterilisation like tubectomy.
“If you have had sex without using any protection or have any doubt about the correct use of any of these contraceptives, the use of emergency contraceptives may become imperative. These include taking the emergency pill as soon as possible and no later than 72 hours or getting a copper-T inserted no later than 5 days from the time of sex,” the doctor warns.
Contraception at different times of life
– Sexually active young women benefit from the use of dual protection — using both barriers such as condoms and another more effective contraceptive like birth control pills or intrauterine devices. Condoms also prevent sexually transmitted diseases. If remembering to take pills is an issue, long-term contraceptives can be considered.
– Women who have just delivered must not rely completely on lactation amenorrhoea (the phase of no periods during breastfeeding). They must seek contraceptive advice 6 weeks after their delivery and ideally plan for an 18–24-month gap between pregnancies. For the first 6 months, progesterone-only pills can safely be used. Long-term reversible contraceptives also are ideal after completing the family.
– Women over 40 also need effective contraception as there is a possibility of falling pregnant until menopause. The average age of menopause in Indian women is 46 years. Options such as birth control pills, long-acting reversible contraceptives, or even permanent methods are suitable.