Contraceptives should sound familiar. Though familiar, they’re not widely discussed because of their direct relationship with a topic we are ever shying away from, sex.
Contraception is a way to prevent pregnancy using medications, devices, or abstinence. Contraceptives can be used regularly prior to, at the time of, or after intercourse.
There are different methods:
Female condoms are hardly used because of the inconvenience associated with them: They have to remain in situ (in place), 6-8 hours after intercourse before removal. They offer great labial protection. Male condoms are commonly used, inexpensive and almost readily available. Condom rupture, incorrect application and reduced sensitivity may be a few drawbacks.
Fun Fact: Condoms are the only contraceptive method that protects against STIs.
Other barrier methods are Spermicides, Diaphragm and cervical caps.
2. Hormonal Agents
a) Combined Oral Contraceptives (COCs)
These tablets contain hormones, estrogen and progestin, which inhibit ovulation and thicken cervical mucus to pose as a barrier for sperm migration. They are taken, once daily, at the same time for 28 days.
The pill should be started between day 1 and day 5 of the menstrual cycle OR at times it can reasonably be certain that the woman is not pregnant. If commenced after day 5, extra precautions should be taken for 7 days.
What then happens if one has missed the pill?
Missing the pill reduces the effectiveness of the contraceptive. If you miss a day, consult a health professional when getting started on COCs or when in any dilemma about missed pills.
b) Oestrogen Patches
They have a similar mechanism of action as the combined oral contraceptives. These patches are placed on the skin. The first patch is applied on day 1 of menstruation and a new patch is applied weekly for 3 consecutive weeks (on days 1, 8,15), followed by 1-week patch-free (days 22-28). If patch remains on for more than 9 days or a patch-free interval exceeds 1 week, replace the patch and extra protection has to be used for the next 7 days.
These are given as intramuscular injections and act to block ovulation (egg release).
I) Medroxyprogesterone Acetate (Depo-Provera) is given every 3 months.
II) Norethisterone enanthate (Nur-isterate) is given every 2 months.
The side effects include menstrual irregularities (Note: Heavy bleeding should be reported for medical attention), delayed return of fertility (6-9 months) after use, reduced libido and weight gain.
Also known as Implanon, is a progestin hormone-containing rod that is placed just below the skin on the upper arm. It’s effective for 3 years. It acts to inhibit ovulation. Side effects include irregular bleeding, acne, breast tenderness etc.
4. Intrauterine devices (IUDs)
An IUD is a T-shaped device inserted into the endometrial cavity to inhibit sperm migration and viability and also damages the ovum to avoid fertilization.
There two types: Copper T, effective for 10 years and Levornogestrel IUD, effective for 5 years. Pelvic Inflammatory disease, Ectopic pregnancy and irregular menstrual bleeding are the common side effects.
5. Permanent Sterilization
Sterilization is an elective surgery that leaves a male or female unable to reproduce. Vasectomy for males and Bilateral tubal ligation for females.
These are put in place to prevent pregnancy following unprotected intercourse, in cases of rape, or following a contraceptive accident such as forgotten pills, slipped or broken condom.
There are two categories:
a) Those effective for 72 hours following intercourse
Levonorgestrel tablet is given in two doses. The first within the first 72 hours of coitus and second dose is given 12 hours after the first dose.
b) Those effective up to 5 days after intercourse.
Copper T is used (see its description under IUD).
I hope this article helped, if you have any more questions on contraceptives or sexual health, feel free to comment below or email your suggestions and comments to our Editor, Twapewa, at firstname.lastname@example.org.
First Aid Obstetrics and Gynaecology book
South African Medicines Formulary.