Health x Wellness

Contraception and Prevention of Unexpected Pregnancy

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Preventing unexpected pregnancy.  

Contraception is often used for family planning purposes as well as preventing pregnancies. While there are many options available, different couples may opt for different methods. Some are chosen based on age, stage of life, underlying medical conditions, and personal preference. Most of the methods are user-dependent, based on how correctly it is administered or how compliant the user is to the administration interval.

What contraception options do I have? 

Natural Methods
Natural methods include keeping track of your menstrual cycle and avoiding having sexual intercourse during the time of ovulation, which is usually in the middle of the menstrual cycle.  

The body temperature method can also be used to keep track of ovulation days as during ovulation, an individual’s body temperature may rise a few degrees Celsius higher than basal body temperature. 

However, this method is not reliable, as some still get pregnant due to irregular menstrual cycles, miscalculation of dates, or poor compliance.

Barrier Methods
Barrier methods such as condoms, caps, or diaphragms are the most widely available options, and can be self-administered without medical consultation. In most cases, these methods rarely cause any side effects unless they are administered incorrectly.  

These physical barriers are approximately 85 percent effective in preventing unexpected pregnancy, and methods such as condoms can also help to prevent sexually transmitted diseases by minimising body fluid exchange during intercourse.

Hormonal Methods and Contraceptive Devices

1. Combined Oral Contraceptive Pills and Contraceptive Patch

Oral contraceptive pills and patches contain estrogen and progesterone, working together to prevent ovulation by thickening the cervical mucus, thus affecting the endometrium lining and consequently preventing implantation of the egg onto it. Additionally, the pill can also be prescribed to treat acne or regulate the menstrual cycle.

Some common side effects may include migraine, weight gain, nausea, and mood changes. Women who wish to begin on a combined hormonal contraception method must first consult with their doctors to ensure no risk factors are present to counteract its usage.

Such examples of risk factors include a medical history of breast cancer, clotting disorders, smoking, and major cardiovascular diseases. However, if used properly and consistently, such methods can be over 90% effective in preventing pregnancies. 

Return to fertility is immediate upon skipping or cessation of the medication.

2. Progesterone Injections/Depots

While the previous method utilises both estrogen and progesterone, this method only consists of the progesterone hormone, and is injected into the body to prevent ovulation. Much like the contraceptive pills and patch combination, the progesterone injections also thickens the cervical mucus, increasing the difficulty of the sperm to swim through the cervix, subsequently preventing fertilisation. 

The injection will usually be given in the clinic and is not available over-the-counter. This method however, provides an effectiveness of up to 99% and lasts for three months per dose. 

Common side effects include mood changes, headache as well as weight gain.  

Despite its high efficacy, it is inadvisable to use this method for more than 2 years consecutively because it can increase the risk of developing osteoporosis (lower bone density). 

Return to fertility may take a few months from the last injection. 

3. Contraceptive Implants (Implanon/Nexplanon)

This contraceptive implant consists of a small rod inserted into the arm through a minor surgical procedure. Once inserted, the rod releases the progesterone hormone and can remain effective for 3 years, after which a new one has to be inserted to ensure its effectiveness.

Contraceptive implants are incredibly effective, with an efficacy rating of 99 percent.

Common side effects that are procedure-related include pain, bleeding, infection, while hormonal-related side effects include amenorrhea (no period), irregular bleeding, weight gain, and headache. 

Return of fertility is almost immediate, and usually happens within a few days to a few weeks after the implant is removed.

4. Intrauterine Device (IUDs)

An Intrauterine Device is a form of long term contraception where a hormonal containing device (Mirena) or a non-hormonal copper device is inserted into the uterus to prevent implantation of the egg, thereby preventing pregnancy. 

The insertion of the IUD is best done during menstruation when the cervix is most dilated. The hormonal variation of the IUD has additional benefits such as reducing menstrual flow and menstrual pain. 

While the efficacy rate is 99 percent, the device may come with side effects such as heavier bleeding with the copper IUD, and hormonal side effects such as weight gain from the Mirena IUD. 

All IUDs also increase the risk of pelvic infections and ectopic pregnancies (occurs when an egg implants itself outside of the womb).

Return to fertility is almost immediate for copper IUDs, while hormonal IUDs require a few days to a few weeks.

5. Emergency Contraception

Other than long term contraception methods, there are options for emergency use. More commonly known as the ‘morning after pill,’ the oral pill contains a higher dosage of hormones compared to the usual daily contraceptive pill.

The ‘morning after pill’ can be used in cases of unexpected intercourse or failure of other contraception methods, such as condom failure or missed dosage of an oral contraceptive pill. It is not widely available over the counter and can only be prescribed on a case by case basis after consulting with a doctor.

How Do I Choose and What Are The Factors to Consider? 

To summarise, contraception methods are advisable for any woman or couples who do not want any unplanned pregnancies. Before starting on any hormonal contraception methods or devices, it is paramount to seek consultation from a doctor on the suitability of each method.  

Those who have risk factors against estrogen-containing methods may consider progesterone-only methods as discussed above. It is also important to consider the methods based on efficacy, potential side effects, contraception duration, and return to fertility.

Article contributed by Dr Goh Lit Ching. She is the resident doctor at DTAP Clinic, she completed her Bachelor of Medicine and Bachelor of Surgery (MBBS) at the University of London in the United Kingdom. Her clinical interests include Family Medicine, Women’s Health and Preventative Care via Health Screening. Dr Goh is a firm believer of primary prevention and early detection improving disease outcome.

With her knowledge and training, she hopes to make a difference by improving patients’ quality of lives. By empowering her patients with health awareness, knowledge and understanding, she believes her patients can achieve a well-balanced lifestyle that leads to less illnesses in their personal lives.

Feature Photo by Reproductive Health Supplies Coalition on Unsplash