Contraception questions are sent in by followers to the social media project quite commonly. Let’s break down the basics about this important aspect of women’s health:
“Just wondering have you ever covered a post on contraception options that I could read ? I have Read HSE website but I am 40 so not sure what’s suitable at my stage of my life .”
Women’s health is always worth covering again.
Just before we get started on talking again about contraception, I do want to highlight one important point: Way, way too much urban myth and folklore still surround women’s health. There are a few reasons why this continues unchallenged, despite the real risk to women’s health:
1. Lack of knowledge: Studies in university age women show that large percentage of them have poor understanding of their own basic anatomy and many have not been given enough sex education to help protect them from dating violence, sexual transmitted diseases, or unwanted pregnancies.
2. Culture of quiet and shame: “we don’t talk about these things” – which unfortunately can be passed from mother to daughter, leaving girls and women reluctant and unempowered to seek appropriate medical treatment for common women’s health problems.
3. An alternative medical industry that exploit the first 2 points above, marketing often directly targeting the concept of the female body as “natural.” It is misogyny dressed up to look like female empowerment. Feminity (whatever it means to you) is nature – but frankly, all humans are natural, illness is also natural but flavoured gynae products or vaginal steaming/inserting jade eggs is not natural…sorry, not sorry Goop)
For straight information on all things gynaecological and women’s health, you can’t do better than starting with my recommended books for women and parents of girls: “The Vagina Bible” and “The Menopause Manifesto” written by expert gynaecologist and women’s health advocate, Dr. Jen Gunter.
The best and short answer here is to make an appointment with your GP. Doctors believe in a “shared decision making” for contraception. That is, docs will help you consider your short and long-term family planning goals, other symptoms such as heavy periods, current partner(s) and can give you accurate advice about effectiveness and side-effects of different methods. Together, you and doctor can agree on the best option to try.
So, how to get the most out of your appointment? Think before you go and be honest with yourself about your health, your concerns, your short and long term family planning. Do you want to consider a partner’s input? This will help your GP help you. Things to think about include:
● Is convenience important? How will you take it: pill? patch? implant? injection?
●How often you take it (Are you worried that you’ll forget a daily pill?)
● How effective is it? (For any number of personal reasons, would an unexpected pregnancy be catastrophic for you right now?)
● Are their other health goals to keep in mind besides preventing pregnancy – such as acne, heavy menstrual flow or rsks of spotting?
● Do you have concerns about certain side effects or risks, based on your age or family history (your doc will run through them, but if you are worried about something, make sure you bring it up, too)
● How reversible is it if you were to reconsider pregnancy in a few months? Next year? 5 years?
●Do you also need to protect against STDs?
So, in general terms, what your options out there?
[VERY brief overview of the 10 most popular options – using common terms/brands most familiar to women – in the order of most-likely-not-to-fail to most-likely-to-end-up-pregnant.]
1. Completely done? You and your partner agreed? Vasectomy or tubal ligation “tube tying” are definitive options. Upside: Almost 100% effective Downside: Difficult to reverse if you change your mind later; invasive surgical procedure.
2. The “IUD” Intrauterine devices: There are 2 common types in Ireland. Quite effective with failure rates of less than 1%. The Copper Coil and the Mirena Coil. The Mirena Coil has hormones. Advantage of Mirena: lighter periods and less cramping. Advantages of Copper: no hormones. Disadvantages of both: It may come out. Disadvantage of Copper Coil: slightly less effective, heavier periods/cramping.
3. “the Bar” (Implanon – a small implant put into your arm for 3 years) or Contraceptive injection “Depo” from your GP. Advantage: Really effective, failure rate of less than 1%. You don’t have to remember to take it. Nothing to fall out or fall off. Disadvantage: irregular periods/spotting, side effects may include weight gain, headaches, dizziness, acne, breast swelling and reduced sex drive. It can take time for regular periods and fertility to return to normal when you stop the injection
4. “The Pill” (“combined pill” with oestrogen and progesterone): Advantages of Pill: it can help with irregular, heavy or painful periods, PMS, acne. For some women, It protects against types of uterine and ovarian cancers. 8% failure rate. Disadvantages of the Pill: Remembering to take it daily. It’s not good for women with high blood pressure or who have had a clot. Some women don’t like the side effects of irregular bleeding, nausea, headaches and breast tenderness. There is also a small increase in the risk of developing breast cancer. #mythbusting: Weight gain hasn’t actually been shown to be caused by the pill. The pill doesn’t protect against STDs.
4. “Mini-pill” or “POP” has just progesterone. Slightly less effective but has fewer side effects and is safer for some women who may not be able to take a pill that has oestrogen. Advantage: you can use it while breastfeeding. Disadvantage: less effective, needs to be taken same time, every day.
5. “Evra” or “The Patch” – Works like the Pill, so same hormonal advantages and disadvantages. Advantage: easier to remember to re-apply a patch weekly than take a daily tablet. Disadvantage: may cause local skin reaction, up to 9% failure rate
6. NuvaRing: This goes into your vagina, and releases hormones, just like the Pill. So, similar hormonal. advantage and disadvantages to Pill. Advantage: you won’t forget to take it. Disadvantage: up to 9% failure rate
7. Diaphragm or cervical cap, used with local spermicide. Disadvantage: You will need to be fitted by specialist GP/nurse or referred to family planning clinic. Advantage: This is just a barrier, so no hormones or side effects Disadvantage: up to 12% failure rate
8. The traditional “rhythm” method: Advantages: This is the acceptable method for many religions. No side effects. May also increase awareness of your fertility cycle if you want to try for a baby later. Disadvantage: difficult for women with irregular periods, failure rate of around 25%
9. Local spermicides into the vagina: local irritation to vagina is common, failure rate of 28% unless used with a barrier such as condom, diaphragm, or cap
10. Breastfeeding. There are SO many advantages to breastfeeding, but contraception just isn’t one of them. #mythbusting: It doesn’t protect against pregnancy.
Condoms – are in a category all on their own for a good reason: they are the ONLY way to protect against STDs. Full stop. Can also be a good option for you and your partner when changing birth control methods, such as going on the pill.
Want to read more in depth on options? You can also try:
https://www.mycontraception.ie
https://www.ifpa.ie
Information geared for teens/young adults: https://spunout.ie/signpost/going-on-the-pill
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