‘Contraception is about empowerment,’ says GP Dr Serena Cardoso. ‘We’re deciding when – and if – we’re going to have babies. The right to have access to contraception is something women fought very hard for, yet it’s something many take for granted. And a lot of women – usually out of a fear of side effects – are not using contraception.’
The pill has lately come to be considered something of a frenemy, with new studies – including fake ones – putting it in a less than positive light. One good thing about this raised awareness, says Dr Cardoso, is that it has caused women to make more detailed investigations into their contraceptive options, and what each one entails.
It’s important to discuss your contraceptive choices with your gynaecologist or GP, who will take into account your medical history, lifestyle and past experiences with contraception before recommending a new method for you. To help you prep for that appointment, here’s a no-BS breakdown of modern contraceptive options.
1. THE IMPLANT
What: A matchstick-sized rod fitted under the skin of the upper arm by a doctor or nurse. ‘The implant slowly releases a low dose of hormones that provide protection against pregnancy for three to five years, depending on the model,’ says the Marie Stopes website.
Need to know: There are horror stories
of the implant moving around and travelling to different body parts but ‘while there is a chance, it’s rare,’ says Dr Cardoso. She says the majority of women are ‘very happy’ with the implant because of its convenience.
Cost: Free at government clinics, +/-R1 700 in the private sector.
• Most effective contraceptive
• Long-term solution
• Easy insertion
• Possibility of irregular periods
• Chance of migration
• Some patients report pain at the insertion site
2. INTRAUTERINE DEVICE (IUD)
What: A T-shaped device placed inside the uterus. IUDs can either be hormone-releasing (such as the Mirena) or coated in copper (known as the copper T or loop). Although fitting it is a non-surgical procedure, it has to be done by a medical professional. An IUD provides protection for three to 10 years, depending on the model, but can be removed at any time.
Need to know: Many women experience absent or significantly lighter periods with the Mirena, which works by thickening cervical mucus to prevent sperm from entering your uterus and fertilising the egg. It also thins the lining of the uterus, which usually builds up monthly, thus ‘reducing the chance of implantation of an egg and also reducing the frequency and volume of menstrual blood loss,’ says Dr Cardoso.
The Mirena releases levonorgestrel, a synthetic version of your body’s natural progesterone hormone. Dr. Cardoso recommends the copper T or loop if you like the idea of an IUD but are not keen on synthetic hormones.
It’s recommended that you do a monthly ‘thread check’ to make sure your IUD is still in place. Wash your hands and feel at the top of your vagina for the small removal strings that hang just outside the cervix. However, the chances of the Mirena being expelled in the first year are only between three and six percent.
Some men claim to be able to feel an IUD during intercourse, which can often be put down to their imagination. Our advice: don’t tell him about the threads. An IUD won’t move during sex because no matter how big he (thinks he) is, a penis cannot enter the cervix.
Cost: Between R500 (copper T) and R3 000 (high-end hormone IUDs) at a pharmacy. Price of insertion depends on your gynaecologist or GP.
• Long-term solution
• Can be used to reduce heavy periods,
or stop them altogether
• Low possibility of ectopic pregnancy
• There is the chance of infection (although it’s only 1% in the first 20 days, and 0.5% in the first six months) therefore not recommended for women who experience regular vaginal/pelvic infections.
• Currently fits uteruses of six centimetres or larger, although a smaller Mirena is due to be released this year
3. THE INJECTION
What: The contraceptive injection delivers progesterone, which thickens cervical mucus thereby stopping sperm reaching an egg. It also thins the womb lining (making it unable to support a fertilised egg) and, in some women, prevents the release of an egg entirely. The injection is delivered into your buttocks muscle or upper arm. The most popular brand in SA is Depo-Provera, which lasts three months.
Need to know: The biggest worry regarding the injection is the return-to-fertility period. Some women also complain about irregular, longer periods, while for others menstruation may be absent completely.
Cost: Free in government clinics. Depo-Provera from R28 at pharmacies, and between R90 and R250 at Marie Stopes.
• Medium-term solution
• Good for women who can’t use oestrogen contraception
• Not affected by other medication
• Possibility of cessation of menstruation (which some women prefer)
• Studies show it can help in the preventionof cervical cancer
• Common side effects can include the usual culprits experienced with the pill: weight gain, headaches, mood swings and breast tenderness
• Periods can become irregular and longer
• Can delay fertility up to a year after discontinuation, so it’s not ideal for women who would like to conceive soon after going off their contraception
4. THE NATURAL PILL
What: A daily contraceptive pill with lower, more natural doses of hormones.
Effectiveness: 99.9%*, when used correctly and consistently
Need to know: The major concern most women have with the original pill is the cocktail of hormones it contains. ‘As a result,’ says Dr Cardoso, ‘the medical community has realised there’s quite a big demand for lower doses of hormones and more natural options.’ Zoely and Qlaira are natural-hormone pill options that are available in South Africa. ‘These contain much lower doses and are natural in that the hormones they use are more similar to hormones that are in your own body.’ Both pills deliver estradiol, the natural oestrogen that occurs in the female body, whereas most others contain the synthetic oestrogen ethinylestradiol.
Natural-hormone pills work closely with your natural cycle. A course contains different pills for different times of the month. This means there’s less room for error and forgetfulness. For this reason, some doctors recommend having up to 10 years’ experience of taking the regular pill before prescribing this one, but Dr Cardoso says that if you know yourself and are conscientious, it’s an excellent alternative.
Cost: Zoely is R225, and Qlaira R270 for a month’s supply.
• Natural hormones
• Mimics natural cycle
• No room for error
What: A Band-Aid-like patch that prevents ovulation by transmitting hormones into the bloodstream via the skin.
Effectiveness: 99.9%* if used correctly and consistently
Need to know: The patch isn’t too popular, mostly because of unfounded distrust of its topical nature. However, it is as effective (if used correctly) as the contraceptive pill.
You apply a new patch every week for three weeks, then go one week without (similar to the cycle of active and inactive contraceptive pills). Doctors recommend changing the position of each weekly patch, alternating between your upper arms, torso (excluding breasts), buttocks and abdomen.
Cost: Ortho Evra is R93 for a month’s supply.
• Easy to apply and remove weekly
• Can use patches to skip your period
• Same hormones as the pill
• May be associated with oestrogen-related effects (such as breast tenderness and headaches)
• Potential skin irritation at site of patch
What: A small, flexible ring inserted into the vagina for three weeks. The Nuvaring releases hormones that inhibit ovulation and stimulate cervical mucus to prevent sperm entering the uterus.
Effectiveness: 99.7% when used correctly and consistently
Need to know: This method is not very well known in South Africa, according to Dr Cardoso. ‘But it’s great for women who forget to take the pill.’ She suggests setting a reminder to take it out after three weeks, at which point you will experience your period, then insert a new one after a week. As for insertion, ‘It’s as easy as putting in a tampon.’ Another bonus: ‘Less than three percent of users report noticing the ring during sex,’ says Dr Cardoso.
Cost: Approximately R240.
• Easy to insert and take out
• Not systemic, meaning the hormones released are not processed by the rest of the body
• You can insert a new ring after only three weeks to avoid your period
• Less widely available than other methods in SA
• Rare but potential vaginal irritation
7. NATURAL CYCLES APP
What: An app that tracks your menstrual cycle and other variables to work out when you’re fertile and when you can (theoretically) have protection-free intercourse without fear of pregnancy.
Effectiveness: The app’s creators claim it’s as effective as the pill.
Need to know: Natural Cycles is recognised by the government of the UK as an approved method of contraception, but many remain unconvinced. ‘Fertility apps use algorithms, the majority of which are proprietary and have not been methodologically evaluated in peer-reviewed literature,’ says Dr Cardoso.
Cost: Free on App Store and Google Play.
• No added hormones or foreign devices in the body
• You can view your cycle and fertility history easily, helping you to get to know your body better
• Generally accepted to be the riskiest method
• You have to take your temperature daily
8. COPPER PEARLS
Also known as intrauterine balls (IUB), these are fairly new in South Africa. IUBs work in the same way as the copper T, but are shaped in a way that minimises the chance of uterine perforation.
Need to know: Several copper pearls are strung on a uterus-friendly polymer frame. The pearls release copper ions into the uterus, which (just like the copper T) inhibit progress of sperm into the uterus and thin the uterus wall to discourage an egg implanting.
Cost: Your GP or gynae can order the copper pearls online for R1 800 to R2 100 from Copperpearls.co.za.
• Lower chance of perforation
• No hormones
• Long-term (five years)
• Effective from the moment of insertion, and fertility returns immediately after removal
• Reduces period pain and heaviness
• Possible increased bleeding that can last up to five months while the body adjusts to the device
• Not for women who experience frequent pelvic infections or have an existing STD
For more about contraception from Dr Serena Cardoso, visit Doctorsrooms.co.za or call 021 423 2425.