Contraception refers to the deliberate measure used to prevent natural conception. There are many methods available and they include rhythm methods, hormonal pills, implants or uterine devices, barrier methods and permanent sterilisation.

What natural options are available?

  • Sexual Abstinence means no sexual intercourse. It is very effective in avoiding unplanned pregnancy and keeping safe from sexually transmitted infections such as gonorrhea, syphilis, and chlamydia. This approach is more suitable for certain periods in one’s life such as early teenage years.
  • Withdrawal Method or “pull out method” is when the penis is withdrawn prior to ejaculation. This method is often unreliable and pre-ejaculate fluid often contains sperm.
  • Calendar Rhythm Method uses the menstrual dates to predict the most fertile time in a menstrual cycle by keeping track of the first day of menstrual period. Intercourse is either avoided or condoms used during the fertile days (usually from days 10 – 18 if there is a regular 28 day cycle).
  • Basal Body Temperature Method involves keeping track of a woman’s daily body temperature (first temperature recorded in the morning upon waking up). A rise in the body temperature signals that ovulation had taken place. A variation on this method, called the Billings method, requires that the woman check her cervical mucus to determine if she is near ovulation and hence fertile. The fertile cervical mucus is clear, watery and stringy. Intercourse is avoided when the stringy cervical mucous is present.

What barrier methods of contraception are available?

  • The male Condom is made up of a thin latex material and is worn over the erect penis prior to intercourse. This is an effective method for preventing unplanned pregnancy and transmission of sexually transmitted infections. It is important to wear the condom correctly prior to intercourse and ensure that the penis is withdrawn whilst erect to prevent leakage of semen when flaccid.
  • The female Condom is a mechanical barrier worn by women. It is a pre-lubricated sheath that fits into the vagina and prevents the semen from being deposited into the vagina. It is also effective in the prevention of pregnancy and transmission of sexually transmitted infections.
  • A diaphragm is a soft rubber or a latex cup used by the woman to cover her cervix prior to intercourse. It is often used with spermicide. Cervical Cap is a smaller version of the diaphragm

What hormonal contraceptive methods are available?

  • The combined Birth Control Pill also known as “The Pill” contains two active synthetic hormones called oestrogen and progesterone. It works by inhibiting ovulation and preventing the lining of the womb from becoming receptive to an implanting embryo. The combined actions of these two hormones are very effective in preventing pregnancy. However it must be taken daily to ensure maximal effectiveness. The pill tablet can be less effective if a tablet is missed, if there is vomiting or diarrhoea, or if antibiotics are taken. The pill is not suitable for every women, and may not be appropriate if there is high blood pressure, a history of blood clots (deep vein thrombosis or pulmonary embolism) , or a smoker over the age of 35.
  • The mini Pill is also known as Progesterone-Only Pill. It is oestrogen free and works by interrupting the lining of the womb and preventing implantation. The pill also thickens cervical mucous and prevents sperm from getting through. Mini-pill is recommended for breastfeeding women because it does not tend to reduce the production of milk. It must be taken daily and generally at the same time to ensure effectiveness.
  • Depo-Provera is an estrogen-free contraceptive given by injection by the doctor every three months. It contains a different type of progesterone hormone to the pill and works by inhibiting ovulation, thins uterine lining and thickens cervical mucous.
  • A vaginal Ring is a thin, transparent and flexible ring positioned in the vagina. It releases synthetic hormones that are absorbed into the bloodstream through the vaginal wall. It works like the combined pill. The ring is worn for three weeks and then removed for a “ring-free” week. A period comes during this week.
  • The contraceptive Implant is a long-term birth control method. A small flexible plastic rod-containing hormone is inserted under the skin in the upper arm. It releases synthetic progesterone to inhibit ovulation, thickens cervical mucous and thins womb lining. It can be effective up to three years.

What is an Intrauterine Device?

The mirena is a hormone-releasing intrauterine device that is placed in the uterus to prevent pregnancy. It may stop the release of an egg but its main action is to prevent sperm from reaching the fallopian tube. But if fertilization did occur the device makes the womb lining unfavourable for implantation. It is effective for up to five years. Copper-T is an intrauterine device that does not contain hormones but instead copper. It kills sperm and also causes the lining to be unfavourable for implantation of the fertilized egg.

What about permanent contraception?

  • Tubal Ligation is a type of surgical sterilization method performed either through a small cut on the lower part of the abdomen or via keyhole surgery. The fallopian tubes are either tied and cut or clipped so to prevent the egg from meeting the sperm in the tube. A variation of this method called Essure is also a permanent sterilization procedure. However this method requires no cuts on the abdomen and is done through a hysteroscope. This device like the laparoscope is inserted into the womb and then small metal coils are inserted into each fallopian tube. This causes scarring and eventual blockage of the tube. It takes about three months to work.
  • Vasectomy is a permanent sterilization method for men. It is achieved by cutting or cauterizing the vas deferens, a tube that carries sperm from the testes to the epididymis, situated near the base of the penis. This results in blockage of sperm but may not be immediate. The semen should be checked by your doctor to make sure no sperm are present.

Can contraception fail?

Contraception is usually effective, however some forms are less reliable than others. All contraception can fail. Make sure you discuss your particular situation with your doctor and be aware of factors that make failure more likely.

This information is provided as general information only. It is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Always see your doctor regarding your personal health matters. © National Association of Specialist Obstetricians & Gynaecologists 2010