Choice of contraceptive method

What it is

The hormonal methods, and what each of them does:

• Combined hormonal contraception: the combined oral pill, a contraceptive patch every week, or a vaginal ring placed for 3 weeks with 1 week ring free. The transdermal patch takes 3 days to give effect and is applied once a week for 3 wks, gives no STD protection, and is less effective if weight is above 90Kg. The vaginal ring is estrogen with progesterone, kept 3 wks and changed once a month, and carries an 8% failure rate. It suppresses LH and FSH to give anovulation, thickens the cervical mucous, and thins the endometrial lining to inhibit implantation. It reduces the risk of endometrial, ovarian and colorectal cancer, and reduces acne.
• Progesterone only pills: one tablet a day, taken at the same time each day. Thicken cervical mucous, inhibit ovulation.
• Injectable DMPA: 150mg IM 3 monthly, the injection taken within 5 days of the cycle. One mechanism is given for the injectable and the implant together: thicken the cervical mucous, inhibit ovulation, slow tubal motility and thin the endometrium.
• Progesterone implant: etonogestrel 68mg, inserted subdermal on day 1-5 of the cycle, and the most effective method. Its duration is reported as 3 years in one source and for 5 yrs in another, the second adding a failure rate under 1%, that fertility returns rapidly, that a professional is needed to insert it, and side effects of irregular bleed, fluid retention and weight gain.

The copper IUD is effective up to 10 years and the Mirena up to 5 yrs on one page; the other page has the copper last 10-12 yrs with 0.8% failure and the Mirena 7 yrs with 0.1% failure. With these are the barriers, where the male condom is safe for all young women and gives protection from STIs, the natural methods, and the permanent ones, vasectomy and tubal ligation. The permanent methods are set out side by side. Vasectomy is occlusion of each vas deferens, performed in an outpatient setting under local anesthesia with easier recovery and minimal surgical risk, but it is permanent and irreversible, it needs alternative contraception until the ejaculation is deemed free of sperms, and it does not prevent STD. Tubal ligation is performed during laparotomy or laparoscopy or during C-section, the fallopian tube being cut, tied and cauterized to prevent the egg from reaching the sperm; it is permanent and irreversible, carries surgical risk and needs anesthesia, carries a risk of failure and of ectopic pregnancy, involves no hormone and no change in cycles although she may experience a heavy period, and needs a back up method in the first 3 months after the procedure. The chance of getting pregnant after tubal reversal is age-related: 63% in women under 35 years, 44% in women 35 to 40 years and 5% in women over 40 years.