What is Contraception?

The act of preventing pregnancy is known as contraception. A gadget, a medication, a process, or a behavior might all fall under this category. Contraception gives a woman control over her reproductive health and allows her to participate actively in her family planning. This article will not discuss abortion because it is not a method of preventing pregnancy.

Contraception is a technical advancement that aims to transcend biology. The twenty-first century has seen the most significant breakthroughs in female reproductive health, with new medical treatments, equipment, and even operations becoming available. This article will focus on the various drugs, technologies, and procedures that couples can use to avoid becoming pregnant. It will not concentrate on the many behaviors and barriers that are available.

When it comes to contraceptive methods, efficiency, safety, acceptability, and availability should all be considered (including accessibility and affordability). The importance of voluntarily informing the choice of contraceptive methods is a guiding principle, and contraceptive counseling, when available, is a significant contribution to successful contraceptive use.

Birth Control Methods

When choosing the most appropriate contraceptive technique, many factors must be addressed by women, men, or couples at any stage in their lives. These factors include safety, effectiveness, accessibility, and price, as well as acceptability. Contraceptive counseling, when available, may be a major contributor to the successful use of contraceptive techniques, and voluntary informed choice of contraceptive methods is an important guiding concept.

Dual protection from the danger of HIV and other STDs should be considered while choosing a method of contraception. Despite the fact that hormonal contraceptives and IUDs are quite successful at preventing conception, they do not protect against STDs like HIV. The use of a male latex condom correctly and consistently lowers the risk of HIV infection and other STDs such as chlamydial infection, gonococcal infection, and trichomoniasis.

Methods of birth control are intended to prevent conception or to interrupt or nullify implantation and growth. Conception can be avoided by hormonally altering the menstrual cycle (OC pills), physically restricting the passageway (barrier methods or sterilization), or, less successfully, abstinence during fertile periods or withdrawal procedures. The use of a foreign body (intrauterine device, IUD) or surgical removal can prevent implantation (Salpingectomy or Vasectomy).

When efficacy is the highest priority, it is best to discuss contraception with the patient. The following are listed in order of most effective to least effective contraception:

Etonogestrel contraceptive Implant

Levonorgestrel intrauterine system (LNG IUD)

Copper intrauterine device (IUD)

Female sterilization

Vasectomy

Injectables

Combined oral contraceptives

Progestin-only pill

Patch

Hormonal vaginal contraceptive ring

Lactational Amenorrhea

Diaphragm or cervical cap

Sponge

Male condom

Female condom

Spermicides

Fertility awareness-based methods

Withdrawal

Emergency Contraception

Copper IUD

Reversible Methods of Birth Control

Intrauterine Contraception

Levonorgestrel intrauterine system (LNG IUD)—Like the Copper T IUD, the LNG IUD is a small T-shaped device. A doctor places it within the uterus. Each day, it produces a small quantity of progestin to prevent you from becoming pregnant. Depending on the device, the LNG IUD can stay in your uterus for 3 to 6 years. The failure rate for typical use is 0.1-0.4 percent.

Copper T intrauterine device (IUD)—A copper T IUD is a tiny device fashioned like a “T.” It’s placed within the uterus by your doctor to prevent conception. It might last up to ten years in your uterus. The average rate of failure during use is 0.8 percent.

Hormonal Methods

The implant is a single, tiny rod that is implanted beneath the skin of the upper arm of a woman. A progestin is contained in the rod, which is delivered into the body over a three-year period. The average rate of failure during use is 0.1 percent.

Every three months, women are given shots of the hormone progestin in the buttocks or arm by their doctor. The average use failure rate is 4%.

Combined oral contraceptives—Also known as “the pill,” combined oral contraceptives are a combination of estrogen and progestin hormones. A doctor has prescribed it. Every day, a pill is taken at the same time. Your doctor may advise you not to take the tablet if you are over 35 years old, smoke, or have a history of blood clots or breast cancer. The average use failure rate is 7%.

Unlike the combination pill, the progestin-only pill (also known as the mini-pill) contains only one hormone, progestin, rather than both estrogen and progestin. A doctor has prescribed it. It is taken every day at the same time. It could be a viable choice for women who are unable to take estrogen. The average use failure rate is 7%.

The patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). A doctor has recommended this procedure. The hormones progestin and estrogen are released into the bloodstream. For three weeks, you apply a new patch once a week. You do not use a patch during the fourth week so that you can have a menstrual cycle. The average use failure rate is 7%.

Hormonal vaginal contraceptive ring—The hormones progestin and estrogen are released by the ring. You insert the ring into your vaginal canal. Wear the ring for three weeks, then remove it for the week of your period and replace it with a fresh one. The average use failure rate is 7%.

Barrier Methods

Diaphragm or cervical cap—Both of these barrier measures are used to cover the cervix and prevent sperm from entering the vaginal canal. The diaphragm has a shallow cup shape. The cervical cap is formed like a thimble. You inject them with spermicide before sexual contact to prevent or kill sperm. Because diaphragms and cervical caps come in varying sizes, see your doctor for a good fit. The diaphragm has a typical failure rate of 17%.

Sponge—The spermicide-containing contraceptive sponge is inserted into the vaginal canal and fits over the cervix. The sponge lasts up to 24 hours in the vaginal canal and must be left in place for at least 6 hours after the last act of intercourse before being removed and thrown. Women who have never had a baby have a 14 percent failure rate, while women who have had a kid have a 27 percent failure rate.

Male condom—A male condom is a device worn by men to prevent sperm from entering a woman’s body. Latex condoms, the most prevalent form, as well as newer synthetic condoms, help prevent pregnancy, HIV, and other STDs. Condoms made of “natural” or “lambskin” can also help prevent pregnancy, but they may not protect against STDs like HIV. The failure rate of typical use is 13%. Condoms are only good for one use. Condoms, KY jelly, and water-based lubricants can all be purchased from a drug shop. When using latex condoms, avoid using oil-based lubricants like massage oils, baby oil, lotions, or petroleum jelly. They will weaken the condom to the point that it may rupture or break.

Female condom—A female condom is a device used by a woman to prevent sperm from entering her body. It comes in a lubricant package and is sold at drug stores. It can be used up to eight hours prior to sexual activity. The typical use failure rate is 21%, and it may also assist to avoid STDs.

Spermicides—These products kill sperm and are available in a variety of forms, including foam, gel, cream, film, suppository, and pill. They should be inserted into the vaginal canal no later than one hour before intercourse. After intercourse, you should leave them in place for at least six to eight hours. In addition to a male condom, diaphragm, or cervical cap, you can use a spermicide. They’re available at drugstores. A typical use failure rate is 21%.

Fertility Awareness-Based Methods

Methods based on fertility awareness—The number of days in a month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely but possible is your fertility pattern. Each month, if you have a regular menstrual cycle, you will have nine or more fertile days. If you don’t want to get pregnant, you either don’t have sex on your fertile days or use a barrier method of birth control. The failure rates of these approaches differ. Typical use failure rates range from 2-23 percent.

Lactational Amenorrhea Method

When three conditions are met: 1) amenorrhea (no menstrual periods after delivering a baby), 2) fully or nearly fully breastfeeding, and 3) less than 6 months after delivering a baby, the Lactational Amenorrhea Method (LAM) can be used as birth control for women who have recently had a baby and are breastfeeding. LAM is a temporary type of birth control, and if any of the three parameters are not met, another means of birth control must be used.

Emergency Contraception

Emergency contraception is not a regular birth control strategy. If no birth control was used during sex or if the birth control technique failed, such as if a condom broke, emergency contraception can be utilized.

Copper IUD—Women can have the copper T IUD inserted within five days of unprotected sex.

Emergency contraceptive pills— Emergency contraceptive tablets can be taken up to 5 days after unprotected sex, however the sooner the pills are taken, the better. In the United States, there are three main forms of emergency contraception tablets. Over-the-counter emergency contraception tablets are available.

Permanent Methods of Birth Control

Female Sterilization—Tubal ligation or “tying tubes”— A woman’s fallopian tubes can be tied (or closed) to prevent sperm and eggs from fertilizing each other. A hospital or an outpatient surgery clinic can do the procedure. You can return home the same day as your procedure and resume your normal activities in a few days. This procedure is immediately effective. The average rate of failure during use is 0.5 percent.

Male Sterilization–Vasectomy— This procedure prevents a man’s sperm from reaching his penis, ensuring that his ejaculate never contains enough sperm to fertilize an egg. In most cases, the surgery is performed in an outpatient surgical center. The man will be able to return home the same day. It takes less than a week to recover. A guy contacts his doctor after the operation for testing to count his sperm and ensure that his sperm count has decreased to zero; this takes about 12 weeks. Until the man’s sperm count is zero, another kind of birth control should be utilized. The average rate of failure during use is 0.15 percent.

Emergency contraceptive pills

Intrauterine devices and subdermal implants are examples of medical technologies used to prevent pregnancy. Progesterone may or may not be present in the intrauterine device, while progesterone is present in all subdermal implants. Long Acting Reversible Contraceptives, or LARCs, are the most frequent name for these contraceptives. The failure rate of various types of contraception devices is less than one woman per 100 women per year, making them the most successful form of contraception available, with rates that are considered better than surgical sterilization.

There are a few absolute contraindications, which are related to uterine anatomical problems or pharmaceutical allergies. Surgical sterilization of both the male and female is used in contraceptive techniques. A vasectomy is the least intrusive, followed by tubal occlusion procedures. At this time, hysteroscopic sterilization is not a commonly used method. Although surgical reversals are possible, procedures are designed to be permanent. Although the failure rates are slightly greater than LARC approaches, fewer than one woman out of every 100 has these surgical treatments each year.

The current injectable on the market is solely progesterone; it contains no estrogen and frequently causes erratic bleeding. Only types of progesterone affect cervical mucous and endometrial lining, limiting conception. The injections are given every 12 weeks, with a failure rate of 6 women per 100 every year.

Combination hormonal pills, patches, rings, and progesterone-only pills are some of the most prevalent contraception options. Monophasic, biphasic, and triphasic oral contraceptive tablets are available. They are given out on a monthly, quarterly, or annual basis. The usual combined oral contraceptive pill contains estrogen and progesterone for 21-24 days to suppress ovulation, modify cervical mucus and the endometrial lining to prevent pregnancy, and placebo for 5-7 days, resulting in an observable menstrual cycle.

Continuous contraceptive pills have an 84-day active phase and a 7-day placebo phase, for a total of 365 days of active pills. Regardless of the format, these forms are similarly effective and have similar failure rates. The combination hormonal patch and contraceptive ring provide a new route for the medicine to enter the body, preventing the first-pass impact and reducing some side effects. The patch is replaced weekly, with a placebo week in between, to simulate normal menstruation. To simulate menses, the vaginal ring was worn for three weeks before being removed for a placebo week.

The failure rates for all of these formulations are the same: 9 per 100 women each year. Before commencing any kind of contraception, a comprehensive medical history and physical should be undertaken because there may be relative and absolute contraindications. Physicians and patients can easily obtain the CDC’s medical eligibility criteria for contraceptive usage, which is dependent on the type of contraception chosen and the patient’s medical circumstances.

Issues of Concern

Concerns occur among women who use hormone-based birth control since they have a higher risk of breast cancer, making contraceptives a major public health concern. Mørch  et al. found that women who used hormonal contraception had a 20% higher risk of breast cancer than women who never used any birth control methods, regardless of estrogen dose.

Irregular bleeding is a typical side effect, and patients should be warned about it depending on the drug or device they use. CIMBCs (contraceptive-induced menstrual bleeding changes) should be acknowledged as a serious risk in contraceptive counseling and use.

In the United States, IUDs are becoming more popular. They provide good contraception with few adverse effects and are only infrequently contraindicated depending on the medical history of the patient. Pelvic infection is a possibility, however the risk is greatest within the first 20 days after implantation. If a woman gets a sexually transmitted infection, the first line of defense is to treat the infection; IUD removal is considered only if the patient fails to respond to treatment. Consideration of sustainability (efficiency, cost, duration of action, and suitability), making a thorough and correct choice, and then providing excellent patient counseling are the keys to reducing issues in contraceptive treatment.

The most serious side effects of the OC pill are venous thromboembolism (VTE) and arterial thrombosis (AT). VTE occurs at a rate of 4-5 per 10,000 in non-pregnant women, 9-10 per 10,000 in OC pill users, and 30 per 10,000 in a normal pregnancy [5]. Lower estrogen doses may be more effective in avoiding myocardial infarction and perhaps thrombotic stroke. The decision to utilize hormonal contraceptives and the formulation to use should be dependent on the patient’s age and smoking status, as well as recognized risk factors.

In the United States, the average number of children desired per family is roughly two. Despite the abundance of options, about half of all pregnancies in the United States are unplanned, and around a quarter of all kids born are unwanted at the time of delivery.

Clinical Significance

By minimizing unwanted pregnancies and abortions and promoting family planning, effective contraception brings social and health benefits to mothers and their children. Indirectly, effective contraception aids in enhancing the general health of newborns and children.

In addition to avoiding pregnancy, using male condoms (a barrier method) correctly and consistently lowers the risk of HIV and other STDs such as chlamydia, gonococcus, and trichomoniasis. Despite the fact that hormonal contraceptives and IUDs are quite successful at preventing conception, they do not protect against STDs like HIV.

Clinically, contraceptives such as OC tablets are used to treat:

Primary dysmenorrhea

Endometriosis

Amenorrhea due to low weight, stress or exercise

Menstrual cramps

Premenstrual syndrome

Primary ovarian insufficiency

Menorrhagia

Acne

Polycystic ovary syndrome