By Christopher Oseh, MBBS
“Your delivery had a lot of complications because of your pregnancy history— this is your 7th child Mrs. James. I will advise you to talk to the doctor about a family planning method you can use”, the midwife told her.
Mrs. James confessed to the doctor that she was hesitant to use a contraceptive because she feared the side effects. Instead, she opted for traditional methods such as withdrawal and periodic abstinence. However, these traditional methods have repeatedly failed. As a result, she now has more children than planned with her husband and almost lost her life during her last delivery.
Low and middle-income countries have a high fertility rate with fluctuations in the adoption of modern contraceptive methods. However, in some African countries, the use of modern contraception prevalence rate has increased.
A study found that the primary reason for under-utilizing contraceptive methods was health concerns, and lack of knowledge.
Health care professionals play a critical role in educating patients like Mrs. James on the benefits of contraception and how to manage the possible side effects of specific contraceptive methods.
Here are common contraceptive methods with an overview of the benefits and risks associated with usage.
How are different contraceptive methods classified?
Contraceptive methods are classified based on their mechanism of action.
Barriers: These are special materials designed to prevent the entry of sperm into the vagina. It can be inserted into the vagina or worn over the penis. Examples include male condoms, female condoms, and cervical caps.
Hormonal methods: Hormonal contraceptives alter the female reproductive tract by inhibiting the ovaries from releasing the ovum and thickening the cervical mucus preventing the sperm from penetrating the cervical lining.
Intrauterine device: These materials are inserted into the fundus of the uterus, where they block the entry of sperm cells into the fallopian tubes—inhibiting the fertilization process
Not all contraceptive methods are suitable for every individual. Therefore, in addition to weighing the benefits and risks of a contraceptive, health professionals should consider other factors such as accessibility, influencing compliance with the contraceptive method.
Types of modern contraceptive methods
Implants
An Implant is a hormonal contraceptive with impregnated hormone- progestin in its core. It is rod- like in shape, similar in length to a matchstick (or almost 4 cm long), and inserted under the skin, usually in the upper arm. The progestin is released gradually over time, and it circulates in the blood and exerts its effects in the uterus.
It is commonly used because of its convenience and effectiveness, but it is not suitable for all women.
An implant has a 99% success rate which means 1 out of 100 women can get pregnant using it. It can prevent pregnancy for 3-4 years.
Side effects: Weight gain and irregular vaginal bleeding are the major cons of using implants.
Reassure patients who complain about vaginal spotting. If vaginal bleeding is profuse, consider the need for estrogen medications after reviewing with a gynecologist.
Injections
Injections are also hormonal contraceptives (progestin) but with a different method of administration.
They are administered into the buttock (intramuscular) every three months. To be effective, the patient is expected to adhere to scheduled family planning clinic appointments for follow-up injections. It has a success rate of 95% with compliance.
Side effects may include headaches, weight gain, irregular menstrual cycle, and delayed ovulation.
Oral contraceptives
These are oral drugs, also called pills that are taken daily to prevent pregnancy.
There are two types:
- Combined oral contraceptives: These drugs contain both oestrogen and progesterone. They are taken daily at a specific time and have a success rate of 93% if taken daily.
- Progestin-only pills: They are also called mini-pills and contain only progesterone.
They are taken at a particular time daily and are prescribed when combined pills are contraindicated in some patients. Mini pills cause side effects similar to other hormonal contraceptives.
Side effects include headache, nausea, and increased risk of a clot. Therefore, oral contraceptives are not prescribed for patients with cardiovascular risk factors such as hypertension, and diabetes.
Health care professionals are often inundated with questions about missing oral contraceptives. Here are answers to two common questions about oral contraceptives:
- Can missing one pill lead to pregnancy?
Yes, especially if the patient is on a progestin-only pill. Take the pill immediately, you remember, even if it is past the usual time. - What can a patient do with missed pills?
Suppose the patient misses a pill on a specific day and remembers the next day. In that case, the patient must take two pills on that day, and then the usual schedule continues.
Intrauterine device
An intrauterine device (IUD) is a T-shaped device inserted into the uterus by a doctor. There are two types:
- Copper IUD: It contains copper, which kills sperm cells and prevents the implantation of the fertilized ovum. According to the World Health Organisation, it prevents pregnancy for five years with a 94% success rate. However, copper IUD may cause intermittent pelvic cramps and transient uterine infection after insertion.
- Hormonal IUD: They contain progestin hormone, which is released in small amounts spontaneously in the uterus. Hormonal IUD can last for five years, and it has the same side effects as other hormonal contraceptives. The success rate is 95%
Side effects of uterine device: Copper IUDs may cause frequent vaginal bleeding during the first three months of insertion. Hormonal IUDs may cause headaches, mood swings, lower abdominal cramps, and vaginal bleeding in the first few months.
Barrier contraceptive methods
Both partner may use barrier contraceptives and they are available in various forms. The most common ones are condoms—male and female condoms.
Common male condoms are disposable latex condoms worn over an erect penis and prevent the sperm from reaching the vagina. It has an 82% success rate and is used once.
In contrast, the female condom is attached to the vagina to stop the entry of sperm beyond the vagina. In addition, spermicides (special chemicals that kill sperms) may be used with a female condom. Female condoms have a lower success rate of 79% compared to male condoms.
Side effects of condoms: Local irritation may manifest as redness, itching, or swelling on the penis or vagina.
What to consider when counseling patients for a contraceptive method
Patients may find the task of selecting a contraceptive method overwhelming. In addition, some health care providers may not have a checklist system that guides them during family planning counseling sessions.
Here are five things to remember when counseling a patient for a contraceptive:
- Convenience: Consider the patient’s lifestyle and determine if it will be suitable for them.
- Affordability: Recommend contraceptive methods that are affordable and fit the patient’s socio-economic status.
- Medical Conditions: Patients with co-existing medical conditions such as cardiovascular disorders are excluded from contraceptives- oral pills.
- Socio-cultural factors and personal beliefs such as religion.
- Reproductive health goals: A patient may choose to defer becoming pregnant for an extended period, so contraceptives that confer prolonged protection fit this goal.
Final Thoughts
Modern different contraceptive methods are crucial to putting a check on the high fertility rate in sub-Saharan countries because traditional contraceptive methods are not so effective in preventing pregnancy.
Common modern contraceptive methods like injections, implants, and pills have pros and cons. Health professionals are expected to communicate to patients clearly. Information provided to patients can help them select the suitable contraceptive method after counseling for proper family planning.
Dr. Christopher Oseh is an experienced primary care physician, health blogger, content marketing professional, and self-published author. He specializes in creating content for health care providers and health technology companies.
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