I remember the first time I bought groceries for myself. My fresh-faced 18-year-old self, standing in the middle of Woolworths with a sea of pasta sauces before me. Did I want the classic Napoletana or the generic red jar of unspecified ‘pasta sauce’. Who knew there were so many versions of the Exact Same Thing at so many different prices. I was stuck there for 10 minutes, frozen by indecision.
It might seem like a strange analogy to make, but my pasta aisle conundrum felt all too similar to my experience with contraception. Too many options, too many decisions, and no idea how to make sense of it all.
I started on the Pill at 16. At the time, it felt like the only way to take ownership of my health (and, well, prevent an unwanted pregnancy). I then spent the next three years ping-ponging my way through every brand name my GP could prescribe. I went from one pill to the next, before circling back again and ending up where I began. The names might as well have been ex-lovers for all I cared. None of them were right for me.
Like so many women, I struggled to find a version of the Pill that ticked my boxes. Some made me bloated, others made me sad, and none of them fixed my acne. So, what are our choices when we can’t find a version of The Pill that suits us?
Why isn’t the Pill right for everyone?
Since hitting Australia’s pharmacy shelves in 1961, the Pill has reigned supreme as the most popular form of contraception in the country. But like any form of medication, the oral contraceptive Pill has side effects. The degree and severity of these are different from person to person, which means everyone’s experience with the Pill will be unique.
However, there are some patterns that do emerge. Some of the common side effects of the Pill can include:
- Bleeds between periods
- Sore or tender breasts
- Mood changes
- Reduced libido
- Delay in return to regular periods
In rare cases, there is also a very small increase in your risk of deep vein thrombosis (a.k.a. blood clots), heart attacks, strokes and cervical cancer. And when it comes to the notion that the Pill causes low mood, a recent Danish study has revealed women taking the Pill were 1.23x more likely to be diagnosed with depression. However, there is no clear evidence to suggest the Pill directly causes depression.
But shouldering the burden of these side effects doesn’t need to go hand-in-hand with having control of our fertility. In fact, between 2008 and 2015, usage of the Pill among women 18 to 49-years-old has dropped by 4.5%. The reasons for this shift are varied and numerous but stem from a rise of alternate contraception options coupled with a desire to manage fertility on our own terms.
As such, The Pill might not be right for those who:
- Suffer from certain types of headaches or migraines.
- Have a family history of deep vein thrombosis.
- Are on certain types of medications that could reduce the effectiveness of the Pill.
- Have health conditions (like high blood pressure, heart or liver disease).
- Have been treated for breast cancer,
What other forms of hormone-based contraceptives exist?
Although the oral contraceptive Pill might seem like the only form of hormone-based contraception, there are more choices than most of us realise.
- The patch: a small, square bandaid-like path that is placed on the skin and releases estrogen and progestin into the body. To maximise its effectiveness, the patch must be changed weekly.
- The ring: a malleable plastic ring that is placed inside the vagina, typically two inches in diametre. Once inside, the ring releases hormones that are absorbed into the vaginal lining. For the best results, the ring must be replaced every month.
- The contraceptive injection (Depo-Provera and Depo-Ralovera): this hormone injection helps to prevent pregnancy using depot medroxyprogesterone acetate (DMPA), a hormone similar to progesterone. These injections slowly release DMPA into the body to stop your ovaries from releasing an egg. To ensure full protection, you must receive an injection every 12 weeks.
- Mirena IUD: the Mirena IUD is a T-shaped plastic frame that is placed inside the uterus by a doctor or nurse. The Mirena disperses a type of hormone called progestin and thickens the mucus in the cervix to prevent sperm from fertalising an egg. In Australia, a Mirena IUD will last five years.
- Implanon: this small, flexible rod (similar to the size of a match stick) is inserted under the skin of the upper arm and slowly releases a progestogen hormone called etonogestrel into the body. This implant can help prevent pregnancy for up to 3 years.
Remember: no matter what method of hormonal birth control you use, none of them will protect you against sexually transmitted infections (STIs). Make sure to use practice safe sex with your partner by using a condom during intercourse (because there’s nothing sexy about an STI).
Are there other types of contraception I can use?
Aside from hormone-based contraception methods, there are a number of different options that can prevent unwanted pregnancy. These include:
- Barrier contraception, such as condoms, diaphragms, and caps: these work to physically stop sperm from reaching and fertilising an egg while also protect against STIs being passed between sexual partners.
- Emergency contraception: to protect against pregnancy following unprotected sex (or as a back-up plan when another form of contraception fails), you can turn to emergency contraception such as:
- The ‘morning after’ pill which works anywhere between 24 hours up to 5 days after unprotected sex.
- Copper intrauterine contraceptive device (Cu-IUD): this device can be a way to prevent 99% of pregnancies if fitted by a healthcare professional within 5 days of having unprotected sex.
- Natural family planning or fertility awareness methods: this means keeping track of the signs of when a woman is most fertile during her menstrual cycle. This involves paying attention to natural signs like cervical fluid and body temperature and can sometimes involve using fertility tracking apps. However, this method of contraception has much lower rates of effectiveness in comparison with all other methods.
What is the most effective type of contraception?
Every woman is different, which means there’s no one-size-fits-all approach to contraception. For some, remembering to take a pill at the same time each day will be a breeze. For others, opting for barrier contraception might be more suited to their needs and lifestyle. And when it comes to effectiveness, it’s important to weigh up the pros and cons of each option.
Contraception is most effective when taken correctly. But regardless of which option you choose, no form of contraception is 100% effective. As a general rule, progestogen IUDs (99.8%) and contraceptive skin implants such as the rod (99.95%) are statistically the most effective at preventing pregnancy.
And this tends to be due to their ‘set and forget’ design, which takes the guesswork out of contraception. There are no daily pill doses or packets of condoms to pick up from the shops, which can help increase the effectiveness of these options. For many women, this level of convenience makes these an attractive method of contraception.
For me, the mood swings and side effects of the Pill didn’t suit me. So I’ve found other options that work better. However, it’s important to speak with a GP to consider unique circumstances when deciding on the most effective contraception for your situation. Each option has a range of side effects to bear in mind, so make sure to do your research before deciding on the best method for you.