Contraception

Contraception

Below, you will find some basic information about reversible and irreversible methods of contraception. Emergency contraception is covered as well.

 

Why is contraception important?

Over half of women who get pregnant did not plan or want to have a baby at the time. If you don’t have sexual intercourse, you can avoid this situation. However, if you do choose to have sex, the correct use of contraception (birth control) will greatly reduce the risk of an unplanned pregnancy. Moreover, for some women with health issues, an unwanted pregnancy can have adverse effects on their overall health.

 

How should I choose?

There are several methods of contraception. Which method to choose needs to be discussed and some of the questions you need to ask yourselves are:

How effective is the method?

How much money will the method cost?

Will you and your partner be comfortable using the method? Is it convenient?

Does the method have any side-effects? Can it be dangerous for certain people?

Does the method provide any protection against sexually transmitted diseases?

 

How effective are birth control methods?

The effectiveness of birth control methods is critically important for reducing the risk of unintended pregnancy. Effectiveness can be measured during “perfect use,” when the method is used correctly and consistently as directed, or during “typical use,” which is how effective the method is during actual use (including inconsistent and incorrect use).

The best way to reduce the risk of unintended pregnancy among women who are sexually active is to use effective birth control correctly and consistently. Among reversible methods of birth control, intrauterine contraception and the contraceptive implant remain highly effective for years once correctly in place. The effectiveness of the contraceptive shot, pills, patch and ring, and barrier and fertility awareness-based methods, depends on correct and consistent use—so these methods have lower effectiveness with typical use.

For each method of birth control, effectiveness with typical use is provided below. We present this as the percent of women who experience an unintended pregnancy within the first year of typical use (also known as the failure rate).

 

Contraceptive methods

You can start by finding out about the methods of contraception you can choose from, including how they work, who can use them and possible side effects. These methods are:

 

Combined oral contraceptives

Also called “the pill,” combined oral contraceptives contain the hormones estrogen and progestin. We need to prescribe it to you. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, we would not recommend using this method. Typical use failure rate: 9%.

 

Female condom

Worn by the woman, the female condom helps keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It can be inserted up to eight hours before sexual intercourse. Typical use failure rate: 21%, and also may help prevent STDs.

 

Male condom

Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy, and HIV and other STDs, as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not provide protection against STDs, including HIV. Typical use failure rate: 18%.

Condoms can only be used once. You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break.

 

Contraceptive implant

The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. Typical use failure rate: 0.05%.

 

Contraceptive injection or “shot”

Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. Typical use failure rate: 6%.

 

Contraceptive patch

This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is available with prescription. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. Typical use failure rate: 9%, but may be higher in women who weigh more than 198 pounds.

 

Diaphragms or cervical caps

Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. Before first use, we have to discuss in order to choose the size that fits you and train you properly in placing it. Typical use failure rate: 12%.

 

Copper T intrauterine device (IUD)

This IUD is a small device that is shaped in the form of a “T” that contains copper. We will place it, through your vagina, inside the uterus to prevent pregnancy. It can stay in your uterus for up to 5 years. Typical use failure rate: 0.8%.

 

Levonorgestrel intrauterine system (LNG IUS)

The LNG IUS is a small T-shaped device like the Copper T IUD. We will place it through your vagina inside the uterus. It releases a small amount of progestin each day to keep you from getting pregnant. The LNG IUD stays in your uterus for up to 5 years. Typical use failure rate: 0.2%.

 

Natural family planning (NFP)

There are three main types of NFP: the symptoms-based methods, the calendar-based methods and the breastfeeding or lactational amenorrhea method (LAM). Symptoms-based methods rely on biological signs of fertility, while calendar-based methods estimate the likelihood of fertility based on the length of past menstrual cycles.The lactational amenorrhea method (LAM) is a method of avoiding pregnancy based on the natural postpartum infertility that occurs when a woman is amenorrheic and fully breastfeeding. Typical use failure rate: 25.3%

 

Progestin only pill

Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It may be a good option for women who can’t take estrogen. Typical use failure rate: 9%.

 

Spermicides

These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. They can be purchased at drug stores. Typical use failure rate: 28%.

 

Hormonal vaginal contraceptive ring

The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. Typical use failure rate: 9%.

 

There are two permanent methods of contraception:

Female Sterilization

Tubal ligation or “tying tubes”— A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately.

 

Transcervical Sterilization— A thin tube is used to thread a tiny device into each fallopian tube. It irritates the fallopian tubes and causes scar tissue to grow and permanently plug the tubes. It can take about three months for the scar tissue to grow, so use another form of birth control during this time. Return to your doctor for a test to see if scar tissue has fully blocked your fallopian tubes. The method has a typical use failure rate of less than 1%.

 

Male Sterilization

Vasectomy—This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero. The method has a typical use failure rate of less than 1%.

 

Emergency contraception

Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke. There are two methods for emergency contraception: the coil and the ‘morning- after’ pill.

Women can have the Copper T IUD (coil) inserted within five days of unprotected sex as a method of emergency contraception.Less than 1% of women who use the IUD get pregnant.

Women can also take emergency contraceptive pill(s) up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. There are three different types of emergency contraceptive pills available in Greece (Norlevo, Postinor, ellaOne). The first two pills can prevent 95% of expected pregnancies when taken within 24 hours of sex. The latter can be used up to five days after unprotected intercourse.

In any case, we recommend getting in contact with us to discuss about your emergency contraception choices and plan together how things should be managed.

 

Deciding which method suits you

Which method works best for you depends on a number of factors, including your age, whether you smoke, your medical and family history and any medication you’re taking.

 

Things to consider when choosing contraception

  • Age, health, lifestyle, side effects
  • How effective is contraception at preventing pregnancy?
  • Is the method reversible?
  • Are the side effects tolerable?
  • Are you in a monogamous realtionship?
  • How much does it cost?

 

Methods that may help heavy or painful periods

  • Combined pill
  • Patch
  • IUS (intrauterine system)
  • Vaginal ring

 

Methods you need to think about every day

  • Combined pill
  • Progestogen-only pill
  • Natural family planning (fertility awareness)

 

Methods you need to think about every time you have sex

  • Condoms
  • Female condoms
  • Diaphragm
  • Cap

 

Methods that protect against STIs

  • Condoms
  • Female condoms

 

Methods that last months or years

  • IUD (intrauterine device, coil)
  • IUS (intrauterine system)
  • Implant
  • Injection

 

Permanent methods

  • Female sterilisation
  • Vasectomy (male sterilisation)

 

Below, you can find a table to compare contraceptive methods at a glance

Method

Reversible

Discreet

Protects against STIs

Doesn’t contain estrogen

Doesn’t need prescription

EXTREMELY EFFECTIVE

Abstinence

X

X

X

X

IUC

X

X

X**

Female sterilization

X

X

Implant

X

X

X

Vasectomy

X

X

VERY EFFECTIVE

CHC (patch/pill/ring)

X

X†

Progestin-only pill/injection

X

X

X

LAM†

X

X

X

X

EFFECTIVE

Diaphragm

X

X

Condom (female/male)

X

X

X

X

Withdrawal

X

X

X

MODERATELY EFFECTIVE

Cervical cap

X

X

EC

X

X

††

†

Rhythm/ calendar method

X

X

X

Spermicides

X

X

X

Sponge

X

X

X

 *For Copper T IUD only †For pill only ††Depends on type

The following abbreviations are used throughout this document:

  • CHCs – combined hormonal contraceptives

  • EC – emergency contraception

  • IUC – intrauterine contraception

  • LAM – lactational amenorrhea method

  • STI – sexually transmitted infection (assumed to include HIV)

 

As deciding about which of these options to choose can be difficult for you, we would be more than happy to discuss everyhting in depth together, in order to make sure that you have chosen the method best suited for you.