A birth control pill is a common form of contraception for women, but it can have serious side effects. Alternatives to the birth control pill are available and some people may be better suited to them than others. In this blog post, we will explore these alternatives and talk about their pros and cons. 

What are birth control pills?

Pills are the hormonal methods of contraception. They either prevent ovulation or prevent an embryo from being fertilized. They are of two types:

1. Combination pills -  Estrogen + Progestin
2. Progestin-only pills – They are more suitable for women who cannot take estrogen-containing products due to some health issues like blood coagulation disorders, pancreatitis, stroke, breast cancer, ovarian cancer, etc. 

How quickly do they act?

Progestin-only pills take 48 hours to be effective, whereas combination pills can take a minimum of 7 days. 

Note: The above does not apply to emergency contraception, which should be taken as soon as possible after unprotected sex, but generally is 75- 85% effective if taken within 72 hours of unprotected sex.

A major reason why people look for alternatives to their current birth control pill is due to their adverse effects which include:

Nausea                                                           Vomiting

Tender breasts                                               Headaches

Spotting                                                         Emotional fluctuations 

Missed periods                                              Decreased libido

Weight gain

Birth control needs to be weighed in terms of their benefit to risk ratio which is based upon your health history. Your doctor or pharmacist can help you with choosing the right pill for yourself or other methods, whatever the case may be.

Now the question arises if not pills then what? Well, the answer to this can be uncovered by discussing all methods of birth control that are available:

HORMONAL METHODS 

INTRAUTERINE DEVICES

IUDs are small T-shaped devices that are inserted through the vagina into the uterus by a doctor. It can remain inserted for up to 3-10 years but can be easily removed by a doctor anytime. IUDs are the most effective long-acting reversible method of birth control at 99% effectiveness.

They are available in two types:    

1. Copper IUDs – prevent pregnancy by stopping sperm from fertilizing the egg and reducing sperm mobility.
2. Hormonal IUDs – also known as Progestin IUDs prevent pregnancy by thickening the cervical fluid to block the sperm from entering the uterus. 

Advantages:

• Most effective reversible birth control method.
• Nothing to remember on a regular basis as the IUD stays in place.
• Once removed, can become pregnant very quickly. 
• Cost-effective.
• Easy to remove by the doctor.

Disadvantages:

• Need an expert to perform the procedure and that depends upon the availability in your area
• Requires pelvic examination
• No protection against STIs (sexually transmitted infections)
• In rare circumstances, IUDs may perforate the uterine lining, causing pain and requiring medical attention 
• IUDs can make periods longer, heavier and less comfortable

Seek medical attention if there is: 

• Abnormal blood spotting
• Abdominal pain
• Abnormal discharge
• Fever or chills
• Strings of IUD missing or seem longer than usual

BIRTH CONTROL INJECTION (Depo Medroxyprogesterone acetate, Depo Provera)

This is a long-acting injectable birth control containing progestin. They act by thickening the cervical fluid, preventing sperm from reaching the egg. These products require repeat injections every 3 months.

Advantages:

• Lighter or no periods.
• Improved menstrual symptoms like cramps.
• Only need to remember to get the shot after every 3 months.
• Can also treat and decrease pain associated with endometriosis.

Disadvantages:

• During the first year of use, uterine bleeding is common.
• There could be weight gain, headache, breast tenderness or mood changes.
• Delay in return to fertility after the stoppage of taking the shot.
• No protection against STIs.

Seek medical attention-

• If you suspect  you are pregnant
• Heavy bleeding
• Severe lower abdominal pain
• Depression

VAGINAL RING 

The vaginal ring is a clear, flexible, thin, plastic ring that is placed inside the vagina where it releases estrogen and Progestin in low amounts. It acts by thickening cervical fluid and stopping the release of an egg. It is 93% effective with typical use. The ring has to be removed once every month to allow for withdrawal bleeding. The ring is kept in place for a continuous period of 3 weeks and removed for a week.

Advantages:

• Reduced period cramping
• Decreased symptoms of premenstrual syndrome(PMS) or perimenopause
• Easy to stop using
• Many protect against osteoporosis

Disadvantages:

• Must remember to remove and replace the ring once a month.
• Spotting, nausea, breast tenderness, headache or dizziness may be experienced by few women.
• No protection against STIs.
• Possibility of high blood pressure.
• Risks increase with age and smoking.

SKIN PATCH

Skin Patches are patches containing estrogen and progestin that is worn over the arm or buttocks. They allow the release of hormones that directly enter the bloodstream. The patch must be replaced weekly. They act by inhibiting ovulation and are effective after one week of use.

Advantages:

• Lighter periods.
• Less period cramping.
• Decreased symptoms of premenstrual syndrome(PMS) or perimenopause.
• Can be used to skip or shorten periods.
• Less anemia.
• Easy to stop using.
• Decreased risk of ovarian and uterine cancer.
• Many protect against osteoporosis.
• Less acne.
• Sexual pleasure may increase.

Disadvantages:

• Need to remember to change the patch every week.
• Spotting, nausea, breast tenderness, headache or dizziness may be experienced by some users.
• Possibility of high blood pressure.
• Risks increase with age and smoking.

IMPLANT

Implants are a device that is inserted just under the skin of your upper arm. It can stay up to 3 years and can be removed anytime by the healthcare provider. It contains the hormone progestin and prevents pregnancy by stopping ovulation (releasing of egg) and also thickens the cervical mucus to prevent sperm from reaching the uterus. It is considered one of the most effective reversible methods of birth control.

Advantages:

• No need to remember to do anything as the implant stays in place.
• Alternative for people who cannot use estrogen.
• Improves premenstrual syndrome symptoms.
• Less period cramping.
• Lighter periods.
• Once removed its side effects go away immediately.

Disadvantages:

• Need a primary care provider to place the implant.
• Spotting, prolonged bleeding may be experienced by few – may improve over time.
• No protection against STIs.
• Must be removed by a qualified healthcare provider.
• Rare but manageable complications may include infection at the site of implant.

NON-HORMONAL METHODS

CONDOMS

Condoms work by restricting the entry of sperm into the vagina. They also help in reducing STIs. Being widely and easily available, they are found to be the preferred choice of contraception among younger generations. Condoms are available for both male and female usage.

Advantages:

• Widely available.
• No prescription required.
• No hormones involved.
• Minimal to no side effects.
• Often low cost or free.
• Protects against pregnancy as well as sexually transmitted infections.
• Can delay ejaculation and prolong intercourse if that is desired.
• Can be easily carried and used.

Disadvantages:

• Not as effective as preventing pregnancy as other birth control options.
• Latex condoms may cause irritation.
• May slip off or tear if improperly or incorrectly used.
• May reduce sensitivity during intercourse or erection problems for some.
• Relies on commitment and cooperation between both the partners.
• Female condoms can be hard to find.

FERTILITY AWARENESS METHOD (FAM) (OR NATURAL FAMILY PLANNING)

If a woman has a regular menstrual cycle and is able to accurately track this, she can make a choice of not having sex during her fertility period in order to avoid pregnancy. FAM may predict the fertile window by using a calendar or counting days from previous menstrual periods or identify by observing symptoms and signs of ovulation or using a combnation of both approaches.

An egg is usually released once each menstrual cycle and lives up to 12-24 hours. Sperm can live up to 6 days in the uterus, during which it can fertilize the egg. This means that a female can get pregnant as long as 6 days before ovulation and 2-3days after ovulation i.e. a total of 8-9 days in each menstrual cycle. The most effective way to use FAM is to abstain from vaginal intercourse during the fertile window.

There are a number of different methods that fall under this:

1. Calendar method

2. Cervical mucus method

3. Basal body temperature method

4. Symptothermal method

5. Fertility monitors

Advantages:

• Free to low cost.
• No medical side effects.

Disadvantages:

• High failure rate.
• Requires commitment from both the partners.
• Decreases spontaneous intercourse.
• No protection against STIs.
• Effectiveness can be impacted by circumstances like irregular periods, sleep issues, changes in discharge, changes in ovulation, aging, stress.
• Cannot be relied on immediately – require several months of use before relying on it.

PERMANENT 

STERILIZATION

There are two types of sterilization methods: VASECTOMY (in males) OR TUBAL LIGATION(in females). 

Vasectomy- the tube carrying sperms (Vas deferens) is ligated, cut or cauterized, preventing sperms from being released during ejaculation. It is 99.85% effective but takes a while. Follow-up visits up to 3 months are required before it is considered safe to rely on as birth control. A backup method of contraception is always needed until ejaculate is free of sperms.

Tubal ligation- the fallopian tubes are cut, clamped, cauterized or tied, preventing the egg from travelling down where it could meet sperm. It is 99.5% effective immediately after the operation.

Advantages:

• Highly effective.
• No future clinic visits are required once it is effective.
• Permanent method.
• 40% reduction in ovarian cancer with Tubal ligation.
• Quick recovery in case of Vasectomy.

Disadvantages:

• Not a reversible method.
• No protection against STIs.
• Tubal ligation requires a surgical procedure which carries more risk than a vasectomy.
• High risk of Ectopic pregnancy if Tubal ligation fails.
• Recovery time needed after the procedure.

Although both are safe, Vasectomy is usually recommended over Tubal ligation as fewer risks are involved.

CONCLUSION

Your choice of contraception depends mainly upon you and your health condition. Whatever the choice may be, it should be thoroughly discussed with your doctor that can help you plan your pregnancies as well as guide you regarding sexual health. 

 

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