Sexual health is something that isn’t routinely discussed at the dinner table or in school, and this leaves a lot of us not really grasping the reality that having our first menstruation is the signal our bodies give us that we are already able to get pregnant and bear children. It’s true: your first menstrual period means your ovaries have gotten the internal signal to mature an egg cell and release it to meet a sperm cell, and the absence of fertilization leads your uterus to shed the warm fuzzy endometrium that was ready to receive an embryo. That shedding of your endometrium is what’s known as menstruation.
It follows, then, that everyone who can menstruate can also have the opportunity to decide if and when she wants to get pregnant. Leaving it up to chance can be risky and may result in unplanned pregnancies. Aside from the health risks associated with pregnancy, the rising cost of hospitalization and childcare may also be deterrents to having children at an early age. Since we are on the topic of choice and deciding when to get pregnant, let’s talk about birth control.
Simply put, contraception or birth control is the practice of preventing pregnancy from happening. It isn’t the same as inducing abortion, which removes a pregnancy that has already formed, but instead focuses on blocking either ovulation, fertilization, or implantation to prevent a pregnancy.
Natural family planning
There are two general categories of contraception - natural and artificial. Natural family planning, also known as fertility awareness methods (FAM) make use of the body’s built-in signals that a woman is already fertile to identify when not to have unprotected sex, preventing the possibility of fertilization. Conversely, FAM may be used by couples trying to get pregnant by creating an awareness of when they will likely be fertile.
The three most popular are the calendar method, the cervical mucus method, and the basal body temperature (BBT) method.
Calendar method
In the calendar method, the longest and the shortest cycles over the past six months are noted, and 11 and 18 are subtracted from them, respectively. The two numbers that result signify “unsafe” days, or those days when pregnancy is possible with unprotected sex. For example, in a woman with 28-34-day intervals, unprotected intercourse should be avoided between days 10 (28-18) and 23 (34-11). However, the calendar method is best used only for women with regular 24-35-day cycles since cycles that are too short or too long can mean inconsistent ovulation.
Cervical mucus method
The Billings cervical mucus method looks at the characteristics of cervical mucus collected before urinating. Feeling “wet” and having cervical mucus that is clear and stretches between your fingers (kind of like egg whites) indicates fertile days, while feeling “dry” and having clumpy non-stretchy mucus indicates non-fertile days. Women who have active reproductive tract infections are not good candidates for this method since their discharge can interfere with the collection of cervical mucus.
Basal body temperature (BBT Method)
The BBT method involves checking one’s temperature daily and noting when a 0.2-0.5 degree Celsius increase happens, which signals ovulation. Women who have ongoing infections and thyroid issues are not good candidates for this method as their health conditions will likely be the cause of their temperature rises. There are several more FAM (read more here) and are recommended to be used in conjunction with each other. The typical use failure rate of FAM is 24%, which is significantly higher than artificial methods 1.
Artificial family planning
Artificial family planning involves hormonal and non-hormonal methods of preventing pregnancy. Non-hormonal contraceptive methods include condoms and other barrier methods, as well as the copper intrauterine device (IUD).
Condoms
Condoms are the most widely available contraceptives and have the added benefit of protecting users from sexually transmitted infections. Condoms are usually made up of latex (and now come in a variety of flavors) and are applied onto the erect male penis, acting as a contraceptive by physically preventing sperm cells from coming into contact with any part of the female tract. Typical use of condoms have an up to 15% failure rate, which may owe to the possibility of condom breakage or improper application 2. Other barrier methods include the female condom and the diaphragm, but both are not marketed commercially in the Philippines.
Copper IUD
The copper IUD is a non-hormonal method that involves inserting a small T-shaped device into the uterus through the vagina, acting as a contraceptive mainly through the action of its copper content, which renders the endometrium unsuitable for implantation and also has some spermicidal effect. Typical use of the copper IUD has a 0.8% failure rate and is one of the most effective long-acting reversible contraceptives (LARC). However, the copper IUD is not recommended for women with allergic reactions to copper and who have active genital tract infections.
Hormonal contraceptives
Hormonal contraceptives may contain only progestin or a combination of a progestin and estrogen. Progestin-only contraceptives may be in the form of the Levonorgestrel intrauterine system (LNG-IUS), the contraceptive implant, injectables, or oral contraceptives (POP). These work through the action of progestin, which primarily thickens the cervical mucus enough to prevent sperms from passing through, and also decreases fallopian tube movement and prevents the endometrium from growing.
For the LNG-IUS, the implant and the injectables, their dosages may be enough to prevent ovulation and, therefore, menstruation, as well. These are some of the safest and most effective contraceptives, with the implant having a typical use failure rate of 0.05%, the LNG-IUS at 0.2%, the injectable at 3%, and the POP at 8% 2.
Levonorgestrel intrauterine system (LNG-IUS)
Similar to the copper IUD, the LNG-IUS is a T-shaped device that is inserted into the uterus transvaginally and emits its hormonal effects locally. It is not advised for women who have active genital tract infections.
Implant
The implant is a matchstick-sized silicone rod inserted underneath the skin of the inner upper arm.
Injectable
The injectable is typically injected into the deltoid muscle, and is usually not recommended in women predisposed to migraines, nor to be used for more than 2 years consecutively due to risk of osteoporosis.
Progestogen-only pill (POP)
The POP is taken orally once a day and the same time everyday. In addition to their contraceptive effects, progestin-only contraceptives may be used in the treatment of conditions like endometriosis and adenomyosis and endometrial cancer and its precursor conditions 2.
Combined oral contraceptive (COC)
The COCs comprise a group of contraceptives made up of both estrogen and progestin components. These work by shutting off the body’s normal signaling for egg maturation and ovulation. Since their formulations involve having days with no intake of hormones (pill-free days or spacer tablet days), menses are expected to be present and are typically regular. They are a mainstay in the management of menstrual irregularities, chronic dysmenorrhea, premenstrual dysphoric disorder (PMDD), and polycystic ovarian syndrome (PCOS). These combined oral contraceptives have a typical use failure rate of about 3% and are contraindicated in women who are obese and at risk of developing blood clots and breast cancer 2.
In summary
The choice of which birth control method to use relies heavily on your current health status and your personal preferences. The best way to find out which method might be the best for you is to consult with a gynecologist who can evaluate you based on your medical, family, and personal history, and can recommend and prescribe the best mode of contraception for you.
Kindred offers consultations with knowledgeable OB-GYNs who can recommend contraceptives based on your medical, personal, and family history, and provides access to several different contraceptives. Schedule a consult with us to know more about which contraceptive would be best suited for you.
REFERENCES:
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Sung S, Abramovitz A. Updated 2023 Jul 24. Natural Family Planning. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546661/
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K Rivlin and C Westhoff. 2017. Family planning. In Comprehensive Gynecology. 7th Ed. Philadelphia: Elsevier. pp237-257.