Sex

The contraception controversy: The pros and cons of every available form

Contraception options abound - but questions surrounding their safety have raised alarm bells. Professor Kerryn Phelps weighs up the pros and cons of each of the different options available.

By The Australian Women's Weekly staff

Recent birth control controversies have prompted fresh discussions around safety. In Canada and the US lawsuits were filed against the Mirena IUD, with women alleging they weren't properly warned about dangerous side effects.

The legal battles continue. Meanwhile, a Danish study reported a link between hormone-based birth control and increased breast cancer risk. Decisions about contraception usually come down to convenience and reliability balanced against potential risks, including protection from sexually transmitted infections (STIs).

Here's a brief guide to a range of contraceptives. Always consult with your doctor before reaching a final decision.

Combined oestrogenprogesterone oral contraceptive pill (OCP)

What is it? Hormones to stop ovulation.
Reliability: 95-99%.
Advantages: Convenient. Regulates cycle. May improve acne and reduce period pain.
Disadvantages: No protection against STIs. May reduce libido. May cause depressed mood.
Risks and precautions: Increased risk of blood clots. Possible increased risk of breast cancer.

Copper intrauterine device

What is it? A plastic/copper device inserted into the uterus.
Reliability: 99%.
Advantages: Hormone-free. Insert-and-forget convenience. Works for five or 10 years. Easily removed.
Disadvantages: No protection against STIs. Must be inserted by a doctor.
Risks and precautions: May increase period pain or heaviness of periods. Small risk of pelvic infection.

Mirena IUD

What is it? A plastic device containing progesterone.
Reliability: 99%.
Advantages: Insert-and-forget convenience. Lasts five years. No need for daily pill. Lightens periods.
Disadvantages: No STI protection. Must be inserted by a doctor, occasionally under anaesthetic.
Risks and precautions: May cause irregular periods. Side effects may include headache, acne, weight gain, mood change and bloating.

Progesterone-only “Mini-Pill”

What is it? An oral contraceptive pill.
Reliability: 91-99%.
Advantages: Effective. May suit women who can't take OCP.
Disadvantages: Must be taken at same time daily. No protection against STIs. Irregular periods.
Risks and precautions: May cause headache, acne, weight gain, mood change and bloating. May not work if you miss a pill.

Condoms

What is it? A rubber sheath over the penis before vaginal contact.
Reliability: 98% if used correctly every time.
Advantages: Protects against STIs. No medication side effects. Easily available.
Disadvantages: May slip off or break.
Risks and precautions: Some people allergic to latex (latex-free versions are available).

Withdrawal (Coitus Unterruptus)

What is it? A sexual technique of removing the penis from the vagina before ejaculation.
Reliability: 73-96% depending on technique.
Advantages: Free. Convenient. No medication side effects.
Disadvantages: No protection against STIs. Relies on excellent timing and control.
Risks and precautions: Higher risk of pregnancy than other methods.

Tubal ligation

What is it? Fallopian tubes which carry egg to the uterus are cut and tied.
Reliability: Almost 100%.
Advantages: Permanent female contraception.
Disadvantages: No protection against STIs. May not be reversible if you change your mind.
Risks and precautions: Requires laparoscopic surgery. Future pregnancy may require surgery or IVF.

Hormone depot injection

What is it? Progesterone injection lasting 12 weeks.
Reliability: 94-99% if renewed in time.
Advantages: Lasts three months.
Disadvantages: Can't be removed if side effects. Must be repeated each three months. No protection from STIs. Periods and fertility may take months to return to normal.
Risks and precautions: Irregular bleeding common. Long-term use may reduce bone density.

Vaginal ring (Nuvaring)

What is it? Small ring containing oestrogen and progesterone, inserted into vagina. Removed during periods and replaced.
Reliability: Around 91%.
Advantages: Lower hormone dose than contraceptive pills.
Disadvantages: No STI protection. Must be removed, replaced and correctly positioned.
Risks and precautions: Increased blood clot risk. May cause headache, nausea and weight gain.

Diaphragm

What is it? A cup-shaped silicone device that is a form of barrier contraception. Inserted into the vagina before intercourse to prevent sperm entering uterus. Needs to remain in place at least six hours after sex.
Reliability: 85-95%.
Advantages: Few side effects.
Disadvantages: No protection against STIs. Not spontaneous.
Risks and precautions: Must be used with a spermicide. Rubber allergy is possible.

Emergency contraception (Morning After Pill)

What is it? Single dose of hormones ideally within 24 hours of (but up to four days after) unprotected sex.
Reliability: 85%.
Advantages: Available without prescription.
Disadvantages: Not for "regular" contraception. No protection from STIs.
Risks and precautions: Possible side effects are nausea and breast tenderness.

Vasectomy

What is it? A surgical procedure which cuts the tubes that carry sperm from the testes.
Reliability: 99.9%.
Advantages: Permanent male contraception. Woman has no risk of side effects.
Disadvantages: No protection against STIs. May not be reversible if you change your mind. Consider storing sperm in case of a later change of mind.
Risks and precautions: Sperm count may take several months to drop to zero.

Hormone implant (Implanon)

What is it? Plastic rod containing progesterone, surgically inserted into the upper arm. Lasts three years.
Reliability: Over 99%
Advantages: Insert-and-forget convenience. Relieves period pain.
Disadvantages: No STI protection. Must be surgically removed. May get spotting.
risks and precautions: pain and bruising at insertion site. Possible headaches, acne, weight gain and breast tenderness.

Ovulation method

What is it? Avoiding sex when you are likely to be fertile.
Reliability: 75-99% depending on accuracy and commitment to monitoring.
Advantages: Avoids side effects of medication.
Disadvantages: Unreliable if cycle is irregular. Can be difficult to accurately predict ovulation. No STI protection.
Risks and precautions: Relies on close monitoring of cycle and predictable ovulation.

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