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Contraceptives – Methods and Overview

Contraceptives are methods or substances used to prevent unwanted pregnancy. They include hormonal, barrier, and chemical approaches.

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Things worth knowing about "Contraceptives"

Contraceptives are methods or substances used to prevent unwanted pregnancy. They include hormonal, barrier, and chemical approaches.

What Are Contraceptives?

Contraceptives are methods, substances, or devices used to prevent pregnancy. They are intended for sexually active individuals who wish to avoid conception. The choice of contraceptive method depends on individual factors such as health status, lifestyle, and personal preferences. A healthcare provider can help identify the most suitable option.

Types of Contraceptives

Hormonal Contraceptives

Hormonal contraceptives contain synthetic hormones – typically a combination of oestrogen and progestogen, or progestogen alone – and work by interfering with the female reproductive cycle. Common forms include:

Combined oral contraceptive pill: A daily tablet containing oestrogen and progestogen.
Progestogen-only pill (mini-pill): Particularly suitable for breastfeeding women.
Contraceptive patch: A skin patch that releases hormones through the skin.
Contraceptive injection: A progestogen injection administered every 8 to 12 weeks.
Hormonal intrauterine system (IUS): A small device inserted into the uterus that continuously releases progestogen.
Contraceptive implant: A small plastic rod inserted under the skin of the upper arm that releases progestogen.
Vaginal ring: A flexible ring inserted into the vagina that releases hormones.

Barrier Contraceptives

These methods physically prevent sperm from reaching the egg:

Condom (male and female): The only contraceptive that also protects against sexually transmitted infections (STIs).
Diaphragm: A rubber cap inserted into the vagina before intercourse.
Copper intrauterine device (IUD): A small copper-containing device inserted into the uterus that inhibits sperm.

Chemical Contraceptives

Spermicides are substances available as creams, gels, or suppositories that immobilise or destroy sperm. They are most effective when used in combination with barrier methods.

Emergency Contraception

The morning-after pill (e.g., levonorgestrel or ulipristal acetate) is an emergency measure taken after unprotected intercourse. It should be taken as soon as possible, ideally within 72 hours and at most within 120 hours. It is not intended for regular use as a contraceptive method.

Surgical / Permanent Methods

For individuals who no longer wish to have children, surgical options are available:

Tubal ligation: Blocking or cutting the fallopian tubes in women.
Vasectomy: Cutting the vas deferens in men.

Mechanism of Action of Hormonal Contraceptives

Hormonal contraceptives work through several mechanisms:

Suppression of ovulation
Thickening of the cervical mucus, preventing sperm from entering the uterus
Alteration of the uterine lining (endometrium), making implantation of a fertilised egg less likely

Efficacy and the Pearl Index

The reliability of contraceptive methods is measured using the Pearl Index. It indicates how many out of 100 women become pregnant within one year of using a given method. A lower Pearl Index indicates higher efficacy:

Hormonal IUS and implant: Pearl Index < 0.1 (very high reliability)
Combined pill (when taken correctly): Pearl Index 0.1–0.9
Condom: Pearl Index approx. 2–12 (highly dependent on correct use)
Diaphragm: Pearl Index approx. 1–20

Side Effects and Risks

Hormonal contraceptives may cause side effects. Commonly reported ones include:

Changes in menstrual bleeding pattern
Mood changes
Headaches
Weight changes
Increased risk of thrombosis (blood clots) with certain combined preparations
Rarely: increased risk of heart attack or stroke, particularly in smokers over the age of 35

Contraindications to hormonal contraceptives include a personal history of thrombosis, certain cardiac conditions, high blood pressure, or migraine with aura.

When to Seek Medical Advice

A medical consultation is recommended before starting hormonal contraceptives. This is especially important for individuals with pre-existing health conditions, those taking other medications, or those returning to contraceptive use after a prolonged break. Medical advice should also be sought if side effects occur or if a change of method is desired.

References

World Health Organization (WHO): Medical Eligibility Criteria for Contraceptive Use, 5th edition, 2015. Available at: https://www.who.int/publications/i/item/9789241549158
Faculty of Sexual and Reproductive Healthcare (FSRH): FSRH Clinical Guidelines on Contraception, 2023. Available at: https://www.fsrh.org/standards-and-guidance/
Glasier A.: Contraception. In: Harrison's Principles of Internal Medicine, 21st edition. McGraw-Hill Education, 2022.

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