The most suitable method of contraception will be based on each person's individual circumstances, which may also change over the course of a lifetime.

Here is a brief overview of the most common methods of contraception, including the advantages and disadvantages of each method and its effectiveness.

An independent method of evaluation known as the "Pearl Index" measures the effectiveness of each birth control method. The lower the index, the more reliable the contraceptive.


Contraception

COMBINED HORMONAL CONTRACEPTIVES


In the developed world the most common method used to prevent pregnancy from occurring is "the pill". All combination pills contain two hormones, oestrogen and progestogen. In new combination contraceptives, the classic oestrogen (ethinylestradiol) has been replaced by a more natural form of oestrogen.

Combined hormonal contraceptives are not only available as a pill, but also come in the form of a contraceptive ring (vaginal ring) or a contraceptive patch.

Combined hormonal contraceptive methods may not be suitable for all women. For example, the pill may not be suitable for women who suffer from any of the following conditions: high blood pressure, s/p thromboembolism, s/p deep vein thrombosis, migraines with focal neurological symptoms, known thrombophilia, lipid metabolism disorders or liver disease. It is also not the most suitable method for smokers over the age of 35, for anyone who will be immobile for an extended period of time such as being on bed rest after a serious operation and should not be used while breastfeeding.

When used correctly, this method of birth control can be very effective and has a rating of <= 1 on the Pearl Index. However, this method can occasionally "fail", particularly if not used correctly or due to interaction with other medications.


Medications that may decrease the effectiveness of combined hormonal contraceptives:

Tuberculostatics (rifampicin), antifungals(griseofulvin), antidepressants (imipramine), St. John's wort, antihistamines (cimetidine), antiepileptics (carbamazepine, phenobarbital, primidone, phenytoin, oxcarbazepine, felbamate, topiramate)

and the following antibiotics

  • Penicillin (amoxicillin, piperacillin, benzylpenicillin, phenoxymethylpenicillin, flucloxacillin, clavulanic acid, tazobactam)
  • Tetracycline (doxycycline, minocycline, demeclocycline, lymecycline, tigecycline)
  • Cephalosporin (cefaclor, cefazolin, cefuroxime, cefamandole, cefotaxime, ceftriaxone, cefixime, ceftibuten, cefpodoxime, ceftazidime, cefprozil, cefepime, ceftobiprole)
  • Chloramphenicol
  • Sulfonamides (sulfadiazine, sulfamethoxazole - cotrimoxazole, sulfasalazine)
  • Nitroimidazoles (metronidazole, ornidazole, tinidazole)
  • Potentially macrolide antibiotics (azithromycin, clarithromycin, erythromycin, roxithromycin, spiramycin)

Other factors that my decrease the effectiveness of oral contraceptives (not applicable to the vaginal ring and contraceptive patch): gastritis, enteritis, Crohn's disease, cystic fibrosis, diarrhoea, vomiting


PILL WITH NATURAL OESTROGEN


Pearl Index: 0,4

Advantages:

  • short, light periods
  • contains an oestrogen identical to the hormone naturally produced by the body
  • can be taken up to 12 hours later if forgotten

Disadvantages:

  • needs to be taken daily
  • possible decrease in effectiveness due to diarrhoea/vomiting or interaction with other medications


PILL WITH ETHINYLESTRADIOL


Pearl Index: 0,1-0,9

Advantages:

  • usually makes periods lighter and less painful
  • potential additional benefits, e.g. acne
  • regular periods
  • can be taken up to 12 hours later if forgotten

Disadvantages:

  • needs to be taken daily
  • possible decrease in effectiveness due to diarrhoea/vomiting or interaction with other medications


BIRTH CONTROL RING


The contraceptive vaginal ring releases a continuous dose of hormones which are absorbed through the vaginal mucosa.

The ring is made of soft plastic. It is inserted into the vagina and removed after three weeks. Menstruation takes place during the seven ring-free days.

Pearl Index: 0,6-1,0

Advantages:

  • only needs to be inserted and removed once a month
  • low oestrogen dose due to local application
  • stable cycle
  • no decrease in effectiveness due to diarrhoea/vomiting or interaction with certain antibiotics (amoxicillin and doxycycline)

Disadvantages:

  • possible foreign body sensation (rare)


CONTRACEPTIVE PATCH


The contraceptive patch releases hormones into your body through your skin. Each patch remains effective for 7 days, i.e. it needs to be changed once a week.

Pearl Index: 0,9

Advantages:

  • regular periods
  • needs to be applied/removed three times a month
  • no decrease in effectiveness due to diarrhoea/vomiting

Disadvantages:

  • skin irritation may occur
  • limited effectiveness for individuals with a body weight greater than 90 kg
  • patch is visible


OESTROGEN-FREE HORMONAL CONTRACEPTIVES


This form of birth control contains only one type of hormone, progestogen (progesterone). Women who suffer from side effects caused by oestrogen, such as nausea, headaches and water retention can benefit from this pill. However, it should be noted that this method of contraception may cause changes in bleeding patterns (e.g. missed periods, bleeding between cycles).


MINI PILL OR PROGESTOGEN-ONLY PILL (POP)


The mini pill's active ingredient is the progestogen desogestrel. It provides a suitable method of birth control for women who are breastfeeding and can be used by women with risk factors such as obesity, migraines, high blood pressure, nicotine consumption and thrombophilia. The primary issue with this contraceptive is the occurrence of irregular bleeding in about 15-20% of users.

Pearl Index: 0,5-3,0

Advantages:

  • low hormone dose
  • can be taken while breastfeeding

Disadvantages:

  • change in bleeding patterns
  • possible decrease in effectiveness due to diarrhoea/vomiting
  • can only be taken up to 3 hours later if forgotten


CONTRACEPTIVE IMPLANT


The contraceptive implant is a small plastic rod (4cm in length and only 2mm wide) which contains 68mg of the progestogen etonogestrel. Similar to the pill, the continuous release of this progestogen prevents ovulation. It is placed under the skin on the inside of the upper arm and is fitted within the first five days of your menstrual cycle. It is inserted under local anaesthetic using a special applicator. During the first 7 days after fitting, an additional method of contraception (e.g. a condom) should be used during intercourse. Local anaesthetic will be necessary to remove the implant, which must be pulled out from under the skin.

Pearl Index: 0,0-0,1

Advantages:

  • low hormone intake
  • no decrease in effectiveness due to diarrhoea/vomiting
  • can be also used while breastfeeding
  • only needs to be inserted once every 3 years

Disadvantages:

  • change in bleeding patterns
  • insertion and removal require a minor surgical procedure performed under local anaesthetic
  • in overweight users the implant may become less effective during the 3rd year
  • possible side effects include acne, headaches, breast tenderness and weight gain


CONTRACEPTIVE INJECTION


The contraceptive injection is a pre-filled syringe that contains progestogen and is normally injected into the buttocks. This method works by disrupting maturation of the egg and preventing ovulation. In addition, hormone-induced changes lead to a thickening of the cervical mucus, making it difficult for sperm to move through the cervix. Long-term use of the contraceptive injection may result in a decrease in bone density, which increases the risk of developing osteoporosis. For this reason, it is recommended that the contraceptive injection is not used for longer than 2 years.

Pearl Index: 0,3-1,4

Advantages:

  • no decrease in effectiveness due to diarrhoea/vomiting
  • can be used while breastfeeding
  • reliable form of contraception for users who are required to take medication for epilepsy
  • prevents cycle-related migraines

Disadvantages:

  • change in bleeding patterns - disruption to menstruation, especially during the first 6 months and periods may stop altogether later on
  • once use is discontinued, it may take time for regular ovulation to resume
  • possible decrease in bone density, use should therefore be limited to 2 years
  • possible side effects include water retention, headaches and anxiety


COIL CONTRACEPTION


For women who want reliable contraception for a period of between 3 and 5 years. This method of contraception is not subject to a decrease in effectiveness due to interaction with other medications, bouts of illness such as diarrhoea or vomiting, or incorrect use. There are essentially two categories of coil contraceptives, the copper coil or intrauterine device (IUD) and the hormonal coil or intrauterine system (IUS).

HORMONAL COIL FOR YOUNG WOMEN (Jaydess®)

Pearl Index: 0,33

Advantages:

  • new contraceptive designed especially for young women who have not yet given birth
  • long-term contraception for three years
  • duration and intensity of bleeding are reduced, periods become less painful
  • protects against infections of the uterus and fallopian tubes due to impermeable cervical mucus

Nachteile:

  • bleeding patterns may be disrupted during the first 6 months after insertion, resulting in irregular periods and bleeding between cycles

For more information:
www.jaydess.de
www.skyla-us.com (the American Jaydess)

HORMONAL COIL MIRENA®

Pearl Index: 0,2

Advantages:

  • only needs to be inserted once every 5 years
  • can be used while breastfeeding
  • duration and intensity of bleeding is reduced, periods become less painful
  • for about 20% of women, periods stop completely without posing any health risk and without increasing the risk of osteoporosis
  • protects against infections of the uterus and fallopian tubes

Disadvantages:

  • disruption to bleeding patterns, especially during the first 6 months after insertion
  • possible side effects include acne, breast tenderness and headaches

COPPER COIL (INTRAUTERINE DEVICE))

The intrauterine device (IUD) is a small copper-coated plastic device also known as a copper coil. The device releases a small amount of copper into the uterine cavity. This amount is completely safe for humans. It works by making it difficult for the sperm to reach the egg and affects the structure of the uterine lining. It therefore impairs successful fertilisation and prevents fertilised eggs from being able to implant themselves in the uterine lining.

Pearl Index: 0,9-3,0

Advantages:

  • no hormonal effect on the body
  • pregnancy can occur immediately after removal of the coil
  • can be used while breastfeeding

Disadvantages:

  • periods may become longer in duration with a heavier flow during the first 3 to 6 months/li>
  • bleeding between periods may occur
  • increased risk of ascending infection (inflammation of the uterus and fallopian tubes)
  • If you currently have an IUD inserted and are experiencing symptoms that may suggest an infection, please come and see us at our surgery. Symptoms can include a fever of unknown origin, sudden abdominal discomfort, discharge and/or spotting.

HAVING AN IUD OR IUS FITTED

Fitting should preferably take place during your menstrual cycle as the cervix is slightly open and an existing pregnancy can be excluded with certainty. A Pap smear with normal results should have been carried out within the previous 6 months.

Before the device is fitted, a vaginal infection will be ruled out. The vagina and cervix are then disinfected, and the length of the cervical canal is measured using a thin probe. The coil is then gently inserted through the cervix and into the womb. Finally, the strings are cut to the appropriate length. During insertion and for the first few days, a slight tugging or pinching sensation in the abdomen may occur. This is temporary and will cease after a short while. A painkiller may be administered prior to inserting the coil and a local anaesthetic may be applied.

BARRIER CONTRACEPTIVE METHODS


Below is a brief summary of the effectiveness of barrier contraceptive methods and natural contraceptive methods

CONDOM

Pearl Index: 2.0- 12.0

DIAPHRAGM (in combination with spermicide)

Pearl Index: 1.0 – 20.0

SPERMICIDE

Pearl Index: 3.0 – 21.0

SYMPTOTHERMAL METHOD (natural contraception method through temperature measurements in the morning)

Pearl Index: 2.0 – 18.0