Dossier: Young adults

What method of contraception's best for me?

These days young people want contraception to be safe and as natural as possible. But how realistic is this expectation? What choices are available?

Text: Katharina Rilling; Fotos: Unsplash

Your first crush, your first kiss, your first sex: so many new experiences, and so many butterflies in your stomach, is what makes becoming an adult so exciting. You also have to start thinking about the right method of contraception. So what is the best contraceptive now available? "That can vary from woman to woman," explains Irène Dingeldein, president of the Swiss Society of Gynaecology and Obstetrics. "The most important thing is to choose a method that's safe, easy to use, doesn't have major side effects, and matches your lifestyle."

Consultation with a gynaecologist: not just for women

To find out the best type of contraceptive for you it's crucial to get advice from a gynaecologist. Most young women are aged between 14 and 17 when they first visit a gynaecologist. "Often they go because of pain or discomfort during their period, or when they have their first boyfriend," says Dingeldein. "In the consultation we talk about the young woman's lifestyle, whether they smoke or take medication. I ask whether the family has any history of disease, for example thrombosis, lung embolism, heart attack, high blood pressure or cancer."– This influences the choice of recommended contraception.

"I'm glad when a girl's mother comes with her and supports her," adds Dingeldein. "And of course also if her boyfriend is with her too. After all, contraception also affects him." Nobody has to be examined during the consultation,  unless they opt for an IUD: "This has to be placed in the uterus. So I first examine the woman and show her how it all works."

Preference for natural contraception

At the moment gynaecologist Irène Dingeldein is noticing a trend to natural contraceptives: "More and more young adults are interested in a copper IUD. They'd prefer not to take hormones and avoid affecting their body or the environment," says Dingeldein. Ruth Drahts at the Buchenhof women's practice in Sursee observes the same development: "I also hear a growing number of women say they don't want to take hormones. But when I explain all the pros and cons they often end up choosing the pill after all. It's often the best solution, at least as their first contraceptive," she explains. It's important to realise that "there's no such thing as a completely natural –safe contraceptive. You're always interfering with nature." 

Drahts also points out that there aren't actually that many alternatives to choose from. Either you suppress ovulation, –which is very reliable but affects the woman's body, or you prevent pregnancy mechanically or chemically, for example using a copper IUD.– This isn't completely free of risks and side-effects either.

How safe are cycle tracking, the temperature method, and so on?

The gynaecologist doesn't recommend young women to rely completely on tracking their cycle, for example by monitoring temperature or using an app to calculate ovulation. "It's supposed to work out your fertile days. But that's very unreliable and requires a lot of discipline. A woman has to abstain from sex or use a condom around ovulation, the very time she most want it. So it's not an actual method of contraception."

The other options aren't likely to change any time soon either: "There's research being done into preparations which have even fewer hormones, or other forms of the coil. But there's no real prospect of really new methods, for example contraceptives that put more of the onus on the man," says Drahts. "But if you take the time you'll find a good, safe contraceptive to suit you."

 

Three contraceptive options

1. Combined hormonal birth control: pill, patch and ring

These forms of contraception contain a combination of oestrogen and progesterone. These synthetic hormones suppress the woman's cycle and come with some desirable side-effects: they can reduce acne, heavy bleeding and pain during her period. They can also bring about improvements in benign conditions of the uterus such as myoma.

But they do slightly raise the risk of thrombosis. This option is not suitable for seriously obese women, those with a family history or an underlying condition such as thrombosis, epilepsy or diabetes, and smokers. It's also important to realise that antibiotics, diarrhoeal disorders and vomiting render the contraceptive less effective. "Some women also gain weight and feel that the hormones are causing a physical change. They can trigger depression in those with a predisposition. On the other hand the hormones can also help reduce mood swings," says Dingeldein.

The combined pill

The daily pill inhibits ovulation, prevents the lining of the uterus from building up, and keeps sperm away from the uterus by thickening the mucus at the cervix. Irène Dingeldein: "There's no need to worry about thrombosis. But you have to remember the pill's a drug, not candy.»

Reliability: very high
Pros: may postpone menstruation
Cons: has to be taken daily; slightly increases the risk of thrombosis

Hormone patch

The hormone patch is stuck to the skin on the buttocks or stomach, the outside of the upper arm or the upper body. You have to change the patch every week, and after three weeks you take one week's break. The hormones are absorbed via the skin.

Reliability: high
Pros: vomiting and diarrhoea don't reduce efficacy, may postpone menstruation, doesn't have to be taken every day
Cons: can irritate skin, is visible and can come off, slightly increased risk of thrombosis

Vaginal ring

The soft plastic ring, five centimetres in diameter, can be inserted in the vagina yourself. It remains there, releasing hormones, for three weeks. If the ring interferes with sex you can remove it for up to three hours.

Reliability: high
Pros: vomiting and diarrhoea don't reduce efficacy, may postpone menstruation, doesn't have to be taken every day
Cons: the ring may be rejected and feel like a foreign body; slightly increases the risk of thrombosis

2. Oestrogen-free contraception: Minipill, hormone implant, hormone IUD and hormone injection

These contraceptives only contain the hormon progesterone. The main advantage is that they don't increase the risk of thrombosis. "These methods are getting more and more popular. Taking them long term often substantially or completely reduces menstrual bleeding and pain. The downside is that it can lead to a less clear complexion and recurring mid-cycle bleedings," explains Ruth Drahts. Unlike combined methods, its efficacy isn't affected by diarrhoea, vomiting, medication, jet lag or wrong application.

Progesterone-only pill

The progesterone-only pill is suitable for women who can't or don't want to take oestrogen. Like the combined pill, it suppresses ovulation. "The lining of the uterus isn't built up but remains flat. If you don't want to get pregnant, it doesn't have to be built up again," explains Dingeldein.

Reliability: very high
Pros: can be used by women who don't tolerate oestrogen
Cons: has to be taken every day, can lead to irregular bleeding

Hormone implant

A hormone implant is a small plastic rod placed under the skin in your upper arm by your doctor. It can remain there for up to three years.

Reliability: very high
Pros: long-term birth control, suitable for women who can't tolerate oestrogen, vomiting and diarrhoea don't impair efficacy, don't need to take a daily pill
Cons: involves minor surgical intervention by gynaecologist, frequent mid-cycle bleeding

Hormonal IUD

The hormonal IUD is placed in the uterus by a gynaecologist. It can remain in place for three to five years.

Reliability: very high
Pros: long-term birth control, suitable for women who can't tolerate oestrogen, works right at the scene of the action, efficacy not impaired by vomiting or diarrhoea
Cons: has to be inserted by gynaecologist

Hormone injection

Administered by your gynaecologist, a hormone injection prevents pregnancy for three months.

Reliability: very high
Pros: can be used by women who can't tolerate oestrogen, efficacy not impaired by vomiting or diarrhoea
Cons: requires regular injections, only become fertile again after several weeks or months

3. Hormone-free contraceptives: copper IUD, condom, diaphragm, sterilisation

Non-hormonal birth control methods rely on mechanical or chemical contraception.

Copper IUD

The copper IUD is placed in the uterus by a gynaecologist, where it can remain for up to ten years (depending on the model). Copper impedes the mobility of sperm cells and produces an inflammatory reaction that prevents the implantation of fertilised eggs. "I think this method is over-hyped. I can't actually recommend the copper IUD as a young woman's first contraceptive," says Drahts.

Reliability: very high
Pros: long-term birth control, hormone-free, suitable for women who can't tolerate oestrogen, works right at the scene of the action, efficacy not impaired by vomiting or diarrhoea
Cons: has to be inserted by gynaecologist; painful, severe bleeding or pelvic inflammation can occur

Condom

A condom is a sheer sheath rolled over the man's erect penis to prevent semen from entering the woman's body. However, there is a risk of mishaps and using it incorrectly. "I advise young women to always use a condom in addition to other methods of contraception. It prevents the spread of sexually transmitted diseases," explains Dingeldein.

Reliability: medium
Pros: protects against sexually transmitted diseases, only used when needed, hormone-free, few side-effects
Cons: can trigger allergic reactions; must be used immediately before sex; can tear

Diaphragm, etc. (= female condom)

Women can insert the diaphragm in their vagina themselves. It blocks sperm from the uterus. But it only works if it's the right size and fits perfectly. For better protection it can be used with spermicidal cream.

Reliability: medium
Pros: latex and hormone-free
Cons: tricky to use

Chemical contraceptives

These contain substances that kill sperm and are available as creams, gels, vaginal suppositories, vaginal film and foam. They're not very reliable and should only be used in conjunction with mechanical contraceptives such as condoms and diaphragms.

Sterilisation/vasectomy

This is only suitable for people who are absolutely sure they don't want (more) children. The decision usually can't be reversed. Both men and women can have the operation.