Contraceptive Meaning and Methods
- Contraceptive methods are the birth control measure that is taken to prevent unwanted pregnancies and to maintain population stabilization.
- Some commonly used contraceptive devices are- condoms, IUDs (Intrauterine devices), diaphragms, implants, etc.
Intra Uterine Devices(IUDs)
Surgical methods of contraception
Features of an ideal contraceptive-
An ideal contraceptive or birth control measure should have the following features-
a. It should be user-friendly i.e. easy to use.
b. It should be affordable and easily available.
c. It should be effective i.e. chances of failure should be very low and also reversible.
d. It should not have any kind of side effects.
e. Also, there should not be any interference of the contraceptive with sexual activity.
Types of contraceptive methods-
Contraceptive methods have been divided into several categories-
- Conventional or natural or traditional methods
- Barrier or mechanical methods and chemical methods
- Intra Uterine Devices (IUDs)
- Oral Contraceptives
- Injectable contraceptives
- Surgical methods of contraception
On the basis of reversibility, contraceptive methods are further classified into two groups- Reversible and irreversible.
1. Reversible Methods-
- Those contraceptive methods that can be reversed whenever a woman wants to conceive fall into this category.
- It includes barrier methods, IUDs, chemical methods, implants, oral contraceptives, injectable contraceptives.
2. Irreversible Methods-
- Those contraceptive methods which permanently prevent pregnancy by sterilization of an individual.
- It is a permanent birth control measure, which is generally adopted when an individual achieves the desired family size and wants no more children.
- It includes surgical methods of birth control in which males and females are sterilized using surgical procedures.
Conventional methods of contraception
- Conventional methods of birth control are also referred to as natural or traditional methods of contraception.
- Natural or traditional methods are those birth control methods that depend on the natural rhythms or functions of the body and avoid the meeting of the sperm and ovum in order to prevent fertilization.
- It does not involve the use of any kind of device for preventing pregnancy.
- These have no side effects.
- Some of the natural methods are discussed below-
a. Coitus interruptus:
- In this method, the penis is withdrawn by the male partner from the vagina just before the ejaculation, in order to prevent the entry of semen into the female reproductive tract.
- Chances of failure of this method are high, due to the presence of sperms in pre-ejaculate.
b. Periodic abstinence or rhythm period:
- In this method, the sexual act should avoid or abstain from coitus during the fertile window i.e., 10th to 17th day of the menstrual cycle.
- Chances of fertilization are high during this period, as ovulation is expected.
- This method also has a high failure rate due to irregularities in the menstrual cycle.
c. Lactational amenorrhea:
- Lactational amenorrhea absence of menses in females when they are lactating intensely, following parturition.
- During this period ovulation and therefore the menstrual cycle doesn't occur.
- It is temporary postpartum infertility, as is maximally effective up to a period of 6 months and that too when intense breastfeeding is performed.
- Has high chances of failure.
- Mechanical or barrier methods are those methods of contraception which prevent the physical meeting of ovum and sperms.
- It includes the following measures-
These are disposable rubber or latex sheaths that are used to cover penis in males or vagina or cervix in females before copulation.
This checks pregnancy by preventing depositions of sperms in the vagina.
Condoms are known to prevent various sexually transmitted diseases as they prevent semen from entering into the female’s body and a major cause of spreading STDs is the exchange of body fluids.
The only shortcoming of condoms is that these can not be reused.
Condoms are two types:
- Male condoms
- Female condoms or femidoms.
- Made up of thin rubber or latex sheaths and has a ring on one end.
- It is used to cover male genitalia/penis just before coitus to prevent the entry of ejaculate semen into the female reproductive tract.
- Also referred to as femidom.
- It is a device made up of polyurethane material that contains rings at both ends.
- This also prevents the meeting of the sperms and ovum.
Diaphragms, Cervical caps and vaults:
- These are dome-shaped devices made of rubber or latex or silicon.
- These are used to cover the cervix during copulation as a measure of birth control.
- These can be inserted hours before sexual intercourse.
- These prevent pregnancy by checking the entry of sperm into the uterus.
- Cervical caps are also known and Fem shields.
- These are reusable devices.
- These have higher efficiency than other barrier contraceptives, due to the usage of spermicides with them.
- To increase the efficiency of barrier methods like vaults, diaphragms, cervical caps, etc. chemical methods are used along with them.
- It includes the use of spermicidal substances like jellies, tablets, creams in the vagina for about 5-10 minutes before sexual intercourse.
- It kills the sperms and thus prevents pregnancies.
- The commonly found chemical substances that are spermicidal are zinc sulfate, lactic acid, potassium permanganate, boric acid, etc.
Intra Uterine Devices (IUDs)
- IUDs are devices that are meant to be inserted into the female reproductive tract for preventing pregnancy or as a method of contraception.
- These are made up of either plastic or metal, or can be a combination of both.
- These are instead by doctors or experienced nurses into the uterus by vagina.
- IUDs are the most widely used method of contraceptive in India for spacing children because they are highly effective and have long-term protection against pregnancy.
- On the basis of their shapes, they can be called loops,Ts, rings, etc.
- These are effective methods for spacing children.
Classification of IUDs:
- IUDs are divided into three categories-
- Copper-releasing IUDs release copper ions which suppresses sperm motility and fertilizing capacity of sperms.
- Some examples of copper-releasing IUDs are Multiload-375, Cu-T, Cu-7, etc.
- Multiload-375 can prevent pregnancy up to 5 years.
- Progestasert and LNG-20 are hormone-releasing IUDs.
- Levonorgestrel is a synthetic progestin that is used in hormonal method of birth control.
- Hormones released by this type of IUDs are responsible for making the uterus unsuitable for implantation and the cervix hostile to sperms.
- Non-medicated IUDs are devices made up of polyethene, impregnated with barium sulphate.
- It creates a spermicidal effect by stimulating the immune system and increasing the production of phagocytes in the female reproductive tract.
- It results in the killing of the sperm and thereby preventing pregnancy.
- Lippes loop is a non-medicated type of IUD.
- Birth control pills are physiological/oral devices, used as a method of contraception.
- These are preparations containing either progestin (progestogen or synthetic progesterone) alone or a combination of progestogen and oestrogen (estrogen).
- The pills are taken orally for 21 days in a menstrual cycle starting within the first 5 days of the menstrual cycle.
- It is advisable to repeat the course after a gap of 7 days, irrespective of the onset or absence of menstruation during the pill-free period,till the time female desires to prevent conception.
- If a dosage is missed, it should be taken as soon as one remembers, even if one has to take 2 pills at once.
Types of oral pills-
- Oral pills are of two types:
Steroidal oral contraceptive pills
Non- Steroidal oral contraceptive pills.
Steroidal Contraceptive Pills:
- Combined pills contain a combination of both estrogen and progestogen.
- Hormones have an antiovulatory effect i.e. these inhibit ovulation.
- These prevent implantation and alter the quality of cervical mucus to prevent or retard sperm entry.
- The most commonly used progestin/ progestogen is levonorgestrel or desogestrel.
- The most commonly used synthetic estrogen is ethinyl oestradiol or mestranol.
- In monophasic combined pills, both estrogen and progestin are present in nearly the same amount.E.g., Mala D, Mala L.
- In multiphasic combined pills, estrogen is maintained at the same level throughout the 21-day course. The amount of progestin is increased gradually. E.g., triquilar, ortho novum.
- Mini Pills are the preparations that are progestogen-only pills, they do not contain estrogen.
- These should be taken daily without break eg., POP.
Action of oral pills-
- Hormonal pills act in four ways-
(a) Inhibition of ovulation.
(b) Alteration of uterine endometrium in such a way that it becomes unsuitable for implantation.
(c) Changing the quality of cervical mucus, impairing its ability to allow passage and transport of sperms.
(d) Inhibition of motility and secretory activity of fallopian tubes.
- Progestogen and estrogen are hormones that inhibit the secretion of FSH (Follicle-stimulating hormone) and LH (Luteinizing hormone) from the anterior lobe of the pituitary gland and thereby inhibit ovulation and implantation.
Non-steroidal Oral Contraceptives:
- ‘Saheli’ is a birth control pill, developed at CDRI (Central Drug Research Institute) located in Lucknow.
- Saheli contains only the non-steroidal preparation called centchroman.
- It is the only birth control pill that is non-hormonal.
- This pill has to be taken once a week to prevent pregnancy.
- Saheli blocks the estrogen receptors in the uterus and prevents the implantation of even fertilised eggs.
- Injectable contraceptives are the methods in which suitable chemicals are injected into the woman’s body for birth control.
- These are reversible and long-term acting chemical birth control methods.
- These are one of the widely adopted birth control methods.
- These contain progestogens or a combination of progestogen and estrogen.
- Their action is similar to that of steroidal oral contraceptives.
- Depo-Provera is an example of an injectable contraceptive.
- Depo-Provera i.e. depot-medroxyprogesterone acetate (DMPA) is effective for a period of three months.
- Cyclofem and mesigna are combined injectable contraceptives which are given once every month. These contain progestin preparation as well as oestradiol.
- Implants are structures containing either progestogens or a combination of progestogens and estrogen that are implanted subdermally for providing long-term contraception.
- These are inserted under the skin in a fan-shaped manner inside the upper arm or forearm through a small incision. Suturing is not required.
- As they are placed under the skin and release hormones in the blood, these act the way oral pills do.
- These have a much longer effective period.
- Norplant is a progestin-only device having six small silicone (permeable) capsules each having levonorgestrel which is the most commonly used implant in India.
- It releases hormones that make the uterus unsuitable for implantation and the cervix hostile to sperms.
- These hormones inhibit ovulation and implantation.
- It is effective for 5 years.
- Implanon is a single rod-like device that is implanted through a wide-bore needle. It contains 3-keto desogestrel (progestin). It remains functional for three years.
- Along with the great effectiveness, implants also have some negative side effects like irregular bleeding and long-term spotting.
- Administration of steroidal pills with levonorgestrel or IUDs or implants or injections within 72 hours of coitus is found to be very effective as an emergency contraceptive.
Surgical methods of contraception
- Surgical methods of birth control are also called male/female sterilisation.
- These are generally advised to couples as a terminal method to prevent further pregnancies.
- These are usually irreversible in nature and are therefore a permanent method of birth control.
- These methods are highly effective with a 100 percent success rate.
- But a major disadvantage of these methods is that their reversibility is very low.
Classification of surgical method:
- Surgical methods have been classified into two categories that are male and female sterilization methods.
- Male sterilization method.
- It involves cutting and removal of a piece or tying up of vas deferens, through a small incision in the scrotum.
- This technique prevents the transfer of sperms from testes to semen via vas deferens.
- It blocks the transfer of male gametes, preventing conception.
- Female sterilization method.
- It involves tying or removal of a piece of the fallopian tube, through a small incision in the abdomen or through the vagina.
- It prevents fertilization by preventing the transport of the ovum to the site of fertilization.
- Tubectomy is also called tubal ligation.
- Oophorectomy (surgical removal of ovaries) and Hysterectomy (surgical removal of the uterus) are therapeutic, but they help in contraception.
- The figure given below depicts vasectomy and tubectomy-
Frequently asked questions (FAQ)
Q1. What are the disadvantages of using barrier contraceptive methods?
- Spermicidal chemical and latex used in barrier methods may cause allergy to some.
- Also, there are chances of urinary tract infections with the use of certain barrier methods.
Q2. What are the risks associated with oral contraceptive pills?
- Sometimes oral contraceptives may fail to prevent pregnancy.
- Other associated risks with oral contraceptives are- migraine, cardiovascular disease, high blood pressure, blood clots, breakthrough bleeding, irregular menses and even breast cancer.
Q3. What are emergency contraceptive pills?
- Emergency contraceptive pills are the contraceptive pills that are taken within 72hours of unprotected sexual act, to prevent pregnancy.
- These are hormone-based pills that generally contain progesterone which inhibits ovulation.
- Also known as "morning-after pill".
Q4. What is implant migration?
- Implant contraceptives are devices that are placed under women’s arms and they act as oral pills for preventing pregnancy.
- Sometimes the implants placed under the skin move beyond the original place it was inserted at least 2cm away from the original location, this act of implant movement is called implant migration.
- Implant migration is a very rare phenomenon.
Q5. What are the disadvantages of implant contraception?
- Implants bring a hormonal imbalance in the body therefore they may have certain negative effects on the body.
- The major side effect of the implant is irregular bleeding and long-term spotting.
- Other side effect includes nausea, headache, etc.
Q6. What pattern has to be followed for taking a birth control pill?
- Saheli is once is week pill that means it should be taken once a week for preventing pregnancy.
- While birth control pills like Mala-D and Mala-N should be taken in the following manner-
- The starting date of taking the pill is within the first five days of the menstrual cycle.
- The pill has to be taken on a regular basis for a period of 21 days in a manner that one pill has to be taken daily.
- After 21 days, the pill should not be taken for a period of 7 days.
- This means the pill has to be taken in a gap of 7 days.
- The menstrual cycle occurs in the week when the pill was not taken by the woman.
Q8. What is the function of progesterone and estrogen in oral contraceptive pills?
- Progesterone and estrogen are the hormones that are present in oral contraceptive pills.
- These inhibit the release of the egg from the ovary, that is they inhibit the ovulation and thereby prevent pregnancy and eventually they act as a contraceptive method.
- These also make changes in cervical mucus and prevent sperm entry.
Q9. What are hormonal IUDs and how do they act as contraceptives?
- Hormonal IUDs are the intra uterine devices that contain hormones which when fitted in the female reproductive tract prevent pregnancy.
- Progestasert and LNG-20 are hormone-releasing IUDs.
- Progesterone and estrogen are the hormones that are found in this type of IUDs which are responsible for inhibiting ovulation.
- Hormones also make the uterus unsuitable for implantation and the cervix hostile to sperms.