Choosing the best contraceptive technique can be challenging. Experts list the pros and cons of various methods to prevent unplanned pregnancies
· Written by Nandita Narayanan & Swathy R Iyer
· With quotes from Dr. Shalini Chawla Khanna (senior gynecologist), Dr. Sarada M (obstetrician and gynecologist), Dr. Nandita Palshetkar (gynecologist), Dr. Kevin Gala (gynecologist and obstetrician), Dr. Priyanka Dilip Kumar (gynecologist and obstetrician)
From male and female condoms to oral contraceptive pills and vaginal rings, several birth control methods to prevent unplanned pregnancies are available today. However, there is no one-size-fits-all when it comes to choosing the right contraception, say experts.
Dr. Shalini Chawla Khanna, senior gynecologist, IVF and laparoscopy consultant, Max Hospitals, Delhi & NCR, explains that when a couple seeks birth control, they are counselled on the various methods available and the success rate, side effects and advantages of each method. “They can then choose the one that suits them the best.”
Dr. Khanna says that there are natural, hormonal and barrier methods available to prevent pregnancies.
The abstinence method: Avoiding sexual intercourse.
The withdrawal or pull-out method: Where the man pulls his penis out of a woman’s vagina before ejaculation.
The withdrawal method has a higher failure rate and is hence not recommended, says Dr Khanna.
Male and female condoms: They act as a barrier and prevent sperm from getting into a woman’s vagina.
Spermicide: Chemicals known to stop sperm from reaching an egg.
Diaphragm: A cup inserted in the vagina to block the sperm’s access to the cervix.
Dr. Khanna says, “Male condoms are 98 per cent effective. They are also the only method of contraception that can also prevent sexually transmitted diseases (STDs).”
Dr. Priyanka Dilip Kumar, consultant gynecologist, obstetrician and reproductive medicine, Milann Fertility and Birthing Hospital, Bengaluru, says that for people with latex allergies, latex condoms may not be a viable option. She advises switching to another contraceptive method or using non-latex condoms.
Dr. Sarada M, consultant obstetrician and gynecologist, Yashoda Hospitals, Hyderabad, says that hormonal contraceptives mainly come in the form of:
Implants: A rod that contains progestin, the hormone that prevents pregnancy, is inserted under the skin of a woman’s upper arm.
Pills: Oral contraceptive pills contain a combination of estrogen and progestin and must be taken every day. Progestin-only pills are also available, which are usually recommended for lactating mothers as estrogen can reduce milk supply, informs Dr. Nandita Palshetkar, Mumbai-based gynecologists and former president of the Federation of Obstetric and Gynaecological Societies of India (FOGSI).
“Combined oral contraceptive pills are highly effective and the failure rate is just 0.1 per cent. It is highly recommended. They are easy to use and you can stop whenever you want to,” Dr. Khanna adds. Moreover, Dr Khanna says that combined oral contraceptive pills can help regularise period cycles, decrease the menstrual flow, reduce dysmenorrhea (the pain you experience during periods) and lower the risk of endometrial and breast cancer.
However, Dr. Khanna also cautions that if one misses taking a pill for a day, it could cause breakthrough bleeding or spotting. “One could also have nausea, vomiting, fatigue, and gain weight temporarily,” she adds.
Krishnendu K J, a creative designer from Bengaluru, recalls how she was advised to be on the pill in 2020 due to hormonal imbalance issues. “Although it did help clear my acne, one of the predominant side effects that I faced was extreme weight gain,” she says. “Within two years, I went from being underweight to obese.”
Dr. Khanna says that a person who wants to opt for the combined oral contraceptive pill should consult a gynecologists. “If one is severely diabetic, has jaundice, is hypertensive, smokes, has migraines or a history of thrombosis (when blood clots form within blood vessels), they should avoid taking these pills,” she explains.
These pills also help prevent ovulation by thickening the mucus of the cervix, Dr. Kumar explains. “They are cyclical — they have to be taken duly. There have been instances where women have skipped the pill, and the contraceptive effect reduces.”
Dr. Palshetkar says that one of the rarer side effects of oral birth control pills is the formation of blood clots.
Injections: Progestin is administered in the form of injections every three months.
However, there are chances of unwanted pregnancy if the course is not followed diligently as well as irregular periods, says Dr Kumar
Skin patches: The skin patch contains the hormones estrogen and progestin, and can be worn on the arm or belly, among other body parts.
Vaginal Rings: Small plastic contraceptive rings inserted into the vagina. It needs to be worn for three weeks, after which it is to be removed for a week before one inserts a new ring.
Intrauterine devices (IUD)
Also known as long-acting reversible contraceptives or LARC, IUDs such as Copper-T and hormonal IUDs are placed in the uterus.
IUDs, especially Copper-T, can work for five to ten years, Dr. Khanna informs. She adds, “If a couple is looking for a long gap before the birth of their second child, for instance, these might be the methods they prefer. They can get it removed whenever they want to conceive.”
Dr. Kevin Gala, consultant, gynaecology and obstetrics, SRCC Children’s Hospital, Mumbai, says that LARC birth control methods such as implants and IUDs are highly effective as birth control methods and have a low failure rate. “They provide long-term contraception without requiring daily maintenance. They also do not interfere with sexual spontaneity,” he says.
At the same time, IUDs could cause irregular, breakthrough bleeding and irregular, scanty periods. “These are also operator-dependent. One must get these devices placed only in a hospital setting and not take it on their own,” says Dr Khanna.
Permanent birth control
Tubal ligation: A permanent birth control method for women whereby a portion of the fallopian tube is cut or tied to prevent the fertilizations of eggs by the sperm.
Vasectomy: A procedure to cut and seal the vas deferens for men, which prevents sperm from entering the semen.
Dr. Palshetkar says that emergency contraceptive pills, which contain a high dose of progestin, can be taken up to five days after one has had unprotected sex. These pills are known to have side effects like nausea, irregular bleeding, and tiredness.
There are many contraceptive methods, including barrier methods like condoms and diaphragms and hormonal contraceptive methods like pills and implants. These methods do come with risks and adverse effects. However, besides preventing unplanned pregnancies, your choice of birth control could also help regularise your periods or lower the risk of endometrial and breast cancer. It is crucial to understand the different forms of birth control available and pick the one best suited to you.