Today, numerous contraceptive options are available, but what do women really know about them? What do women really need to consider when choosing a contraceptive method? Contraception is an important part of sexual health and family planning. It provides opportunities to have and space children and enhances opportunities for education and employment, thus improving the quality of life. Generally, women’s need for contraception varies according to life stage, health status, socio-economic status, and cultural beliefs (Suri, 2016). However, using contraception is complicated. Despite the efforts and progress made over the years, many women face difficulties in accessing contraceptive choices and services. Furthermore, the impact of contraceptive choices can be so significant in women’s lives that it can either enhance their quality of life or otherwise lead to disastrous outcomes, such as health issues or even death. Therefore, it is critical to know the factors to consider and the types of contraceptives available in order to make the most suitable choice. To help make the best choices, these topics will be discussed: 1. Factors to consider when choosing a contraceptive method 2. Different types of contraceptives. Choosing the right contraceptive method is a personal decision that should be based on individual health, lifestyle, and preferences. However, there are things that every woman should keep in mind when discussing contraceptive options with a health care provider.
Factors to Consider When Choosing a Contraceptive
Selecting the right contraceptive method is a deeply personal decision for women, involving various factors related to their unique needs and circumstances. To make the best choice, women should evaluate several key considerations. First and foremost, effectiveness, side effects, and convenience are the primary contraceptive factors. Effectiveness refers to how well each contraceptive method can prevent pregnancy. To assist women in evaluating their options, statistical insight into the effectiveness of different methods helps women compare choices realistically (Malarcher et al., 2016). Side effects address the potential health impacts and discomforts that can accompany contraceptives, with hormonal methods raising the most concerns. Convenience looks at how easy it is to use each method regularly and as prescribed, in addition to effectiveness and side effects. Vasectomy, for instance, is highly effective, but its permanence may be an issue for some couples (A. Higgins et al., 2020).
Beyond these considerations, women’s decisions will also hinge on more personal factors that are often more difficult to discuss, such as future pregnancies, primary relationships, and health conditions. Many preferences take shape in a particular social context. In some cases, broader social arrangements concerning gender roles, education, and wealth will shape priorities, often making it difficult for outsiders to understand them. Considerations of sexual health may also be paramount, but these are even harder to specify from a distance or to quantify in ways that would lend themselves to broader comparisons. Nonetheless, within this framework of more universal criteria and considerations, women need to select the best contraceptive method from available options.
Effectiveness
Effectiveness is how successful a method is at preventing pregnancy and is typically measured in pregnancy rates. All pregnancy rates have a certain timeframe, usually one year, but sometimes they can also be monthly. Each method has a different effectiveness, that is, a different likelihood of becoming pregnant after one year of use; this reliability can also depend on proper usage. In general, there are three groups of contraceptive methods rated from most effective to least effective: Long-acting reversible contraceptives (LARCs), Permanent methods, and Short-acting methods (Malarcher et al., 2016).
Each method has two rates: Typical use and Perfect use. The typical use rate takes into account all instances of incorrect or inconsistent use, which is often how people use methods in real life. The perfect use rate excludes all human error and assumes that methods are being used exactly as intended. Most fertility awareness methods fall within the short-acting methods category; however, they are generally less effective than hormonal or barrier short-acting methods. The list below concerns typical use rates unless specified otherwise.
* Hormonal methods: (implants 0.05%, IUDs 0.4%, injections 4%, the pill and patch 7%, and the ring 9%) * Barrier methods: (the diaphragm 12%, spermicide 18%, and male and female condoms 18% and 21% respectively) * LARCs: (implants 0.05% and IUDs 0.4%) * Permanent methods: (vasectomies 0.15% and tubal ligations 0.5%) * Other methods: (withdrawal 20%, fertility awareness 24%, and no method 85%)
When choosing a method, it is important to consider one’s lifestyle and how consistent they plan on using it. Generally, the more effective a method is, the less it requires day-to-day attention. Choosing a method in the least effective category can have serious ramifications; that is, a woman will need to consider whether she is prepared to parent if she becomes pregnant. In contrast, if a woman is confident that she would not want to parent should a pregnancy occur, she should choose a method with a higher effectiveness rate and not rely on fertility awareness or withdrawal. If a woman is still undecided about parenthood but is leaning towards parenting, she should carefully weigh the benefits of less effective methods against the potential implications of becoming pregnant. Either way, understanding effectiveness will help women choose a method more appropriate to their needs.
Side Effects
Each contraceptive option comes with its own potential side effects. Every method of contraception has the potential to cause some sort of side effect, and it may be different from woman to woman. It is important to be aware of these side effects to better manage them. For some women, the side effects might be tolerable and not a big issue, while for others it could be unbearable (A. Zimmerman et al., 2021). Side effects can range from mild “nuisance” symptoms that can be irritating but tolerable (such as weight gain or skin changes) to serious health conditions women could die from (such as blood clots). It is necessary to understand that side effects can really take a toll on a woman’s day-to-day life (Rothschild et al., 2022). Although safety is most important when it comes to choosing contraceptives, it is the side effects that have the greatest impact on women’s everyday lives. Therefore, side effects must be taken into consideration.
Before discussing each method of contraception and its common side effects, it is important for women to note that every woman’s body is different. As a result, every method can react differently in different women. Some side effects might disappear over time, while others can become debilitating and consider switching to another method of contraception. To be informed on how these side effects may affect one’s personal health is crucial. It is encouraged to consult with a healthcare professional to better understand these side effects. There is also a discussion on common side effects for each method selected. A side effect could be something that happens to most of the women using that particular method. For hormonal methods, some common side effects include nausea, headaches, breast tenderness, mood swings, weight changes, decreased libido, spotting, and more. For barrier methods, a common side effect is irritation or allergy to latex or spermicide. For long-acting methods, common side effects include spotting or no periods, headaches, weight gain, mood changes, or some others. It is essential to prepare women on how to manage these side effects should they arise.
Convenience
Convenience is a crucial aspect to consider when assessing various contraceptive methods and how they fit into individual lifestyles. Some methods require daily attention, while others allow for longer periods without the need for active management. This chapter examines how different options for contraception vary in terms of ease of use and accessibility for women. A clear distinction is made between user-friendly methods that can be easily incorporated into daily routines, such as work and travel, and those that might require more stringent attention. Although most methods are user-friendly enough to avoid major inconveniences, women will have their particular preferences regarding convenience.
Some methods, like the pill, the patch, the ring, and the diaphragm, require daily or regularly active management, while other methods, such as injections or implants, require only one action for several weeks, months, or years of effectiveness. The IUD is a middle-ground method; it does not require active management for several years, but in some cases, insertion can only be done by a trained provider. The impact on adherence and, consequently, the effectiveness of the chosen contraceptive is also considered. In general, it seems that the less attention a method requires, the more effective it is. A side consideration in this context is the impact of convenience on mental well-being. Some women may feel more stressed if they have to remember to take a method every day, avoid certain activities, or keep track of the timing. Furthermore, some methods entail appointments or follow-ups that may not align with some women’s lifestyle choices.
Personal preferences regarding appointment schedules or whether these should be conducted by a specific provider or any trained individual are also considered. It is ultimately the balance between effectiveness and convenience that helps women select the most suitable contraceptive method for their circumstances.
Types of Contraceptives
This section outlines the contraceptive options available to women. Contraceptives are categorized based on their basic mechanism of action: barrier methods, hormonal methods, Long-Acting Reversible Contraceptives (LARCs), and natural methods. Each category is introduced, including how they work, typical use, and effectiveness. Broader considerations are also evaluated, such as implications for reproductive health and regularity of menstruation. This section aims to aid women in determining which contraceptive options to consider and provide a clearer framework for the following deeper discussions on specific contraceptives. Women’s health advocates emphasize that women should have access to a wide range of contraceptive methods (Malarcher et al., 2016). However, many women choose contraceptives based on very limited options. In a 2019 survey of 866 family planning clients in the greater Phnom Penh area of Cambodia, only 27% had considered more than one method before selecting an initial contraceptive. Moreover, 51% selected a method mostly based on provider recommendations. Although informed choice in family planning is complex, the desire for children is often the most decisive factor in method selection, even when women have considered other aspects. Providing a wider range of contraceptives makes it more likely that women will consider methods outside the default, particularly those that currently do not use any contraceptives. Ultimately, the goal is to ensure that all women can consider the contraceptive methods that they would prefer to use. With this in mind, the contraceptive options currently available are outlined here. Barrier methods are discussed first. These methods physically block sperm from entering the uterus. They are the most straightforward and oldest category of contraceptives. They are also the easiest to understand and find information on, so they are discussed first. Hormonal methods are discussed next. These methods rely on the regulation of hormones to prevent ovulation. Hormonal contraceptives are often the first type women think of when considering birth control. Long-Acting Reversible Contraceptives (LARCs) are featured next. These are contraceptives that require very little maintenance after insertion and provide protection for several years. LARCs have been the most significant advance in contraceptive technology in the last half century. Natural methods are discussed last. These involve tracking fertility to avoid sex during fertile periods. Of all the methods, these are the most invasive-free, appealing to women who wish to avoid pharmaceuticals or implanted devices (Anne Howard and Rahima Benhabbour, 2023).
Barrier Methods
Barrier methods serve as a physical barrier to sperm and are an effective means to prevent pregnancy. The most common barrier option is the male condom, a sheath made of thin latex, lambskin, or polyisoprene that fits over an erect penis. When used properly, male condoms are 98% effective at preventing pregnancy and should be considered an appealing option for most women (Anne Howard and Rahima Benhabbour, 2023). Male condoms also have the added benefit of being the only method of contraception to protect against sexually transmitted infections. Outside of abstinence, they are the next best means of protection against STIs. Male condoms are easily accessible at drugstores, supermarkets, and gas stations, and they are usually free at health clinics—making this method a generally appealing option for women. To ensure maximum effectiveness with male condoms, be sure to: open the condom package carefully, pinch the tip of the condom to leave room for semen, place the condom on the tip of the erect penis, roll the condom down the entire length of the penis, and use additional lubricant to reduce the risk of breakage if necessary. In terms of barrier methods, this is generally the simplest option for a woman, but it can lead to feelings of insecurity and lack of control because the onus is on the male partner. There are a number of reasons why a male partner may refuse to wear a condom—many focusing on the sensation of being “too restricted” or “not feeling anything.” With these valid concerns in mind, it’s crucial that women also consider their male partner’s options in regards to sensation when thinking about barrier methods.
The female condom is another barrier option that is less widely known. The female or internal condom is a soft, loose-fitting plastic pouch that lines the vaginal walls and fits inside the vagina. Unlike the male condom, the female condom is inserted prior to sex, which can be empowering for women. To ensure maximum effectiveness, the following steps should be taken with female condoms: take the condom out of the package carefully, pinch the inner ring and insert the condom like a tampon, use your finger to push the condom in as far as it will go, and make sure the penis is entering the condom pouch. Female condoms are 95% effective at preventing pregnancy when used correctly. However, female condoms are often seen as “too complicated” to use properly, and many express a fear of the condom “slipping” during use. Similar to the male condom, a number of women expressed that they simply want to feel their partner’s skin. Some women considered the female condom “uncomfortable,” explaining that it feels “bulky” or “like there’s a barrier.” Polyurethane diaphragms are another barrier option that can be used alone or in conjunction with spermicide. This small, dome-shaped latex cup with a firm ring must be inserted into the vagina prior to sex, which can also be empowering for women. Diaphragms are 94% effective at preventing pregnancy when used correctly. To ensure maximum effectiveness, be sure to: insert the diaphragm before intercourse, feel for the diaphragm’s rim to ensure it’s in the correct position, and leave the diaphragm in for at least six hours after sex but no longer than 24. Diaphragms are the only barrier method that women have expressed preference towards, which makes sense given the various concerns women have about male and female condoms. However, similar to the female condom, many women find diaphragms “complicated” or “not worth the effort.” Women have also expressed concerns about sensation, with some men saying it feels “too tight.” Overall, women have valid concerns regarding barrier methods, particularly in terms of comfort and sensation.
Hormonal Methods
For women seeking to prevent ovulation and manage different aspects of their reproductive health, contraceptives that carry hormones may be a good fit. Hormonal options come in a variety of forms. The most well-known are the oral contraceptive pills (often just referred to as “the pill”), which are small tablets taken daily. Other hormonal methods available in the United States include the contraceptive patch, which is stuck to the skin and changed weekly, the contraceptive injection, given by a healthcare provider every three months, and the vaginal ring, a flexible ring inserted into the vagina that is replaced monthly. With perfect use, all these contraceptives are over 90% effective at preventing pregnancy. However, typical use has effectiveness rates that range from about 70% to 90% (Gorenoi et al., 2007).
Hormonal contraceptives primarily keep a woman’s ovaries from releasing an egg (ovulation) by delivering synthetic versions of the hormones estrogen and progesterone (or just progesterone) into her body. However, these hormones can also provide other benefits. For some women, hormonal methods can reduce painful periods, heavy bleeding, and symptoms of endometriosis, as well as improve acne and lessen premenstrual mood changes. Many women wonder if they could get pregnant quickly after stopping hormonal contraceptives. Most women’s cycles return to regular ovulation and menstruation within one to three months of stopping hormonal contraceptives. However, it is important to note that every woman’s situation is different, so there are no simple answers (Anne Howard and Rahima Benhabbour, 2023).
In choosing a contraceptive, it is helpful to know that different health conditions and habits may influence whether a woman can use certain hormonal methods or which methods may be a better fit. For example, a woman is strongly advised against using the pill, patch, or ring if she smokes and is over 35 years old. Other lifestyle factors, such as obesity, may lower the effectiveness of some hormone-based contraceptives. Women are encouraged to have open discussions with healthcare providers about personal health histories, preferences, and concerns regarding hormonal options. There are also many misconceptions about what hormonal options can and cannot do, so it is important to understand the basics. Ultimately, the goal is to make sure that women have the knowledge they need to talk to doctors about hormonal contraceptives if they are interested in learning more about this option.
Long-Acting Reversible Contraceptives (LARCs)
Long-Acting Reversible Contraceptives (LARCs) are an excellent option for women looking for something reliable. LARCs are among the most effective contraceptives and are easy to use. LARCs are a group of fertilization preventors that give you a long time of protection against pregnancy. LARCs include an intrauterine device (IUD) and a contraceptive implant, which are inserted into the body by trained healthcare professionals. The great thing about LARCs is that, once they’re inserted, there’s next to nothing to worry about for a long time; just be aware they’re there and have to check once a month, and make an appointment for removal when their time is up. LARCs come in both hormonal and copper varieties and are safe contraceptive options for most people (Kopp Kallner, 2018). Hormonal: LARCs release hormones that primarily work by thinning the endometrium, which reduces the likelihood of implantation, and by thickening the cervical mucus, which prevents sperm from reaching the egg. Contraceptive implants are capsules that contain hormones and are inserted just beneath the skin of the upper arm, where they gradually release hormones for three years. There are currently two different hormonal IUDs available; Mirena® and Kyleena® are designed to work for five years, while Jaydess® is designed to work for three years. All hormonal IUDs generally bring on lighter periods and may lead to the absence of menstruation altogether after a while. Some people may experience side effects from these hormonal IUDs, such as prolonged bleeding after insertion, headaches, and mood changes. Copper: Copper IUDs don’t contain hormones; instead, they have copper wire wrapped around them. Copper is toxic to sperm, so it works mainly by preventing fertilization. The copper IUD Paragard® is designed to work for ten years but may be effective for up to twelve. Copper IUDs can be beneficial for those suffering from heavy menstruation since the copper may help regulate the menstrual cycle. Still, copper IUDs can sometimes lead to heavier periods with more cramping.
It’s important to know that LARCs are for everyone, regardless of whether they have given birth or not. A common misconception assumes that IUDs are only for people who have already given birth. This is false, and neither of the LARCs that go inside the uterus should be ruled out because one hasn’t given birth. Intrauterine devices are often considered the best option for women who have already given birth because they want a reliable option that will last a long time and don’t want to think about contraception. However, both IUDs are a solid choice for women who have not had children; many healthcare professionals would recommend them. A great benefit of LARCs is that they aren’t user-dependent or take very little user dependence. With the IUDs, there are three steps to follow: make the appointment for insertion at a healthcare clinic, ensure there’s a LARC in place, and have the insertion strings checked once a month. Once a LARC is in place, it takes very little user dependence. They can also be removed whenever desired, and fertility returns to normal almost immediately after removal. LARCs do have some side effects, so it’s essential to double-check that a specific LARC is the right choice and to make follow-up appointments as necessary. IUDs can be inserted any time during the menstrual cycle as long as there’s a certainty that one isn’t pregnant, but extra care should be taken if they’re fitted outside the clinic’s regular menstrual cycle, as there’s a higher risk of pregnancy. Both types of LARCs can cause irregular bleeding or spotting the first six months after insertion, so frequent appointments are good for getting the hang of the LARC.
Natural Methods
Natural methods is a catch-all for contraceptive options that do not involve hormones or physical intervention. With that being said, some of the options on this list require education and time commitment to accurately monitor fertility signs. Fertility awareness-based methods track menstrual cycle length and related physiological signals to assess fertility status. If you want to try a fertility awareness method, find an educator for one of the options below rather than going rogue. The success of these methods relies on an understanding of how to interpret fertility signs and the lifestyle commitment to sticking with it. Natural methods are non-invasive, have no side effects, and are free. However, they require meticulous record-keeping, and most methods have higher failure rates when not used correctly. If you’re intrigued by natural methods, educate yourself about the different fertility awareness methods to find what suits you best. For some people, the cultural acceptance of natural methods and personal beliefs about conception and health make these the only contraceptive options they would consider.
Fertility awareness methods estimate when you’re fertile based on the observation of natural signs of fertility and infertility. While there’s a robust scientific understanding of how hormonal cycles are linked to physiological changes in the body, these signs can be difficult to interpret without education. Some methods require daily basal body temperature measurements, while others track observable changes in cervical fluid. Some methods use a combination of these two signs, while others rely only on menstrual cycle length. All methods rely on tracking menstrual cycles to some degree. If your cycles are irregular or shorter than 21 days or longer than 35 days, it might be worth consulting with a doctor before pursuing these methods. Even with a diagnosis, these methods may still not be right for you, as anovulatory cycles or cycles disrupted by hormonal birth control make it impossible to accurately interpret fertility signs. Prior to trying any method, research the condition of your menstrual cycles and consider methods of monitoring that may work with them.
Consulting Healthcare Providers
With such a wide array of options, it is necessary to consult a healthcare provider when choosing a contraceptive method. While the final decision lies with the individual, having professional guidance is extremely helpful. Healthcare providers can help navigate these choices and find the best option based on personal health history, lifestyle, and needs. These consultations can also be a time to ask questions and voice any concerns or preferences (Suri, 2016). It is essential to choose a provider that makes you feel comfortable and safe, as open communication is vital in this process. Some might prefer to start with a general practitioner (GP) or family doctor, while others might want to speak to someone specializing in sexual and reproductive health or women’s health. Regardless of where one goes, it is important to remember that these professionals are there to help and want to provide the best care possible. Be sure to discuss any personal circumstances that may influence the decision, such as smoking, medical conditions, or specific side effects that are a concern or wanted (Burgin and V Bailey, 2022). Providers can also assist in sorting through any misconceptions or myths regarding contraceptive methods. For example, some women may have heard that hormonal contraceptives can prevent pregnancy but are hesitant to use them due to the fear of weight gain. It is important to discuss where these ideas stem from, and if there are specific concerns, they can help address them. Contraceptives may also come with side effects, but healthcare providers can explain why some effects happen and how to manage them. Generally, it is recommended to have a check-up or follow-up appointment within three months of starting a new contraceptive to ensure it is working well and there are no unwanted side effects. Once a method has been used for a while, providers can help determine if it is still the right one according to health and lifestyle changes. During these appointments, it is important to remember that women have control and can ask for explanations if something is not understood, as well as request that the information be presented differently. It is vital to be aware that everything discussed during these appointments is confidential, meaning employers or family cannot be told unless consent is given. Overall, it is best to view healthcare providers as allies in the process of choosing a contraceptive method.
In conclusion, contraception is a nuanced and complex thing that encompasses numerous aspects of people’s lives. This discussion clarified some of the things to consider when choosing a method of contraception, as well as expanded knowledge of the options available. Women should consider the effectiveness, side effects, convenience, and healthcare provider guidance of a method when deciding on one (Suri, 2016). However, individual choice is tricky, as what is best for one person will not necessarily be best for another. Additionally, people may not fall into a certain category or may have considerations outside of those presented here, but this is merely a framework from which to start. Ultimately, women should reflect on their unique circumstances and what they desire in a method of contraception, as there is no one-size-fits-all solution. Choosing a method of contraception can be an overwhelming process, but it is important to take the time to educate oneself on what each option entails and consider what factors are the most important. These choices affect more than just pregnancies; they can impact a woman’s health and lifestyle and convey a sense of power over one’s body. There is clear and vast literature on contraception, and though it cannot all be read at once, each choice is made within specific contexts. As such, it is crucial to learn what those contexts are and how decisions are being made within them. Ultimately, women should feel empowered to choose contraception methods that align with their reproductive health goals.