Contraception: Hormonal Methods

ORAL CONTRACEPTIVES (THE PILL)

The first method that comes to mind when speaking of hormonal contraception is, of course, "the Pill". This was developed in the early 1960's and, although the ingredients that compose it are the same, the dosage is now twenty times less than that for the first pill. The pill contains two hormones - estrogen and progesterone - which are very similar to the ones produced by the ovaries. Different brands of pill have different advantages but, at the very low dosage levels now used, they are all more or less equivalent with respect to effectiveness (92% - 99,9% for perfect users) and side effects, which are now minimal. As mentioned, the first pill contained high levels of hormones because the thinking was "the more, the better". Over the years, doses have decreased substantially, and today's pill is very safe and can be used by most healthy women, whatever their age. If they are over 35, they should not smoke. Even though it is now so safe, the pill can still only be obtained on prescription. It is therefore up to the doctor to assess each woman before prescribing this medication. It has to be taken every day, in accordance with the doctor's instructions, for it to be effective. Detailed instructions accompany each new pack and, ideally, they should be read and understood by all women taking contraceptive pills. In addition to being very effective, the pill also provides substantial benefits that are quite separate from contraception. It reduces menstrual pain, as well as the volume of menstrual blood, which, in turn, reduces the incidence of anemia. It also reduces the risk of endometrial and ovarian cancer, benign breast lesions and the incidence of pelvic inflammation. It also decreases the number of ectopic pregnancies.

CONTRACEPTIVE VAGINAL RING

This is a flexible, transparent ring that is easily inserted into the vagina, where it releases the same hormones as those contained in the pill. The hormones are absorbed through the vaginal mucous tissue into the blood stream and provide contraception that is as effective as the pill, using the same mechanisms. The ring must be left in the vagina for three weeks and taken out the fourth week when the woman's menstrual period occurs. It does not interfere with sexual relations.

CONTRACEPTIVE PATCH

The adhesive contraceptive patch is applied to the skin on any part of the body except the breasts, and is changed every week for three weeks. The patch is not used during the fourth week when the menstrual period occurs. It contains the same hormones as the pill and is just as effective, although it may prove less so in women weighing more than 90 kg.

PROGESTIN-ONLY PILL

This is also called the "Mini Pill". It contains progestin only and is intended for women who cannot take estrogens. It is often used after childbirth by women who are breast-feeding.

DEPOPROVERA

Injections are also very effective for those women who absolutely cannot take the pill or who forget to do so too often, with consequent unwanted pregnancies and therapeutic abortions. The injections (which contain progestin only) are given every three months (four injections per year), and provide a level of contraception that is almost as good as sterilization. They are suitable for most women, but do have some side effects. This method should be discussed with your doctor.

EMERGENCY CONTRACEPTION

This is more commonly known as the "morning after" pill. It is, in fact, composed of two progestin pills that can be taken after unprotected sex in order to prevent pregnancy. Maximum effectiveness occurs when taken within 24 hours following sexual relations, but can be taken up to 5 days later. The "morning after" pill is available in pharmacies and no prescription is necessary.