Pregnancy prevention: hormonal methods
These methods tend to be more effective than barrier methods in protecting against pregnancy, but they do not protect against STIs.
They tend to be more convenient for use, but usually require advance planning and have more potential side effects.
These methods tend to be easier for a female to use, requiring less active participation from the partner.
Oral contraceptives
What is it?
A hormonally active pill taken by women on a daily basis which contains either a progestogen combined with an estrogen or a progestogen alone (two different female hormones).
How does it work?
Combined oral contraceptives (two hormones) suppress ovulation. Progestogen-only contraceptives also suppress ovulation in about half of women. Both types cause a thickening of the cervical mucus, blocking sperm penetration.
When can you use it?
A woman can decide to start taking the pill if she is sexually active or planning to become sexually active and is certain she is not pregnant. Some pills are taken daily for 21 days and stopped for seven before starting a new package.
Other kinds are taken continuously for 28-day cycles. Oral contraceptives should be taken in order, at a convenient and consistent time each day. They are appropriate for women who are willing to use a method that requires action daily and who will be able to obtain supplies on a continuous basis.
Advantages
• Continuous protection against pregnancy
• If the first cycle of pills is started within the first five days of a menstrual period, they are effective immediately
• Nothing to apply or insert at time of intercourse
• More regular and shorter periods and often a decrease in menstrual cramps
• Ability to become pregnant returns quickly when use is stopped
• Protects against ovarian and endometrial cancer, ectopic pregnancies and infections of the fallopian tubes
Disadvantages
• Must remember and be able to take daily
• Possible side effects: nausea, breast tenderness, mild headaches, weight gain or loss.
• Very rare, but serious health risks (blood clots, heart attack, and stroke – risks are higher for women over 35 who smoke)
• No protection against STI
What does it protect against?
Oral contraceptives are 92-99+% effective against pregnancy. In general, the effectiveness of progestogen-only pills is slightly lower than that of combined oral contraceptives, especially if a pill is missed. Oral contraceptives do not protect against sexually transmitted diseases (STI).
Oral contraception troubleshooting
What do I do if...
What do I do if I have to take antibiotics?
Antibiotics can interfere with the effectiveness of oral contraceptives. Continue to take your pill as you usually do, but use a back-up method of protection (a condom, for example) during intercourse.
Other types of medicine can also affect oral contraceptives. You should always check with a health professional if you are unsure. If you have unprotected sex while on antibiotics, you may need emergency contraception and should seek medical advice immediately. Keep taking the pills and use condoms in the meantime.
What do I do if I vomit or have diarrhea while I’m on the pill?
If you vomit within 3 hours of taking the pill or if you have very severe diarrhoea, the way your pill works may be affected. You should seek medical advice and use condoms as extra protection in the meantime (but keep taking your pills as you usually do). If you have had sex in the last few days, you may need to take emergency contraception. Note that the contraceptive patch is not affected by vomiting and diarrhea.
What do I do if I miss a pill?
Depending on the type of pill you are taking and on how much time passes before you remember to take it, you may need to use another form of protection, such as a condom.
Check the instructions that came with your pills and seek medical advice. If you have had sex in the last few days, you may need to take emergency contraception.
If you miss pills frequently, you may want to consider switching to another form of contraception (for example, the contraceptive patch, the injection, or an IUD).
Negotiating use
Review the negotiation techniques mentioned for condom use and how they can be applied to oral contraceptives. Discuss potential obstacles that might differ from condom use and how these might be overcome.
Attitudes and values
Gender issues and responsibility
Currently, hormonal contraceptives are only available for women. Although some women prefer having control over contraception, women feel a lot of pressure because of the responsibility.
Even if men cannot take hormonal contraception, there are ways in which they can be involved, sharing part of the responsibility.
For example, a male partner can take the responsibility of reminding the woman to take her pill everyday or he can keep the pills for her if she does not have a safe and adequate place to store them.
A male partner can also suggest using condoms in addition to hormonal contraception to offer dual protection.
Oral contraception and pleasure
Can increase sexual pleasure by removing the fear of pregnancy. Some types of oral contraceptives may decrease vaginal lubrication or diminish libido. If spotting occurs (mainly with progestogen-only contraceptives), may reduce sexual activity in setting where sex with bleeding in women is taboo or if sex in the presence of vaginal bleeding is not appealing.