Contraception is an important sector of female reproductive health. Contraception is needed before a desired pregnancy, between pregnancies and after the desired number of children has been reached.
Choice of contraceptive method
In addition to its contraceptive function, hormonal contraception treatment has other beneficial effects, e.g., reduction of menstrual bleeding and pain, normalization of the menstrual cycle, reduction of the number of functional ovarian cysts and reduction of the risk of ovarian and endometrial cancer. On the other hand, some chronic illnesses may limit contraception options. Typical illnesses of this kind are migraine with aura and familial thrombophilia (tendency to get blood clots).
Thus, it is important that the contraceptive method is chosen based on individual consideration and needs. The goal is, in any case, to choose an effective method that is as safe as possible, i.e., has a minimum of side effects, e.g., like headache, bleeding disturbances or mood problems.
The condom is the only contraceptive method that also protects against sexually transmitted infections (STI). When used properly, the condom has quite a good contraceptive effect. The condom is recommended for occasional relations as a complement to a more effective method. Other mechanical contraceptive methods include spermicidal foams and vaginal suppositories. The effectiveness of these methods is not as good as of the other methods presented previously and they are nor recommended as the sole method for contraception.
An intrauterine device made of copper is a non-hormonal contraception method. The copper-IUD may also be used by women who have not had children and for emergency contraception if the women has had unprotected intercourse within the previous five days. The copper-IUD tends to increase the volume of menstrual blood.
Hormonal contraception comes in two forms: combined hormonal contraception (estrogen and a progestin) and progestin contraception. For combined hormonal contraception pills, vaginal rings or skin patches may be used and all are effective when used correctly. There is a selection of combination pills which contain a variable amount of different female sex hormones. Combination pills come in a form requiring daily dosing and in a form that requires intervals when no pills or placebo pills are taken during some consecutive days per cycle. These drugs also alleviate menstrual pain, heavy menstruation and irregular periods, reduce the formation of ovarian cysts and prevent ovarian cancer. Combination pills are contraindicated (may not be used) for patients with migraine with aura, high blood pressure, blood clots in the family, smokers aged more than 35 years and heavily overweight women.
Contraception is also possible with progestin pills, hormonal IUDs, contraceptive implants (under the skin) and injections taken every three months. The progestin-containing contraceptive pill is to be taken daily and there are several preparations to choose from.
The hormonal IUD is a very reliable contraceptive method. The hormonal IUD Mirena® has been approved for five years of use, but it is effective for seven years after implantation. It reduces menstrual volume and menstrual pain significantly. The hormonal IUD is an established method also for treating heavy menstruation, regardless of whether contraception is needed or not. Hormonal IUDs of smaller size and shorter duration of effect than the Mirena® are also available in the market. The hormonal IUD may also be used by women who have not had children. The physician can insert an IUD during a regular office visit.
One contraceptive implant is inserted under local anesthesia under the skin of the upper arm and provides contraceptive effect for three years. If two implants (containing a different progestin) are inserted, the effect will last for five years. The implant is removed under local anesthesia by a physician during a regular office visit. The progestin injections are administered by a nurse at three-month intervals. Progestin injections may increase bone mineral loss. Progestin contraception is safe and there are no contraindications against the use of progestins.