Contraceptive methods that suit your needs and wallet

When it comes to contraception or birth control, women have more options than ever, but more choices also mean that there is a lot more to consider. How can you choose which pregnancy prevention method is right for you? Alina Hardcastle gets an idea of what’s on the market, the advantages, disadvantages and costs.

Different types of contraception

Dr Tom Mokaya, a specialist obstetrician and gynaecologist practising in Johannesburg, says that there is no one size fits all best contraception on the market. “The most suitable for one woman may not be suitable for the next woman. All contraceptive methods must be evaluated in light of the woman’s circumstances to arrive at the most appropriate one for her.

We take a look at five methods of contraception that are currently available on the market:

  1. Birth control implant (Implanon)

The implanon is a long acting hormonal contraceptive method that is inserted under the skin of a woman’s upper arm. It works by gradually releasing the hormone etonogestrel (a type of progesterone) continually into the woman’s body thereby preventing conception. It is designed to last up to three years.

Mokaya says that studies have shown the implanon to be more than 99% effective. He adds, “A higher failure rate may occur in incorrectly inserted devices or when used in combination with certain drugs. Therefore, one should consult their doctor before opting for this method.”

The FDA and most regional regulatory bodies have approved this contraceptive.

Advantages and disadvantages

Mokaya highlights that the procedure is discrete and it is easy to return to fertility once the contraceptive is removed. Some women may experience negative side effects such as irregular bleeding. Mokaya warns that once the contraceptive is removed it may cause scarring. He discourages women who are overweight or are taking other medication to consider this type of contraceptive.

Costs

The Implanon is available at most family planning clinics, hospitals and medical specialist rooms.  Mokaya says that the cost is varies but is approximately R 3000. While this is a bit of an upfront cost you have to consider that the implant lasts up to years.

  1. The contraceptive injection

The contraceptive injection contains progesterone. It works by thickening mucus in the cervix, stopping sperm from reaching an egg. It also thins the womb lining and in some women can also prevent ovulation. Mokaya says if used within five days of menstrual period the injection is effective immediately. “But if given after that an additional [contraceptive] method is needed for approximately seven days after the injection is administered.”

Mokaya warns that this method is not suitable for women who had a history of fractures, breast cancer, or if a woman suspects she is pregnant.

Advantages and disadvantages

Mokaya inform us that this contraceptive helps prevent endometrial cancer and can be used while mothers are breastfeeding. He also adds that it can improve the spontaneity of sex.

On the other hand there are also the potential side effects that need to be considered such as alternations in your menstrual cycle i.e. you may bleed in between periods; it may cause breast tenderness; and it could your alter sex drive and appetite. There may also be a delay in return to fertility especially if this method is used for a long time. Mokaya warns that certain medications can affect the injection, so chat to your doctor beforehand.

Costs

This contraceptive can be obtained in a doctor’s room and family planning clinics. Dr Bright Mhlongo, medical director at the AIDS Healthcare Foundation, says that the costs are dependent on whether the patient is on medical aid or will be paying cash. Cash payments range between R150 and R500.

  1. Mirena

The Mirena is an intrauterine device (IUD) that contains the hormone levonorgestrel (a type of progesterone). It is made of plastic and appears as a ‘T” shape. It’s placed in the uterus where it slowly releases the hormone to prevent pregnancy for up to five years. It works by causing changes in the cervical mucus and lining of the uterus which makes it hard for sperm to enter the uterine cavity and unfavourable of any fertilised egg to attached to the uterus.  Mokaya explains that the woman lies on her back in a lithotomy position (similar to when a pap smear is taken) when insertion takes place. This is performed in either a doctor’s room or family planning clinic by experienced medical personnel.

Mokaya explains that this contraceptive is over 99% effective when inserted properly but the longer it stays in the less effective it gets. “The Mirena is safe for most women. However medical advice must be sought before insertion to establish any underlying conditions that may make it unfavourable to use e.g. pelvic infections or abnormal Pap smear.”

Advantages and disadvantages

Mokaya says that the Mirena can assist in reducing menstrual cramping and the amount of bleeding in women with heavy periods. It also reduces the risk of developing endometrial cancer. He cautions that there is a slightly higher risk of pelvic infection within the first month after insertion as well as a very small risk of uterine perforation; and that your sexual partner may experience discomfort if the string is not cut short enough.

Costs

The Mirena is available in most family planning clinics, hospitals and medical specialist rooms. The cost is variable; a rough approximation is R 4000.

  1. The birth control pill

The combined oral contraceptive pill contains artificial versions of the female hormones oestrogen and progesterone, which women produce naturally. It prevents the ovaries from releasing an egg (ovulation with every cycle). It also works by thickening the cervical mucus and thinning the uterine lining making it harder for sperm to penetrate and unfavourable for an egg to implant respectively.

Mokaya says, “When used properly the pill is over 99% effective in preventing pregnancy. It should be noted that the pill should be taken at approximately the same time every day and care taken not to miss or forget to take any doses as this affects its effectiveness.”

Advantages and disadvantages

Mokaya expresses that this is a simple method of contraception, it doesn’t interfere with sex, and it reduces the flow of periods especially in women who have heavy bleeding as well as reducing period cramps. Although some women may have conditions that increase the risk of serious side effects. Mokaya says that some of these conditions may even rule out using the pill e.g. women with migraines, any hear conditions, history of getting bloods, or autoimmune disorder etc. There are also some of the other side effects one should be aware of such as nausea, vomiting, bleeding or spotting between periods, breast tenderness, changes in libido, weight gain and acne.

Costs

The cost is variable dependant on brand and outlet. However, it is free in government clinics and hospitals. According Mhlongo, the birth control pill can cost anything between R90 to R400 depending on the brand.

  1. Female condom

The female condom is a lubricated polyurethane sheath/pouch that has two ends. One end is closed and the other is open, with flexible rings at each end. It protects against pregnancy by catching the sperm in the pouch and preventing it from entering the vagina. It cannot be used with the male condom. This can be purchased at grocery or pharmacy outlets without a prescription from a doctor.

Advantages and disadvantages

The upside of this contraceptive it allows women to take responsibility and protect themselves against not only pregnancy but STIs. The outer ring may irritate the female’s vagina/vulva. Sutter Health, a Palo Alto medical foundation, says that some argue that feeling/pleasure from intercourse is reduced or that it is noisy, which means that more lubrication might be needed.

Cost

Mhlongo says that the cost of female condom depends on the type of brand but can be anything between R80 to R160. They are generally more expensive to manufacture than men’s condoms hence their higher price.

Conclusion

When enquiring about the most economical contraception, Dr Sibongile Nomganga, medical advisor on women’s health at Bayer, says that contraception goes beyond the issues of reliability and suitability for woman. “If you take the pill for instance, the upfront cost is cheaper but because you have to buy it every month then it becomes costly in the long run. Whereas if you were to look at a method like the intra uterine device the upfront cost is expensive but because it is effective for up to five years in a woman who requires a long term method it will become cheaper in the long run. In the same way it will not be affordable if the contraception is only needed for a year.”

She concludes that the key factor to bear in mind is that contraception needs to be personalised because each woman is different and has different needs.

 

 

 



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