Contraception

1: Hormonal Method; These normally use a synthetic form of the natural hormones progestogen and estrogen to prevent pregnancy. These are easily available, convenient and easy to use. Like any other method they have benefits and side effects which you should consult your Gynae on. Available options include:

• Combined pill with Folate (Vitamin B9)
• Combined pill
• Progestogen-only pill
• Contraceptive patch
• Sub-dermal Implant
• Vaginal Ring
• Injection
• Intrauterine Device

Intrauterine Device; Intrauterine devices (IUDs) are small, T-shaped contraceptive devices inserted into the uterus to prevent pregnancy. They are long-acting, reversible, and highly effective. There are two main types of IUDs: 1. Hormonal IUDs (Progestin-Releasing) These IUDs release a small amount of levonorgestrel, a form of progestin, which thickens cervical mucus and may suppress ovulation. Common brands:

• Mirena (effective for up to 8 years)
• Kyleena (effective for up to 5 years)
• Liletta (effective for up to 8 years)
• Skyla (effective for up to 3 years) Features:
• May reduce or stop periods
• Helpful for women with heavy or painful periods
• Slightly higher initial cost, but cost-effective over time
• Effectiveness: Over 99% effective in preventing pregnancy
• Fertility Return: Fertility returns quickly after removal

2. Copper IUD (Non-Hormonal) This type of IUD releases copper ions, which are toxic to sperm, preventing fertilization. Brand:

• Paragard (effective for up to 10–12 years)
• Pearls (Up to 10 years of effective contraception) Features:
• Hormone-free (good for those sensitive to hormones)
• Can increase menstrual bleeding or cramps initially
• Can be used as emergency contraception if inserted within 5 days of unprotected sex
• Fertility Return: Fertility returns quickly after removal
• Effectiveness: Over 99% effective in preventing pregnancy

1: Combined Oral Contraceptive Pills (COCs): Contains:

• Estrogen (usually ethinyl estradiol)
• Progestin (a synthetic form of progesterone) How They Work:
• Prevent ovulation (no egg released)
• Thicken cervical mucus (blocks sperm)
• Thin the uterine lining (prevents implantation) Common Brands (names vary by country):
• Yasmin / Yaz
• Microgynon / Levlen
• Marvelon
• Diane-35 (also used for acne and PCOS)
• Femodene
• Qlaira (uses natural estrogen) Pill Pack Types:
• 21-day pills: Take for 21 days, then 7-day break
• 28-day pills: 21 active pills + 7 placebo (reminder) pills
• Extended-cycle pills: Fewer or no periods (e.g., Seasonique) Who Should Avoid:
• Smokers over 35
• Women with high blood pressure, history of blood clots, or migraines with aura

Side Effects Specific to Combined Pills (COCs) Because they contain estrogen and progestin:

• Increased risk of blood clots (deep vein thrombosis, pulmonary embolism)
• Slightly increased risk of stroke or heart attack (especially if over 35 and a smoker)
• Higher blood pressure
• Breast enlargement
• Pigmentation changes (melasma or “mask of pregnancy” on the face)

2. Progestin-Only Pills (POPs): Also called: “Mini-pill” Contains:

• Only progestin (no estrogen) How They Work:
• Mainly thicken cervical mucus
• May suppress ovulation (less consistent than COCs)
• Thins the uterine lining Common Brands:
• Cerazette / Desogestrel (often suppresses ovulation)
• Micronor
• Norgeston
• Noriday Timing is Crucial:
• Must be taken at the same time every day (within 3 hours for older POPs, 12 hours for newer ones like Cerazette) Good For:
• Breastfeeding women
• Those who can’t take estrogen (e.g., due to clotting risk)

Side Effects Specific to Progestin-Only Pills (POPs) Because they contain no estrogen, they're safer for some women but may cause:

• Irregular bleeding (can be frequent, prolonged, or stop altogether)
• Ovarian cysts (usually harmless and temporary)
• Acne or oily skin (in some women)
• More strict timing for effectiveness (must be taken at the same time daily)

Summary Comparison:

• Hormones: COCs contain estrogen + progestin; POPs contain progestin only
• Timing: COCs allow a few hours' flexibility; POPs must be taken at the same time daily (within 3 hours for older POPs, 12 hours for Cerazette)
• Who they suit: COCs are avoided by smokers over 35 and those with a clotting/migraine-with-aura history; POPs are the go-to for breastfeeding women and anyone who can't take estrogen
• Bleeding pattern: COCs give a predictable withdrawal bleed; POPs are more likely to cause irregular or absent bleeding

Other Notes:

• Neither type protects against STIs.
• Always consult a doctor or nurse to find the best option for your body, medical history, and lifestyle.

Common Side Effects (Both COCs & POPs) These usually improve after a few months as your body adjusts:

• Nausea
• Headaches
• Breast tenderness
• Spotting or breakthrough bleeding (especially in the first 1–3 months)
• Mood changes (including low mood or anxiety)
• Weight changes (more commonly due to fluid retention)
• Changes in libido (sex drive)
• Bloating
• Mild skin changes (acne may improve or worsen depending on the pill)

Contraceptive Patches The contraceptive patch is a hormonal birth control method that sticks to your skin and releases estrogen and progestin into the bloodstream to prevent pregnancy. It's a combined hormonal contraceptive, similar to the combined oral pill, but used weekly instead of daily. Common Brands of Contraceptive Patches

• Evra (widely used globally)
• Xulane (USA)
• Twirla (USA – lower-dose patch for certain users)

How It Works The patch:

• Prevents ovulation (no egg released)
• Thickens cervical mucus (blocks sperm)
• Thins the uterine lining (prevents implantation)

How to Use the Patch

• Apply one patch per week for 3 consecutive weeks
• Place it on clean, dry skin (buttock, stomach, upper arm, or back—not on breasts)
• Week 4 is patch-free to allow for a withdrawal bleed (like a period)
• After the 7-day break, start a new patch cycle—even if you're still bleeding

Where to Apply

• Buttocks
• Abdomen
• Upper outer arm
• Upperback 🛑 Do not place on breasts or irritated skin

Benefits

• Once-a-week convenience (no daily pills)
• Highly effective when used correctly (≈ 99%)
• Helps regulate periods
• May reduce acne, menstrual cramps, and PMS

Disadvantages / Side Effects

• Possible skin irritation at the patch site
• May cause breast tenderness, nausea, or mood changes
• Not suitable for women over 35 who smoke (increased clot risk)
• May be less effective in women over 90 kg (198 lbs)

Who Should Avoid the Patch?

• History of blood clots, stroke, or estrogen-sensitive cancers
• Uncontrolled high blood pressure
• Migraine with aura
• Smokers over age 35

Sub-Dermal Implants: Sub-dermal implants are a long-acting, reversible contraceptive (LARC) method that involves inserting a small, flexible rod under the skin of your upper arm. These implants slowly release a progestin hormone (usually etonogestrel or levonorgestrel) to prevent pregnancy for several years.

Types of Sub-Dermal Implants 1. Implanon / Implanon NXT

• Hormone: Etonogestrel (68 mg)
• Duration: Up to 3 years
• Rod count: Single rod
• Brand: Implanon (older), Implanon NXT (newer version with pre-loaded applicator)
• Manufacturer: Organon (formerly MSD/Merck)

How it works:

• Inhibits ovulation
• Thickens cervical mucus (blocks sperm)
• Thins uterine lining (prevents implantation) Nexplanon:
• Hormone: Etonogestrel (68 mg)
• Duration: Up to 3 years (some evidence suggests effectiveness up to 5 years)
• Rod count: Single rod
• Brand: Nexplanon (improved version of Implanon)
• Features: Radiopaque (visible on X-rays for easy location) Advantages:
• Quick and easy insertion/removal
• High effectiveness: >99%
• Return to fertility is quick after removal Jadelle:
• Hormone: Levonorgestrel (150 mg total)
• Duration: Up to 5 years
• Rod count: Two rods
• Brand: Jadelle (used widely in low- and middle-income countries)
• Manufacturer: Bayer

Contraceptive Injections; Contraceptive injections are a form of long-acting, reversible hormonal birth control that contains progestin (no estrogen). A healthcare provider administers the injection at regular intervals to prevent pregnancy. How Injection Contraceptives Work

• Prevents ovulation (no egg is released)
• Thickens cervical mucus (blocks sperm)
• Thins the uterine lining (prevents implantation)

Types of Contraceptive Injections; 1. Depo-Provera:

• Hormone: Medroxyprogesterone acetate (150 mg)
• Interval: Every 12 weeks (3 months)
• Route: Intramuscular (IM) injection – usually in the buttock or upper arm
• Brand names: Depo-Provera, Sayana Press (subcutaneous version) Features:
• One of the most common injectable contraceptives
• Suitable for women who can't take estrogen
• May cause periods to stop over time

2. Sayana Press

• Hormone: Medroxyprogesterone acetate (104 mg)
• Interval: Every 13 weeks
• Route: Subcutaneous (SC) injection – under the skin (often in thigh or abdomen)
• Format: All-in-one prefilled injector (easy for self-injection) Features:
• Same hormone as Depo-Provera, lower dose
• Can be self-injected at home
• Available in some public health programs globally

3. Noristerat:

• Hormone: Norethisterone enantate (200 mg)
• Interval: Every 8 weeks (2 months)
• Route: Intramuscular (IM) injection
• Brand name: Noristerat Features:
• Shorter-acting than Depo-Provera
• Common in Europe and some African countries
• Often used postpartum or short-term contraception

Advantages:

• Highly effective: >99% when used on schedule
• Convenient: no daily action required
• May reduce or stop periods over time
• Suitable for women who can't use estrogen
• Discreet and private Possible Side Effects:
• Irregular bleeding or spotting
• Weight gain
• Delayed return to fertility (may take 6–12 months after stopping)
• Headaches, mood changes, or acne
• Reduced bone density (especially with long-term use of Depo-Provera)