Contraceptive choices: the non-hormonal methods
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Welcome back to Contraceptive Central!
If you checked out the range of hormonal contraceptive options in my last post and decided they weren’t for you, don’t despair- this week I have a veritable smorgasbord of non-hormonal contraceptive methods.
Let’s see if we can find the right way to keep you hormone and pregnancy free…
‘Natural’ methods
These include Fertility Awareness methods and withdrawal. Fertility Awareness methods are probably most suited to couples with mature committed relationships and women with regular periods who have a good awareness of the cyclical changes in their bodies.
They rely on both partners agreeing to avoid intercourse during fertile times of the month, generally the week leading up to ovulation. The ‘withdrawal’ method requires a commitment from the male partner to withdraw his penis from the vagina prior to ejaculation, thereby minimising the number of sperm transferred to his partner.
Whilst natural methods are often considered unreliable, experienced users can achieve up to 99% efficacy (although typical efficacy for withdrawal would be around 73%). Fertility awareness also comes in very handy for those trying to conceive.
Calendar (Rhythm) method: As outlined on MyDr: “This method is based on the assumption that ovulation takes place 12-16 days before your period starts. Knowing the length of your last six menstrual cycles, you can use this information to roughly predict when you should abstain from sexual intercourse- but only with an accuracy of 82 per cent for your next 3 cycles”.
Billings method: A woman can learn to notice changes in the type of vaginal mucus present at fertile times (stringy, ‘egg-white’ mucus) of the month compared to non-fertile times (drier mucus that breaks up easily). Similarly the ‘cervical mucus method’ involves learning to identify ‘wet’ (fertile) days and ‘dry’ (infertile) days.
Temperature charting: This method relies on accurate checking and recording of your body temperature upon waking every morning. A small rise in basal body temperature can be observed just after ovulation, and after three days at this higher temperature it is ‘safe’ to have sex. If using this method by itself you could only have intercourse during the second half of your cycle.
Modern fertility ‘systems’: There are a number of centres which train women to monitor their biological signs and identify periods of fertility and infertility, such as FertilityCareTM . Similar processes are also taught by clinicians of the Australian Council of Natural Family Planning.
Condoms (Male and Female)
Male condoms are probably one of the most well-known and easily accessible forms of contraception and have the added advantage of providing good protection against a wide range of sexually transmitted infections such as Chlamydia.
It is also a great choice for people who wish to or need to avoid hormonal contraceptives. With ‘perfect’ use they can provide up to 98% effective contraception but this depends on factors such as storage at the correct temperature, expiry date, correct fit and many others, so ‘actual’ use efficacy is around 82%.
It also depends on actually having one available at the right time and obtaining agreement from your partner to use it, which is often a fall-down point for immature users or new relationships. Female condoms are not so popular or accessible but can be obtained through clinics like Sexual Health and Family Planning ACT (SHFPACT).
Diaphragm
This is a dome-shaped silicone cap which is placed in the upper vagina before intercourse to cover the cervix and prevent sperm from entering. It needs to remain in place for at least six hours after intercourse. Although not so popular these days it is still a very effective and appropriate choice for women who feel comfortable to insert and use them correctly, particularly if hormonal contraception is not desirable.
Diaphragms are not as effective at preventing pregnancy as some other methods (84-94%, possibly improved with additional use of spermicide) and may not be suitable for women with a weak pelvic floor or problems with recurrent urinary infections. Diaphragm consultations are available at Family Planning agencies such as SHFPACT, and this video from Caya demonstrates its use.
Copper IUDs
These have been around for a long time and are still popular for women who want a semi-permanent form of contraception with no hormones at all. They are (usually) T-shaped devices around 2cm long which are inserted into the uterus by specially trained doctor. IUDs are designed to remain within the uterus for 5-10 years preventing pregnancies but can be easily removed at any time for a rapid return to baseline fertility.
Copper IUDs work by creating a spermicidal environment within the uterus and are very effective contraceptives (99.2%). The main downside of copper compared to progestogen IUDs is that some women will experience heavier, more painful periods so this would not be a good choice if you already have that problem. Copper IUDs are also great ‘morning after’ (emergency) contraception; 98% effective if inserted within five days of unprotected intercourse, but you need quick access to a doctor who can insert it for you.
As discussed in Part One under ‘IUDs’, there are some risks and downsides, as with any medical intervention. To get the best idea about whether an IUD might suit you, book in for a consultation with a doctor who does the procedure: some GPs can do this, or SHFPACT Canberra, Marie Stopes (Canberra), Gynaecology Centres Australia (Queanbeyan) or your gynaecologist.
Sterilisation
This is available for women (usually in the form of tubal ligation) and for men (vasectomy). Sterilisation procedures are designed to be permanent, so don’t even think about it unless you’re quite sure you won’t want more children under any circumstances.
There is some belief that reversal operations are reliably successful but you can’t count on that; surgeons may therefore refuse to operate on younger people. With good alternatives like IUD’s available however, there’s often no reason why a long-acting reversible method can’t be used instead.
Some women will undergo a hysterectomy for other problems like heavy bleeding but such a major operation is not generally done for contraception alone. For any of these female sterilisation options you will need a GP’s referral to a gynaecologist. Male sterilisation is usually done by a general surgeon although some specialist GP’s also do the procedure.
For more information about these contraceptive methods click on the embedded hyperlinks in this post or chat to your doctor or sexual healthcare provider.
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