Is it your first time using birth control?
Or your current contraceptive is not agreeing with you.
Being a lady in 2023 means you have the power of choice. Birth control methods for females might seem overwhelming, but your doctor will guide you in narrowing them down.
My mantra is that knowledge is power.
Let us start at the beginning and run through all the available contraceptives. That way, you might have something in mind when seeing your GP or gynecologist.
I have also included a pros and cons table at the end of the post, bet viewed on a PC.
When can I start birth control?
Whatever your age, if you are at risk of unwanted pregnancy, consider long-term contraception.1,2,3
What is the best birth control for me?
“It is essential to understand that no contraceptive is 100% safe.”
You can get up to ≥ 99% by ensuring your contraceptive choice fits into your lifestyle, and you follow the instructions perfectly.
For some of us, getting into a routine of taking something every day is easier than weekly or monthly. Other people find a pill every day impossible.
Your doctor will discuss your needs and medical history with you. They will help you make an informed decision about which available option best suits your needs.
Part of the conversation might be:
- What is your age?
- Do you smoke cigarettes or vape?
- Do you have any other chronic illnesses, like high blood pressure?
- Do you have acne?
- Do you have irregular periods, heavy bleeds, or period pains?
- Are you breastfeeding?
- Have you or your parents had blood clots or strokes?
- Do you have a history of depression or anxiety?
- Do you have a history of migraines or severe headaches?
- Will it freak you out if your period stops?
- Do you want to get pregnant in the next few years?
- What is your financial situation?
So, let’s go through 8 reliable birth control methods for females
Male Condoms – Method 1
Male condoms in the birth control methods for females?
“Let’s face it, ladies, with new partners, you should insist on using condoms.”
I’m going to start with a lecture, back to basics.
Pregnancy is just one of the concerns that a sexually active female should be protecting herself against.
Chlamydia and gonorrhea can affect your fertility long-term. Herpes, HIV, and Hepatitis B will be with you for life. Protect yourself against sexually transmitted infections (STIs) until both partners have clear screening tests, and indefinitely if trust is an issue.
Other reasons to use a condom:
- For at least seven days when starting most contraceptives.
- When you break the rules of your chosen birth control until you are protected again.
After years in GP practice, I have seen too many unforeseen bun-in-the-oven situations that cause stress. We are all human, and accidents happen in the heat of the moment.
“Always have condoms in your handbag, even if you are on other birth control.”
Combination hormonal contraceptives (CHC)
These are contraceptives that contain estrogen and progesterone.
‘The Pill’ or Combined Oral Contraceptive (COC) – Method 2
- 91 – 99% effective. 4,5
Adhere to the rules and use the COC accurately to achieve the 99%.
This is the most commonly prescribed form of CHC birth control and a topic unto itself.
I have a whole blog dedicated to FAQs about the pill; click on the link if you think this is your preference.
The main reasons patients can’t take the pill is if they are:
- terrible at a daily routine, or
- oestrogen intolerant.
The patch – Method 3
The contraceptive patch is also a CHC.
- 93 – 99% effective. 4,5
Stick to the schedule exactly to achieve the 99%.
It is a fantastic option for patients who are useless with daily routines but want the same benefits as the pill.
Applied once a week for three weeks, followed by one patch-free week.
“Personally, I find it easier to get into a daily routine than weekly. You might be different.”
If this appeals to you, but you are nervous you’ll forget to change the patch:
- You can set a reminder alarm once a week.
- Download an Apple store app that will help you to remember.
Vaginal ring – Method 4
- 93 – 99% effective. 4,5
Strictly stick to the schedule to achieve the 99%.
The contraceptive ring contains estrogen and progesterone that are steadily absorbed into the bloodstream through the vaginal wall.
Some Apple and Google Play apps remind you to replace the ring.
Very popular in the USA and Europe.
For some reason, South African women are not very open to this option. Perhaps this is because we are a more conservative society and do not discuss female health and sexuality openly.
“The vaginal ring won’t be challenging to master if you’re comfortable using tampons.”
Watch the video below for everything you need to know about the ring before moving on to the progesterone-only options.
Progesterone-only options
All progesterone-only options have similar potential side effects:
- Irregular bleeding; spotting or long heavy periods
- Weight gain
- Trouble with skin or acne
- Painful swollen breasts
- Decreased libido
‘Mini Pill’ or Progesterone-Only Pill – Method 5
- 91 to 99% effective. 4,5
The progesterone-only pill is less forgiving than the COC; even a 3-hour delay can increase your chances of falling pregnant. 6
They are often used during breastfeeding because the COC is contraindicated.
“I generally do not recommend using this as the first choice because of the three-hour failure window. Even during breastfeeding, there are safer options.”
Intramuscular Progesterone Injections – Method 6
- 94 to ≥ 99 % effective 4,5
Injectable progesterone birth control is a popular option in South Africa.
It is cheap and readily available, a fantastic option if cost or daily routine are issues.
Depending on the type of progesterone injected, you would follow up at the contraceptive clinic every 2 to 3 months.
“I generally do not recommend this for my patients as a first-line option for the following reasons:
- Initially, dysfunctional bleeding means heavy spotting for up to six months.
- After stopping this birth control, cycles can take 9 to 18 months to return to normal and fertility to resume. Not a good option for patients planning a family within the next 2 to 3 years.”
Subcutaneous Implant – Method 7
- 99% effective 4,5
It is inserted just under the skin of the right upper arm in less than 5 minutes and lasts for three years.
Pros include not needing to think about falling pregnant during this time and a fast return to fertility.
Cons include irregular bleeding 6 to 12 months after insertion and the need for a local anesthetic procedure for removal.
Intrauterine Devices – Method 8
- 99% effective 4,5
These are plastic devices that are usually t-shaped. They contain either copper or progesterone. 7
They are inserted into the uterine cavity, usually by a gynecologist.
A speculum is used during the procedure so the doctor can clearly see your cervix. Similar to when you have a PAP smear or HPV testing.
They prevent pregnancy by: 7
- Causing inflammation and a hostile environment in the womb so that pregnancy cannot occur.
- Thickening mucous and creating an obstacle for sperm.
- Affecting sperm’s ability to move (copper).
- Thinning the womb lining makes implantation less likely (progesterone).
“For patients who cannot tolerate any hormones, I recommend considering copper IUDs.”
The emergency contraceptive pill
“I mention this last. I do not include this as a reliable method of contraception.
Avoid ending up in a situation where you need to use this.
Plan, get onto one of the above options and prevent emergency anxiety.”
The morning-after-pill or emergency contraceptive is often used to remedy an unprotected-post-coital-panic-attack. But be warned; it causes hormone havoc and menstrual cycle irregularities.
Patients should take this once-off progesterone (levonorgestrel) dose within 72 hours of unprotected intercourse.
The efficacy drops significantly the longer you wait: 8
- 95% within 24 hours
- 85% within 25-48 hours
- 58% within 49-72 hours
I find that patients abuse it because it is available without a prescription.
Now that you know the options, one or two might stand out.
Make an appointment with your GP or gynecologist, discuss it in more detail, and see if they agree.
Contraceptive Options – Pros & Cons Table
This is best viewed on a PC or laptop.
With so many choices, you might still feel overwhelmed. This is a summary of the main advantages and disadvantages of the the options available.  |   | |
|---|---|---|
| Condoms | -Cheap -Free from community clinics -Readily available -Easy to carry in your purse -Protects against STIs | -Affects sexual feeling |
| Combined Oral Contraceptive (COC) Contains oestrogen | -Daily routine easier than weekly or monthly for some -Follow-up visit every 6 to 12 months -Cycle regulation -Acne control (certain brands) -Different combinations mean that there is a pill for everyone | -Need to remember to take it same time daily or ineffective -Drug interactions might decrease efficacy -Possible mood changes -Increased clotting risk |
| Evra Patch Contains oestrogen | -Change once a week -Follow-up visit every 6 to 12 months -Cycle regulation | -Visible -Reaction to adhesive -Risk of dislodging -Increased clotting risk -Once weekly routine difficult for some patients |
| NuvaRing Contains oestrogen | -Change once a month -Cycle regulation -Follow-up visit every 6 to 12 months | -Possible vaginal discomfort -1/10 partners can feel the ring during intercourse -Risk of ring expulsion -Increased clotting risk -Once a month routine difficult for some patients |
| Progesterone injections | -Given every 2 or 3 months into buttock -Cost effective -Periods may stop with extended use; money saved on pads/tampons | -Follow-up visits every 2 to 3 months -Delayed return to fertility after stopping compared to other methods -Extended irregular bleeding pattern -Possible acne -Possible weight gain |
| Progesterone implant | -Lasts 3 years -Quick procedure | -Invasive procedure -Skin needs a small cut for removal -Extended irregular bleeding pattern |
| Intrauterine Device-Progesterone (IUD) | -Lasts 5 years -Once-off cost -Periods may stop with extended use; money saved on pads/tampons | -Invasive procedure -Discomfort with insertion -Some bleeding post-insertion for up to 2 months -Expensive (once-off) |
| Copper Intrauterine Device (IUD) | -Lasts 5 years -Once-off cost -Hormone-free | -Invasive procedure -Discomfort with insertion -Some bleeding post-insertion for up to 2 months |
References
- Child rights based on age. Legal Aid South Africa. (n.d.). https://legal-aid.co.za/2018/09/26/child-rights-based-on-age/#:~:text=HIV%20Testing%2FContraceptives,his%20or%20her%20HIV%20status.
- World Health Organization. (n.d.). Contraception. World Health Organization. https://www.who.int/health-topics/contraception#tab=tab_1
- American Academy of Pediatrics Committee on Adolescence. (2023, July 13). Contraception explained: Options for Teens & Adolescents. HealthyChildren.org. https://www.healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Birth-Control-for-Sexually-Active-Teens.aspx#:~:text=Pediatricians%20start%20talking%20about%20sexual,other%20resources%20in%20the%20community
- NHS. (2020, April 17). How effective is contraception at preventing pregnancy?. NHS choices. https://www.nhs.uk/conditions/contraception/how-effective-contraception/
- American College of Obstetricians and Gynecologists. (2023, April). Effectiveness of birth control methods. ACOG. https://www.acog.org/womens-health/infographics/effectiveness-of-birth-control-methods
- Scottish Government. (2022, December 30). Progestogen-only pill (POP, Mini Pill). NHS inform. https://www.nhsinform.scot/healthy-living/contraception/progestogen-only-pill-pop-mini-pill
- Cleveland Clinic MD (2022, November 13). Intrauterine device (IUD): Birth Control, use & side effects. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/24441-intrauterine-device-iud
- Emergency contraception. (2003, March 1). Paediatrics & child health, 8(3), 181–192. https://doi.org/10.1093/pch/8.3.181
