Female contraceptives – options and considerations you need to know

In South Africa, unintended pregnancies remain a significant concern.

According to the United Nations Population Fund (UNFPA) State of the World Population 2022 report, 81 out of every 1,000 South African women aged 15 to 49 experienced an unintended pregnancy between 2015 and 2019. This is well above the global average of 64 per 1,000.

Despite advances in healthcare, Dr Caitlin Hegter, Specialist Obstetrician and Gynaecologist at Mediclinic Kloof, says that many women still struggle to access the right contraceptive information and services. “In today's world, it may seem like we have all the information we need at our fingertips, especially through social media. But much of this information is unreliable and not evidence-based, leading many women to receive advice that may not be in their best interests.”

To set the record straight, Dr Hegter runs through the available options and explains the key considerations to keep in mind when choosing a contraceptive method. “Women have a variety of contraceptive methods to choose from, broadly categorised into non-hormonal and hormonal methods,” she says.

Non-hormonal methods:

• Barrier methods: Condoms (male and female) and diaphragms create a physical barrier to prevent sperm from reaching the egg. While readily available and free of hormonal side effects, these options are not as effective as other methods, requiring consistent and correct use.
• Permanent methods (sterilisation): Tubal ligation for women and a vasectomy for men offer a very effective solution but require surgical intervention and are only reversible in select cases.
• Spermicides and sponges: While inexpensive and easy to use, these have higher failure rates and offer no protection against sexually transmitted infections (STIs).

Hormonal methods:

• Birth control pills: These can be either progesterone-only – known as “the mini pill” – or a combination of progesterone and oestrogen. They are highly effective when taken correctly but require daily adherence and may increase the risk of blood clots in some women.
• Contraceptive patch: A small adhesive patch worn on the skin that releases hormones to prevent pregnancy. It requires weekly replacement and can improve menstrual symptoms but may, in some cases, cause skin irritation.
• Vaginal ring: A discreet ring inserted into the vagina that releases hormones. It only needs to be replaced monthly and can regulate periods but may have some temporary side effects.
• Long-acting reversible contraceptives (LARCs): These include implants and injectables. While an implant provides long-term protection (up to three years) and can be removed at any time, it requires a healthcare provider for insertion and may cause changes in menstrual cycles. A hormonal injection – administered every three months – may offer some protection against endometrial conditions but can lead to temporary delays in fertility return after discontinuation. It may also have an impact on bone mineral density in some patients with long-term use.

Intrauterine devices (IUDs):

• The Copper T: Also known as a copper IUD, the Copper T contains no hormones and can provide long-term contraception, though it may cause heavier than normal periods.
• Levonorgestrel containing IUD: Hormonal IUDs, like the Mirena or Kyleena, reduce menstrual bleeding but require medical insertion and come with an upfront cost.

Emergency contraception

Often referred to as the "morning-after pill", this is a last-resort method that should not replace regular contraception due to its time-sensitive nature. This method does not protect against STIs and its effectiveness decreases significantly after 72 hours. Emergency contraception is not designed for regular use and should not replace the use of other consistent birth control methods

Choosing the right contraceptive

When selecting a contraceptive method, there are various factors to consider, including effectiveness, convenience, and possible side effects. “There is no one-size-fits-all solution,” Dr Hegter explains. “Each woman’s medical history and personal preferences should guide the decision. Some health conditions, like a history of blood clots, may make certain hormonal options unsuitable.”

She also highlights the importance of involving both partners in contraceptive decisions. “Contraceptive responsibility should not fall solely on women – male options like condoms and a vasectomy should be considered as part of the conversation.”

While most contraceptives are safe for long-term use, some methods, such as injectables, may delay the return to fertility after discontinuation. However, Dr Hegter reassures women that contraception does not cause permanent infertility. “The misconception that using contraceptives for years makes it difficult to conceive is one of the biggest myths. Most women will regain their natural fertility levels once they stop using contraception.”

She adds that many people are also unaware that contraceptive methods are not strictly used for preventing pregnancy. “We often use the same methods, like the pill or the Mirena, to treat other gynaecological conditions as well.”

Mediclinic is committed to providing the most up-to-date fact-based information to help women make informed choices about their reproductive health. “Articles like this one play an important role in educating women, but it’s also vital to seek guidance from trusted healthcare professionals when deciding which form of contraceptive is best suited to you,” Dr Hegter advises. “And if you ever feel unsure about your options or current contraceptive, don’t hesitate to seek a second opinion,” she concludes.