The saying goes “there are eleven methods of birth control and crossing your fingers is not one of them!” The popularity of any one method depends on many factors, which may be cultural, religious, age, marital status, publicity (such as pill scares or safe sex adverts) but above all individual choice. Genuine contraceptive failure is uncommon and in this age, unplanned pregnancies should be rare. Despite contraception being free in the UK, there were 193,737 terminations in 2006 with 44 women having their 8th termination!

The ideal method of contraception for any one person (or couple) should be safe, reversible (apart from vasectomy or female sterilisation), have few or no side effects, should not rely on the user’s memory, should be simple to use, prevents infections, affordable and, especially in the young, cause minimal embarrassment. No one method has all these properties. Surveys show that half of British couples use either the pill or condoms in equal numbers. We do not endorse  coitus interruptus (withdrawal) and the rhythm method as they carry a high risk of failure and require a higher level of self-discipline. Douching and other such old wife’s tales are misconceptions and should not be entertained.

Non-hormonal methods work by preventing contact of the egg and sperm or prevent implantation of the early-fertilised egg. They include:
̃   Male Condom

̃   Female Condom

̃   Diaphragm and the cap (used with spermicide)

̃   Intra-uterine contraceptive device or coil (May contain Hormones)

̃   Vasectomy and female sterilisation

Hormonal methods have been popular in this country since the advent of the combined oral contraceptive pill and work by either preventing ovulation or preventing entry of sperm into the womb by thickening the mucus plug at the cervical opening. The hormone oestrogen tends to inhibit ovulation and progesterone affects the quality of the mucus by making it thicker, although in those who do not have periods whilst on a progestogen only preparation, ovulation is also inhibited. The route of administration varies but the mode of function is essentially as described. Each method has its advantages and disadvantages, which are not present in all users. The methods include:
̃   Combined oral contraceptive pill

̃   Progesterone only pill

̃   Injectable long acting progestogen

̃   Intra-uterine system (Mirena)

̃   Sponge

̃   Hormonal implant

The male pill has received much press of late but it is at least 5 years from being marketed. A novel idea that it is, it remains debatable whether most women would put the responsibility of birth control on their partner.

Emergency Contraception
This can be achieved by using hormones as soon as practical but within 72 hours of unprotected intercourse. It is not as effective as regular contraception and also because of the high doses of hormone should really only be used for emergencies. If 72 hours have gone by but before 5 days have passed, a coil can be inserted into the womb as emergency contraception to prevent implantation. Some women may then choose to continue with this as long-term contraception.

Sterilisation
Either the male or female partner in a relationship can be sterilised, although the operation is more invasive in the female than the male. It should be viewed as a permanent and irreversible method of birth control, which as with any other method carries a small risk of failure. Either partner can be sterilised without the other’s consent but because of its implications, one would hope that the decision is made jointly within the relationship.

Where Do You Get Advice
Most of us first hear about contraception from school and friends but, especially for young people, it is worth discussing it with a professional before selecting any one method. Condoms offer the best protection against sexually transmitted diseases as well as unwanted pregnancy and are advisable in those not in a stable relationship even when on hormonal contraception.

School nurses, practices nurses, GPs, Family Planning Clinics (of which there is one in every area), advisory services like the Brook Advisory Centre are very useful good sources of advice. Pharmacists are now able to advise and prescribe ‘the morning after pill’.