How to choose the contraceptive

The choice of the most suitable contraceptive depends on numerous factors, to be evaluated with the help of the gynecologist.

To avoid unwanted pregnancies the first step is to choose the right contraceptive method. It is a decision that must take into account different variables, from lifestyle to age and personal health status.

The criteria for choosing

The choice of the contraceptive system must be made following certain criteria. There are factors that can be decisive in preferring one method to another.

Health status is an important element. The pill is par excellence the safest contraceptive system and is suitable for women of any age, also for the countless extra-contraceptive benefits that characterize it (for example, it regulates cycle disorders and has a positive action on the epidermis in case of acne and hirsutism). However, it is not recommended for heavy smoking women who are over 35 years old or in case of obesity, diabetes and hypertension; In addition, it is advisable to discuss with the gynecologist the risks and benefits of taking it if there are cases of thrombosis or venous thromboembolism (VTE) in the family.

When choosing, it is also important to take into account your sexual lifestyle. If you frequently change partners or have casual intercourse, it is good to use a double protection, ensured by the pill, which is the most reliable method to avoid the risk of pregnancy, and by the condom, which guarantees protection against sexually transmitted diseases.

You should also assess your risk appetite for an unplanned pregnancy. If you do not want to run any danger, you should not consider natural contraceptive methods, which are considered unreliable.

Condom

It is used by “him”: it is a thin latex sheath, flexible but resistant. It covers the penis during sexual intercourse and collects seminal fluid at the time of ejaculation, preventing sperm from coming into contact with the vagina.

It is a reliable contraceptive method, but the rules of use must be followed well. If the condom breaks or comes off, the relationship is to be considered at risk and to be sure of not having “surprises” you must resort to emergency contraception.

Its use can create some psychological resistance due to the need to apply it by interrupting the intimacy of the moment.

The pill

The estroprogestin pill contains a combination of two female hormones (steroids): an estrogen and a progestin.

There are different types. There is the monophasic pill (fixed dose), the biphasic pill (which contains a fixed dosage of estrogen and a variable dosage of progestin) and the triphasic pill (which involves associated hormones in three different dosages and a very low total dose). Finally, there is a pill, so-called quadriphasic, which contains estradiol and a progestogen combined in four different dosages.

The estroprogestin pill works mainly by inhibiting ovulation by blocking the synthesis of two hormones, called FSH and LH. The pill also causes a thickening of the cervical mucus and a thinning of the endometrium, the mucous membrane of the uterus, which thus becomes less suitable for the possible implantation of an egg.

It is taken for 21 days, starting from the first day of menstrual flow. This is followed by a week’s break, during which there is pseudomenstrual flow.

There are also contraceptives in packs of 28 dragees, to be taken without any interruption between one box and the next: to contain the hormones are the first 24 or 26 pills, depending on the contraceptive, followed by other 4 (or 2) “placebo” pills, which do not have any active ingredient inside, but are useful as they reduce the risk of forgetfulness. Generally, pseudomenstrual flow appears when taking the last tablets and may still be present when the new pack is started.

Contraception with the pill involves taking a dragee a day, possibly always at the same time or with a delay that for most pills is a maximum of 12 hours. However, today there are oral contraceptives of the latest generation (in 24/4 regime) that allow you to lengthen the contraception window in case of forgetfulness from 12 to 24 hours.

If taken following the indications, whatever the regimen (21/7, 24/4 or 26/2), the estroprogestin pill has a very high contraceptive efficacy and also has other beneficial “side” effects, such as the decrease of premenstrual syndrome and a beneficial action on acne and seborrhea. In general, it can be used by both young and older women and is well tolerated.

The pill with only progestogen has a lower contraceptive safety than the classic pill, but it is also indicated for women who cannot take estrogen.

Hormonal contraception is also available in other “formulations”.

The transdermal patch

It is a transdermal release system of an estrogen and a progestin. After application, small amounts of the two hormones are regularly released daily. Its effectiveness is very high. Indications and contraindications are similar to those of the pill.

Intrauterine system (IUS)

It is a flexible, T-shaped device that contains the progestogen hormone in a reservoir. It is inserted into the uterus by the gynecologist and lasts from 3 to 5 years depending on the model. It is one of the safest methods of contraception.

Vaginal ring

It is a flexible ring that contains estrogen and progestin and that the woman can introduce alone into the vagina, where it should be left for three weeks, followed by a 7-day interval. The vaginal ring does not seem to interfere with sexual intercourse.

Copper spiral (IUD)

It is a mechanical contraceptive. There are different models, with different characteristics. The thin copper filament, wrapped in the rod of the device, enhances the mechanical effect of the spiral, acting as a “spermicide”. The copper ions, released into the uterine cavity, have a direct effect on the spermatozoa.

The device should be replaced after 3-5 years. The spiral is a very effective contraceptive method. Many women sometimes report abundant flows in the months following insertion.

Emergency contraception

When you have had unprotected sex, you can resort to emergency contraception to reduce the likelihood of pregnancy.

Emergency contraception is typically well tolerated and uses a low amount of hormones. However, it is good to remember that its use must still be episodic and limited to real emergency situations.

Natural methods

In addition to hormonal and barrier contraceptives, there are also other so-called “natural” methods. Among the most common are coitus interruptus and the Billings method.

The former does not actually possess high contraceptive security. It requires the man to retract the penis from the vagina before ejaculation, preventing sperm from spreading into the female genital tract. It is a simple method, but not safe and that is often unwelcome to the couple because it abruptly interrupts the relationship.

The Billings method is based on the observation of the characteristics of cervical mucus, whose consistency and appearance vary during each monthly cycle. Following the rules of this method, one should single out the fertile period every month. It is considered a system of medium contraceptive effectiveness, but it is necessary to follow precise rules daily, which require considerable constancy and good knowledge of your body.