Dear Helen,
I’m sure you must have had this question before, but I hope not recently as I missed a few editions of this magazine.
I want to talk to my granddaughter about contraceptives, and want to be able to make sense of all the information out there. What can I tell her are the best or safest types to use? She is 17 now and will soon be 18. I don’t know for sure if she is sexually active yet, but she does now have a boyfriend, which is why I want to talk to her.- Jackie.
Dear Jackie,
Thanks for your question and no worries.
I’ve been writing this column for many years now and don’t expect today’s readers to have read all of those or even if they have, to remember what they contained. Plus, there are a couple of new methods that are useful, particularly for younger women.
The simplest answer to part of your question is that the method that’s used correctly and consistently is generally the best one. Used erratically, or incorrectly, there’s a reliable record of failure. That said, any method can fail but when used as advised, that’s far less likely.
Methods split into two categories hormonal and non-hormonal. Then split again, as user-dependent and userindependent.
The choice of which method also depends on an individual’s medical history plus that of their first degree blood-relatives. The more she can be informed about you, your husband, her mother and her father’s medical history, the safer choices can be made for her down the line. That holds for all other areas of medicine, not just contraception.
THE HORMONAL METHODS INCLUDE: 1. Combined Hormonal Contraceptives- CHCs – which contain synthetic oestrogen and progestogen. These are suitable for a wide range of women, depending on certain medical conditions:
• The Pill – a combined pill that’s taken for 21 days, stopped for 7, during which time the woman has a withdrawal bleed, rather than a natural period.
• The Patch – the woman places a sticky patch on her body that stays in place for seven days, after which she replaces it with a fresh one, for a further seven days, then again for a third time before leaving one off for a week before repeating the 21/7 process. The common name in the UK for this is Evra® contraceptive patch.
• The Vaginal Ring – in the UK we use NuvaRing® – a hollow silicone ring that’s impregnated with a combined hormonal mixture that is placed in the vagina by the woman once a month. It can stay in place during intercourse or be taken out for that but replaced straight after to maintain protection.
2. Progestogen-only methods of contraception – POMs – which only contain progestogen:
• Progestogen-only-Pill – POP – a pill that has to be taken daily, without a break, every day of the year, to maintain contraceptive protection. Sometimes called ‘the mini pill’ as it only contains one hormone.
• DepoProvera® – 12 weekly LARC (long acting reversible) contraceptive injection, containing progestogen. This is also available as a selfadministered injection, in the UK called SyanaPress®. As with the subnormal implant, it is userindependent, once injected.
• Sub-dermal implant – a LARC (long acting reversible) contraceptive device that’s inserted just under the skin of the inner upper arm, which slowly releases progestogen for three years. In the UK, this is now called Nexplanon®. As with the injection, it is user-independent after insertion.
3. Emergency Contraceptive Pills
• Also known as ‘the morning after pill’, although it can be used up to 72 hours following unprotected sex, hence the new name. It has a place but is not as reliable as using ongoing any of the regular methods above. It’s a backup method.
4. Intra-Uterine methods of contraception
• IUD – copper coil – a T-shaped device wrapped in copper which is inserted into a woman’s uterus by a specially trained doctor or nurse. They commonly last for 5-10 years, but if inserted at or after 40 years of age, don’t necessarily need replacement, just removal at menopause. It is suitable for women of all ages, depending on certain medical conditions. These are LARCs (long acting reversible methods).
• IUS – intra-uterine systems – T-shaped devices that have a barrel of progestogen surrounding the device which releases the hormone slowly for 3-5 years, sometimes longer.
It’s suitable for a wide range of women, depending on certain medical conditions. These are LARCs (long acting reversible methods).
5. Barrier methods of contraception
• male condoms – male method of protection against pregnancy and/ or sexually transmitted infection
• female condoms – worn by females instead of males, it lines the vagina and covers part of the vulva, too. It provides the same protection as male condoms against pregnancy and/or sexually transmitted infection
• diaphragms/Dutch caps – devices that cover the cervix and line the upper side of the vagina to keep sperm from entering the uterus.
• cervical caps – devices that fit over and adhere to the cervix.
These are not used much today but for some, still have a place.
6. Fertility Awareness/Natural Family Planning
• a deep understanding of the menstrual cycle, safe and unsafe times during the cycle if pregnancy is wanted or wished to be avoided. Not suitable for a range of women and certainly not safe enough for young women establishing their menstrual pattern. It’s very useful if trying to conceive, however. It can be good, when understood by both partners well and practiced very carefully. Periods of abstinence are required each cycle to avoid pregnancy.
7. Sterilisation
• male sterilisation – vasectomy
• female sterilisation – tubal ligation or other techniques – not what your granddaughter would want for quite some time. Not particularly suitable for anyone who wonders if it can be reversed.
8. Abstinence
• Not having sex is 100% safe – 100% reliable against both pregnancy and sexually transmitted infections! Highly recommended… even if not particularly appealing or exciting at times for some people. The most reliable method of all, though.
These are the main methods available today. Long acting reversible methods of contraception, ideally independent of the user in order to work, are the most effective and reliable for her age.
For more information and to discuss in person, why not go with her to the Barbados Family Planning Association in Bay Street. They have a young people’s section as well as everything else.
They’re very friendly and she’d benefit from understanding more in general and for them, as a couple, to be able to make informed decisions before taking things further.
Alternatively, she can speak to her own doctor, though they may want her mother or you to be present. Barbados FPA will talk to her on her own or with her partner, too.
I hope this helps. – Helen
