Intra-Uterine Device (IUD)

The two main types are bio-active and unmedicated IUD’s, both offering immediate protection once inserted and no delay in fertility on it’s removal. The bio-active or medicated IUD, is very similar in comparison to the unmedicated type, although it differs in having a copper wire coiled around it and is probably a more effective option with fewer complications.

This device should be replaced every three to five years. The unmedicated IUD’s are manufactured from plastic and there is no release of any chemicals. They are generally inexpensive and can be left in place indefinitely as long as no problems arise. Both types offer the woman peace of mind as once it is correctly inserted she can forget about it – they do however require regular check-ups to ensure that the device is still firmly in place. The woman may find that her periods are far more painful after having an IUD inserted, but this tends to settle once the body adjusts.

Who shouldn’t use the IUD?
Women should not be fitted with an IUD if they are prone to recurrent vaginal infections, are often exposed to sexually transmitted diseases or if they suffer from undiagnosed heavy, irregular bleeding. Women who have not yet had children, or those where pregnancy is suspected should also not consider using the IUD. It is therefore only suited to women who have had one child or more and who for whatever reason are unable to take the Pill.

WARNING !
If while using an IUD you suffer from any of the following conditions, contact your doctor immediately.

Menstrual irregularities – missed period or spotting
Severe cramps of the abdomen
Shoulder or leg pain
Painful sex
Marked increase in vaginal discharge.

Diaphragm and Cervical Cap

The diaphragm is a rubber cap that is positioned over the cervical opening to prevent sperm from entering. This method can be very effective if used correctly with a spermicidal cream, and you see your doctor regularly for refitting (especially after childbirth). Some may find that having to fit the device before intercourse takes place involves too much hassle and dampens the mood.

A cervical cap works in a similar manner, but is smaller and firmer. Both are to be used with gel or cream spermicide, and both must cover the cervix every time you have sex in order to be effective. Both the diaphragm and cervical cap must also be fitted by a doctor or health care provider, to obtain the correct measurements.

You should insert the diaphragm into your vagina a few minutes to 6 hours before intercourse, the cervical cap, 30 minutes to 40 hours before.
Keep the diaphragm in place for at least 6 hours after sex, the cap, 8 hours after sex.
Never keep the diaphragm in your body for longer than 24 hours, as it may increase your risk of developing toxic shock syndrome; the cervical cap must be removed within 48 hours.
When using a diaphragm, remember to insert more spermicide into the vagina before each act of sexual intercourse, but leave the diaphragm in place.
Do not remove the diaphragm for at least six hours after the last act of sexual intercourse.
It’s important to wash and carefully store the diaphragm or cervical cap after removal.
Do not share a cervical cap or diaphragm, even among family members.
They must be measured to fit you.
If you have had a weight change or pregnancy, another fitting should be scheduled because you may need a new prescription.

*For both diaphragm users and cervical cap users, in a 1-year period, 6 to 18 women out of every 100 get pregnant.*

Vaginal Sponge

Contraceptive sponges are small, round, specially made sponges filled with spermicide that fit into your vagina and over your cervix.

Competing with all other barrier methods, the vaginal sponge acts in the same manner by blocking off the entrance of sperm to the uterus, but also has the added advantage of releasing a spermicide. This method may seem somewhat less effective than other barrier methods, but may benefit the user by reducing the risk of contracting certain sexually transmitted diseases if it contains nonoxynol-9. This on the other hand may cause an allergy in those concerned. The vaginal sponge is inserted by the user, is relatively easy to use and does not require a prescription or a visit to your doctor. It is important though to ensure the entire removal of the sponge, as any left-over pieces may cause infection.

You can have sex more than once while you have a sponge in place.
To work, it must cover the cervix completely – every time you have sex.
The sponge should be put in your vagina (follow package instructions) 30 minutes to 18 hours prior to sex and kept in place for at least 6 hours after.
Never keep the sponge in your body for longer than 24 hours.
After removing the sponge, throw it away.
Sponges can be purchased without a prescription at most chemists and selected stores.

* In a 1-year period, 6 to 28 women out of every 100 become pregnant while using sponges.*

Spermicidal Creams and Foams

A spermicide is a gel, foam, cream, or tablet that kills sperm. It is inserted into the vagina, as close as possible to the cervix, a few minutes prior to having sex. This must be done each time you repeat intercourse, leaving the spermicide in place afterwards.

Be sure to read the package insert for the spermicide.
Some products require a waiting period before using and others must be inserted immediately before intercourse.
Do not use tampons or douche for 6 to 8 hours.
Spermicides can also help in protecting against some sexually transmitted diseases.
Spermicidal creams require no prescription and are easily obtainable from most pharmacies and selected stores.
It is suggested that these agents be used in combination with other methods, as they tend to be ineffective when used on their own.

* In a 1-year period, 3 to 21 women out of every 100 become pregnant while using a spermicide.*

Condoms

This rubber sheath that is fitted over the penis prior to intercourse can effectively prevent conception if used with care. Condoms can be used on their own or with an alternate method and are very effective in reducing the risk of sexually transmitted diseases. All condoms should be thoroughly checked for any damage before use and your partner should withdraw his penis before the loss of total erection and while the condom is still firmly attached.

While very effective in preventing the spread of sexually transmitted diseases, condoms should not be your first and only choice of contraception when avoiding pregnancy – Every year, between 2 and 12 women out of every 100 become pregnant while using condoms.
For maximum efficiency, it is therefore recommended that you use them together with a spermicide or other reliable contraception method, and carefully follow the instructions for correct application:

put the condom on the head of the hard penis, leaving room in the tip to catch semen;
squeeze the air out of the tip of the condom and unroll it all the way down over the penis;
use only water-based lubricants, not oils (including petroleum jelly) or hand creams because they can cause condoms to break;
after sex, the wearer should hold the condom at the base of the penis and pull out of his partner carefully.

Always keep a fresh supply of condoms on hand and never use the same condom twice!

Withdrawal Method

This mostly unreliable form of protection, involves the withdrawal of the penis from the vagina before sperm is released, and is not recommended from a family planning and a safety point of view.

Rhythm Method

The effectiveness of this method depends entirely on careful recording of the menstrual cycle. Intercourse is avoided during the middle 10 days of the cycle, when conception is most likely, but this varies, from woman to woman. If you have an irregular cycle, it may be difficult to calculate the exact ‘safe-time’.

Rhythm method calculations:

Calendar method

Counting the first day of her menstrual period as day 1, the woman keeps a record of her menstrual pattern for the last three to six months, or longer if possible. She then calculates her ‘safe period’ by recording the number of days in her shortest cycle, and subtracts 18. She then records the number of days in her longest cycle and subtracts 11. Thus if her longest cycle runs on a 30 day schedule she will after subtracting be left with the number 19, and the number 10 if her shortest cycle is 28 days. This means that her most fertile period, which would obviously be ‘unsafe’ would be the days between 10 and 19. This is not a recommended method as it may fail if something such as stress alters the length of your cycle.

Basal body temperature method

The woman takes her temperature every morning upon waking, with an ordinary or specially designed thermometer and records the taking on a chart. From day 1 of your period, until around ovulation, your temperature will be 0,3 – 0,6°C lower than the time between the end of ovulation and your next menstrual period. Intercourse should be avoided three to four days before and after this temperature change, as that is when you are likely to be at your most fertile. This method can be unreliable especially if your cycle is upset for whatever reason or an illness affects your temperature reading.

*1 to 20 women out of every 100 become pregnant while using Natural Family Planning methods.*

Injectable contraception

These consist of progestogen given in the form of an injection, and because there is no oestrogen present many are led to believe that they act in the same manner as the ‘progestogen-only pill’ would. Although there are a few similarities, there are also a number of differences, such as allowing for complete cessation of ovulation.

This is probably due to the larger dose of progestogen used in an injectable than in a ‘progestogen-only pill’ and the fact that it is not exposed to the hazards of being destroyed by stomach acids or being affected by bouts of diarrhoea and vomiting.

Advantages:

Extremely effective
This method is very effective in preventing pregnancy and also allows for spontaneity in love-making by not always having to resort to the bathroom cabinet before ingaging in intercourse.
Reduced risk of ectopic pregnancies
Seeing as it prevents you from ovulating, there will be no chance of traveling sperm meeting an egg in one of the tubes.
Can be safely used while breastfeeding
A small amount of the drug would pass through into your breast milk, however it would not place your baby in any danger and would not affect the production of your milk.
No oestrogen-related side effects
This would mainly benefit those women who are unable to take oestrogen for whatever reason, or those over the age of 35 years who smoke.
No drug interaction
Antibiotics and other medications that would normally affect the Pill’s actions, would not interfere with the injectable.
No effect on blood pressure and blood clotting
There are no factors that may contribute towards developing thrombosis, and can also be used by those who have previously suffered with this condition.
Reduced likelihood of ovarian cysts
The injectable prevents ovulation, and in so doing prevents the ovaries from becoming ‘active’, this greatly reduces the risk of developing ovarian cysts.

Disadvantages:

Long-term side effects
Apart from the fortunate aspect of only having to receive one injection every two to three months, there is a problem for those who suffer with side effects as they would have to endure them for the duration of it’s action.
Weight gain
Many women find that they gain weight when first using this method, although they do report that it does seem to stabilize after a given period.
Fertility delay
There could be a 6 month to a year delay in falling pregnant after ‘stopping’ the injectable, therefore it shouldn’t be your first choice of contraception if you are planning a pregnancy fairly soon.

Emergency oral contraception

This is an emergency procedure to be used within 72 hours after a single incident of unprotected intercourse. e.g. condom broke or slipped off; diaphragm became dislodged or the women was a victim of rape.

How does the ‘morning-after pill’ work?

This depends entirely on where you are in your cycle at that particular time. If you have already ovulated for instance, then the ‘morning after pill’ will prevent the fertilized egg from becoming embedded in the uterus. In the case of you not yet having ovulated, then it’s actions would be to prevent ovulation.

Effectiveness

It may be quite difficult to determine the effectiveness of this pill, as many users would not have become pregnant anyway. However, it is thought that the failure rate is between 2 and 4%, again depending on where you are in your cycle.

Are there any health risks and side effects associated with the ‘morning after pill’?

Nausea is common in many users, and in this case one wouldn’t want to have to return to the doctor for more tablets in the case of vomiting within 24 hours of taking it. Therefore it may be wise to take an anti-emetic (anti-nausea drug) an hour before taking the tablet. Unfortunately, anti-nausea drugs have a few side effects of their own, which in the end does seem to make this a more complicated matter than one would expect. However, anyone in this position would probably opt for feeling ill for a day or two than have to embark on an unplanned and often unwanted pregnancy!

There is also a slight chance of ectopic pregnancy, whereby fertilization and development occur in the fallopian tube – this is uncommon, but it may just be in your interests to request a follow-up appointment to assess whether all is well.