Why the pill isn't always the best option

In 1961 women’s lives changed forever in Britain when the government made the contraceptive pill available on the National Health Service for the first time.

The 60s went on to become synonymous with sexual liberation and free love, fuelled by the ascendancy of youth and music culture in a shift away from the austere 50s.

But for many women it wasn’t so much about the degree of sexual activity as that they were freed from the fear of unwanted pregnancy and back-street abortions that had plagued previous generations of women.

Today the pill remains the most popular form of reversible contraception in the UK despite scare stories on associated risks and side-effects over the years. But the pill is by no means the only form of contraception available to women in the 21st century.

There are 15 different methods of birth control available today and which is most appropriate depends on factors such as life-style, medical history and physical well-being (risks increase for smokers and those overweight).

For the pill — be it the combined pill, containing the hormones oestrogen and progesterone, or the mini-pill, which contains progesterone only and has fewer side-effects than the combined pill — to be effective it must be taken daily.

But not everyone’s lifestyle allows for the routine and regularity required in taking an oral contraceptive. In this case hormone injections (which have to be renewed every three months), implants (these last up to three years) or an intrauterine system (IUS) or vaginal ring might be a more appropriate alternative, with a similar level of reliability.

For those women who can’t, or don’t want to, take hormonal contraceptives there are other options such as the male condom, the female condom, a cap or diaphragm and natural family planning methods.

Condoms remain the only way to protect against sexually transmitted diseases, as well as pregnancy, although they are not necessarily as reliable as some other forms of contraceptive.

The male condom is 98% effective — this means that two women out of a hundred, using this form of contraceptive for a year, would get pregnant — compared with 99% for the hormonal options when taken according to the instructions.

The female condom and diaphragm are less effective contraceptives and tend not to be so widely used.

Factors to consider include whether you want to use a contraceptive that you only need when you are having sex, or whether you want a method that becomes part of your routine but means you don’t have to think about it every time you have sex.

Also if you are uncomfortable with doctors or nurses fitting devices then the IUS or IUD (intrauterine device or coil) may not be something you want to consider, although they have the benefit of lasting several years once fitted and so can be particularly useful for women with hectic lifestyles.

In all cases there are many considerations to make when choosing a contraceptive and your GP or family planning clinic can help, as can online resources.

More information:

NHS Choices contraceptive tool

Family Planning Association

This article was published on Fri 23 September 2011