How to choose a contraceptive

Right for them personally. So, if you already have a strong preference, a doctor will try to go along with your personal wishes – unless he can see a good medical reason why not.

The potential health risks are always something your doctor has to take into account. Before prescribing the Pill, for example, he will take a medical history and examine you- because high blood pressure, liver disease or a history of thrombosis would mean the Pill is not advisable. If you request an IUD (’coil’) but have very heavy periods, the doctor may advise against this method, as it may increase the blood loss.

Of course, it may not be as clear cut as that. With the Pill there are some ‘marginal’ medical factors such as migraine, epilepsy, being over-weight or in the 35-plus age group (especially if you are a smoker); these can lead the doctor to say an alternative to the Pill would be preferable. But he may well still prescribe it if you insist it is the most convenient method – perhaps with the proviso of more frequent check-ups. The doctor here is really making sure you understand the possible risks of problems. (Detailed discussion of side effects and medical considerations will be covered in separate articles on each method).

If you’re less sure about the type of contraception you want, or perhaps want to change to another method, the doctor will be able to discuss with you the pros and cons of different contraceptives. Don’t be afraid to bring up vour feelings about a particular method, even ir you think perhaps they sound trivial. If you don’t want to have a cap because you think it’s a real nuisance to put it in before you have sex – then say so; if you’re worried about the Pill making you put on weight or giving you varicose veins, then discuss it.

There is no point in having a contraceptive you dislike or that makes you feel anxious; in many cases the doctor will be able to reassure you about a particular worry. Most family doctors are very helpful when it comes to contraception, but remember there are alternatives – specialist family planning and birth control clinics-where you can go for advice and contraceptive supplies.

How does a husband’s or boyfriend’s opinion count as far as contraception is concerned? In a regular relationship, it should certainly concern both partners that they can make love without fear of an unwanted pregnancy. Often it’s a case of discussing it together, then the woman coming along to a doctor or clinic. But if a man wants to know more about any of the methods available, the doctor will be happy to see the couple together, although some men are a bit daunted by the predominantly female clientele in the waiting room at a clinic.

Sometimes a couple’s attitudes towards having children diverge a lot, which can make contra-ception and sex in general an area of conflict. If a man wants more children but the wife refuses to embark on another pregnancy, then it may be a question of a wife reluctantly seeking contraception. She really wants another baby, but her husband is insisting the he doesn’t want, or can’t afford, another child.

This kind of conflict about contraception can have a real effect on a couple’s sexual feelings. Some women who blame the Pill for the fact that they have ‘gone off sex’ are actually reacting to the fact that it is so They enjoy the risk of conception as part of the experience of sex or perhaps, despite practical considerations, deep down would like a child.

If this is causing sexual problems, perhaps the most important thing is for the couple actually to acknowledge their feelings and manage to talk through the difficulty with their doctor. But, besides this increased understanding, a change of contraceptive method may help too. If a woman feels sex is futile without chance of conception, she may feel happier even with the very slightly increased risk associated with an IUD, while an anxious husband can still be reassured that she is continuing to use a reasonable contraceptive.

Absolute safety is an important factor in choosing a contraceptive for many women – particularly when they are young, unmarried, training or pursuing a career. The figures above show you the figures on effectiveness.

Although there is no ‘most suitable’ method for different age groups, there are some considerations- like absolute reliability, effects on fertility ©r breastfeeding, various health concerns – that have a different emphasis at various stages of most women’s lives.

These case histories are loosely based on the experiences of a doctor at one family planning clinic (of course, anything you say to a doctor is stricdy confidential). They show how these factors can operate – but they also demonstrate how very are the needs and preferences of every woman.

Most women want the maximum protection when they first start having intercourse, perhaps they are still students, interested in their career, buying their own flat or are just not ready for children. At this time, the health risks of the most effective and carefree method, the Pill, are also minimal, so this is often a very sensible choice. But individual feelings and personality may mean some other method is preferable. On surveys taken from a group of highly motivated women who used their contraceptives conscien-tiously.

The combined Pill, containing oestrogen and progestogen, is the most effective reversible method – pretty well 100 per cent effective if taken regularly. Only very rarely, when taking other medicines such as anti-epileptic drugs or antibiotics, is there a failure.

I suggested that the coil, though in theory less effective, would give her better protection because once it was fitted she would then have nothing to remember. As she was menstruating I could fit her immediately. I emphasized the importance of coming back to the clinic regularly for her check-ups, or at any time she had low abdominal pain, because although the coil has no effect on fertility in a healthy woman, there can be a more rapid spread of pelvic infection to the Fallopian tubes in a woman fitted with an IUD, and this can occasionally lead to sterility.

Vasectomy are the only other methods that offer complete protection but they must be regarded as irreversible so you should feel absolutely convinced that you don’t want more children. Even when an operation is done to join up the tubes which carry the sperm or the egg, it does not often restore fertility.

The progestogen-only Pill (mini-Pill) and the IUD both have a failure rate of about 2-3 per cent, but it is important to realise that this drops as you get older and fertility declines, so that it is less than 1 per cent over the age of 35 years. The effectiveness of the cap and sheath depends on how carefully they are used. For a woman who is highly motivated (who has completed her family, perhaps), and therefore always remembers to use the cap, the failure rate for this method can be as low as 1 per cent.

First married

Although most couples want to continue to use contraception when first married, they may want to reconsider the methods that they are using. If they plan to start a family in the near future, a woman may now be more concerned about any likely effect of the various types of contraceptive on her future fertility.

After a baby

Some women prefer to use a different method of contraception after childbirth; while spacing children, they may be content with a method that is less than 100 per cent effective. Breast feeding affects the use of the Pill, but it is easier to insert an IUD alter childbirth.