Natural methods

• Withdrawal: Also known as coitus interruptus, this method involves withdrawing the penis from the vagina before the ejaculation of sperm. It is not very reliable, as failure to withdraw the penis at the correct time can result in pregnancy.
• Rhythm method: This is also not a failsafe method. It involves abstaining from sex during the fertile period in a woman’s menstrual cycle. The fertile phase begins at the beginning of follicular development and ends 48 hours after ovulation. Sperm retains the capacity to fertilise the egg for up to 5 days in the cervical mucus. Thus the combined unsafe phase for sex is about 6 to 8 days of every cycle. Owing to individual variations and irregularities in the date of ovulation, it is unwise to depend on the rhythm method for effective contraception.

Condoms (to be used by the man)

Advantages of IUCD

• They do not have any associated systemic metabolic effects.
• A one-time insertion is required for protection over a long (but limited) period of time.
• They are highly effective in preventing pregnancy.

Disadvantages of IUCD

• Uterine bleeding: Women who discontinue the use of IUCD mostly do so because of heavy periods or intermenstrual bleeding. In most cases the bleeding stops after the uterus gets used to having a foreign body within it. If it does not stop, the IUCD should be removed.
• Perforation of the uterus: This can occur rarely, due to careless insertion of the IUCD.
• Infections: For 24 hours after an IUCD has been inserted, there is an infection of the uterus (which is normally sterile) with bacteria. In most cases, the bacteria are destroyed naturally, but in some, infections develop. IUCD use is associated with a greater risk of salpingitis. The risk of infection is also higher in women under 25 who have not had children, in those with a history of pelvic infection and in those with multiple sexual partners.

Birth control pills (to be taken by the woman)

Birth control pills are also known as oral contraceptives. They are commonly referred to as “the pill” and are highly effective. These pills, which have to be taken every day by the woman, contain oestrogen and progestogen in combination, or progestogen alone. These substances prevent pregnancy by suppressing gonadotropin and inhibiting ovulation. The cervical mucus becomes thick and does not allow sperm to penetrate beyond it. The endometrium becomes flat and inactive and is not prepared for implantation of a fertilised egg.

Minor side effects of birth control pills: Headaches, nausea and vomiting.

Serious complications associated with birth control pills

• Thromboembolic complications: Oestrogen (which is contained in oral contraceptives) causes an increase of certain blood clotting factors. Users Women who take birth control pills are at higher risk of both superficial thrombosis (coagulation of blood) and deep vein thrombosis. They are also at a 4 four times greater risk of dying of vascular diseases than women who do not take the pills.
• Hypertension: Hypertension can occur in a small number of users women as a result of taking the pill. About 5% of users women in the USA have been reported to develop hypertension after 5 years of use. Almost all women who have developed hypertension return to normal after discontinuing the pill.
• Amenorrhea after stopping the pill: Some women develop amenorrhea (absence of periods) for a while after stopping the pill.
• Rare liver tumour: There is an association between the use of birth control pills and a rare liver tumour called the hepatocellular adenoma. The risk of this tumour increases with more than 5 years of oral contraceptive use.

Long acting injectables