We have more birth control options than ever but we've never been so confusedTuesday, 16 August 2011
The Pill is widely held to be one of the leading inventions of the 20th century, giving women power over their bodies. Yet half a century after its launch, birth control in the UK remains hit and miss – with 600 abortions every day and more than 40 per cent of pregnancies unplanned.
It's not that we take risks: three out of four women are using some form of contraception when they get pregnant. A new YouGov survey shows that we may not be sufficiently careful when we decide on which contraception to use. One in two spend less than half an hour choosing – less time than they take to pick a new washing machine. Inevitably, decisions are based on half-truths and gossip rather than getting informed. Here are the top myths experts say are to blame for our contraception mistakes – and how we could behave differently.
Myth: The Pill is the most effective contraceptive
Reality: On paper, the Pill has a failure rate of just 0.3 per cent, making it among the most effective types of contraceptive. In real life, however, the failure rate is 8 per cent – with one in 12 women forgetting to take up to four pills every month. "The riskiest time to forget to take a Pill is just after the week off medication that is built in to most oral contraceptive regimes," says Dr Diana Mansour, head of sexual health services at Newcastle General Hospital. "The same is true of contraceptive patches."
What to do: The Pill has major benefits but doesn't suit everyone. "It's not just personality that you need to take into account. Women who work shifts regularly or cross time-zones, such as air stewards for instance, will have problems taking the Pill on time," says the Family Planning Association's information manager, Lynn Hearton. An effective aide-mémoire is the "everyday Pill" (brand names with ED added), which contains seven dummy pills so you don't break the habit.
Myth: Condoms are useful only to prevent STDs in casual sex
Reality: Available in a range of thickness, size and texture, with sophisticated lubricants, condoms are "brilliant" for couples in and out of long-term relationships, says Hearton: "Used properly, they are very effective with no side effects."
As the only barrier method that can help to prevent some sexually transmitted infections (STIs), condoms are also seen as best for casual sex. However, the failure rate drops from 2 per cent in perfect use to as low as 15 per cent in typical use in one-night stands. "Anything can go wrong in the heat of the moment," says Hearton.
What to do: Practise condom negotiation with the help of the International Planned Parenthood Federation's website: ind.pn/condomnegotiation.
Myth: Long-acting reversible contraception (LARCs) is difficult to remove and can cause infertility
Reality: Only 8 per cent of women use long-acting contraceptives, including implants, injections, the copper coil (IUD) and hormonal coil (IUS); but usage is higher in Scandinavia and much of Europe where women are better informed. NICE (the National Institute for Clinical Health and Excellence) recognises that lack of information results in under-use and requires all health professionals to provide it.
LARCs are suitable for women of all ages; they are very effective, easy to remove and do not affect fertility – apart from the injection, which delays conception by a few months. "One of the best, the IUS with the brand name Mirena, is used by at least of half of female family planning doctors," says Dr Mansour. "It's worry-free, yet allows you to become pregnant within a month of having it taken out."
What to do: Fitting long-acting contraceptives requires training. Find a specialist in your surgery or clinic.
Myth: Girl talk is the best route to a properly informed decision
Reality: It's the worst possible way to decide – but common, say experts. "Women say: 'My friend uses the Pill and her skin looks great so can I have the same brand?' or 'I'd never have an IUD because I know someone who had terrible periods'," says Lynn Hearton. "It leads women to make bad choices."
What to do: Your own research – easy to do online. Many experts recommend the FPA's interactive page: www.fpa.org.uk/mycontraceptiontool.
Myth: Contraception only affects fertility
Reality: Different contraceptive methods can bring major health benefits. Heavy periods or endometriosis? IUS makes your periods lighter, shorter or stop. The combined Pill can help alleviate heavy, painful periods. PMS? Combined Pill, especially when used continuously. Acne, hirsutism or polycystic ovary syndrome (PCOS)? Combined Pill containing anti-androgenic progestogen. Yasmin is the best product for mild symptoms, while Dianette is suitable for the more severe disorders. Low libido? There are claims that the contraceptive ring (Nuva ring self-inserted in the vagina monthly), improves blood flow to genital areas, thereby boosting libido. A handful of studies also suggest that contraceptive Pills with lower levels of progestogen boost mood and prevent vaginal dryness. "These claims are slightly suspect, as female libido is probably more complicated," says Dr Mansour. "But if you are comfortable with your contraception, you'll probably have better sex."
What to do: Take account of side effects when making a choice.
Myth: Once you've finished your family, sterilisation is best
Reality: Sterilisation is effective and new methods such as Essure, involving placing a permanent, fibrous implant in both fallopian tubes, are trouble-free, allowing sterilisation to take place in your lunch-hour (not including counselling and post-op checks). "But bear in mind that sterilisation is rarely reversible," says Dr Mansour. "It may make more sense to use a long-acting contraceptive, such as Mirena. It can remain in your womb and even be used eventually as part of HRT. But it can also be removed."
What to do: Consider all your options before asking for a referral.
Myth: The "morning after pill" is the most effective way of preventing pregnancy after sex
Reality: As well as the emergency Pill, the copper intrauterine device (IUD) can also be used as emergency contraception as long it is fitted up to five days (120 hours) after unprotected sex.
What to do: In many areas, pharmacists hand out the morning-after pill.
Myth: Doctors expect you to know what contraceptive you want.
Reality: "No health practitioner expects their patient to be an expert," says Hearton. One common scenario is to make an appointment to see the GP and simply ask for the Pill, as one in two women do. "The result is that they're most likely to end up with the cheapest possible Pill, such the 30mcg levonorgestrel Pill, which costs 80p and which is the most commonly prescribed oral contraceptive," says Dr Tina Peers, consultant in contraception and sexual health at Surrey PCT. "Unfortunately, up to 60 per cent of women discontinue the Pill within a year, often because of unwanted symptoms."
What to do: "We are lucky to have 15 methods of free contraception. So spend time getting informed before you see an expert," says Dr Peers. Make an appointment at your nearest sexual health clinic, staffed by specialist doctors and nurses, or see a practice nurse or specialist GP at your local practice.
Carl Djerassi on the foto