Contraception

Contraception is wanting to prevent pregnancy. It is a way to prevent the fertilisation and/or implanting of a fertilised egg and therefore reduce the chance of a pregnancy to a minimum. This can be done in several ways:

• By administering agents that prevent a woman’s eggs from maturing and ovulation from occurring (e.g.: the pill, vaginal ring, patches)
• By ensuring that sperm cannot reach the egg by creating a barrier (e.g. condom, sterilisation)
• By preventing a fertilised egg from implanting in the uterus (e.g.: coil, mini-pill)
• By avoiding intercourse during the fertile period (timing of ovulation) or by preventing ejaculation in the vagina

Several methods are available to prevent pregnancy:

• the pill
• a vaginal ring
• a hormone patch
• contraceptive injection
• hormone implant in the upper arm
• different types of coil
• timing through monitoring body temperature or urine testing
• male and female condoms
• male or female sterilisation

Not all methods are suitable for everyone. Certain risk factors mean, for instance, that some people are contraindicated for the pill. Based on the way the contraception works, we can divide the methods as follows:

Hormonal methods

Hormonal methods suppress the hormones that trigger ovulation. If the woman does not ovulate, no fertilisation can take place. If used correctly, these methods are very reliable.

Contraception can be divided into two groups:

Methods that combine two female hormones (oestrogen and progestagen): the pill, vaginal ring, patches

• Contraception pill: the pill must be taken every day, preferably at the same time, for 21 or 22 days; this is followed by a period of not taking the pill of up to seven days. During the period that you stop, you usually bleed for a few days. Always start a new strip on the same day of the week. It is possible to continue taking the pill without stopping for a week, but how this is done depends on the composition of the pill you use. If in doubt, consult your physician.
• Contraceptive ring: This flexible ring in the vagina releases a constant low dose of hormones, which are the same hormones used in the classic contraceptive pill. They end up directly into the bloodstream, through the vaginal wall. Because the hormones do not pass through the liver first, the dose can be kept low. The gastrointestinal tract is bypassed too, which means that vomiting, diarrhoea or taking antibiotics do not affect the reliability of the method whatsoever. The vaginal ring can stay in place for three weeks; then a week’s break follows. You can easily insert and remove the ring yourself. When using the vaginal ring, you only have to remember your contraception once a month. It is possible to have intercourse with or without the ring, but the ring must not be left out of the vagina for more than three hours.
• Contraceptive patch: This skin patch is a thin, skin-coloured patch that releases a constant amount of hormones into the body. The patch must be replaced once a week; a week’s break follows after three weeks. You will menstruate during this week. These methods mimic a normal menstrual cycle. The oestrogen ensures menstruation regularity. Every month, during the week’s break, bleeding occurs which is similar to menstruation but is termed ‘withdrawal bleeding’.

Methods that contain only progestagen: the mini-pill, hormonal implant, hormonal coil and contraceptive injection

When using methods that only release progesteron, a recognisable menstrual cycle is often no longer seen. Approximately one third of women has no blood loss at all anymore, a third still has a recognisable cycle but has less blood loss and a third has unpredictable blood loss, which is sometimes experienced as inconvenient. However, the total blood loss when using these methods is less than if no hormones would be used. The method is reliable even if no bleeding occurs.

• Mini-pill: The mini-pill is mainly used while breastfeeding or by women who must not use oestrogen. One pill daily without a week’s break, preferably at the same time. The mini-pill is taken continuously and is equally as reliable as the combined methods.
• Contraceptive injection: The contraceptive injection is an injection into the muscle that is administered once every three months. The contraceptive injection’s disadvantage is that, once stopped, it may sometimes take a long time before the regular cycle returns: up to one year. The advantage is that you only have to remember your contraception four times a year. If you experience any problems with the contraceptive injection, the administered hormone cannot be removed and you will have to wait until they have disappeared from your body by themselves.
• Hormonal implant: The hormonal rod is 4 cm in length and releases a constant amount of progesteron; it is placed under the skin in the upper arm by a physician under a local anaesthetic. The hormonal implant may remain in place for three years.

Intrauterine methods (IUD, coils)

There are several types of coils, which can be divided into two groups:

1. Copper coil: The effect of a coil depends on the presence of a foreign body in the uterus, which means that eggs cannot implant. Additionally, the copper renders sperm cells inactive, making it impossible for them to enter an egg.
2. Hormonal coil (Mirena®): The hormonal coil affects the mucus in the cervix, making it harder for sperm to move through the cervix. It also causes the mucus in the cervix to be thinner so that implantation hardly ever occurs. A pleasant side effect is that most women no longer have periods or have far less heavy periods. It is therefore also often prescribed for heavy, painful or irregular periods. The hormonal coil can cause irregular blood loss, especially in the first months, but after a year of using the hormonal coil, 80% of women is satisfied. Approximately 25% no longer menstruates and approximately 50% still experiences blood loss, but a lot less than before.

Both coils may remain in place for at least five years and can be easily removed, after which fertility recovers.

Definitive methods

Sterilisation of the man involves tying the vas deferens (tubes carrying sperm from the testicles to the penis) under a local anaesthetic. This is called a vasectomy. Sterilisation of the woman can be done by means of keyhole surgery in the abdomen (laparoscopic) under general anaesthetic; this involves closing the fallopian tubes off with a clip (see leaflet by the VVOG or the Flemish Society for Obstetrics and Gynaecology). This method offers definitive contraception and must only be applied if you do not want to have any, or any more, children!

Emergency contraception

If contraception was forgotten or used improperly, it is possible to reduce the chance of pregnancy with the morning after pill (Norlevo®). The pill must be taken as soon as possible after unprotected sex but may still be effective up to three days after unprotected sex. You can buy it over the counter from a pharmacy and it is reimbursed fully for those aged under 21. You can also have a coil (usually one containing copper) placed by a physician, up to five days after having had unprotected sex.

Latest publication date: 09/01/2024
Supervising author: Dr De Craene Annick