Contraceptive alternatives to the pill

Taking the pill is a personal choice. You may decide that it is the right solution for you, or that it is simply the best method of contraception for you.

If you decide not to take the pill and don’t wish to get pregnant you will need another method of contraception. Here, a brief overview of pros and cons for each method is given to help you make your choice.

It is recommended that you do further research on any option that you are considering. Please note that the only forms of contraception that help prevent sexually transmitted infections are the male and female condom.

Copper Intrauterine Device

This device is made of copper and is inserted into the uterus to prevent pregnancy.

Pros of the copper IUD

Ovulation happens as normal meaning you produce your own, real-deal (endogenous) progesterone. This has many benefits over synthetic progesterone.

Endogenous progesterone makes us feel calm and relaxed, promotes restful sleep, improves cardiovascular health, prevents breast cancer and encourages healthy hair growth.

You also produce your own oestrogen, which in healthy amounts is very beneficial to cardiovascular health, lifting mood and ensuring healthy bones.

The copper IUD is also 99.4% effective at preventing pregnancy and can stay in place for up to 10 years.

Cons of the copper IUD

Insertion can be painful, it may come out and have to be reinserted, it usually makes your period heavier, 1/1000 will get a perforated uterus, which requires surgery, if you have low zinc, excess copper in the body can be problematic.

Mirena Intrauterine Device

This is a levonorgestrel-releasing device that is placed inside your uterus to prevent pregnancy.

Pros of Mirena

Low dose, decreases heavy bleeding, although it prevents pregnancy 99% of the time, it doesn’t inhibit ovulation all of the time (which means that we may still produce small amounts of our own progesterone), can stay in for up to 5 years.

It can be used as emergency contraception – you can have one inserted as an alternative to the “morning-after” pill.

Cons of Mirena

Lowers our normal, beneficial progesterone production, irregular periods, spotting or heavy bleeding in the first few months, ovarian cysts (these usually resolve once the device is removed but can cause pain and sometimes need to be removed surgically). 

Around 5-10% of women with Mirena report headaches, depression, acne, heavy or prolonged menstrual bleeding.  Other, less common side effects include: decreased sex drive, bloating, breast tenderness, painful intercourse, anaemia, hair loss, unusual hair growth and pelvic pain.

Mini pill

The mini pill contains only synthetic progesterone, unlike the combined oral contraceptive pill (COCP) that contains both synthetic oestrogen and progesterone.

Mini pill brands include Camila, Erin, Heather, Jolivette, Micronon, Nor-QD and Norethindrone, which all contain 35 ug of the synthetic progesterone, norethindrone.

Pros of the mini pill

You get to avoid the risks of synthetic oestrogen, the dose of synthetic progesterone is relatively low compared to COCPs, 99% effective against pregnancy

Cons of the mini pill

Due to its low dose, you need to remember to take it at the same time every day or you may fall pregnant. The mini pill still carries the risk of fatal blood clots, may cause liver cancer, may cause cervical changes linked to cancer, may cause breast tenderness, acne, facial hair growth, hair thinning, weight gain, fluid retention, mood changes, brown, blotchy skin, irregular or absent periods, insomnia, headaches and nausea.

Implants

Contraceptive implants such as Implanon and Nexplanon are implanted into your arm where they release high doses of the synthetic progesterone, etnogestrel.

Pros of implants

Lasts up to 5 years, >99% effective at preventing pregnancy

Cons of implants

Blocks the production of our own beneficial hormones. Side effects include erratic menstrual bleeding, depression and weight gain, increased risk of serious blood clots, ovarian cysts that may need surgery, headaches, inflammation of the vagina, acne, painful periods, mood swings and depression. 

In rare cases implants have made their way into a blood vessel or the lungs.

Injections

Contraceptive injections such as Depo-Provera and Depo-Palovera deliver a huge dose of the synthetic progesterone, Depot Medroxyprogesterone Acetate.  This injection will protect against pregnancy for three months at which point another shot is given.

Pros of the injection

Lasts three months.

Cons of the injection

Between 94-99% effective (possibly a lower rate than other contraceptive choices).  This contraceptive leads to loss of bone density due to its suppression of our endogenous estrogen.  This could cause osteoporosis long term. 

Other side effects include irregular or prolonged menstrual bleeding, acne, decreased sex drive, hair loss, hair growth on face, mood changes, depression and increased risk of blood clots.

Nuvaring (contraceptive rings)

Nuvaring is a plastic ring that is inserted inside the vagina sits around your cervix. It is left in for 3 weeks at a time and taken out for 7 days, during which you have a bleed. After the 7-day break you insert a new ring.

Pros of the Nuvaring

Not much when you consider the cons.

Cons of the Nuvaring

Nuvaring has a particularly high risk of serious or fatal blood clots. In scientific studies there have been occurrences of cerebral and deep vein blood clots.

A mass litigation, involving 3800 claimants, occurred in 2014, where the manufacturer, Merck, agreed to pay over $100 million dollars in compensation.

Other side effects include acne, decreased sex drive, weight gain, breast tenderness, mood changes, depression, period pain, headaches and vaginal irritation.

Cervical cap or diaphragm 

Both the cervical cap and diaphragm sit over the cervix, creating a barrier so that sperm cannot get into the uterus.

Pros of caps or diaphragms

A non-hormonal form of contraception, it carries less risks.

Cons of caps and diaphragms

Spermicide is needed to make these more effective. Spermicides are made of toxic chemicals. Spermicides also alter the pH of the vagina in favour of infections such as thrush and bacterial vaginosis.

Even with spermicide they are only about 91-94% effective.

Condoms

There are male and female condoms. The male condom provides a protective barrier over the penis whilst the female condom provides a protective barrier inside the vagina.

Pros of condoms

A non-hormonal form of contraception, you avoid many health risks and side effects. You can combine this method with fertility awareness (see below) to increase its efficacy rate. 98% efficacy rate with perfect use.

Cons of condoms

Male condoms sometimes break. Breakages may result in having to take emergency contraception or risk pregnancy.

Emergency contraception (the “morning after” pill)

This is used after unprotected intercourse or contraceptive failure as an emergency measure to prevent pregnancy. It contains two 750 ug doses of levonorgestrel.

Pros of the morning after pill

Considered safe for women prone to blood clots and cancer as it is only a very short term exposure

Cons of the morning after pill

Only 85% effective and needs to be taken within 24-72 hours of intercourse to achieve this rate, otherwise its efficacy sharply declines. Not recommended to be used repeatedly, month after month – for emergencies only.

The Fertility Awareness Method

The fertility awareness method (FAM) involves observing your body daily and charting your cervical mucous for signs of ovulation. This method has a 95-99% efficacy rate when used correctly.

Best learned with the help of a teacher, you learn to detect ovulation and take extra precautions when you know you are fertile. Then you can abstain or use extra precautions (such as condoms) when you know you are fertile.

Pros of the Fertility Awareness Method

A non-hormonal form of contraception, you avoid many health risks and side effects. You get to learn heaps about your cycle and what your hormones may be doing. You feel in control of your fertility and in touch with your body. It often brings couples closer together if they learn it together. Can be used whether your period is regular, irregular or even absent.

Cons of the Fertility Awareness Method

Requires understanding partners, good communication and consistent charting. For the highest efficacy, FAM requires a teacher for 3-6 months to ensure you accurately understand the signs of ovulation.

Withdrawal Method

The withdrawal method actually has a pretty high success rate at preventing pregnancy when it is performed correctly. When done correctly your partner will pull out prior to ejaculation and ejaculate away from the entrance to your vagina. This has a 96% efficacy rate. There are 3 things you should be aware of if you choose to use this method to avoid pregnancy:

1. Your lover needs to pull out in time otherwise there is a very high risk of becoming pregnant
2. There is a tiny amount of sperm in pre-ejaculatory fluid that may make you pregnant but the risk is very small. However, when you have sex twice in a row, the pre-ejaculatory fluid will have a lot more sperm in it the second time, making the risk higher. It is not known how long it takes for the sperm to dissipate
3. If he ejaculates on your vulva (the outside parts of your vagina) and you are close to ovulation, there will be fertile mucous present that can assist sperm to swim inside and make you pregnant. This is why some people fall pregnant without penetration

Pros of the withdrawal method

A non-hormonal form of contraception, you avoid many health risks and side effects. You can combine this method with fertility awareness (see above) to increase its efficacy rate. This is best done under the guidance of a qualified teacher.

Cons of the withdrawal method

You can’t use this method twice in a row and it is not known how long after the first time that the risk of pregnancy lowers again. Failure results in having to take emergency contraception or risk pregnancy.