Which birth control method works best for you

What is birth control and how do they work?

The myriad of birth control methods can sometimes prove confusing for many especially when considering different lifestyle factors. Contraception, commonly known as birth control, comes in various forms that are used to prevent unplanned or unwanted pregnancies. Before we learn about how birth control works, it is important to understand that birth control is only efficient when used properly, correctly, and consistently. A poor lapse of judgement may not only result in an unplanned or unwanted pregnancy but may also bring about a sexually transmitted infection (STI). 

In this article, we will delve into:

1. Different types of birth control methods 
2. The pros and cons of each birth control method 
3. Factors affecting the selection of a birth control method

Types of birth control methods

There are many different types of birth control methods such as:

Hormonal medications/devices

These rely on hormones to prevent pregnancy. Routes of administration vary and range from oral tablets, skin patches, vaginal rings, intramuscular injections, contraceptive implants (aka Implanon/Nexplanon), to intrauterine devices.

Types of hormonal birth control include: 

• Oral contraceptives: such as birth control pills. There are 2 types of birth control pills available in Singapore, these are combined oral contraceptive pills (COCP) and progesterone-only pills (POP). 
• Intrauterine contraceptive devices: also known as IUCDs or IUDs. The Mirena IUD, one of the most popular options for IUDs, provides long-term contraception [1].
• Birth control patches: prevent pregnancy by releasing hormones through the patch and into your bloodstream. Works in a similar way to combined oral contraceptive pills.
• Vaginal ring: a soft, plastic ring that is inserted into the vagina. It releases the hormones oestrogen and progesterone to prevent pregnancy.
• Birth control injections: progesterone injections that are injected into the arms or buttocks to prevent pregnancy.
• Birth control implant: a flexible rod that is placed under the skin of your upper arm. It releases the hormone progesterone which works to prevent pregnancy.
• Emergency contraception: typically used as a last resort when your usual birth control methods have failed, e.g., condom breaks during intercourse. An example of hormonal emergency contraception is the Morning After Pill (Postinor, Ellaone). The Morning After Pill should not be taken frequently by a woman as part of her regular contraceptive method. 

Some of these methods also serve dual functions such as menstrual regulation and relief of menstrual symptoms which include menstrual cramps/heavy period flow, etc [2]. 

Non-hormonal methods

These methods prevent pregnancies without the use or interference of hormones. 

Types of non-hormonal birth control include: 

• Abstinence: refraining from sex to prevent pregnancy. 

• Fertility awareness/natural family planning: this involves being aware of a woman’s bodily changes throughout her menstrual cycle, including changes in basal body temperature, monitoring of cervical mucus, tracking of the menstrual calendar, and using urine ovulation test strips (to avoid fertile times).
• Barrier contraceptives: the most easily available birth control method and is sold over the counter at most convenience shops. Examples include male condoms and female diaphragms.
• Copper intrauterine contraceptive device (Cu IUCD): this is an intrauterine device (IUD) that is similar to the Mirena IUD, except that it does not have hormones and primarily works only to prevent pregnancy. 
• Sterilisation: this surgical method is a permanent form of contraception and is generally deemed irreversible. Examples include female tubal ligation and male vasectomy.
• Emergency contraception: typically used as a last resort when your usual birth control methods have failed, e.g., condom breaks during intercourse. An example of non-hormonal emergency contraception is the copper IUCD.

The pros and cons of each birth control method

There are strengths and weaknesses for each birth control method. It is important to evaluate them to ensure you are making an informed decision. 

These methods have varying effectiveness and different pros and cons when it comes to preventing pregnancy, however, not all birth control methods are created equal. 

Of note, only barrier contraceptives can prevent pregnancies and sexually transmitted infections (STIs) – that means if you are on another form of birth control e.g., birth control pills and also wish to protect yourself against STIs, you should combine them with the use of condoms during every sexual encounter. 

Factors affecting the selection of a birth control method

“So, what is the best birth control for me?” This answer will vary on a case-by-case basis. The decision will boil down to which factor you deem most important. In fact, your ideal birth control method may differ depending on which part of your life you are in. 

There are several things to consider before deciding on the most effective birth control method, including:

• Convenience: do you prefer something over-the-counter or something that requires a doctor’s prescription? Does your lifestyle/personality fit methods that require daily/weekly/monthly administration or do you prefer something more user-independent? 
• Lifespan of contraceptives: when are you thinking of conceiving– are you looking for something short-term or long-term? Perhaps something permanent as you have completed your family? 
• Affordability: although some methods e.g., IUCD may be more expensive upfront, the cost over time may prove to be more economical than short-term options such as birth control pills. 

• Side effects: which side effects are you willing to put up with? The most common reason why women are non-compliant with their birth control methods is that they are unable to cope with the side effects, e.g., if you are used to having regular, on-the-dot monthly periods, methods such as the contraceptive implant/IUCDs, etc may not be suitable for you. 
• Efficacy: what degree of “risk” are you willing to take? 

• Comfort: what options are you and your partner comfortable with? 

Bear in mind that these factors must be considered in relation to your lifestyle and whether you are able to commit to the responsibilities necessary for the birth control method to be effective.

Is the pull-out method an effective method of birth control?

No. The pull-out method, also known as the withdrawal method or coitus interruptus, involves pulling the penis out before ejaculation occurs. It is not an effective form of birth control as sperm exists in pre-ejaculate [3,4]. Pre-ejaculate is released during arousal and may contain sperm due to previous sessions of ejaculation. This sperm can still result in pregnancy, in fact, statistics have shown that 1 in 5 couples who use the pull-out method will still end up falling pregnant [5]. 

How do I get birth control pills in Singapore?

There are two main types of birth control pills in Singapore, these are prescription-only and include the following:

• Combined oral contraceptive pills (COCP): these contain both oestrogen and progesterone.
• Progesterone-only pills (POP): these contain progesterone only.

In general, if you are thinking about going on contraception, do make an appointment to see an obstetrician who will be able to tailor and individualise your birth control options according to your needs – there is no one-size-fits-all. 

References

1. Jeffrey T Jensen, E. L.-L. (2022). Contraceptive efficacy and safety of the 52-mg levonorgestrel intrauterine system for up to 8 years: findings from the Mirena Extension Trial. American Journal of Obstetrics and Gynecology, doi: 10.1016/j.ajog.2022.09.007.
2. Sarina Schrager, M. L. (2020). Beyond Birth Control: Noncontraceptive Benefits of Hormonal Methods and Their Key Role in the General Medical Care of Women. Journal of Women’s Health, 937-943.
3. Stephen R. Killick, C. L. (2011). Sperm content of pre-ejaculatory fluid. Human Fertility, 48-52.
4. Ekachai Kovavisarach, S. L. (2016). Presence of Sperm in Pre-Ejaculatory Fluid of Healthy. Journal of the Medical Association of Thailand, 38-41
5. Planned Parenthood. (2023, June 21). How effective is pulling out? Retrieved from Planned Parenthood: https://www.plannedparenthood.org/learn/birth-control/withdrawal-pull-out-method/how-effective-is-withdrawal-method-pulling-out