Contraceptives

Definition

Birth control (contraceptives) are used for the purpose of contraception. They protect against unwanted pregnancy by preventing ovulation, fertilization of the egg or implantation of the fertilized egg in the uterus. Only condoms or femidoms protect against the transmission of sexually transmitted diseases.
The Pearl Index is a measure of the safety of a contraceptive method. A Pearl Index of 20 indicates that 20 out of 100 women who took a contraceptive for a year became pregnant anyway. Consequently, the lower the PI, the safer the contraceptive.

What contraceptives are there?

• Condoms: Condoms not only protect against unwanted pregnancy, but also against the transmission of most sexually transmitted diseases. They prevent the transfer of bodily fluids to the sexual partner and should also be used during oral and anal sex. PI 2 – 12
• Femidom: The female condom also offers protection against sexually transmitted diseases and unwanted pregnancy. Femidomes are significantly more expensive than condoms and more difficult to handle. PI 5 – 25
• Vaginal diaphragm: The diaphragm is inserted into the vagina before sexual intercourse and comes to rest in front of the cervix. The correct fit requires a lot of practice and sure instinct. It should be used in combination with spermicidal creams. The diaphragm can be used again and again after cleaning. PI 1-20
• Cervical cap: The cervical cap is also inserted into the vagina before sex and should also be used in combination with chemical contraceptives. The adjustment for the right fit must be done in advance with the gynecologist.
• Chemical contraceptives: The spermicidal mode of action of chemical contraceptives is based on killing sperm. There are various gels, creams, suppositories and tablets that are inserted into the vagina before sex. Chemical contraceptives are very unsafe and should only be used in combination with other contraceptive methods. PI 3 – 21
• Natural contraception:There are several ways to prevent pregnancy naturally. As hormone-free contraceptive methods, these offer an alternative to conventional contraceptives. The symptothermal method is explained here as the safest variant. Here, the cycle is tracked via the temperature and the condition of the cervical mucus. Shortly before ovulation, the body temperature rises and the mucus becomes more liquid and easier to spin. As a result, condoms must be used or sex abstained during ovulation. The women have to take their temperature and check the spinnability of their slime at the same time every morning. Prerequisites for the safety of this method are a regular sleep-wake cycle and high reliability: even fluctuations such as night shifts can lead to falsifications. With relatively high effort, there are no side effects with this method. When done correctly, symptothermal contraception has a Pearl Index comparable to that of the pill. PI 0.4 – 1.8
• Sterilization: Sterilization involves cutting the fallopian tubes in women under general anesthesia and cutting the vas deferens in men under local anesthesia. While the procedure is final for women and involves high risks, it is comparatively easier and less risky for men. Sterilization should only be carried out once family planning has been completed. The costs amount to around 500 to 600 euros.

Hormonal contraceptive methods

Hormonal contraceptives work through the hormones estrogen and progestin. While estrogen prevents ovulation, progestogens prevent the fertilized egg from implanting in the uterus. What they all have in common is the increased risk of side effects: some women experience dizziness, headaches, breast tenderness, depression, weight gain and loss of libido (low desire for sexual intercourse). In addition, the risk of developing a thrombosis increases, especially in the first year of use, but it also remains over the course of time. Women with a high body weight and smokers should not use this contraceptive method. Interactions with St. John’s wort in particular and certain medications must be taken into account. In addition, there are other contraindications that should be urgently discussed with the doctor.

• pill:The pill is probably the best known contraceptive for women. There are different types of birth control pills that are composed of estrogen and/or progestin. Estrogens prevent ovulation and progestins prevent the fertilized egg from implanting in the uterus. The micropill is an estrogen-progestin combination preparation with a very low dose of hormones that is often prescribed. The mini pill, on the other hand, is a low-dose progestin preparation that must be taken without a break and always at the same time. The pill has an impact on the risk of developing cancer: while the risk of breast and cervical cancer increases, the risk of ovarian, colon and endometrial cancer decreases. When taking the pill, a regular gynecological check-up should take place. The pill is also used for diseases such as PCO syndrome, endometriosis, fibroids or severe menstrual cycle problems. PI micropill 0.1 – 0.9 PI minipill 0.5 – 3
• Vaginal ring: The ring is inserted into the vagina at the beginning of the cycle. It releases the hormones progestin and estrogen evenly over a period of 21 days. It is then removed and reinserted after menstrual bleeding. The costs amount to around 80 euros for half a year. PI 0.4 – 0.65
• Plaster: The plaster is also worn for a period of 21 days and releases hormones through the skin. It has to be changed every seven days and costs 13 euros. PI 0.8
• Spiral (intrauterine device): There is a choice between copper spirals and progestin-coated hormone spirals, which are used by the gynecologist. The intrauterine devices can remain in the uterus for three to five years. The cost of the implantation is around 300 to 400 euros. Side effects can include pain after the IUD has been inserted, inflammation of the lining of the uterus (endometritis) and the body’s defense reaction. PI (hormone IUD) 0.16 PI (copper IUD) 0.3 – 0.8
• Three-month injection : The hormone progestogen is injected into the muscle every three months. The costs are around 30 euros. PI 0.3 – 0.88
• Birth control rods : The hormone implant is implanted in the skin of the upper arm and releases the hormone progestin into the skin. It remains there for around three years and costs a one-time fee of 350 euros. PI 0.05

Doctor’s consultation

When advising on the right method of contraception, a detailed discussion should be held with the doctor. Important factors such as previous illnesses, a gynecological medical history and risks such as smoking should be addressed. Lifestyle and future family planning should also be discussed. When using the chosen preparation, you should always keep an eye on your body and inform the doctor treating you of any changes.
There are some free apps available that you can use to track your menstrual cycle. This can help you and the doctor to identify and understand irregularities and abnormalities.

Pregnant despite birth control

Since most contraceptives do not offer 100% protection against pregnancy, an unwanted pregnancy can occur. A gynecologist should always be consulted in the event of cycle irregularities or the absence of a menstrual period. If you are pregnant, you should also stop taking the pill. The progestin-containing mini pill should be used during breastfeeding, as it cannot pass into breast milk.

Sexual intercourse without contraception

If you have had unprotected sex or if you forgot to take the pill, you can take the morning-after pill. It is highly likely to prevent pregnancy. At best, it is taken within 12 hours after sexual intercourse has taken place (maximum three to five days depending on the preparation). However, taking the morning-after pill also has side effects and should only be taken in exceptional cases.
If your sexual partner has an STD, you should consult a doctor. He can advise you and, if necessary, prescribe medication if you are infected with a sexually transmitted disease. There is also the possibility of HIV post-exposure prophylaxis if your sexual partner is infected with HIV and passes on the virus. This should usually be done as soon as possible to avoid contagion.

How can Med-Healths help?

Would you like to extend the prescription of your pill? You can use the Med-Healths app to request a new prescription from the comfort of your own home. The Med-Healths doctor will also answer your questions about risks and side effects and will refer you to a gynecologist if you have any symptoms.