These methods of contraception provide contraception by physically causing a barrier between the intended meet-up of the sperm and the ova and thus prevent fertilization from happening

They include male and female condoms, diaphragms, cervical caps, birth control vaginal rings, and birth control sponges. Consistent and correct use is key in ensuring the effectiveness and efficacy of barrier methods of contraception. Condoms have the additional advantage of providing dual contraception-prevent pregnancy and also preventing the spread of some sexually transmitted infections or diseases (STDs/STIs)

Types of natural family planning methods

1. Fertility Awareness Methods of Family Planning
2. Breastfeeding or Lactational Amenorrhea Method
3. Abstinence
4. Withdrawal or pulling out method

Disadvantages of the natural family planning methods

• They do not offer protection against sexually transmitted diseases or infections (STDs/STIs)
• Consistent and correct use with your male partner’s cooperation is of considerable importance
• Periodic abstinence is a requirement and some couples may not be motivated enough to undertake this.

This is a type of natural family planning involving observation of different physiologic or biological markers that occur during the reproductive cycle of a woman –related to ovulation, to know the fertile days and therefore avoid sexual activity by abstaining or using a barrier method around this time (fertile days) and thus avoid pregnancy.

The reproductive cycle begins from the first day of your menses/periods till the first day of the next menses. The reproductive or menstrual cycle lasts between 24 and 38 days. Most women have 28-day cycles. Ovulation is a process whereby an egg/ovum is released from the ovary and occurs 14 days before the beginning of the next reproductive cycle.

Types of Fertility Awareness methods of family planning are:

1. Calendar days-based Methods (Calendar calculation/ rhythm method and Standard Days Method)
2. Symptoms-based methods (Cervical mucus monitoring, basal body temperature charting and Sympto-thermal Methods

-This method predicts the fertile days to avoid sexual intercourse around the time of ovulation. The sperm can remain viable in the female genital tract for 3 to 5 days while the egg remains viable for 24 hours. The fertile days are calculated by subtracting 18 days from the shortest cycle of the woman as per her previous six to twelve cycles. This is to determine the start of the fertile period and subtract 11 days from the longest cycle length to determine the end of the fertile period. When using the Standard days method, you avoid sex during days 8-19 of your reproductive or menstrual cycle with the caveat that your reproductive cycle length is between 26-32 days. The standard day’s method is a simplified version of the rhythm method.

Cervical mucus monitoring means that you will be checking the changes that happen to the cervical secretions or mucus and avoiding intercourse when you notice cervical mucus. Cervical mucus is noticeable when it increases in amount just before ovulation and becomes slippery or stretchy and thin. After ovulation has occurred it becomes thick and less noticeable. You should avoid sexual intercourse when you notice cervical mucus. These changes are brought about by the reproductive hormones Estrogen and Progesterone. However, the changes may be interfered with in cases where there is vaginitis; douching; or use of feminine hygiene products or lubricants.

The two-day method is a variant of the cervical mucus monitoring method whereby you avoid sexual activity whenever you notice cervical mucus any day while you have been monitoring cervical mucus twice a day and asking yourself whether you noticed cervical mucus today or yesterday.

Basal Body Temperature charting is a fertility Awareness method whereby you chart your body temperature at rest every day, preferably in the morning at the same time and before any activity or eating, while checking if there is any increase in temperature. The basal body temperature rises by about .1 and .5F (0.2C) from the time ovulation occurs till the end of the reproductive cycle. You can stop monitoring after three consecutive days once you notice the rise in basal body temperature. It notifies you that ovulation has occurred in retrospect and therefore is not a good method to use to avoid pregnancy. It is used together with other methods.

The sympto-thermal method uses a mix of cervical mucus monitoring and basal body charting to determine the fertile days or even cervical mucus monitoring and standard days method.

Lactation means breastfeeding and amenorrhea is a medical term which denotes lack of menses/no periods. 

How does the lactational amenorrhea method prevent pregnancy?

This method is based on the premise that ovulation may not occur during the six months postpartum/post-delivery so long as these four conditions are met:  it is within the first six months postpartum; exclusive breastfeeding (lactation) is going on; there is amenorrhea which means that your menstrual periods have not resumed and the breastfeeding is being done every 4 hours and not more.

How effective is the lactational amenorrhea method in preventing pregnancy?

It is 92% effective.

What are the Permanent Contraception Methods? 

1. Tubal Ligation or “tying of tubes”
2. Vasectomy

How effective are the permanent methods of contraception?

They are 99% effective.

These are long-acting reversible methods of contraception which are highly effective in preventing pregnancy. 

How do Birth Control implants prevent pregnancy?

They prevent pregnancy by releasing small doses/amounts of progestogen hormone into the body every day till the end of the manufacturer’s duration of use. Progestogen is a synthetic form of the hormone progesterone produced majorly in the ovary. It works majorly by preventing ovulation and thus providing contraception. It also thins the endometrial lining making it less receptive for implantation and thickens the cervical mucus thus not permitting sperm entry into the upper genital tract; No sperm, no fertilization of the ovum.

What is a Birth Control Implant?

Birth control implants are made of tiny flexible plastic rods which contain progestogen hormone which will be placed just under the skin on the inner side of your arm by your healthcare provider once you decide that it is the most suitable method. 

How Effective are the Birth Control Implants?

Birth control implants are 99% effective as contraceptive methods. 

How long do birth control implants last?

The duration of action ranges from three years to five years depending on the type of implant. 

Can you get pregnant immediately after Implant removal?

Birth Control Implants have a quick return to fertility once it is removed either on expiry of the 3 or 5-year duration or any time you decide you want it removed. 

What are the Side effects of birth control implants?

Like all the other birth control options it carries its side effects which range from menstrual irregularities; Different studies have demonstrated menstrual irregularities as a major side effect of implants with women complaining of amenorrhea (no menstrual bleeding), oligomenorrhea or infrequent menstrual bleeding, frequent menstrual bleeding as well as heavy and prolonged menstrual bleeding. The number of women complaining of amenorrhea in one study increased from 11.6% at three months to about 25% at the end of the three years. The three-year birth control implant had more women complaining of menstrual irregularities than the ones using the five-year implant in comparative studies.

Other short-term side effects are nausea, headache, dizziness, mood changes, decrease in libido, breast pain, abdominal pains, acne and weight gain. Follicular ovarian cysts spontaneously regress within a short period. 

Remember not every woman experiences similar side effects and a period of three to six months is allowable for your body to adjust to the implant

Disadvantages of birth control implants

You will not be protected against Sexually Transmitted Diseases (STDs). Correct and consistent condom use during sexual intercourse is advised

Both insertion and removal are done by a qualified healthcare provider or ob-gyn.

Did you know that other than the widely used copper intrauterine device (Copper IUD) which is non-hormonal, there are hormonal IUDs/IUS that are available as birth control methods?

Effectiveness and return to fertility

Hormonal IUDs are effective family planning options with more than 99% efficacy and have a quick return to fertility.

 How do hormonal IUD/IUS work to prevent pregnancy?

Hormonal IUD/IUS are long-acting reversible birth control methods which are laced with hormones like Levonorgestrel (a progestogen) which is released into the uterus in very small quantities every day.

They act by thickening the cervical mucus and thinning the endometrial lining which affects the endometrial receptivity of the embryo and inhibits ovulation.

In which other medical conditions can your OB-GYN prescribe hormonal IUS/IUD?

They have other additional benefits and may be used in the treatment of heavy menstrual bleeding, pain during menstruation (dysmenorrhea) which may be the case if you have endometriosis or even in adenomyosis and as add-back treatment in case of HRT (hormonal replacement therapy) in management of menopausal symptoms.

What is the duration of action of hormonal intrauterine devices?

The duration of action is 3-7 years depending on the type of hormonal IUD/IUS.

How safe is the hormonal intrauterine system/device?

Both insertion and removal are done by a qualified healthcare provider or OB-GYN.

These are given as an injection either deep into the muscle or in the subcutaneous layer just under your skin

DEPO-PROVERA

This is commonly known as Depo injection or Depo-shot.

This is a hormonal contraceptive method which contains progestin hormone (medroxyprogesterone acetate-MPA)

It is administered as a 3-month injection either into the muscle or just under the skin. 

How is Depo Shot Administered?

It is administered within 7 days of menses, immediately following a miscarriage or delivery and when a pregnancy test is negative. Talk to your doctor if you present late, more than 7 days after menses, for your injection for a back-up contraceptive method

How Effective is Depo-Provera as a family planning method?

Depo-shot is a highly effective contraceptive method with perfect use, meaning you go for repeat injections as scheduled. The chances of failing are only 0.2 per cent with perfect use within one year. When do we go wrong? The effectiveness of Depo injection is reduced to 99.4% with imperfect use; when one goes late for a repeat injection. This means that your chance of getting pregnant increases to 0.6 per cent if you don’t get your next injection on time

What Benefits do you get with DEPO SHOT as a birth control option?

It is highly effective; is a reversible method of contraception; offers some privacy compared to other methods and has some non-contraceptive benefits which include reduced heavy menstrual flow and pain associated with menstruation; better menstrual hygiene and protection of the inner lining of the uterus. 

Disadvantages of using Depo as a contraceptive method?

Depo-Provera has been shown to have a slower return to fertility compared to the other contraceptive methods. Only half of the women can conceive within 10 months of the stoppage of Depo. Because of this unpredictability on the return of fertility and individual patient variability, “no one method fits all”; it is advisable to avoid Depo-shot and choose another method of contraception if planning to conceive within the next 1-2 years. If already on Depo, you can stop usage earlier if you have plans to get pregnant soon. 

What Side Effects do you expect when using Depo Provera?

Knowledge of the side effects will help you understand what is going on with your body and therefore make you continue using this method for a longer duration.

Menstruation changes occur in all women using Depo. They include unscheduled or unpredictable menstrual bleeding or spotting and this can be disturbing, especially in the first few months following your shot. Bleeding patterns become more predictable as one year approaches. No menses or lack of menses is another change that may occur especially with a longer duration of use; one in two women using Depo will experience no menses after one year of use. Headache, mood changes, dizziness, low libido and bloating may be experienced by different women at lower levels. If you are likely to gain weight, Depo-Provera is not your portion to use (Avoid!!!). 

What are the disadvantages of using Depo Provera as a family planning option?

Depo-shot does not protect you against acquiring sexually transmitted infection and thus condom use together with the Depo injection is advised with every sexual act.

They are also known as “the pill” and are taken orally. They contain hormones and there are three types of birth control pills.

What are the types of birth control pills available?

Combined oral contraceptive pills containing both estrogen and progesterone; progestin-only pills containing progestin-synthetic form of the hormone progesterone and extended/continuous use birth control pills. A combined oral contraceptive pill is the most commonly prescribed birth control pill.

How does a birth control pill prevent pregnancy?

Progestin Only Pills provide contraception by preventing ovulation from occurring; thickening the cervical mucus to prevent the entry of sperm into the female upper genital tract and impairing implantation by thinning the endometrial lining

Combined oral contraceptive pills also offer birth control or family planning by the same mechanisms as the progestin-only pills

How effective are the birth control pills?

The effectiveness depends on how you use the birth control pills. If you use them perfectly; meaning, taking them every day and at the same time you will get 99% effectiveness while with typical use (inconsistent and incorrect use they are only 91% effective. 

 Can you get pregnant while on the pill?

Yes, you can get pregnant while using the birth control pill if you do not use the correctly and consistently. 

How soon can you get pregnant after you stop taking the birth control pills?

The return to fertility is immediate. A study conducted on women taking birth control pills continuously for one year found that 97 out of 100 women had spontaneous menses three months after discontinuation of the birth control pills.

What are the side effects of the birth control pills?

Breakthrough bleeding, nausea, headache, abdominal cramps, breast tenderness, mood swings, increased vaginal discharge and reduced libido

Acne flare-ups and follicular ovarian cysts have been documented with progestin-only pills.

Other risks include hypertension, stroke, venous thromboembolism (VTE), heart attack and chloasma 

 What are the benefits of the birth control pills?

Birth control pills are primarily used to prevent pregnancy. They offer additional benefits which include regulation of menses, control of menstrual or period pains, reduce the amount of heavy bleeding or control of menstrual flow and specific types are used in acne management

Additional benefits with prolonged use include; reduced risk of endometrial and ovarian cancer. 

Disadvantages of birth control pills?

 Birth control pills do not offer protection against sexually transmitted infections and diseases (STIs/STDs). You need to use condoms correctly and correctly to offer protection against STIs.

If the birth control pill is not started on the first day of menses, you will be required to have a backup method of contraception for the first seven days of pill use. This can be abstinence or other contraceptive methods like condoms.