Happy World Contraception Day everybody!

Progesterone vs. Progestin

Side Effects of Hormonal Contraceptives

• Depression and anxiety. Some women, especially those aged 15-34 years can experience depression, mood swings or anxiety as a result of the OCP. This still needs more research, however one of the larger studies in this area (1 million women over 13 years) showed that 23% of adolescent women who started the OCP and had not experienced depression before, needed an antidepressant after starting the OCP.
• Blood clots. This is a risk that is so great that for those women who smoke or are overweight, they really should not use the OCP. For women without these factors, their risk of clotting still increases fivefold, and can be greater depending on the type of contraception that they use.
• Metabolic syndrome. Depending on the type of pill you are taking, the OCP can negatively affect cholesterol levels and raise triglycerides. It can also raise blood glucose and reduce insulin sensitivity, potentially leading to insulin resistance. For women choosing to take the OCP as a way to control Poly-cystic Ovarian Syndrome (PCOS), this can unfortunately worsen the condition as Insulin Resistance is a contributing factor.
• Low libido. This side effect also needs further research, and while I have seen this very common in clinic there is not that many papers which support it. One of the mechanisms is potentially the drop of natural hormones responsible for a healthy libido such as oestrogen and testosterone, but I also suspect that the nutritional deficiencies that can occur as a result of the OCP, such as zinc, magnesium and B vitamins can also play a role. While not necessarily harmful to ones health, it can cause some issues in a relationship and also goes against the concept of greater sexual freedom that should come with the OCP.
• Candida/Thrush and other infections of the reproductive and urinary system. Many women experience thrush whilst on the OCP, especially in the initial period of use. The risk of candida infection is actually higher for IUD use rather than OCP, and is also affected by other factors such as hygiene and antibiotic use.
• Post Pill Amenorrhoea. The standard length of time for a woman’s period to return after stopping the OCP is 3 months, however for some women they may return to normal straight away (yay!) or it can take much, much longer. This can be a real bother when the woman is stopping the OCP to try to fall pregnant. It may be that the pill was masking hormonal problems such as PCOS (a condition that is often made worse by the OCP) or that the woman was put on the OCP at such a young age that her hormones never had a chance to regulate themselves. Or potentially the hormonal production and messenging has been disrupted by the OCP, and the normal time to recover this is longer for some women.

So what are some safer alternatives?

• Pen and paper or app supported Fertility awareness method. Apps I recommended include Kindara and Read Your Body, but the purpose of these apps is for record keeping rather than analysis. For true accuracy you must input your cervical mucous, and this is not something that an algorythm in an app can read. Learn from an instructor for approximately 3 months before using this as a method. This is my recommendation of choice.
• Daysy is a fertility monitoring device that learns your cycle and uses this information to report back to you when you are fertile or not, based on your morning temperature.  Simply insert the tip of Daysy under your tongue each morning and allow it to take your temperature, input menstruation on the days that you have it. You can tell from either an App or the device itself whether you are in your fertile period or not, or if Daysy is still learning your cycle. Its accuracy is reported at 99.3% however as I mentioned above you cannot rely on an algorhythm to predict fertility and the analysis of cervical mucous must be included for accuracy and reliability.  Daysy retails at $499. I no longer recommend this device.
• Natural Cycles in an app which requires you to take your temperature and input the data into the app, and this then calculates the information and tells you whether you are fertile or not. The app is available on a monthly or yearly subscription. In the past I have recommended this app, however with further learning I have realised that temperature alone is not effective at predicting ovulation, and so this poses many concerns with those using it for contraceptive purposes. I no longer recommend this app.
• Condoms and diaphragms. Not everyones favourite but they are side effect free (except when allergic to the substance they are made from, however latex free condoms do exist). They are known to break, and there are many instances where they have been forgotten to be used in the first place.
• IUDs. Not free from side effects, but the side effects are less than other hormonal contraceptives. the copper IUD has no hormonal activity, is effective and not subject to user error. It can potentially worsen period pain for some women, and like all implants has a slight risk associated with the implatation and removal. The Mirena IUD has hormonal activity but seems to be less likely to produce the other risks and side effects than other implants, injections and the OCP.
• Vasectomy and tubal ligation. Effective and long lasting, mostly side effect free, not subject to user error,  and with a pearl index of 0.02 for male sterilisation and 0.13 for female sterilisation, this is something that can be considered once a couple has decided they are ready.