How do the different birth control methods work?

Long-acting methods include intrauterine device (IUD) and implants, while condoms, injectables and pills are grouped as short-term methods because they offer protection against pregnancy for a limited period of time. Other methods of birth control are fertility awareness methods such as moon beads, diaphragm, withdrawal method and spermicides.

The Implant

The implant is a small flexible tube, about 40 milimetres long that is inserted under the skin of a woman’s upper arm. It is inserted by a trained professional, such as a doctor, or trained nurse and lasts between three to seven years, depending on the type used.

It works by stopping the release of an egg from the ovary that slows the release of progesterone into a woman’s body. Progesterone thickens the cervical mucus and thins the womb lining, making it harder for sperms to move through the cervix to fertilise the egg and cause pregnancy. In the first year after the implant is inserted, a woman may experience irregular periods that could also be heavy or light. But after one year, they will become normal.

Possible side effects of implants include weight gain, headache, nervousness, continued bleeding and nausea. Dr Henry Bukenya, a gynaecologist at Mulago National Referral Hospital, says these side effects usually last a short time, but if they persist beyond the first year after an implant has been inserted, a woman should seek medical advice or change the contraceptive method. It can be removed by a trained health care provider at any time, and a woman can become pregnant without much delay.

Lactational Amenorrhea
Lactational Amenorrhea method is based on the natural effect of breastfeeding on fertility. The act of exclusive breastfeeding suppresses the release of hormones that are necessary for ovulation. This method should only be used by women who exclusively breastfeed their babies every day. It is usually recommended in the first six months after childbirth.

Oral contraceptive pills
“Birth control pills can be divided into combined and progesterone-only oral contraceptives,” says Dr Milton Awudo, the medical director at Marie Stopes Uganda. Combined oral contraceptives contain both progesterone and estrogen hormones, while progestin oral contraceptive pills are usually taken by breastfeeding mothers, beginning six weeks after childbirth.

The hormones restrict an egg from growing and being released from the ovary. They trick the ovary into thinking that it has already released an egg. The hormones in these pills are however effective for 24 hours. This means a woman using this method is required to take the pill at the same time after a 24-hour cycle every day.

According to Dr Henry Bukenya, a gynaecologist at Mulago National Referral Hospital, most women are advised to start taking the pill on the second day after starting their periods to be able to keep track on when they started.

This contraceptive method has been associated with side effects, with some women reporting cases of headache, weight gain, stomach upset, continuous bleeding or spotting and irregular periods.
“The pills are not supposed to interfere with one’s health. However, when a woman gets any of these effects over a long period of time, I advise them to stop using the method and consult with their doctors for an alternative,” says Dr Bukenya.

The pill is also associated with several misconceptions, and some women believe they burn the woman’s eggs and cause cancer, or interrupt the menstrual cycle. However, pills do not prevent one from catching HIV and other sexually transmitted diseases.

Condoms
There are two types of condoms designed to be used by men and women. According to Dr Henry Bukenya, a gynaecologist at Mulago National Referral Hospital, both types work the same way by preventing sperms from reaching the egg, although the demale condom is not as commonly used as the male condom. When used correctly, condoms help prevent pregnancy and sexually transmitted diseases such as HIV. They are also easy to use compared to other family planning methods. However, each condom should be used only once.

Vasectomy
This method is similar to the tubal ligation procedure for females. However, vasectomy works by preventing the release of sperm when a man ejaculates. During a vasectomy procedure, the vas deferens from each testicle is sealed to prevent sperm from mixing with the semen that is ejaculated from the penis.

The testicles continue to produce sperm, but the sperm are reabsorbed by the body. One still ejaculates the same amount of fluid, however, it usually takes several months after a vasectomy has been performed for all the sperm to be ejaculated or reabsorbed. Therefore, the man should use another method of birth control until he has a semen sample tested to show zero sperm count.

Dr Milton Awudo, the medical director at Marie Stopes Uganda, says there is still a lot of misconception about vasectomy, with 80 per cent of men in Uganda convinced that it is the same as castration, and that it reduces libido.

Injectable contraceptives
Like oral contraceptives (pills), the injectable contraceptive contains depot medroxy progesterone acetate (DMPA), a hormone that prevents a woman from becoming pregnant. The hormone is administered by a health worker as an injection on the upper side of the arm.

After administering the shot, one should not squeeze the area to prevent the hormone from spreading to other parts of the body and becoming less effective. “The injection has similar effects with the pill but it lasts for three months before another dose can be given,” says Dr Henry Bukenya, a gynaecologist at Mulago National Referral Hospital.

It is advisable that women who want to use this method receive it when they are in their periods to make it easy for them to recall when to get the next dose. Some reported side effects include irregular bleeding, gradual weight gain and mild headache.

Female sterilisation
Also known as tubal ligation, it is a surgical operation to seal the fallopian tubes which carry eggs from the ovary to the womb. When the tubes are sealed, the sperm and egg do not meet. The egg then dissolves and is absorbed by the body. This method is permanent and effective in preventing pregnancy.
However, Dr Milton Awudo, the medical director at Marie Stopes Uganda, says there have been rare cases where a woman gets pregnant after undergoing a tubal ligation. This operation is usually preferred by women who are sure they will not want any more children. There are no long-term side effects to using this method.

Intrauterine device (IUD)
The intrauterine device, commonly known as IUD or coil is a small device that contains either copper or hormone, which is inserted inside a woman’s womb to prevent her from becoming pregnant.
The IUD is T-shaped, and one is advised to have it inserted by an experienced healthcare worker to ensure it is properly fixed.

To avoid any complications when using the device, Dr Henry Bukenya, a gynaecologist at Mulago National Referral Hospital, advises that a woman should keep good hygiene at all times, should be free from any infections and must not be in their periods at the time of inserting it. “If you cannot maintain good hygiene at all times, do not attempt to use the IUD because infections will breed in your reproductive system,” says Dr Bukenya.

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