Contraception

Unwanted pregnancies are no joke, especially during teenage years. They can significantly impact the woman's economic and mental health, and impact her educational prospects. That is why contraception is so important. By using contraception (also known as birth control), both pregnancies and (depending on the type of contraceptive) the transmission of sexually transmitted infections and diseases (STIs and STDs) can be avoided. Some contraceptive methods are easy to use and available at pharmacies, making them accessible to most people. The vast majority of contraceptive methods currently available focus on women, however, numerous male contraceptive techniques are currently in development, and condoms are a safe and easy contraceptive that men can use. In any case, anyone who participates in a sexual act is responsible for guaranteeing their own and their partners safety, which includes protection from pregnancy.

Definition and Use of Contraception

Contraception, also known as birth control, is any method used to prevent pregnancy. This may be achieved via hormonal and non-hormonal means. Hormonal means use a variety of hormones to regulate human fertility. Non-hormonal contraception methods include physical barriers or even surgery. Each of these methods may have side effects, with hormonal contraceptive pills having some of the most varied side effects.

Despite their side effects, the ability to control when pregnancy occurs provides numerous benefits for society as a whole, but especially for women. Access to contraception provides both economic and health benefits. In developing countries, pregnancy and childbirth can be incredibly risky, with many women dying due to its complications. An additional economic burden is placed on the family to feed and raise their offspring, further limiting development opportunities. This risk and additional drain on resources often make women seek unsafe abortions, which also come with their own set of risks.

Contraception's economic benefits derive not only from limiting the financial burdens placed on families by offspring, but by allowing women to participate in the workforce. Even if they end up having the same amount of children they would have without access to contraception, the ability to plan these allows more access to training and other opportunities, not only for the woman but her family also. Access to contraception results in increases in women's average earnings, assets and BMI. Their children's level of schooling and BMI also increase. By lowering and limiting population growth, other aid measures also go much further. This results in further savings, with 2-6 dollars being saved per dollar spent on family planning measures.

The History Of Contraception:

While all ancient cultures practised withdrawal to prevent pregnancy, ancient cultures also utilised several other methods to prevent pregnancy.

In historical times, people also attempted methods of contraception, which are still in use today, including both pharmaceutical and physical methods. Early pharmaceutical contraception methods included herbs such as silphium and Queen Anne's lace, along with drinking copper salts, or a mix of oil and mercury.

Early physical modes of contraception include placing leaves, lint or honey into the vagina to block sperm from entering the uterus. References to the use of condoms have been found from 150 AD, however for a long time they were seen as a way of preventing STD's rather than pregnancy.

Types of Contraception

As previously mentioned, there are numerous methods that can be used to prevent pregnancy, including:

• Surgical sterilisation methods
• Barriers to the sperm (for example, condoms)
• Hormonal contraception to prevent eggs from maturing
• Implants, skin patches or injections that prevent eggs from being released
• Spermicidal agents
• Abstinence
• Intrauterine devices that can either release hormones or prevent an embryo from being implanted.

A few of these are described in more detail below.

Non-hormonal Contraception

Surgical Measures Of Contraception

Both males and females may be sterilised by surgical means. In the case of men, this is referred to as a vasectomy. In a vasectomy, the duct that carries sperm to the urethra from the testicle is cut.

This prevents the release of sperm from the testicle, resulting in an absence of sperm in the ejaculate. Vasectomies may be reversed by reconnecting the tubes, however, the success rate of this varies significantly with the length of time since the procedure was performed.

Female surgical sterilisation is a slightly more major procedure due to lack of accessibility; however, it operates on a similar principle to the vasectomy of blocking the gametes from travelling their usual path. In this case, the egg Cells are blocked from travelling through the fallopian tubes into the uterus. Female sterilisation is carried out in one of two methods: tubal ligation and salpingectomy. This is detailed below.

Other non-routine surgical procedures that can result in female sterilisation are hysterectomies and oophorectomies. A hysterectomy is the removal of the uterus, often carried out because of heavy periods, pelvic pain, fibroids and some forms of Cancer. If the uterus is removed, then you cannot get pregnant. An oophorectomy is the removal of the ovaries, usually carried out due to endometriosis, ovarian torsion, benign tumours, abscesses, and as either a prophylactic or curative measure for some cancers. If both ovaries are removed, then it becomes impossible to become pregnant, therefore rendering the recipient sterile.

Barrier Methods Of Contraception

Numerous forms of barrier contraception exist, however, they all centre around blocking sperm from gaining access to the uterus. They are often complemented through the use of spermicides.

Barrier methods include:

• Male Condoms
• Female Condoms
• Diaphragms
• Sponges
• Cervical Caps

Male condoms wrap around the penis, forming a tight-fitting bag that contains the sperm upon ejaculation, preventing its entry into the uterus.

Female condoms are inserted into the vagina, operating on the same principle as a male condom. Both types of condoms protect against STDs and pregnancy.

Diaphragms and cervical caps both consist of small silicone domes that are inserted into the vagina, blocking the cervix. These are used with spermicide. They must be left in place for 6 hours to allow the spermicide to fully work, as removal before this could allow some surviving sperm to gain access to the uterus.

Contraceptive sponges are, as they sound, a piece of natural or synthetic sponge that is placed over the cervix and soaked in spermicide. As with diaphragms and caps, this must be left in place for 6 hours to prevent accidental sperm entry to the uterus.

Non-Hormonal Implants

The intrauterine device functions a lot like the intrauterine system described below and sits at the entrance to the uterus. Instead of using hormones, they release copper ions into the uterine fluid. This triggers a localised inflammatory response, increasing the levels of prostaglandins and white Blood Cells within the uterine fluid. This along with the copper ions secreted impacts both sperm motility and viability, preventing them from, or destroying them before, they can pass through the cervical mucus. They also prevent the implantation of fertilised eggs.

Hormonal Contraception

Hormonal contraception hijacks the female Endocrine System to prevent pregnancy from occurring. They deliver doses of different steroid hormones to accomplish their effects. Combined hormone methods use oestrogen and a progestogen. Progestogen-only methods use only a progestogen. Hormonal contraception prevents pregnancy by modulating either ovulation or cervical mucus viscosity.

Combined contraceptives use progestogens to decrease the frequency of gonadotropin-releasing hormone being released from the hypothalamus to in turn decrease follicle-stimulating (FSH) and luteinizing hormone (LH) release from the pituitary gland, which stops estradiol levels from increasing. This, in turn, stops the LH surge that normally occurs mid-cycle, which when combined with the lack of follicle maturation prevents ovulation.

Oestrogens stabilise the uterus' endometrium but also decrease the release of FSH, helping to prevent ovulation. Progestogen-containing pills also thicken cervical mucus by limiting the thinning action estrogen normally has on it.

Progestogen-only contraceptive mechanism of action varies depending on the dose delivered. Low levels focus mostly on their thickening effect on cervical mucus, only inconsistently stopping ovulation in around half of the users. Middle doses inhibit ovulation in nearly 97% of users along with the aforementioned mucosal changes. High doses fully inhibit ovulation, along with the mucosal changes.

The hormones may be delivered into the body via any one of several means, each offering different pros and cons. The most well-known form is the pill, a tablet form of the hormones that is taken at the same time each day. This runs the risk however of being forgotten and therefore not working. Other options solve this issue to varying degrees, including hormonal implants.

Hormonal implants

These are small tubes that secrete hormones after being implanted. This occurs through patches, injections, or an intrauterine system. An intrauterine system is placed into the uterus and secretes progestogens. The vaginal ring is a small plastic ring inserted into the vagina that secretes hormones. These all last for varying amounts of time and the hormones are delivered, allowing users to select an option that suits them the best.

Hormonal contraception can also be used after unprotected sex or as emergency contraception. These contain larger doses of the hormones discussed above or an anti-progestogen, and act by inhibiting ovulation.

Side Effects of Contraceptive Pills

The side effects of contraception vary depending on the method. Some, such as male or female condoms, run virtually no risk of side effects outside of an allergy to the materials used in their construction. Physically inserted contraceptives may run the risk of toxic shock syndrome if used during periods.

Some of the most severe side effects, however, result from hormonal contraception. When the pill was first introduced, the doses of hormones used were much higher, causing an increased risk of embolism and stroke, however, the doses have now been lowered, minimising this risk. The most common side effect of the pill is breakthrough bleeding; however, other side effects may also occur, including:

• Nausea
• Libido changes
• Weight changes
• Headaches
• Vomiting
• Fluid retention
• Breast tenderness
• Mood changes and depression

Combined pills have also been linked to a minimal increase in breast Cancer risk, along with an increase in cervical Cancer risk in those infected with HPV. Preogestogen-only pills generally have lower risks of these side effects.

Non-Pregnancy Related Uses of Hormonal Contraception

Oral contraceptives have been used to treat disorders such as polycystic ovarian syndrome (PCOS) or endometriosis, or even as a solution for painful periods. However, the pill does not cure these metabolic disorders, but only serves to combat or reduce their symptoms. Since painful periods, among other symptoms of PCOS and endometriosis, can severly impact women's day-to-day lives, taking the pill can help women continue their usual routine despite their period. However, PCOS and other hormonal disorders can be mitaged or treated by changes in diet and exercise, which have fewer side effects than the pill.

Male Contraceptives

While most methods of contraception currently available focus on women, several methods outside of condoms or vasectomies are in development. As with female contraception, these methods may be hormonal or non-hormonal. Male hormonal products generally consist of a combination of synthetic testosterone combined with a progestogen. The progestogen causes the testes to limit testosterone production and therefore sperm production and the synthetic testosterone maintains normal Blood testosterone levels, limiting adverse effects. Non-hormonal methods include non-vasectomy surgeries such as reversible inhibition of sperm under guidance (RISUG) which uses a Polymer injected in the vas deferens to destroy sperm as they exit, along with vas-occlusive devices such as the "sperm switch" which block the exit of sperm from the testicles. Other methods include heating the testicles using various means to induce infertility.