Like most matters of the body and heart, contraception is very much a personal choice. But are we fully aware of all the choices available to us?
Reproductive and sexual health experts, Dr Mary Stewart and Dr Deborah Bateson, are currently asking health professionals to encourage patients to consider long-acting reversible contraception (LARC) methods.
“Women need to be provided with evidence-based information about the risks and benefits of all contraception methods available so they can make the best choice for themselves,” says senior medical officer at Family Planning NSW, Dr Stewart.
“LARC methods offer highly effective and cost-effective options for all women, and a discussion about these should be a part of contraception consultations.”
Up until now, LARC methods have been underutilised in Australia, with many women preferring to take the pill. This is despite research showing its inefficacy when it comes to reducing unintended pregnancies.
“Women need to be provided with evidence-based information about the risks and benefits of all contraception methods available so they can make the best choice for themselves."
One study found that women using short acting contraceptive methods, such as the pill, are 20 times more likely to have an unintended pregnancy than women using LARC methods.
“Many women aren’t aware that an IUD or implant may be suitable for them,” says Dr Stewart. “They also don’t realise that these methods are as effective as sterilisation, yet immediately reversible.”
Other benefits to using LARC methods include a decreased risk of blood clots and decreased menstrual bleeding and period pain.
The hormonal IUD means fewer hormonal side effects such as headaches, breast tenderness and mood changes, as progestogen is delivered directly to the uterus, with very little being absorbed throughout the body.
Alternatively, the copper IUD has no hormones so there are no hormonal side effects. It can also be used as emergency contraception within five days of unprotected sex.
However, not everyone is convinced these methods are a better alternative.
Three months ago, Samantha Turner* had the Mirena fitted. She’s had nothing but problems since.
“The bleeding hasn't stopped, my hormones are crazy and the cramps have been out of control,” she says.
“The doctors have done blood tests, swab tests and ultrasounds but, because the tests are clear, they’re urging me to ‘see it through’ or ‘give it another couple of months’”.
Dr Stewart advises women to be aware that the hormonal IUD can cause irregular bleeding initially. However, this generally settles within three-to-five months, after which bleeding significantly decreases or stops.
Despite this, she acknowledges that contraception is not a case of “one size fits all”.
“The bleeding hasn't stopped, my hormones are crazy and the cramps have been out of control."
Choice is based on medical eligibility, medical conditions, experience of adverse effects and personal preference.
“There are many options for women and, for some, the pill is perfect as it’s within their control and doesn’t involve a procedure,” says Dr Stewart.
“It provides excellent cycle control, which many women do not get with the implant, and can help in the management of acne, periods and alleviation of PMS.”
But, what options are available to Indigenous communities, or those with certain cultural or religious beliefs?
“Rural and remote populations can have access issues, however we know that the LARC methods, particularly the implant, are very acceptable to Aboriginal women,” says Dr Stewart
“Training nurses in remote areas to provide IUDs and the implant is an important strategy,” she adds.
Women with certain religious or cultural beliefs need to discuss with a healthcare professional the contraceptive methods most suitable for them.
“Bleeding can impact how a woman might practice religion or other cultural practices so, if a method causes change in her regular bleeding pattern, this may not be acceptable.”
In the future, Dr Stewart believes that LARC method usage will increase as women learn more and healthcare providers discuss and offer them.
She also notes that access to other contraception methods, some of which are currently widely available overseas, will provide even more options.
“We’ll hopefully get the contraceptive patch in Australia in the future, as well as new contraceptive vaginal rings, new female condoms, and a better progestogen only pill,” she says.
“We also hope to get the pill packaged to facilitate women taking continuous active pills, rather than packaged to have a bleed every month.”
In the meantime, a more effective emergency contraceptive pill is now available with a script, and both hormonal and non-hormonal male methods of contraception are being trialled.