Contraception or birth control is something many of us will have to think about at some point in our lives. But how many of us really know about all of the options open to us?
And research has revealed that the pill is still by far the most popular form of prescribed contraceptive among women in England.
Figures obtained by the Guardian under the Freedom of Information Act show almost nine in 10 women who receive contraception from the GP or pharmacies take either the combined pill or ‘mini pill’ – a total of more than 3.1 million women in England in 2017-18.
But with many growing tired of potential pill side effects, such as acne, mood swings and lack of libido, and a growing number looking to go hormone-free, women are beginning to question their contraception choices.
While medical technology has moved on, presenting us with more alternatives, some women are still unsure of their options and how to access them.
Research last year found it is getting increasingly difficult for women to access the contraceptive of their choice, mainly because of budget cuts to sexual health services.
A study by FPA found a fifth of women have had to wait over two weeks for a contraception appointment – and more than a quarter of women surveyed said they felt they didn’t have enough time to go through all their options.
But it is vital that women have a choice.
“All too often, the battle to find the right contraception for yourself can seem relentless – it's all-encompassing and exhausting,” says Dr Elina Berglund, co-founder and co-CEO at Natural Cycles.
“Still, there's no doubt that having a full range of choice in birth control is vital for both physical and mental health – so it's a battle worth fighting for.”
With that in mind and to celebrate World Contraception Day, we take a look about the future of contraception and how the various options stack up.
Contraceptive options for women
Whether you like the regularity of taking a pill every day, or would prefer to test out something hormone-free, it is important to know the options open to you, and those soon-to-be available.
The contraceptive pill
There are two types of contraceptive pill available; the combined contraceptive pill and the progesterone only pill.
“The combined pill contains the hormones oestrogen and progesterone, and the progesterone only pill contains progesterone. They are both more than 99% effective when used correctly,” explains Dr Simran Deo from Zava UK.
Although there are many side effects documented with all contraceptives, every woman reacts differently and so it can be difficult to suggest the most suitable.
Dr Deo suggests a trial for 3 to 6 months is usually recommended, as many side effects will resolve within this time.
“While many women won't experience any side effects at all, we know from our own research that two in three women have remained on their current pill for five years or more despite experiencing side effects,” she adds.
Common side effects of the combined contraceptive include headaches, acne, weight gain, heavy periods and nausea.
“The side effects experienced on the progesterone pill are similar but may also include breast tenderness and mood swings,” Dr Deo continues. “Irregularities in vaginal bleeding within the first 3 months of using either contraceptive have also been reported.”
If the contraceptive pill is not suitable or cannot be prescribed for medical reasons, and thanks to medical advancements, there are other options.
The contraceptive coil is a long-acting method of contraception. It looks like a plastic, T-shaped device fitted in the vagina by your doctor or nurse and there are two types; the intrauterine device (IUD) and the intrauterine system (IUS).
“The IUD or copper coil is more than 99% effective,” explains Dr Deo. “It works by releasing copper into the womb which causes thickening of the cervical mucus at the entrance to the womb.
“This makes it harder for sperm to reach the egg and therefore prevents fertilisation from occurring.”
Dr Deo says the IUD can often remain in place for 5 to 10 years, depending on the type, which makes it an effective long term contraceptive for many women.
Although the copper coil is a better option in some people as it is non-hormonal, there are still some common side effects. These include heavier or more painful periods, irregularities in vaginal bleeding, cramps and backache.
The IUS (also called the hormonal coil) releases progesterone and is also more than 99% effective.
“Once it is fitted, the IUS can stay in the womb for 3 or 5 years, depending on the type being fitted,” Dr Deo explains.
“It has been reported to make periods lighter, less painful or stop altogether. Side effects such as breast tenderness, acne, mood changes, weight gain, facial hair and a reduction in lbido can occur, but in some cases improve in the first 3 - 6 months.”
Other hormonal contraceptives - implant, injection, patch and ring
There are lots of other hormonal contraceptives available such as the implant, injection, patch or ring that contain different doses of oestrogen and or progesterone to help protect women from unwanted pregnancy, or manage painful or heavy periods.
To find out which, if any, might be right for you it might be worth trying a few out or speaking to a contraception expert.
“Sometimes finding the right type of contraceptive will mean trying out a method and switching if it does not feel suitable, so don't be afraid to seek help from a doctor or nurse if you feel like something isn't right,” Dr Deo says.
Though women have been predicting the fertile days in their menstrual cycles to prevent pregnancy for years, the growth of the ‘femtech’ industry, coupled with some looking to move away from hormonal methods of contraception has seen a rise in the use of contraception apps.
A recent survey found 2.8% of contraceptive users aged 18 to 51 were using a fertility awareness method of contraception
“Technology enables a proliferation of choice,” explains Dr Berglund. “Many women still opt for the pill, but now have other alternatives available including digital contraception.
“For women, such technology brings a more comprehensive understanding of their body alongside personalised contraception. Already, algorithms are able to help women understand exactly when they're fertile. It'll be interesting to see more ways that technology enhances our biology and lifestyles in years to come. After all, knowledge is power."
The Male Pill
While trials of a new male pill, which works by lowering levels of testosterone and two hormones required for sperm production, have been showing promise, previous attempts to create a male pill, have resulted in side effects such as liver damage or low sex drive.
But earlier this year a team of Chinese researchers revealed they had been trialling a ‘medium-term’ reversible form of male contraception in rats.
Commenting on the findings, published in the journal ACS Nano, study leader Dr Xiaolei Wang, of Nanchang University, said: “The injected materials kept the rats from impregnating females for more than two months.”
Dr Wang said the pilot experiment was “promising” but more research is needed to verify the safety of the materials uses.
So while testing is ongoing the male pill is still some way off yet.
“In the meantime condoms are 98% effective, protect against STIs and are free and readily available from most sexual health clinics, family planning clinics, and some GP surgeries,” suggests Dr Deo.
According to a blog by Faculty of Sexual and Reproductive Healthcare (FSRH) there are several other methods of contraception new to the market, or currently in the pipeline.
Approved in August 2018 by the FDA, Annovera, is a combined hormonal contraceptive (CHC) in a soft, flexible ring made of silicone.
It is inserted for three weeks, removed for one, and used for 13 cycles.
According to the FSRH a study of more than 2,000 women in the US, Latin America, Europe, and Australia found efficacy and safety similar to other CHCs, while there was no increased risk of vaginal infection.
The first wirelessly-controlled drug delivery microchip is currently being trialled. According to Dr Zara Haider the 2cm by 2cm microchip can be implanted into the buttock, abdomen or upper arm and supplies the hormone, levonorgestrel, for up to 16 years.
Another advance in contraception is the intrauterine ball. This flexible, frameless device, is introduced using a narrow, 3.2mm inserter.
With an efficacy rate of 99.89%, a study of 336 patients showed slightly less bleeding from the ball compared to a traditional IUD.
But Dr Haider believes there is a need for more data comparing the intrauterine ball with other established contraceptive methods.
Male Contraceptive Gel
Earlier this year researchers kick-started a clinical trial of a male contraceptive gel. The gel formulation, includes the progestin compound segesterone acetate (brand name Nestorone), in combination with testosterone. It is applied to the back and shoulders and absorbed through the skin.
It works because the progestin blocks natural testosterone production in the testes, reducing sperm production to low or nonexistent levels.
The replacement testosterone maintains normal sex drive and other functions that are dependent on adequate levels of the hormone.
The trial, funded by the National Institute of Child Health and Human Development(NICHD), is set to enroll approximately 420 couples, from nine different study sites in seven countries scattered across the world, including Chile, England, and Sweden.
Microneedle skin patch
Scientists have designed a new long-acting contraceptive that can be self-administered by women using a painless microneedle skin patch.
The single-use patch only needs to be applied to the skin for a matter of seconds to work, and could prevent pregnancy for up to six months.
Research, published in the journal Nature Biomedical Engineering, may pave the way for a new family planning option.
Professor Mark Prausnitz at the Georgia Institute of Technology in Atlanta said: "There is a lot of interest in providing more options for long-acting contraceptives.
"Our goal is for women to be able to self-administer long-acting contraceptives with the microneedle patch that would be applied to the skin for five seconds just once a month."
But Prof Prausnitz admitted more research and trials are needed to see exactly how the contraceptive patches would work in humans.
"Because we are using a well-established contraceptive hormone, we are optimistic that the patch will be an effective contraceptive," he said.