Consider Your Alternatives
You now know you would like to get off chemical contraception, whether it is the Pill, the injection (Depo Provera), the implant (Implanon) or the hormone-secreting IUD (Mirena).
You understand how they work and don’t feel happy with what they are doing to your body.
Or, you may already have experienced negative side effects. You understand the problems or the potential problems.
It’s just not worth it to you.
But what on earth are you going to do instead?
This depends a lot on whether you are using it for contraception or for a health issue like acne, irregular periods or heavy, painful periods. We’ll cover the alternatives to deal with health problems in another series. All I will say now is that complementary medicine has a lot to offer these issues, be it naturopathy, Chinese herbal medicine, Western herbal medicine, or acupuncture.
But let’s focus on the conundrum of contraception and the alternatives to chemicals.
There are permanent options and temporary options.
If you have decided you don’t want anything involving putting chemicals into your body, there is a finite list of contraceptive alternatives. Let’s divide these into two groups: permanent and temporary.
The permanent options include male sterilisation (vasectomy), female sterilisation (tubal ligation) and hysterectomy (taking out the uterus).
The temporary options include condoms and fertility awareness methods including the Billings Ovulation Method, the Sympto-Thermal Method, the Creighton Model, and Natural Fertility Management.
Let’s go through these one by one.
Vasectomy – “Getting the Snip”
The first three months after a vasectomy is a “wash-out” period, but after this, it is very effective for contraception: only up to 20 couples out of 10 000 will fall pregnant in the first year. This compares with 500 couples out of 10 000 using the Pill as contraception. Vasectomies are very safe and considered a minor surgical procedure. If you are after permanent contraception, talking your partner into this one could be a good option!
Tubal Ligation – “Getting Your Tubes Tied”
Getting your tubes tied so that sperm and egg can’t unite is over 99% effective for avoiding pregnancy. The downside is that if you are unlucky enough to fall pregnant, there is a high chance (up to 80%) of this being an ectopic pregnancy. This is where the pregnancy occurs in the tube instead of the uterus and can be dangerous. On the up side, the laparoscopic or “keyhole” method makes this procedure a safer surgery than in previous years. It is commonly done at the same time as a Caesarean section when a woman is sure she doesn’t want to have any more children.
Hysterectomy, quite logically, is 100% effectiveness in avoiding pregnancy. A drastic choice though! The only reason I have included it is as an acknowledgement there are other reasons other than contraception that women are on the Pill, such as extremely painful or heavy periods. I have seen women with endometriosis choose to have a hysterectomy rather than stay on the Pill for this reason.
Condoms are convenient. That is their major advantage. But after that, it’s not great news.
Let’s face it. Condoms are risky. 1400 couples out of 10 000 will fall pregnant using condoms in one year (compared again with 500 out of 10 000 on the Pill).
Fertility Awareness Methods
This next section covers the systems of contraception based on awareness of fertility signs. On the whole, the studies into these methods have not been as “scientifically rigorous” as we’d like. This means it may be harder to interpret their effectiveness. As a group, they have about a 1-3% failure rate – that is, up to 3 couples out of 100 fall pregnant unintentionally using the method.
Billings Ovulation Method
Teachers of this method are called Accredited Teachers of the Billings Ovulation Method,
This is the system with the most published research studies of all the fertility awareness-based methods. Again, while it is hard to compare the results of research with drug-based contraception, we do have some figures from studies. The most recent figures find that the Billings Method is greater than 99% effective for contraception. This means that in a year of use, up to 1 couple out of 100 will unintentionally fall pregnant.
A 2007 study that looked at them as a group found just a 0.6/100 pregnancy rate in 13 cycles (which in a “textbook woman”, might be approximately a year). By my calculations this is 6 couples out of 1000 or 60 out of 10 000, which seems to compare remarkably well with the vasectomy and Pill examples above. Note that this was when sexual activity was (correctly!) avoided during the fertile times! The real-life situation was that couples didn’t always “follow the rules” and in 13 cycles, 1.8 women out of 100 fell pregnant unintentionally. By my calculations, this equates to 180 out of 10 000. Again, this still seems to compare favourably with the Pill. As I mentioned in a previous blog post, human error is common with the Pill – women forget to take it or fail to take precautions if they have had vomiting and so on, so the actual “real life” effectiveness of the Pill drops for this reason.
The Creighton Model describes itself as “a standardised modification of the Billings Method”. It is more prescriptive than the Billings Method, giving a limited array of options for women charting their fertility signs. Teachers of this model are called Fertility Care teachers. At the time of writing this post, there were fewer Creighton Model teachers in Australia than Billings Method teachers.
The effectiveness rates for this system were similar to Billings – a study of almost 2000 couples found a greater than 99% effectiveness rating. But note! This study also looked at “user effectiveness”, also called “user failure”. It compared user effectiveness with method effectiveness, which means what happened in “real life” rather than what happened if all rules were strictly followed. (Basically, couples break the rules at times, and this can be their downfall!) User effectiveness dropped to around 96%.
Natural Fertility Management
This is a method that combines the Symptothermal Method with an awareness of the lunar cycle. The website promotes a high success rate of over 99% if used effectively by committed couples. Unfortunately, there are no research studies published on it.
Some of the studies of the fertility awareness methods mentioned that couples sometimes dropped out of these methods after a year or so of use – sometimes less. This makes sense; they do involve rules, commitment and discipline. They require both partners to be committed.
My next post looks at preparing to take the plunge getting off the Pill by getting your health and your nutrition in hand.