Contraceptive pills and minipills

Contraceptive pills generally mean oral contraceptives which contain a combination of oestrogen and gestagen. Their mainly exert their effect by preventing ovulation. If the pills are administered without error, the safety of contraception is very high. As, however, safety is considerably decreased by irregular administration, certain drugs, as well as emesis and diarrhea, the figure for everyday life is not so high (the Pearl Index is 8.0 for normal use). The risks of thrombosis, myocardial infarction and cerebral apoplexy are particularly higher in the case of women over 35 who are smokers. In addition, the risks of some types of cancer, jaundice and high blood pressure are also higher. Concomitants such as intermenstrual bleeding, breast tension, headache or indisposition may occur in the first months of administration in particular. In case of long-term administration, the intensity of menstrual bleeding and / or the premenstrual syndrome are frequently decreased, but changes in sexual desire, body weight and mood can also occur. Contraceptive pills are especially suitable for young healthy women who are disciplined enough to adhere to regular daily use. Minipills generally mean oral contraceptives which only contain the hormone named gestagen, in small quantities compared to other drugs. They exert their effect by thickening cervical mucus, thereby making it difficult for sperms to enter the uterus, as well as by preventing nidation. Application of the minipill requires the user to demonstrate stricter discipline as it must be taken within a maximum of three hours before or after the time specified for administration in order to ensure safety of approximately the same degree as contraceptive pills. Many of the concomitants of contraceptive pills fail to occur in case of minipills, but about one third of users have intermenstrual bleeding.

Other hormonal methods

For women who would like to have hormonal contraception but do not want to bother about taking contraceptive pills each day, there is a series of other hormonal methods available. However, these methods are also characterized by higher risks of thrombosis, myocardial infarction and cerebral apoplexy, particularly for women over 35 who are smokers; in addition, the risks of certain types of cancer and high blood pressure also increase during their administration. Concomitants include irregular menstrual bleeding or stronger and longer menstruation, especially in the first months. In case of long-term application, however, menstruation is frequently weaker and less painful, and it can even completely fail to occur in case of certain methods. In addition, other hormonal concomitants can appear, including changes in sexual desire, body weight and mood. Similarly to contraceptive pills, vaginal rings and birth control patches contain a combination of oestrogen and gestagen and prevent ovulation. Both of them are highly safe (the Pearl Index is 8.0 for typical use). Vaginal rings are placed into the vagina for 3 weeks and removed for a week, when withdrawal bleeding occurs. Hormone patches are stuck 3 times – each for a week – on the arms, for instance, to be followed by one patchless week when withdrawal bleeding occurs. Skin irritation can develop at the place where hormone patches are stuck on; vaginal rings may result in vaginal irritation, vaginal discharge and infections. Hormonal birth control implants and the so-called 3-month injections only contain gestagen, the continuous and systematic release of which prevents ovulation, fertilization and nidation. Both of them are highly safe (the Pearl Index is 0.5 and 0.3, respectively, for typical use). A hormonal birth control implant is a small-sized cylindrical device implanted into the arms for a period of 3 years. 3-month injections are administered in the form of an injection by a physician.

Hormonal IUDs

Hormonal IUDs consist of a T-shaped plastic base and a hormone container on it, which releases small amounts of gestagen into the uterine cavity. Its safety is very high (the Pearl Index is 0.2-0.8 for typical use). They are put in place by a physician. Hormonal IUDs are available in a single size only and are allowed to remain at the place of application for 5 years. Contrary to most methods of contraception, the action of hormonal IUDs is based on the local effect of gestagen, which thickens the mucous plug at the cervix, making it difficult for sperms to enter the uterine cavity, thus inhibiting their mobility and fertility. In addition, hormonal IUDs cause changes in the endometrium by the so-called foreign body reaction, thereby affecting menses. Particularly in the first few months, concomitants may appear such as irregular bleeding and strong menstrual pain. In case of long-term application, hormonal concomitants or ovarian cysts may develop. Menstruation is frequently weaker or less painful, and it can even completely fail to occur. Hormonal IUDs can be applied, above all, in case of women who would like to have hormonal contraception, have already given birth, and their body fails to properly tolerate oestrogen and / or their menses is accompanied by heavy bleeding.