Don't want more children, which contraception method is best?

Phyathai Group

5 Min

15/09/2022

AI Translated

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Don't want more children, which contraception method is best?

Who doesn’t want to have (more) children but is still confused about which contraception method to choose? Each method has different pros and cons. Is it true that contraception can still result in pregnancy? Let’s update the “contraception” methods in detail, a guide for those who don’t want to have children.

The first type is “temporary” contraception, suitable for those who might change their mind—that is, they don’t want children now but plan to have babies in the future. There are 7 methods, including:

 

Contraception with “condoms”

A popular method that everyone knows. It is convenient, simple, and effectively prevents pregnancy and sexually transmitted infections if used correctly. Condoms prevent sperm from fertilizing the egg but may cause irritation in some women.

 

Contraception with “oral contraceptive pills”

There are 3 main types: emergency contraceptive pills, which must be taken within 72 hours after intercourse, with a second pill 12 hours after the first to be effective. These pills contain twice the hormone level of regular contraceptive pills and are not recommended for continuous use. Another type is progestin-only pills, containing only progesterone, and combined pills, containing both estrogen and progesterone in one pill. These combined pills are highly effective and very popular.

The key principle is that contraceptive pills make the uterine environment unsuitable for pregnancy by thickening cervical mucus to prevent sperm from fertilizing the egg. However, pills must be taken continuously; missing even one day increases the chance of pregnancy.

 

Contraception with “injectable contraceptives”

Another effective method that can be used postpartum. The injection is given intramuscularly and can prevent pregnancy for 1-3 months depending on the type. The mechanism is similar to oral pills: suppressing ovulation, making the uterus unsuitable for embryo implantation, and thickening cervical mucus. However, side effects include irregular spotting initially, followed by cessation of menstruation. After stopping the injection, it may take 6 months to 1 year for ovulation and menstruation to return to normal, so it is not suitable for short-term contraception.

 

Contraception with “implant contraceptives”

Implant contraceptives can also be used postpartum. This method does not affect the baby or breast milk. A small plastic rod containing hormones is implanted under the skin of the inner upper arm, about 3 cm long. One implant can prevent pregnancy for 3-5 years. The mechanism is similar to injections but fertility returns faster after removal—ovulation and menstruation usually normalize within about 3 weeks. If antibiotics are needed during implantation, consult a doctor as they may reduce contraceptive effectiveness.

 

Contraception with “contraceptive patches”

This involves applying a hormone patch externally, suitable for those afraid of needles or unwilling to take pills. The patch’s effectiveness is comparable to oral contraceptives. It is thin, flexible, and applied to the hip, abdomen, upper back, or outer upper arm. Hormones are absorbed through the skin into the bloodstream to prevent pregnancy. The downside is that the patch must be changed weekly, and after 3 weeks of use, a patch-free week is needed to allow menstruation. It is a short-term but effective method, and fertility returns within 1-2 menstrual cycles after stopping.

 

Contraception with “contraceptive rings”

The contraceptive ring is a soft, flexible, transparent white plastic ring containing two hormones: progesterone and estrogen. It works like combined pills and is effective for 21 days (3 weeks). After 21 days, the ring is removed to allow menstruation before reinsertion. Like the patch, it can be self-inserted by pushing it deep into the vagina. If inserted correctly, it should not be felt. It is recommended to use another contraceptive method during the first 7 days after insertion for maximum effectiveness.

 

Contraception with “intrauterine devices (IUDs)”

This method is ideal for those who do not want hormonal contraception. The IUD is a small T-shaped device inserted into the uterus to prevent embryo implantation. It has strings extending 2-3 cm from the cervix. This method does not affect menstruation, hormones, cause nausea, vomiting, or weight changes. It lasts 3-5 years but requires regular checking of the strings. Postpartum women can use IUDs but it is recommended to insert them 4-6 weeks after delivery to prevent expulsion.

For those who are sure they do not want more children and want “permanent” contraception, the best method is “sterilization”. Most of the above methods are for women, but this method can also be done by men!

 

Male sterilization

It is simple, safe, quick, and does not require hospitalization. The doctor ties or cuts the vas deferens to prevent sperm from exiting. Sterilization does not reduce sexual performance; ejaculation remains normal but without sperm. It is recommended to use other contraception methods for at least 3 months after surgery because some sperm may remain. After 3 months, a sperm count test is done, and if clear, other contraception is no longer needed.

 

Female sterilization

There are two main methods:

  1. “Wet sterilization”, which means sterilization immediately after delivery. It can be done right after a cesarean section. For vaginal delivery, if the mother recovers well, sterilization can be done 24-48 hours postpartum. This method is easier because the uterus is still floating in the abdomen and not yet contracted into the pelvis, making the fallopian tubes easier to find. The procedure involves general anesthesia and a 2-5 cm incision below the navel to tie and cut parts of both fallopian tubes to prevent eggs from reaching the uterus for fertilization.
  2. “Dry sterilization” is the same procedure but done at a normal time when the uterus is in the pelvis, making the fallopian tubes harder to locate. There are two options: “open surgery” with an incision in the groin area, and “laparoscopic surgery,” which is less painful and has smaller incisions but requires insufflation of the abdomen with gas, so it is not suitable for patients with heart or circulatory problems. Dry sterilization is usually done after menstruation to confirm no pregnancy and requires a health check before the procedure.

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