Contraceptives: tips for managing side effects and knowing when to switch methods

Assumed autonomy and control over reproductive health is the great attribute of female contraceptive methods. And while this path may be very easy for some women, for others it is not so easy. There are different methods, and each human body is unique and special, and in some cases an unpleasant uncertainty opens up, full of pain and discomfort. Yes, we are talking about side effects.

Nail survey made by a vaginal ring mark at the start of 2022, it reveals that 60% of women started using contraceptives between the ages of 15 and 20, but that half of them no longer use them. Among other reasons, because 60% of those consulted are concerned about the amount of hormones contained in oral methods — that is, contraceptive pills, which are used by almost a third of the women questioned — , and 39% find it difficult to negate the protection they provide against sexually transmitted infections as well as the need to remember their daily intake.

If we analyze hormone contraceptives, you can find them in different forms: oral pills, vaginal rings, injections, transdermal patches, subdermal implants and hormone-releasing intrauterine devices.

But all of the hormones themselves can be divided into two broad subgroups, as Milena Zamboni, an obstetrician-gynecologist at the UC Christus Health Network and assistant professor at the Pontificia Universidad Católica explains: Combinations that contain estrogen and progesterone and others that provide a single hormone, progesterone.

“The most used are the pills that contain the two hormones, even if estrogen increases blood pressure and the risk of thrombosis, especially in obese women or who smoke”, warns Daniela Ribbeck, doctor member of the association. Gynecologists Chile .

But how do they work? By increasing the dose of natural female hormones, such as progestins (progesterone) and estrogen, a signal is given to the pituitary gland, the area of ​​the brain that regulates the reproductive cycle, not to ovulate. Progestogen also limits the production of mucous in the cervix, through which sperm could arrive on the way to fertilization. Thus, in addition, they prevent them from reaching their destination. There are pills that contain both hormones and others that only contain progestin.

Among the contraceptives without hormones, there are alternatives such as the diaphragm, the copper T, the female condom and of course the male condom: the latter, in addition to preventing fertilization, provides 96% effective protection against sexually transmitted diseases (STDs).) . Neither diaphragm nor copper T is able to prevent STDs.

According to the study carried out by The Ring that frees you, 93% of women prefer to obtain advice and guidance from a specialist in gynecology before choosing their contraceptive method, so not many of them decide on advertising or current trends.

Before recommending an option, Eliecer Pincheira, gynecologist at Clínica Dávila and Dávila Vespucio, first establishes a good medical history, “which includes your personal and family history, as well as previous experiences of using the contraceptive method. I am interested in knowing what knowledge the patient has on the subject, often to demystify misinformation that can be learned socially”.

This is where side effects come into the conversation, which Pincheira says “are an inherent response to each particular method.” Some may even be positive for some women. For example:

• Decreased menstrual volume: something that can happen with all methods except copper T.
• Reduction of dysmenorrhea: Menstrual pain is usually alleviated by contraceptive methods, especially hormonal ones.
• Reduce acne and body hair: this can be an advantage for those who are not comfortable with these hormonal reactions in the body.
• stabilize the mood

However, these consequences do not appear in all cases. On the contrary: for some users, more than side effects, they are undesirable effects that can mean more than one problem.

“These reactions can be mild and don’t require manipulation, but there are also severe cases where the method can be stopped,” he says. “For each user there is the most suitable method, which is why a personalized indication is important.”

Once each of the risks has been assessed, the gynecologist advises her which is the best method for her and thus reduces the undesirable effects. “You must also explain each of the effects that may appear according to each method and that the user knows that most are manageable: in some cases the method will have to be suspended, but this must always be supervised by a professional,” he specifies. he.

There aren’t many studies on the long-term or side effects of using hormonal birth control, but what there is isn’t very reassuring. A survey conducted in Denmark suggests that hormonal contraception is correlated with an increased risk of depression, whereas another Swedish study which followed 300 women who took oral contraceptives or a placebo pill for three months, found that those who took the pill scored lower on a measure of general psychological well-being.

According to US Centers for Disease Control and Prevention According to the CDC, about 63% of women who stopped taking birth control pills and about 65% of those who had an intrauterine device removed (the two most popular forms of birth control) reported that side effects were one of the main reasons they decided to make a change.

“Each method is different, each has its own benefits, its own risks, and its own side effects,” says Zamboni. Pincheira assures that the user and what they feel should never be minimized, even if it is a mild symptom. “If she doesn’t feel comfortable, you have to listen to her, welcome her and offer her management options.”

“The most frequent consequences are a change in the bleeding pattern or even the absence of menstruation,” adds Pincheira. “Also headaches (headaches) and decreased libido, in the case of oral contraceptives, as well as mastodynia (breast pain or engorgement)”, he specifies. In the case of T-type copper devices, “increasing the amount of menstrual flow is most common.”

On libido, Zamboni says that “hormonal contraception has never been shown to decrease libido in large populations. It’s very multifactorial, it doesn’t just depend on contraception: it depends on the relationship, stress or time of year, etc. It has too many factors to attribute to just one.

“If a woman feels that her libido is actually reduced by hormonal contraception, then she should be offered a non-hormonal one”, analyzes the gynecologist-obstetrician.

“If a woman wants contraception, she doesn’t have to go without it,” says Zamboni. This is why it is so important to have all the information available at your fingertips, advised by specialists. “There are many contraceptive methods: depending on the side effects or the symptoms, it is necessary to assess whether it is arbitrable or not,” he specifies.

For Pincheria, this process should be personalized and discussed with the user. “There are adverse effects which signify a contraindication to the method and it must be suspended. In this case, a new method must be chosen. However, when there are moderate or mild effects, therapeutic alternatives or a change of method can be offered if the patient wishes,” he explains.

When changing methods, the doctor emphasizes that it is generally suggested to use barrier methods or abstinence for seven days. “The best contraceptive method,” commented Daniela Ribbeck, “is that chosen by the informed woman.” But for that, necessarily, it is important to have a good advice in contraception with a trained professional.

One way to fully understand the process you go through when you start a new birth control method is to write down how you are feeling on a daily basis. By documenting the symptoms, you will be able to remember the sensations you feel, which will make communication with a specialist easier and more orderly. You can write them in your own handwriting, do it via notes on the phone, or using period tracker apps.

Pincheira recommends it, “because it guides the professional at the time of the consultation to establish a menstrual calendar, with the quantitative and qualitative characteristics of the menstrual cycle, and thus make a decision with the user on the most recommended method for her. “

“Any information the user can provide is extremely important in balancing current method permanence against a change in contraceptive method”

In an article on the site SELF , recommend recording the entire period: when the period comes and goes, physical and psychological changes, the amount of supplements you take per day, variations in diet and exercise, etc. Taking all of these variables into account, and after a few days, you might have a more general idea of ​​what’s going on with your body.

If you experience any side effect or adverse reaction that you suspect may be associated with your type of birth control, do not hesitate to contact your gynecologist.