Contraception roulette

The Pill was revolutionary for women’s rights and the feminist movement when it gained approval and entered public circulation in 1960. It allowed women to control their bodies and reproductive health, remaining free from the burden of an unwanted pregnancy. It allowed a freedom, and an independence from their male counterparts. Marketed as a “lifestyle pill” it was to be a cure all; from moodiness to eliminating acne to reducing menstrual pain but today, many women are pulling away from The Pill, and in some cases, away from contraception as a whole.

The oral contraceptive pill typically works off two different hormones; oestrogen and progesterone to halt ovulation therefore preventing fertilisation. As explained by Dr Cathy Brooker, Medical Director of Sexual Health Quarters Northbridge, these hormones may have numerous side effects that either improve or deteriorate four main areas. It can affect skin, weight, breast size and mood. 

“There are some people that get a much better mood with the hormones and then there are some people that get a deterioration in their mood and you really have to try and see if it’s okay for you,” she says. This trial and error stance is a common thread when discussing contraceptive options.

Holliea Fairleigh from Shakti Holistic Healing is one woman who moved away from the oral contraceptive pill, and hormonal contraception all together, due to the negative side effects she was experiencing.

Ms Fairleigh felt that the pill was impacting her health in a number of ways: “It could have been one of the causes of my hyperthyroidism, it was definitely linked to my poly-cystic ovarian syndrome, for sure, and the anxiety and depression, I can’t say definitely it was it, but I must say, I felt so much better in myself once I did stop taking it.”

So with all this uncertainty, why is the oral pill the most common form of contraception in Australia? Dr Cathryn Higgins from Subiaco’s Rokeby GP explains that it is “very much a cultural thing as far as Australia goes because elsewhere, in Europe particularly, they have been using non-pill forms and are a lot more comfortable with non-pills forms. Here it has been the commonest, the best known, the cheapest option since it came into effect, so it’s very much based on familiarity more than anything.” 

Dr Brooker agreed, adding that when young women are having intercourse, regardless of the risks involved, sometimes the contraceptive pill is the best option for the time being.

The issue arises when these women abandon the pill but do not switch to other reliable contraception risking an unwanted pregnancy. 

“A termination is much more dangerous [than hormonal side effects] and that’s what you’re trying to avoid, that termination, and if you stop the pill and take another contraception that’s great, but if you stop the pill and play Russian Roulette then that’s really bad,” reiterated Dr Brooker.

The trend is backed by the World Health Organisation, which says long acting reversible contraceptions (LARCs) are now the first line recommendation for general practitioners to prescribe. This is rooted in greater effectiveness. As Dr Brooker described, the pill’s effectiveness rate lies between just 93-96 per cent, similar to the injection.

“If 100 couples are using them for contraception, at the end of the year four to seven of those couples will be pregnant, so there is significant numbers when you look at them on a population scale,” she said.  

Effectiveness scale for contraceptives available in Australia. Photo: Amber Lilley

Dr Brooker explained there are two types of LARCs available in Australia; IUD’s and Implanon (a slow release hormone implant). Each one is fixed in place through a small procedure, and can last between three and ten years with 99.5 per cent effectiveness. Barrier options include condoms, although Sexual Health Quarter recommend these for STI prevention they say they should be used alongside other contraception for effective birth control. 

Interest in natural fertility tracking has increased as more women turn away from hormonal contraception, but leaves many modern medical professionals concerned about its low reliability.

Ms Fairleigh runs clinics, workshops and e-courses as a holistic fertility coach and said the process of fertility tracking is quick, easy and all about paying attention to your body. 

“When you’re fertile, you’ll get cervical mucus so it will start with a creamy discharge, then it will go to an egg white, then usually women will go dry for a day and then the egg is released the next day,” she said.

“If you can take your temperature at the same time every morning throughout your cycle, the day that the egg’s released, your progesterone spikes which increases your body temperature. So if you’ve been taking your temperature at the same time every morning, your temperature will then go up and you know the egg has been released.” It is after this egg has dissolved (which takes about 24 hours) and before menstruation, Ms Fairleigh said there is “no chance of getting pregnant”. There is more information on this timing on the UK National Health Service website here.

Dr Brooker warns Sexual Health Clinic does not recommend this method, nor the use of mobile apps for this purpose, as while when used perfectly this method can ensure 95 per cent effectiveness, the typical use is only around 80 per cent perfect despite the array of cycle tracking apps boasting much higher numbers.

Contraception is typically left in the hands of women and while there are male contraception options in development, many have been halted due to financial viability concerns. Dr Higgins said she will be supportive of this movement if the male alternative is both reliable and has minimal side effects.

“Until we get something that works properly, it’s not going to be useful. We need to have something that is as reliable, as effective as either the LARCS or when someone is perfectly taking the oral contraceptive pill. Until it reaches that point, it’s not applicable because women will fall pregnant,” she said. 

Experts working in the field agreed the conversation and education within Australia needs to be improved. Dr Higgins stresses the importance lies within both availability and knowledge. 

“The important thing is that it’s available and there are options and in the right setting and with the right amount of time women can be well educated about their options,” she said.

Categories: Health, Women

Tagged as: ,