We asked Dr June Tan to explain the contraception options available for women and the pros and cons of each. We hope this simple guide helps guide your decision making.
The combined oral contraceptive pill (COCP) is usually just called “the pill”. It contains two hormones, oestrogen and progestogen, similar to the natural hormones women produce in their ovaries. The main way it works is by stopping ovulation.
Pros: Easily reversible, regulates menses making it lighter, regular, less painful, may help with premenstrual symptoms, reduces acne in some women, decreases risk of ovarian, uterine and colon cancer.
Cons: Remembering to take a pill daily; possible side effects of hormones; risk of venous thrombosis (blood clotting) especially in women with risk factors like cigarette smoker, diabetes, high blood pressure among others; a small increased risk of breast cancer and cervical cancer.
Suitable for: Healthy women who do not smoke and have no medical reasons against taking the pill.
The Copper IUD (Intrauterine Contraceptive Device)
The copper IUD is a small plastic and copper device that is placed inside the uterus. The most common type of IUD in Singapore lasts 5 years. The main way it works is to prevent fertilization. It is inserted by a doctor in clinic after a pelvic examination.
Pros: Long-acting contraceptive cover for 5 years. It contains no hormone and therefore is not associated with hormonal adverse effects. It is suitable for women who cannot take any form of hormonal contraception. There is no need to remember to take a pill daily. It can be used in breastfeeding. It can be removed any time by a doctor with quick return to fertility.
Cons: It may cause heavier, longer or more painful periods. Potential rare complications include uterine perforation, infection, expulsion of the device and ectopic pregnancy – a pregnancy occurring in the fallopian tube in the unlikely event of pregnancy.
The Progestogen-releasing Intrauterine System (IUS)
This is an intrauterine device containing a progestogen, commonly known as the Mirena. It is placed inside the womb and slowly releases progestogen. It is effective for 5 years. It works by thinning the lining of the womb and therefore making implantation less likely. It also thickens cervical mucus and may inhibit ovulation.
Pros: Long-acting contraceptive cover for 5 years. Periods often become much lighter and shorter, sometimes less painful, and may stop completely. It is licensed to treat heavy, painful periods. It can be used during breastfeeding.
Cons: In the first six months it is common to have irregular bleeding or spotting. Some women report hormonal side effects. Potential rare complications similar to those of the Copper IUD.
Both the Mirena IUS and Copper IUD are suitable for women looking for longer-lasting contraception or who feel that their family is complete but not ready for sterilization methods. Please note that both the Mirena and Copper IUD are available at IMC and can be fitted by our family doctors.
The Contraceptive Implant
The contraceptive implant is a small flexible rod placed just under your skin in the inner upper arm. It releases a progestogen hormone. The brand available in Singapore is Implanon which is effective for 3 years.
The way is works is by stopping ovulation, thickening cervical mucus and thinning the lining of the womb. Insertion of the implant is performed under local anaesthesia by a doctor in clinic. Removal is also done under local anaesthesia and can be done anytime you desire.
Pros: Long-acting contraceptive cover for 3 years. It can be used during breastfeeding. May reduce heavy and painful periods.
Cons: May cause menstrual irregularities – may stop, become irregular, spotting, last longer or heavier. Sometimes hormonal side effects may be experienced.
Implanon is available at IMC and can be inserted by our family doctors.
Also known as Depo Provera, the injectable progestogen is given every 3 months by injection into the buttock muscle.
Pros: Can be used while breastfeeding, may help with heavy or painful periods.
Cons: It is irreversible for its 3-month duration. Menstruation and fertility may take time to return after stopping the injections. It is not suitable for women planning a pregnancy after a year. It stops menstruation in many women and in some, it causes irregular bleeding or spotting. It is associated with weight gain. If used continuously for the long term it is associated with osteoporosis.
The Progestogen-only Pill or “Minipill”
The minipill is different to the combined pill because it doesn’t contain any oestrogen and is taken every day continuously without a break. It works by thickening cervical mucus, thinning the lining of the uterus and inhibiting ovulation. Currently the brand available in Singapore is Cerazette.
Pros: Suitable for those who cannot take oestrogens, is easily reversible, may help premenstrual symptoms and painful periods. It can be taken during breastfeeding.
Cons: Having to take it daily and at the same time everyday. Hormonal side effects but usually mild. Some women experience irregular bleeding and spotting.
Natural Family Planning
Natural family planning uses observation and recording of your body’s different natural signs of fertility indicators on each day of your menstrual cycle. Changes in these indicators, like body temperature, cervical mucus and length of the menstrual cycle, may help you identify your fertile time. The level of effectiveness is variable and almost certainly less predictable than other methods of contraception. The methods of contraception previously discussed are all over 99% effective in preventing pregnancy; however, typical use of natural family planning for a year results in 24% of women falling pregnant.
Sterilization is a permanent method of contraception, suitable for people who are sure they never want children or do not want any more children. Female sterilization involves tubal ligation and male sterilization, vasectomy. You should not decide to be sterilized if you or your partner are not completely sure or if you are under any stress, for example after a birth, miscarriage, abortion or family or relationship crisis. You may wish to consider long-acting reversible methods of contraception (eg Mirena, Copper IUD, Implanon) which are as effective as sterilization but reversible.
The right contraceptive for you depends on your needs and preferences, stage of life and medical history. A thorough discussion with your family doctor will help you determine the most appropriate method for yourself.