Why long-term birth control offers greater protection than the pill

Young Irish women tend to to stick to traditional methods of birth control rather than using effective, long-term contraceptives that cut out the risk of forgetting to take a daily tablet, says Ailin Quinlan.

Why long-term birth control offers greater protection than the pill

THEY chatter on the latest smart-phones and sport cutting-edge fashions — yet the contraception used by the majority of 20-something women in Ireland is archaic.

86% of Irish 20-29-year-olds still opt for the pill, despite sophisticated, ‘user-proof,’ effective and reversible methods that can last for years.

Pharmaceutical giant, Bayer Healthcare, had a Europe-wide Valentine’s Day consumer awareness campaign, #YourPerfectMatch, last month to tackle ignorance about the new techniques. These are recommended by a number of international bodies, including the National Institute for Health and Care Excellence, in Britain, and the American College of Obstetrics and Gynaecology, in the US.

LARCs (long-acting reversible contraceptives) include the hormonal intra-uterine system (IUS). This releases small, daily doses of progesterone, the plastic and copper intra-uterine device (IUD) that prevents sperm from surviving in the womb.

A contraceptive injection provides long-acting protection and an implant, often known as ‘the rod in the arm, releases progesterone in tiny doses.

The problem with the pill, say the experts, is that it has to be taken every day for 21 days of the month, and young women juggling busy lives can forget to do so — in fact, research as far back as 1996 showed that 60% of users didn’t take the pill properly.

The result? Early morning dashes to the pharmacy for the morning-after pill, or, worse, pregnancy tests, tears, and sometimes, warns one expert, deeply traumatic terminations.

There are two types of morning-after pill.

The first is an over-the-counter medication that offers a three-day window of protection after unprotected sex and which costs €35 at Boots, including consultation — but it is important to take it as quickly as possibly following unprotected sex, because its efficacy diminishes as time passes.

The second offers a five-day window of protection. This is available on prescription and costs €29.

The reason why so many young women fail to opt for LARCs is a ‘knowledge gap’ — research last year, on behalf of Bayer Healthcare, in Ireland, showed that 79% of Irish women are not even aware of LARCS.

According to Dr Shirley McQuade, medical director of the Dublin Well Woman Centre, the vast majority of young women opt for the pill without even considering newer methods: “Younger women have lots of information on the internet, but they still take guidance from mum on this area,” she says, adding that older mothers may not be familiar with the new methods, such as ‘the rod in the arm,’ or may erroneously believe that coils are not suitable for younger women.

A study by the Crisis Pregnancy Agency, in 2010, found that only 11% of young women were using the new methods, she says.

Research carried out last year on Irish women aged 20-29, by IMS Health, a company that provides information and services for the healthcare industry, found that the number of LARCs users has climbed to 15% — but that’s still far too low, says Dr McQuade.

“Young women should consider it,” she says, adding that the pill is not always the best match for the modern, 20-something lifestyle.

Dr Sinead Beirne, resident doctor on TV3’s Ireland AM show and a GP in Irishtown, Dublin, says: “Between the ages of 20 and 29 is a very busy time. It’s an age group where you are more likely to forget to take it, because there’s so much going on in your life, between career, social life, travel.

“The figure of 15% reflects the situation in Ireland, because what I see is the vast majority of women in this age group tend to go for the pill.”

The biggest drawback to any form of contraception, Dr McQuade says, is user-failure — and this, she says, is not an issue with LARCs.

“LARCs would be more dependable for real-life use.

“The pill has a failure rate of 5% a year, and, with LARCs, it’s under one per cent,” says Dr McQuade.

However, she says, some young women don’t like the idea of an implant.

Others are reluctant to put in the coil, because they’re under-25 and under-25s have not had many vaginal examinations — routine smear tests only start after that age, she says.

“However, I make sure to inform people coming through the clinic that LARCs are more effective and safer,” says Dr McQuade.

User-failure with the pill is a serious issue, says Dr Beirne.

“I have 20-something women coming to see me who haven’t thought about anything but the pill,” she says.

“Sometimes, they might start on something like the pill and then just stay on it.

“There’s an element of inertia about it. They’re used to going in to renew the prescription and they don’t consider something else.”

But, unfortunately, they don’t always use it properly, she says, and the consequences can be traumatic if a young woman believes, or discovers, that she is pregnant.

“I’ve had people in the surgery in tears, because they forgot to take the pill.

“I’ve seen 20-something women who are on the pill, but who don’t manage it properly, and get pregnant and have to seek a termination.

“This is a terrible trauma and one which could be avoided by considering options like the LARCs, which really are fool-proof.”

Instead, however, Dr McQuade says, “a lot of people” are making up the shortfall with the morning-after pill.

While emergency contraception is an important fall-back, the pill is clearly not the best option for someone who has had to resort to the morning-after pill on several occasions, she says.

“The pill is a bit of a big deal to take 21 days of the month. It’s a decision every day for 21 days, whereas you can have a device put in that can last for three to 10 years.”

There is still a taboo about talking about sex in Ireland. This contributes to the lack of clarity about effective new contraceptive methods, she says.

While LARCs are not widely discussed, the pill gets a lot of “casual mention”, so young women just assume that this is what they should use.

“If somebody knew what LARCs would cost and how beneficial it would be, I believe they would go for it, and the risk of pregnancy is close to zero,” Dr Beirne says.

LARCs works out cheaper in the long run, she says, though there is an initial financial investment up-front.

“You can get the implant at around €144 in the chemist. It can cost another €100 or so to get it fitted by a GP, so that is €244, whereas the pill would cost you around €80 or so every six months, with two doctor’s visits a year.

“Initially, the pill looks cheaper, but in the long-term it’s more expensive,” she says.

However, young women don’t always see that side of it, she says — or think about the effort of remembering to constantly stock up and take it.

LARCS require a doctor’s appointment of about 10-15 minutes, and is neither painful nor difficult to be inserted or removed, though some women may experience temporary slight cramping or discomfort following insertion.

The results of a study undertaken in the US in 2012 appear to underline her assertion — when more than 9,000 women, aged between 18 and 35, were given information on all types of contraceptive methods, including LARCs, 75% chose a LARCs option.

Getting a LARCs device inserted may require more initial investment, in terms of effort and cost, than simply taking a tablet, says Dr Beirne, but in the long run it’s cheaper, easier, and more effective.

For more information, visit www.mycontraception.ie

TO USE OR NOT TO USE...

NO

Siobhan* (24) has been on the Pill since she was 17.

“I had older sisters who told me about it. They were on it themselves, and it seemed the easiest thing to do.

“I don’t think I knew about other forms of contraception at the time. I just got the Pill and stayed on it.

“You can take the pill like Panadol.

“I’ve never had problems because I always remember to take it. I have an app on my phone to remind me.

“I’m really careful because one of my sisters forgot to take the pill and got pregnant.

“I know other people my age who are on the Pill but are reckless about it. They’ve had to get a good few morning-after pills but I’ve only ever had to do it once.”

YES

*Miriam (23) recently decided to opt for one of the LARC methods – the IUD.

She chose it, she says because it was “mindless birth control.”

“I don’t have to worry about forgetting to take something and the impact forgetting would have on its effectiveness. The IUD lasts for five years. Its effectiveness doesn’t depend on my ability to remember to take pills.

“Some of my friends have had it inserted also and it really worked for them.

“My doctor mentioned that it’s more effective than taking the pill and there’s no user-error involved.

“Also I liked that fact that when I am ready to have a child, I can have it taken out and from then on I’m fertile once again.”

*Not their real names

FERTILE MARKET: CONTRACEPTIVE OPTIONS

Intra-Uterine System (IUS)

Mirena Coil — This is a T–shaped device inserted into the womb. It emits low-level progesterone and offers contraceptive protection for five years, by thinning the lining of the uterus to prevent implantation of the fertilised egg.

Jaydess Coil — A smaller device that is easier to insert in women who have not given birth. It provides contraceptive protection for three years. Both 99% effective.

Long-term effects: If they fail and the user becomes pregnant, which is extremely rare, there is a slightly increased risk of miscarriage or ectopic pregnancy.

Short-term effects: In the first three months following insertion, women may experience slightly heavier or more erratic periods, but this settles down and the periods become lighter — these devices are often used as a treatment for heavy periods.

Intra-Uterine Devices (IUD)

Copper T 380 — This coil contains copper, which is toxic to sperm and provides protection for up to 10 years. It stops the sperm reaching an egg, and may also stop a fertilised egg implanting in the uterus.

Flexi-T 300 — This is smaller than the standard, copper T 380. It offers contraceptive protection for three to five years.

Both options are non-hormonal and 99% effective.

Long-term effects: Periods may become slightly heavier.

Short-term effects: None.

Implant

Implanon — Often referred to as ‘the rod’, it is implanted into the arm, and provides contraceptive protection for up to three years. It is more than 99% effective. It stops ovulation completely. It lasts three years.

Long-term effects: One third of women may experience bleeding every day of the month after insertion.

Short-term effects: There may be side-effects, such as headaches, breast tenderness, mood swings, bloating or nausea, which usually settle down within a few weeks, while the bleeding pattern of your period may change, and users may experience spotting and bleeding in the first few weeks.

Injection

Depo-Provera — Single injection given every 12 weeks. It is 99% effective. The injection releases the hormone progestogen, which stops ovulation, thickens cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus to prevent a fertilised egg from implanting.

Long-term effects: After two years, it may reduce bone density and users are advised not to use this consistently for longer than that. It can also take about a year after the last injection to return to normal fertility levels.

Short-term effects: Same as implant.

OVERALL COSTS

Initial consultation with your GP — normally between €50 and €60.

Cost of LARC device — the Mirena Coil costs €144 on drug payment scheme, to which everyone is entitled. Fitting of device — from €100.

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