Consult the most recent National Contraception Clinical Guidelines (especially in women with medical conditions).
Women should decide their own family planning method, in consultation with their health care professional,taking into consideration safety, efficacy, acceptability, and access. Always obtain a complete medical and sexual history and perform an appropriate physical examination in order to ensure that there are no contra-indications to using a particular method. Always exclude pregnancy before commencing contraception.
Contraceptive methods
Hormonal contraception and IUCDs do not prevent sexually transmitted infections (STIs), including HIV. Dual protection i.e. the use of a condom in combination with another contraceptive method is recommended to reduce the risk of STIs, including HIV.
| Contraceptive method | Advantages | Disadvantages |
|---|---|---|
|
Copper IUD (see Intrauterine device ) |
- Suitable for most women, including nulliparous women. - Provides long-term protection i.e. 5 years. - Convenient, does not require frequent follow up. - Works immediately on insertion. - Non-hormonal therefore no interaction with other medication and no hormonal side effects - Fertility returns on removal of IUCD in women of child-bearing age. |
- Some discomfort or cramping during and following insertion. - IUCD must be inserted or removed by a trained health care professional. - Should not be used in women with menorrhagia, active pelvic inflammatory disease (PID), purulent cervicitis, unexplained uterine bleeding, cervical and endometrial cancers or other uterine abnormalities. |
|
Levonorgestrel Intrauterine device (LNG-IUD) (See: Levonorgestrel Intra-uterine Device (LNG-IUD) |
- Suitable for most women, including nulliparous women. - Provides long-term protection (up to 5 years). - Convenient, does not require frequent follow up. - Works immediately on insertion. - Immediate return to fertility on removal. - Reduces menstrual cramps, heavy menstrual bleeding, and symptoms of endometriosis. - Can be inserted postpartum (within 48 hours after delivery). LoE:II[1] |
- Bleeding changes are common but not harmful. Typically, lighter and fewer days of bleeding, or infrequent or irregular bleeding. - LNG-IUD must be inserted or removed by a trained health care professional. - Should not be used in women with active PID. LoE:III[2] |
|
Hormonal subdermal: progestin-only implant (see Subdermal Implant) |
- Provides long-term protection i.e. 3 years (etonogestrel) or 5 years (levonorgestrel). - Convenient, does not require frequent follow up. - Can be used in women >35 years who are obese, who smoke, or who have diabetes, hypertension, or a history of venous thromboembolism. - Fertility returns on removal of implant in women of child-bearing age. |
- Frequent bleeding irregularities. - Implant must be inserted or removed by a trained health care professional under aseptic conditions to prevent infection. - Incorrect insertion and removal technique may result in complications. |
|
Hormonal injectable: progestin-only (see Hormonal, injectable ) |
- Daily patient adherence is not required. - Long-acting i.e. given every 8 or 12 weeks - Interactions with other medicines do not lower contraceptive effect. - Can be used postpartum. - Can be used in women >35 years who are obese, who smoke, or who have diabetes, hypertension, or a history of venous thromboemolism. |
- Delayed return of fertility, of up to 9 months, after last injection. - Frequent bleeding irregularities (irregular, prolonged and/or heavy bleeding, or amenorrhoea) LoE: III[3] |
|
Hormonal oral: progestin-only (see Hormonal, oral ) |
- Fertility returns 3 months of discontinuing the pill. - Can be used postpartum. - Can be used in women > 35 years who are obese, who smoke, or who have diabetes, hypertension, or a history of venous thromboemolism. |
- Daily adherence is required. - Interactions with other medicines can lower contraceptive effect. - Lower efficacy compared with COC. - Frequent bleeding irregularities. |
|
Hormonal oral: combined oral contraceptive (COC) (see Hormonal, oral ) |
- Non-contraceptive benefits, e.g.: alleviation of dysmenorrhoea, premenstrual syndrome and menorrhagia. - Fertility returns within 3 months of discontinuing COC. |
- Daily adherence is required. - Interactions with other medicines can lower contraceptive effect. - Cannot be used in women with venous thrombo-embolic disease. - Cannot be used immediately postpartum. |
|
Barrier: male and female condoms (see Barrier methods ) |
- Protects against STIs, including HIV. |
- Possibility of breakage or slipping off. - Possible allergic reaction to latex. - Lower efficacy than other contraceptive methods therefore advised as dual contraception. |
(Refer to the most recent SAHPRA registered package inserts for detailed information).
Effectiveness of family planning methods
Rates of unintended pregnancies per 100 women:
|
Contraceptive method |
Failure rate in 1st year (%) |
Failure rate in 1st year (%) |
% of women continuing use at one year |
|---|---|---|---|
|
Consistent and correct use |
As typically used |
% of women continuing use at one year |
|
| Copper IUD | 0.6 | 0.8 | 78 |
| LNG-IUD | 0.2 | 0.2 | 80 |
|
Progestin-only subdermal implant |
0.05 | 0.05 | 84 |
|
Progestin-only injectable |
0.3 | 3 | 56 |
|
Progestin-only oral pill (not breastfeeding) |
0.3 | 8 | 67 |
|
Progestin-only oral pill (during breastfeeding) |
0.5 | 1 | n/a |
|
Combined oral contraceptive (COC) pill |
0.3 | 3 | 67 |
|
Barrier: female condoms |
5 | 21 | 4 |
|
Barrier: male condoms |
2 | 15 | 43 |
|
Sterilisation: male - vasectomy |
0.1 | 0.15 | 100 |
|
Sterilisation: female - tubal ligation |
0.5 | 0.5 | 100 |
| No method | 85 | 85 | n/a |