14 January 2010
Since the sexual revolution in the 1960s and 1970s, women have been encouraged to take control of their own fertility cycles and sexual health. With contraception legalised inIreland as late as 1979 – by prescription only – we have been slower than other nations to adapt to the reality of sexually transmitted infections (STIs) and unwanted pregnancies.
STIs are on the rise here, and the issue of unwanted pregnancy remains sensitive, with thousands of women still travelling to the UK each year for abortions. NGOs like the Irish Family Planning Association are to the forefront of offering advice on sexual health, particularly following the abolition of the Crisis Pregnancy Agency as a stand-alone body in 2007.
While many women planning to become sexually active consider the Pill as the obvious choice of contraceptive, the Pill does not protect against STIs and, increasingly, is being replaced by alternatives.
Health factors that may put women off the Pill include high cholesterol and high blood pressure, as well as painful periods, while lifestyle factors as varied as smoking and shift work mean that the routine of popping a Pill at the same time each day does not suit every woman.
*Mary, a 25-year-old scientist from North Cork, says she gave up the Pill "in order to be assured of not getting pregnant. "I am in a long-term relationship and was tired of having to remember taking it daily. I was also tired of worrying about being pregnant if I had a stomach upset or a split condom." She has had the contraceptive implant for a number of months now. " I feel overall that it has been a good move as I do not need to replace the implant for another three years," she says.
Meanwhile, *Ellen, a student from Cork City, "gave up on the pill years ago". She uses Evra, a transdermal patch.
"Hardly anyone seems to know about this form of contraceptive but it's much handier, you have three patches per month, changing just once per week and having a free week when your period is due," she explains.
"You don't need to take it orally or every day, which is great for scatter brains like me, or even for travelling or staying overnight somewhere, it allows you to be more spontaneous in your planning. They don't fall off in the shower or bath and are easy to conceal, I usually put it on my butt cheek, that way even if I was wearing a bikini you wouldn't see it. I also only go on contraception when I am in a relationship, and give my body a break from the hormones in between."
*Joanne, a teacher living in the city, stopped using the Pill after five years when her periods became debilitating. "I always had bad periods, losing a day of work every time, and realized that I could fix that by changing my contraceptive. After visiting a gynaecologist I had the Mirena coil inserted. It is brilliant – I don't need to remember to take anything, being sick doesn't affect it, and best of all, my period is down to two days of minor spotting."
Interestingly, *Sarah, an information officer, uses a modern natural method called the 'symptom-thermal method'. It involves taking your basal (waking) temperature daily and noting other fertility indicators such as cervical mucus and position of the cervix. "The modern technique is as effective as any pill if used correctly, has no side effects and has the added advantage of giving you a much better understanding of your own body. Another bonus for me is that both partners need to cooperate and take responsibility for their fertility," she says. It might sound complicated, but there is even an iPhone app dedicated to helping women with the method, and it is more commonly used in mainland Europe.
While none of these methods protect against STIs – only a barrier method such as condoms or Femidoms will do that – they all provide just as effective protection against unwanted pregnancy as the Pill does.
So why don't we know about them?
According to Dr Caitriona Henchion, Medical Director of the Irish Family Planning Association, many Irish women have "at least some" knowledge of contraception, which comes from friends, GPs, and maternity hospitals. "However," she says, "this knowledge can be very patchy and often inaccurate reflecting a friend's experience rather than scientific evidence.
"Knowledge in the area of sexual health generally is much poorer particularly in relation to sexually transmitted infections (STIs) and gynaecological issues suggesting that these subjects are still taboo with less knowledge sharing. "Many women also look for information on line, which also is very variable. Generally, sites which have personal accounts can be misleading and cause unnecessary alarm. A good site is yoursexualhealth.ie."
She says the combined oral contraceptive Pill is still a very popular contraceptive choice in Ireland. This pill contains both oestrogen and progestogen. However, there has been a move, as illustrated above, towards 'LARCs'; Long Acting Reversible Contraceptives.
Depoprovera, contraceptive injection, lasts 12 weeks, contains progestogen only, very effective;
Implanon subdermal contraceptive implant, progestogen only, very effective, lasts three years;
Mirena Intrauterine system (IUS), progestogen only, very effective, lasts five years;
Copper intrauterine device (IUCD), hormone free, lasts three to ten years depending on device, very effective.
According to Dr Henchion, "Many women prefer these methods as they offer high efficacy and eliminate the need to remember daily pill taking. Also as they are progestogen only or hormone free, they are suitable for older women, smokers and some women who cannot take COCs." They do have drawbacks; they may interfere with period and may not suit everyone.
As well as this, new brands of Pill are coming on the market all the time. One such pill is Yaz, which eliminates the break between packs, usually the cause of the user forgetting to take the next pill.
Choice of method depends on medical and family history, past history of problems with contraceptive use and personal choice.
"Women should ask for written information on any method of interest to them before deciding," Dr Henchion advises.