As part of our series on sexual health, Rude magazine serves up the idea of the ‘Contraceptive Menu’ and questions why so many women are only offered a taster of what’s on there…
By Rose Crompton
Recently I decided to come off the pill. After 11 years I came to the conclusion that something wasn’t quite right. Periods were missing in action, my libido was low and my moods were all over the shop. There was a feeling that I was missing something about being a woman and my body felt alien to me.
Don’t get me wrong, I’ve not always been anti-pill. There was a decade of my life when I took it without batting an eyelid and I don’t regret the sexual liberated world it opened up to me; the freedom of not having periods made me feel very masculine – I was able to have sex as and whenever I wanted and not be restricted by a bleeding thing, but I was conscious of the fact that I was skipping periods and that it can’t be normal. My GP always reassured me, though, that it was.
My gut instinct was enough to convince me otherwise, and looking into it deeper I realised I wasn’t the only one as there were many hundreds of online forums listing anecdotal records of hormonal contraceptive horror stories. Something was wrong and deciding that I had to come off it and not wanting to use any other form of hormonal contraceptive for fear of repeat, or worse, effects I was left with one unnerving question: what is there instead?
The frustrating answer was: I don’t know. With over 3 million women in the UK taking the pill, and it appearing to still be de rigueur, it’s hardly surprising that knowledge and awareness of alternative contraceptive options is limited. Could you honestly explain how the copper coil works? Or the difference between the Rhythm Method and the Fertility Awareness Method? Now think about the pill or implant and how much easier it is to recall information – good or bad – about these.
However, listen carefully and you can hear the rumblings of a growing unrest as women demand information on other options. Books like Holly Grigg-Spall’s Sweetening The Pill are raising questions and concerns about hormonal birth control (HBC) that many of us are thinking, but are unsure how to answer. There are also a growing number of smart phone apps that help women chart their menstrual cycles and the idea that we are swapping the hormones to become a “pull-out generation” with an emphasis on barrier methods or abstaining from sex during ovulation is emerging. Women are already taking matters into their own hands and looking for alternatives, most of which seem to be err on the non-hormonal side.
There are 15 forms of contraception available in the UK, as outlined by the Family Planning Association (FPA). Five of these are non-hormonal methods of birth control (NHBC) that are available to women: the copper coil (or IUD), female sterilisation, female condoms, diaphragm cap with spermicide and Natural Family Planning, or the Fertility Awareness Method (FAM). There are six if you include the male condom, preferred by many women to the female equivalent.
What should be served to us when we search out contraceptive options is The Contraceptive Menu as Anne Webb, Specialist in Sexual and Reproductive Health explains: “This analogy works on two levels: imagine going to a restaurant. Most people are able to look at the whole menu and say, ‘I want this today’, but there will be some people who choose to be vegetarian and therefore only look at those options. Then, there are some people who may have a medical issue that limits what they can choose from the menu. Contraception is exactly the same. Does every clinician give women that full choice every time? Unfortunately not.”
That feeling of only seeing half the menu is something Vikki Tempest, 26, is all too familiar with. “My GP took me off a brand of pill that I got on with really well. When considering alternatives there was lack of understanding and empathy about my personal circumstances that limited my other choices.”
It’s frustrating not just for the patients, but for the sexual health professionals too. Laura Wershler, is a veteran pro-choice sexual and reproductive health advocate and women’s health writer and was executive director of non-profit Sexual Health Access Alberta in Canada for six years. Working in the industry, even she realises that it falls short sometimes: “We [the sexual and reproductive health community] must acknowledge the right of women to choose HBC or NHBC depending on which best serves their health and contraceptive needs. And it’s our obligation to help them use their chosen method effectively and confidently, without persuasion or dissuasion,” she wrote in a recent article for Hormones Matter.
When asked “why” she thinks there is this dichotomy, Wershler replied, “Our current thinking places birth control methods in a hierarchy of effectiveness and suitability. This thinking holds us back from giving more credibility and time to NHBC methods. In the hierarchy, HBC and now long-acting reversible contraceptives like the Mirena [hormonal coil], copper coil and hormonal implants are typically considered the “best” methods.”
Realistically speaking, there is no reason why NHBC methods should not get equal attention. If it’s a case of thinking that hormonal contraceptives are more effective than NHBC, then there is evidence through clinical trials to suggest otherwise. It has been shown that the Fertility Awareness Method, when followed correctly, has an effectiveness of 99.4% for women that abstained during the fertile period. That is as reliable as the progestogen only pill or implant.
Although it’s listed in the FPA leaflet, when it comes to Fertility Awareness as a form of contraception it could be argued that there are still too many risks involved. As Anne Webb suggests, “FAM is not a top menu option; it’s more on the specials board,” as it might not be accessible to some women (those that have irregular periods, for example), but there is evidence that more women and couples are willing to try it, rather than opt for a quick fix pill.
As much as I, and others, would like to slam the pill for its negative side effects, the truth is that it’s a viable and workable option for millions of women. The problem is that all too often the pill is prescribed and popped, or we go for a “fit and forget” option without knowing the full story, because it’s easy.
There can never be a one size fits all idea when it comes to contraception. Wershler commented, “Most women will transition between method groups throughout our reproductive lives, therefore we need to know how to use all methods, or where to go to learn or access all methods should we want to use them.” Varying factors means that different methods have to be and should be available. The problem many women unfortunately face at the moment is a lack of balanced education and the question should not be limited to what is there instead of hormones, it should be, why are we not getting the full picture?
For more information on contraceptive options, check out these websites to get a fuller picture of what is available to you…
- The Family Planning Association
- Faculty of Sexual & Reproductive Healthcare
- Fertility UK – lists UK Fertility Awareness practitioners and information
- Justisse Heathworks for Women
- Hormones Matter