Dear Dr Mitchell,
I want to start a long-term birth control method and want to know what are the benefits or disadvantages of the two methods I'm trying to choose between — the pill and the injection. I am 25 years old with no children, getting married soon, and wanting to wait a year before I have children.
The combined oral contraceptive pill is a widely used method but requires the discipline to take a pill everyday for it to be effective, and to prevent breakthrough bleeding. The oral contraceptive contains both oestrogen and progesterone.
There is actually a contraceptive pill that has progesterone only; this, however, requires a lot more discipline to take it the same time everyday and so the chance of an unwanted pregnancy is higher if a pill is missed.
The combined oral contraceptive pill might not be a good choice if oestrogen is contraindicated for any reason — like if you have had a history of clot in the legs or lungs, history of breast cancer, uncontrolled hypertension, or diabetes mellitus. In these cases it is best to avoid taking preparations containing oestrogen. The advantage of the pill, however, is that there are preparations containing antiandrogens (substances that reduce your level of male hormones) and these reduce your risk of developing acne and help significantly in controlling severe acne. There are preparations which contain extremely low dosages of oestrogen and so the usual main side-effects such as nausea, breast tenderness, bloating and weight gain are significantly reduced.
The contraceptive injection may be one containing both progesterone and oestrogen or just progesterone alone. The injection with oestrogen and progesterone is usually given once monthly and like the pill you will get a withdrawal bleed in between injections every month. The side-effects and contraindications are similar to those of the combined oral contraceptive pills.
The progesterone-only injection is given every 90 days. Initially there may be irregular vaginal bleeding in the first few months of usage. After one year of regular usage the usual course is for complete absence of the regular menstrual period. Weight gain may be a feature of the monthly injection in some patients. If you are extremely overweight then the injection might not be a good choice for you.
The advantage of the progesterone-only contraceptive injection is that it can be used in patients when oestrogen is contraindicated. The advantage of this method is that it is extremely effective and does not require the discipline of remembering to take the pill every day.
There are other methods such as the intrauterine contraceptive device and the subdermal implants that will give long-term reversible contraception that is effective.
Consult your doctor who will advise you further.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to firstname.lastname@example.org; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.