Condom, implant, pill, IUD….
Female contraceptives come in many forms.
With or without hormones, they are not without side effects and their tolerance varies according to women.
What are the different methods of contraception for women?
How effective are they?
Are they all reimbursed?
Explanations with Professor Geoffroy Robin, university lecturer, hospital practitioner in reproductive medicine and medical gynecology at the University Hospital of Lille, secretary general of the national college of French gynecologists and obstetricians.
Why choose contraception with hormones or without hormones?
“
The first criterion will be the choice of the patient.
If she prefers a mechanical method, we will turn to a non-hormonal method
, ”explains Geoffroy Robin.
Nevertheless, these methods are not tolerated in the same way by all women and remain limited in terms of choice.
“
Besides the condom, the only medicalized mechanical method is the copper IUD.
However, its use is not always appropriate, due to menstrual pain for example
,” continues the doctor.
Ditto for hormonal contraception: depending on the type of hormones, they will have more or less side effects and can induce risks in the event of vascular contraindications.
Methods of birth control without hormones
The female condom
: it comes in the form of a long sheath of nitrile or polyurethane (in case of allergy).
Closed at one end, it presses against the cervix.
This form thus makes the intrauterine environment inaccessible to spermatozoa.
For optimal use, the condom must perfectly adhere to the walls of the vagina.
It can be placed up to 4 hours before intercourse.
It has an efficiency of about 85% but unlike other contraceptives, it is the best protective device against sexually transmitted diseases (STDs) in the absence of prior tests carried out by the partners.
Spermicides
come in the form of vaginal tablets, ovules or creams to be applied in the vagina before intercourse.
If the cream is immediately effective, it will take at least 10 to 15 minutes for the eggs and tablets to break down.
“
Very underestimated, spermicides are nevertheless very effective when combined with other condom-type contraceptives
,” says Professor Robin.
Some condoms also have spermicides incorporated into their membrane.
The copper intrauterine device (IUD) or copper IUD
: equipped with a copper wire, it has a T shape about 3 cm long.
Copper inactivates the spermatozoa by making them less mobile to prevent them from going back up the fallopian tube which houses the egg.
Its strong point is that it has a high efficiency over a long period (from 4 to 10 years).
"
Nevertheless, it will only be suitable for women who have regular cycles, whose periods are neither painful nor heavy because it will not solve problems with the regularity of cycles and will even tend to exacerbate the pain and abundance of periods
" , insists Geoffroy Robin.
The placement of the IUD is exclusively performed by a gynecologist or a midwife.
The diaphragm and the cervical cap
are two quite similar devices, made of silicone or latex and having the shape of a cup for the diaphragm or a dome for the cap.
Users can insert it directly into the vagina up to two hours before intercourse and keep it for a minimum of 8 hours afterwards, up to 24 hours.
If necessary, it is possible to use a lubricant.
“
A disadvantage is that during insertion by the woman, a complex and sometimes cumbersome vaginal manipulation is necessary.
In addition, these devices must be adapted to the morphology of the patient, which requires preliminary examinations, an assessment of the size of the cervix, the tone of the vaginal wall
“says the gynecologist.
The other disadvantage is that they are less effective than other contraceptives, which is why it is advisable to combine them with spermicides.
"
Cape and diaphragm devices are generally suitable for women over 40 where natural spontaneous fertility is a little lower and/or for women who want a contraceptive
", specifies Professor Robin.
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Methods of birth control with hormones
Combined estrogen- progestogen pills
contain synthetic estrogen and progestogen.
They act by a triple action by blocking ovulation, by making the uterine lining thinner in order to prevent the fixation of the fertilized egg and by thickening the mucus (secreted by the cervix) to prevent the spermatozoa from cross the pass.
In general, one tablet is taken daily for 3 weeks followed by a 7-day break when menstruation occurs.
There are also pills to be taken continuously.
The only difference is that there is never a stop between two pads so as not to forget to start the new one after 7 days of stopping.
"
In any case, these pills have a very high contraceptive efficacy,
Along with their contraceptive effect, they are used to reduce acne, fight against excessive hairiness (hirsutism), regulate cycles and limit the appearance of untimely bleeding.
“
Compared to other contraceptives, these pills reduce the risk of developing colon or rectal cancer by 30%, protect against ovarian cancer, and limit osteoporosis.
The downside is that estrogen can induce coagulation changes that promote a risk of thrombosis, although it is very rare (0.02 to 0.04% per year)
,” explains the doctor.
Thus this type of pill is contraindicated for women at cardiovascular risk or suffering from obesity and diabetes.
Progestin
-only pills
deliver synthetic progestogen only.
They all contain 28 active tablets and are therefore always taken continuously.
“
They are prescribed either to women with vascular contraindications, or to women who cannot tolerate estrogen-progestogen pills
,” says Professor Robin.
The only problem with progestins is that they tend to atrophy the uterine lining, leading to unwanted bleeding.
The implant
: stick to be inserted in the arm, it delivers a synthetic progestogen (etonorgestrel) derived from the hormone progesterone.
Only gynecologists and midwives are competent to place an implant because it requires local anesthesia.
Once applied, this device is effective for 3 years, "
and this, even in women suffering from obesity - contrary to popular belief
", underlines the doctor.
According to the latter, the main disadvantage is that it can be poorly tolerated, and therefore disrupt the menstrual cycle:
“Among the women who tolerate the implant well, 30% are normally menstruating and 30% are not.
The problem is that the rest of the users, 30 to 40%, will have irregular periods, “spotting” problems (regular small drops of blood during the month), even will be menstruating 10 to 15 days every month
.
These effects are all the more restrictive for women with endometriosis or who already have naturally painful periods.
This is why the rate of removal of the implant one year after placement is important.
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The hormonal intrauterine device (IUD) or "
hormonal IUD
"
is inserted by a gynecologist directly into the cervix.
Unlike the copper IUD, it contains a small reservoir that locally delivers a progestogen hormone, making the intrauterine environment hostile to sperm through coagulation of cervical mucus, thinning of the endometrium and blocking ovulation .
This contraceptive method is generally very well tolerated and has a very good effectiveness, for 3 to 5 years depending on the model.
The vaginal ring (nuvaring
and its generic
etoring):
"
this is a very effective method of contraception which acts like a mini-dose estrogen-progestogen pill
", explains Geoffroy Robin.
A study published by an American team in 2013 in the journal
Contraception,
also showed that hormone levels in the blood with the vaginal ring were very stable up to 6 weeks after insertion.
This ring is placed in the vagina at the start of menstruation either for a period of three weeks (bleeding being induced the last week of the cycle), or four weeks for women who wish to remain in amenorrhea.
The advantage is that it presents less risk of forgetting than the pill, and that
completely smooth hormonal fluctuations in patients suffering from premenstrual syndrome (irritability, anxiety, restlessness etc.)
”, continues the doctor.
The contraindications are the same as for the estrogen-progestogen pill.
The vaginal patch
: it contains a combination of estrogens and micro-dosed progesterone.
For optimal effectiveness, women should apply one patch per week for at least 3 consecutive weeks and then remove it on the fourth week of the month in which menstruation occurs.
If the patient does not wish to have her period, the patch can be taken continuously.
“
This means has the same side effects as the pills containing estrogen or the vaginal ring.
The downside is that it tends to come off depending on the type of skin
,” explains Professor Robin.
Injectable contraceptives:
The contraceptive injection, sold under the name depo provera, is intended for women who cannot or do not want to use the pill or an IUD.
This consists of injecting a large dose of a progestin hormone which will completely block ovarian function for 3 months.
This method is very effective.
On the other hand, it combines certain disadvantages: it promotes weight gain in 45% of patients and increases the risk of venous thrombosis and hypertension.
Another observation: the doses are so high that they accumulate until they block the ovary and cause signs of menopause: “
There are only 50% of women who find their cycles after 6 months of stopping.
For the rest of the users, the cycles come back most of the time, but much later
,” warns the doctor.
What reimbursement for female contraceptives in France?
Since January 1, 2023,
condoms
have been free in pharmacies for young people under 26.
The
copper IUD
(about 30 euros), the
hormonal IUD
(about 120 euros) and
the implant
(about 100 euros) are reimbursed by social security up to 65%.
The vaginal ring
(about 15 euros per month), the
patch
(15 euros for a box of 3 patches in pharmacies on average),
spermicides
(about 5 to 20 euros) and
injectable progestins
(2 to 5 euros per injection ) are not reimbursed.
Regarding the pills, some are 100% covered by Social Security.
This only concerns
1st and 2nd generation pills
.
As for
3rd and 4th generation pills
, they have not been reimbursed since 2013, in the wake of the controversy over the cardiovascular risks they can cause.