Sarai Keestra talks to John Guillebaud, UCL Professor Emeritus for Family Planning and Reproductive health about the present and future of contraception
The pill is by far the most popular form of contraception for students, yet it is now outdated by alternatives. According to UCL Professor Emeritus for Reproductive Health, John Guillebaud, Long-Acting Reversible Contraceptives (LARCs) are here now and male systemic contraception might be for the future.
“There is not one perfect way of contraception, but the contraceptive pill is way down the list.” Although still an option for some, after sixty years it is time to move on.
The pill seems like a simple solution: take one every day and you don’t get pregnant. In reality, this is often not how it works. Only ‘perfect’ pill users have a very small chance of getting pregnant, with 3 in 1000 women getting pregnant within a year. However, most women don’t belong to that category. Too often they forget to take the pill in the most risky way, which is to start a new packet late i.e. lengthening beyond seven days, the time the ovaries are without contraception. For those ‘normal’ pill users, the chances of getting pregnant greatly increase, to 9 out of 100 pill users yearly.
Most commonly used is the combined oral contraceptive pill, a combination of synthetics for the female hormones progesterone and oestrogen. This works in three ways: it suppresses the ovaries so the egg doesn’t ovulate; the mucus in the neck of the womb thickens so sperm cannot get through; and it makes the lining of the womb thinner so a fertilised egg is less able to implant in the uterine wall.
Different brands may vary the relative dose of the two hormones but most of them only need to be taken for 21 days followed by a 7 day break. Forgetting to start the new packet of pills after this break is the main cause of unwanted pregnancies in pill users. Some brands came up with solutions like ‘seasonal’ pills or ‘365/365’ pills with fewer breaks. Another solution is putting seven dummy pills in a packet so the pill-free time is less likely to be extended. Although this is common practice in the US and developing countries, placebo pills are less commonly used in the EU and thus there is a greater chance of women forgetting to restart in time. Guillebaud emphasises: “If you do decide that you prefer the pill: the crucial ‘slogan’ is “I must never be a late re-starter!””
So what about the good old condom? Bad news folks, the condom is not as safe as many people think. “With one ejaculation, theoretically, a man produces enough sperm to fertilise the whole population of North-America. If there is even a tiny leakage, one sperm can be enough,” Guillebaud explains. Condoms are a good choice if you are heaving infrequent sex with different people as they also protect against STIs.
However, although one reads on the packet of condoms that they are 98% safe if perfectly used, in reality up to 18 out of 100 women conceive within a year if they only use condoms.
Guillebaud thinks that LARCs are a better alternative to these two contraceptives. “With LARCs, entirely unlike the pill, the default state is NOT getting pregnant. Once fixed up with a LARC you don’t have to remember taking anything and they are therefore the safer option.”
LARCs come in various forms: injections, implants, intra-uterine devices (IUDs, copper-containing) and intrauterine systems (IUSs, progestogen-releasing). Different LARCs suit different people. The implant, inserted under the skin of the upper arm, is the most effective contraception method currently available, beating even female sterilization and nearly as effective as male vasectomy. The hormonal intrauterine system (IUS) can be a good option for some students, though it has to be fitted. Not only is it a very reliable method, it also gives you lighter periods (or none at all) because the uterine lining is not as thick as usual. Although an IUD or IUS is easier because you do not have to think about it every day, there is a small chance of the device slipping out (expulsion).
There seems to be a buffet of female contraceptive methods available but isn’t it weird that women have thirteen different methods to choose from, while there are only two forms of contraception currently available for men? According to Guillebaud, this should change. “It is already normal that man and woman share the tasks in the house. I hope that in the future men and women will take turns in taking some kind of contraception.”
Research teams across the world are trying to make this a reality. Vasalgel shows some promise, being injected into the vas deferens, which is the tube that leads sperm to the mixture of other fluids before ejaculation. The injected chemicals form a plug, which keeps the sperm out of the semen. The plug can be flushed out simply by another injection so it is reversible.
Another hopeful alternative would be some version of the long-awaited male contraceptive pill. Guillebaud is closely associated with the work led by King’s College London researcher Dr. Amobi. This pill leads to a ‘dry’ orgasm, which feels to the man exactly the same as a normal one except no semen comes out. Hence its nick-name, the clean bed-sheet pill. Not only would this method make a great contraceptive, it should also reduce the risk of HIV transmission.
Unfortunately pharmaceutical companies are generally hesitant to invest in the research on any male contraceptive pill. They think males (who do not after all get pregnant, the risk of that being why women are prepared to accept the ‘nuisance’ aspects of contraceptives) would not take it and women would not trust men taking them. They are also put off by the likely long lead-time before they would get payback for their investment.
According to a Telegraph study, 63% of the British women only rely on two forms of contraception: the pill and the condom, despite there being fifteen contraceptive methods available. Lack of knowledge about the alternatives is the main reason that people still take the pill. The best thing you can do is inform yourself. Although the internet is always a good place to start, remember that often only people who have complaints write reviews on the internet. The best option is going to a family planning clinic for information. Guillebaud says: “We give the facts, but the user should be the chooser.”
This article is an edited and accurate version of the article of the same title published in the most recent issue of Pi Magazine (Issue 714). The article published in Issue 714 was found to be the original draft of the article, which still included some misinterpretation of scientific facts, as opposed to the above final edited version in which all scientific facts are correct. We apologise for any inconvenience caused.