Contraception for men and women: what, how, and why?

The pill, the hormone patch, the copper IUD. Many contraceptives for women are on the market. What are the options? What are the pros and cons? And where does that leave men?

What’s contraception?

Women who don’t want to become pregnant can use contraception. They take the pill, wear a hormone patch, or use a vaginal ring. The contraceptive pill and the IUD are also forms of contraception, just like the condom or the morning-after pill for last-minute emergencies.

What do these contraceptives have in common? They prevent the maturation, fertilisation or implantation of an egg, and they minimise the chance of pregnancy. Hormones in the pill, for example, prevent the maturation of ova, thus preventing ovulation. The IUD prevents a fertilised egg from implanting in the uterus. And a condom logically ensures that enthusiastic sperm cells bump into a rubber wall during their race to the egg.

Natural contraception

Of course, natural remedies and methods to prevent pregnancy also exist. They’re not very successful, however, with periodic abstinence being the most dubious one. This method assumes that you won’t get pregnant if you manage to avoid having sex on your fertile days. While it’s true that you can’t just get pregnant on any day of the month, determining those fertile days is quite tricky.

But why? Because most women don’t have a predictable, regular cycle, and because there are all sorts of factors that can suddenly change your cycle. So whether you’re using the calendar method, the temperature method, the ovulation method, or examining your vaginal mucus: the chance of an unwanted pregnancy remains much greater than with other types of contraception. Some 12% to 24% of women become pregnant within a year just by trying not to have sex on their fertile days.

So, think pulling out is all it takes? Definitely not.

What kind of contraceptives are out there?

No form of contraception is completely safe, but that doesn’t mean that there are no methods that come very close. Contraceptives that don’t require any action on your part are the most reliable: hormone rods, IUDs, the contraceptive pill, and the more rigorous option of sterilisation.

Methods like the pill, the ring, the patch, the diaphragm, spermicides, and condoms are slightly less reliable. That’s where the human factor comes into play. After all, there’s quite a difference between an IUD. which you don’t have to think about for years, and a pill that you have to remember to take on time every day.

Do you want to use a contraceptive but are you unsure which one’s right for you? We’ve listed the most commonly used ones below.

• IUD: The IUD is a small, T-shaped birth control device that’s 3 to 4 centimetres long and is inserted in your uterus. You can choose between 2 types: the hormonal IUD and the copper IUD. They both help equally well to prevent pregnancy, but the side effects are slightly different. If you have the copper IUD, you have a chance of a slightly longer period with more pain and blood loss. The hormone IUD can actually make you skip periods entirely. However, you may occasionally experience irregular blood loss. What are the advantages? Its reliability is sometimes compared to a sterilization, and you don’t have to think about contraception for about 5 to 10 years.
• Contraceptive implant: The contraceptive implant is a thin, flexible rod about 4 centimetres long. Your doctor inserts it under your skin, after which it releases a constant quantity of hormones. This prevents eggs from being released and makes your endometrium tough and impenetrable to sperm. You’ll likely have irregular periods for the first few months after the procedure, and after that, your periods will usually disappear completely. The hormones can cause side effects such as headaches, acne, and mild depression. The implant remains in place for about 3 years, after which it has to be replaced.
• Birth control patch: The hormone patch is a thin patch containing oestrogen and progestogen that you stick onto your skin. The hormones then enter your bloodstream through your skin. You apply the patch once a week for 3 weeks in a row, after which you stop applying it for a week. During this week you’ll have your period, but usually for a shorter time and with less blood loss. It’s a godsend if you don’t feel like thinking about the pill every day! However, there are some disadvantages to the patch: it can come off, it’s expensive and, especially in the first few months, you can suffer from side effects such as headaches, tight breasts, depression, low libido, and skin irritation in the place where you’ve stuck on the patch.
• Vaginal ring: The vaginal ring is a flexible, soft ring that you place in your vagina yourself. The hormones oestrogen and progestogen then enter your bloodstream via your vagina. You leave the ring in place for 3 weeks and then you stop wearing it for 7 days. During this week you’ll have your period, but usually for a shorter period and with less blood loss – just like with a patch or the pill. After that, you place a new ring in your vagina. The side effects are the same as with other hormone-based contraceptives. In addition, the ring may cause itching and more discharge from your vagina. Most women don’t feel it during sex, but you may remove it from your vagina for up to 3 hours. Might feel a little freer!
• Hormonal shot: This shot is administered in the buttocks every 3 months. Throughout the first few months, your periods may be irregular, but after that they’ll usually disappear completely. The contraceptive shot does require some planning. If you stop taking it, it’ll take between 6 months to a year for your periods return. This is something to take into account if you do want to become pregnant at some point. Another disadvantage is that you’re stuck with it for at least 3 months. The hormones cannot be sucked out of your body after the injection, so if you experience any side effects, you’ll simply have to wait until the injection has worn off.
• Sterilisation: If you want to have carefree sex, sterilisation is the ultimate form of contraception. The chances of ever becoming pregnant again after sterilisation are nil. During sterilisation, the doctor closes up or removes your fallopian tubes. Sterilisation has no effect on your periods, your menopause, or your sexual desires. It’s a drastic procedure, but it’s a good solution if you already have children and are sure that you don’t want more, or if you’re clear that you don’t want any children at all.

The pill: praised and scrutinised

We hadn’t forgotten about this one 😉 There is, of course, one contraceptive that stands out from the rest: the pill. When the pill appeared on the market in the early 1960s, it was a dream come true for all the feminists who were protesting in the streets.

Women were happy when the pill became freely available. Thanks to that miracle drug, we were free, and we could have sex without worry. Finally, we could make our own decisions about our sexuality and reproduction.

Image issues

In the meantime, some 60 years on, the pill is struggling with an image issue. Fewer and fewer women are willing to take it, and more and more complain about unpleasant side effects.

The American scientist Sarah Hill even wrote a bestseller about it: Your brain on the pill: how the pill changes everything.

She describes how the pill can affect your mood, your libido, and even your choice of partner. And she mentions that this is logical: you can’t expect to dump a load of hormones into your body and then expect those hormones to just do the job they were designed for. In extreme cases, they may even take over your personality. How many women have felt like a completely different person when they stopped taking the pill?

Anxiety and panic attacks

The fact that this isn’t a mental complex is proven by the increased scientific interest in the subject. The University of Groningen and the Netherlands Pharmacovigilance Centre Lareb joined forces to research the psychological side effects of the pill.

In recent years, Lareb has identified almost 1000 reports of psychological side effects. Depressed feelings and mood swings were the most common, but several women also reported anxiety and panic attacks, as well as sleep problems. Remarkably, most women had no history of psychological issues before starting the pill.

Updated guidelines

The Dutch Society of General Practitioners recognised the side effects from daily practice and therefore tightened the guidelines in 2020. This means that general practitioners, when discussing the pill, should pay more attention to its psychological side effects. They should also be alert to reports of symptoms after using the pill.

It’s a good development, but it doesn’t change the fact that you can experience a lot of physical side effects from the pill. From acne to strained breasts, from abdominal pain to fatigue and a few extra pounds: most women simply suffer from the pill. Not to mention the increased risk of thrombosis and breast cancer.

Contraception for men

Women have been dealing with some of these serious side effects for over 60 years. After all, the burden of most contraceptives lies with the woman. Of course, men can grab a pack of condoms from a vending machine, but that’s usually the limit.

The male pill would be a fantastic solution, so that the responsibility for an empty womb could finally be truly shared. Unfortunately, for a long time the prospects haven’t been good.

Dropouts

In 2016, a revolutionary study was set up, in which men were injected with hormonal contraception that consisted of 2 hormones. Because the first hormone, progesterone, caused testosterone levels to drop, synthetic testosterone was added to the cocktail. In this way, the men would not lose their “manliness”.

It worked quite well. With 96% effectiveness, it was almost as reliable as the female pill. Unfortunately, the research was hastily halted when the participants dropped out due to side effects such as acne, pain at the injection site, and mood swings. Exactly: these were the same symptoms that women have been suffering from for decades.

Change is coming

Still, good developments are on the horizon. Dutch research has shown that a large majority of young people believe there should be more contraceptive options for men. Just over half of the male participants said that they’d take a pill if it was uncomplicated and if they would not lose their fertility. It’s not a staggering percentage, but it’s certainly a step in the right direction. Moreover, a whopping 90% did feel that preventing pregnancy was a shared responsibility.

This offers perspective, especially as the scientific world is always moving forward. All over the world, research is currently being carried out into male contraceptives. Researchers are still working on a pill for men, but they’re also developing contraceptive gel and non-hormonal injections. The latter might meet with some obstacles, especially because it is injected straight into the vas deferens. That’s not something that most men would be thrilled to hear, and we can certainly understand.

Promising contraceptive gel

The contraceptive gel seems the most promising. This is a hormone gel that men apply to their shoulder once a day, after which the hormones enter the bloodstream through the skin. These hormones inhibit sperm production, but also ensure that the libido remains intact.

Currently, the gel is being clinically tested on 400 couples around the world. These couples must first wait 8 to 16 weeks before the sperm cells are sufficiently inhibited to prevent pregnancy. Once that period is over, the couple can use the gel as contraception for a year. During this phase, the sperm cells are checked regularly to minimise the risk of pregnancy.

Shared benefits, shared burdens

If all goes well, the gel could be on pharmacy shelves within 10 years. Just like the other contraceptives being developed specifically for men, according to Stephanie Page, lead researcher at Washington University and a driving force behind the development of various contraceptives for men.

After 60 years, it’s about time. Women have always borne the responsibility for contraception, just as the risk of pregnancy rests on their shoulders. At a time when the right to contraception, abortion, and self-determination over one’s own body is being restricted in many countries, it’s only fair that men should step forward and take matters into their own hands.

Polish abortion law

For women, deciding for their own bodies and reproduction is much less of a given. In Europe, millions of women struggle with access to contraception, simply because they cannot afford it. At the beginning of this year, Poland tightened its already quite strict abortion laws.

Abortion was already only permitted in cases of incest, rape, and when the mother’s life was in danger. Now, abortions are also prohibited in the case of foetal abnormalities. Women must give birth in any case, so that the foetus can be baptised before it dies.

Joining forces

In short, it’s high time for men to use their freedom to help women. They should take responsibility for preventing pregnancy. We hope that governments, researchers, and pharmacists will join forces to bring the male pill to the market.

Oh, and while they’re at it, they could also give the women’s pill a makeover, so that we too can finally be rid of the inexplicable crying fits, binge eating sessions, and all those other pleasant side-effects that we’ve been enduring for the past 60 years.

Is this too much of a challenge, and are those wretched hormones still a bitch? For both women and men? Then in 10 years’ time, we’ll undoubtedly tell them a well-deserved “Hate to say I told you so!”