Did you know that birth control methods have other uses aside from preventing pregnancies? Or did you know that there are other available artificial methods aside from condoms and the contraceptive pill? Sad to say, many people still don't because there is still a lot of stigma surrounding sexual and reproductive health services in Southeast Asia. Because of the fear and shame surrounding birth control use, people feel uncomfortable consulting professionals or even talking about it even when they need to do so. However, times are indeed changing; there has actually been an increase in contraceptive use in Southeast Asia according to United Nations reports in 2015 and 2019. But what is contraception and birth control really all about?
We spoke with Dr. Grace Caras-Torres, M.D., an obstetrician and gynaecologist at St. Luke’s Medical Center in Manila to help us break down everything you need to know.
There are different forms of birth control available in Southeast Asia. Here are some of the most common that you could consider.
Barriers. As its name suggests, barriers prevent the sperm from entering the female reproductive tract and thus preventing the sperm from fertilising the egg. They also prevent sexually transmitted diseases like HIV. These include condoms, diaphragms (not available in the Philippines and Singapore), and spermicides.
Oral contraceptives. These are birth control pills with hormones that prevent the release of the egg. Available in two kinds: combined (with both estrogen and progesterone) and progesterone-only contraceptive pills.
Injectables. A longer-term birth control method compared to oral contraceptives. These include Depo progesterone and the combined hormonal injectables.
Implants. Also contain hormones and are implanted underneath the skin of a woman’s bicep.
Intrauterine Device. A birth control method that produces an inflammatory reaction in the cervix or uterus that prevents the entry of a live sperm. It is available in two types which is the plain progesterone IUD and the Levonorgestrel IUD.
Sterilisation procedures. These refer to procedures such as tubal ligation (interrupts the fallopian tubes to prevent the sperm and egg meeting) and vasectomy (cuts the tube that serves as the passageway for the sperm to be ejaculated).
Now that you know the different forms of birth control available, let’s discuss the logistics of starting contraceptive usage.
Getting a prescription. Dr. Caras-Torres recommends consulting a gynaecologist if it’s your first time getting hormonal birth control. This will allow them to screen you for your medical and sexual history as well as current lifestyle in order to prescribe the ideal form of birth control for you.
Frequency. It varies depending on the birth control method. Oral contraceptives require you to take the Pill every 24 hours to fully prevent the risk of pregnancy. Injectables last up to three months, so you need to get the shot every quarter. Implants and IUDs can last years before needing replacement.
Accessibility. The most accessible form of birth control available are condoms, which you can buy over-the-counter. Other methods, like the Pill and implant, require a prescription from a gynaecologist. However, there are a lot of online platforms like Dima.ph and Ease Healthcare that have made getting birth control easier for those who already have a prescription. Dr. Caras-Torres counts these apps as very important especially during the lockdown when people were forced to stay at home. “It helps you continue your contraceptives and prevent unplanned pregnancies. So it was very useful.”
Age requirement. There is no age requirement when it comes to birth control prescriptions, as these hormonal contraceptives are also used to treat severe dysmenorrhea, heavy flows, infrequent periods, and other health issues.
Common side effects of using birth control
As with any medication, contraceptives would have some side effects in the beginning. “Low-dose contraceptives would have rare or very minimal side effects that are tolerable,” explained Dr. Caras-Torres. Low-dose contraceptives, like the Pill, contain enough hormones that are effective in preventing pregnancy for 24 hours. Stronger doses, such as in injectables, contain “the amount of hormones [that] should last up to three months for that contraceptive to be effective” according to Dr. Caras-Torres. Because of the higher level of hormones in your body, you should expect more common side effects. These include experiencing headaches, dizziness, breast tenderness, bloatedness, and weight gain.
Aside from these side effects, oral contraceptive pills can also have a positive effect on one’s complexion. “There are certain types of pills that are beneficial to the skin. The production of pimples is related to the hormone testosterone. There are women whose bodies produce slightly higher levels of testosterone which manifests as severe acne and prescribing an anti-testosterone pill would help improve their acne.”
Debunking birth control myths and misconceptions
There are a lot of misconceptions surrounding birth control methods. Dr. Caras-Torres explains what is true and what is false, as well as the real medical reasons behind them.
I only need to use birth control if I don’t want to get pregnant. This is false. “Some women would have certain medical conditions for which we [doctors] also prescribe hormonal pills as a treatment,” said Dr. Caras-Torres. These include severe dysmenorrhea, chronic pelvic pain, heavy or prolonged menstruation (“that ultimately leads to them being anaemic”), endometriosis, among others. Prescribing hormonal birth control pills can help women suffering from these conditions obtain an improved quality of life.
I will be “safe” immediately after taking birth control pills. This depends on when you start taking birth control and the type of birth control pills you’re using. Dr. Caras-Torres recommends starting within the first five days of your cycle (during your period) as it’s easiest. If you start in the middle of your cycle, abstaining from sexual intercourse or using a barrier for at least a week would be required for the contraceptive pills to fully take effect.
I can’t drink alcohol when I’m on the Pill. “We’re more concerned about women who would drink to the point of intoxication, as they would already have complications with their livers if so. But if you’re more of a social drinker, then it’s safe,” she said.
The risk of miscarriage and infertility increases with using birth control. Dr. Caras-Torres explained that these concerns are not caused by prolonged contraceptive use but rather could be caused by the body's natural ageing process. “The ageing process increases the risk of miscarriage. Ageing eggs, the woman’s health (as women tend to develop medical problems over time. It’s not the contraceptives per se.”
It’s okay if I miss taking the Pill for a few hours. According to Dr. Caras-Torres, there’s a perfectly logical reason for this. “The hormones that prevent you from ovulating that are available in one pill is only enough for 24 hours. If you miss a pill or the hormone-free hours are extended, then that will allow your ovaries to ovulate (and increase your chances of pregnancy).”
It’s unsafe to use birth control indefinitely. “As long as you're healthy, don’t have medical conditions, you can take birth control indefinitely or should we say until you’re menopausal as you won’t need birth control pills by that time.” However, she recommends that you still see a gynaecologist yearly for your regular screenings like mammograms and pap smears as well as check the health of your liver since “hormones are processed in the liver.” She also cautioned women aged 40 and above who still want to continue using birth control to consult their doctor if they develop medical conditions such as hypertension because you would possibly need to switch to another form of birth control.
I need to take a break from using birth control. “This is a myth. The disadvantage of taking a ‘rest’ from your birth control pills is that you would undergo the increased risk of blood clots once you start using birth control pills again. The risk of blood clots diminishes the longer you use birth control,” Dr. Caras-Torres explained. “We don’t recommend a rest period [from birth control] unless you want to get pregnant already.”
Birth control increases one's chances of breast cancer. “There are a lot of studies on it. Not all studies would say the same. If there is a risk, it is not significant or there is a very small increase in the risk. The risk increases when you use it for a long time, say for 10 years,” she explained. However, take consideration if you have a family history for breast cancer. In order to minimise this risk, you must address the lifestyle risks of breast cancer itself such as maintaining a healthy lifestyle, avoiding smoking, lowering your alcohol intake to moderation, and having breast cancer screening.
Oral contraceptives can increase the risk of blot clots. “It is a known risk or side effect of oral contraceptive pills, especially the estrogen-containing pills. We have to check the history of the patient as we don’t give hormonal pills for those with family or personal history of thromboembolic disorders (those with a risk of blood clots), smokers, and people with migraines,” Dr. Caras-Torres explained. But she added that the risk of blood clots is relatively less amongst Asians, in particular, as compared to Caucasians.
I can develop a resistance to birth control. This is a myth. “As long as you don’t take any medications (such as antibiotics) that would interfere with your birth control, then there’s no such thing as [birth control] resistance,” Dr. Caras-Torres said.
Using birth control stops my periods altogether. “It will depend on the particular birth control methods. You will still get your period on the birth control pill, especially if you take it cyclically (in sync with your period cycle). For the progesterone-only pill, it is the option where you most commonly don’t bleed or you would have intermittent spotting or irregularly bleeding. For the injectable, either combined or progesterone-only, you don’t get regular periods.
A few words of advice
Despite the stigma still surrounding contraceptives, and because of the various misconceptions about it, it’s still best to consult your gynaecologist to maintain your sexual and reproductive health. “Don’t be afraid or shy to ask your gynaecologist. Times are different now,” Dr. Caras-Torres explained. “We (as doctors) would not judge you [if you come to us] to ask about contraceptive choices and options. We are more than willing to help you. It would be better to seek the help of a professional rather than asking a friend as this is where you get your birth control myths. If you do it incorrectly, it will increase your risk of unintended pregnancy especially if you just ask around and get the wrong information.”
(Cover photo from: @ease.sg)