Different methods of contraception
A contraceptive allows you to have sexual relations without risking pregnancy. It is a way of controlling fertility.
Since 1 January 2022, young women under the age of 26 have had free access to consultations with a doctor or midwife, examinations, or medical procedures relating to contraception, as well as to the various types of contraception available on prescription from pharmacies, without having to pay in advance (1st or 2nd generation hormonal pills, hormonal contraceptive implants, IUDs, hormonal emergency contraception).
There are many methods of contraception available in France, and it's sometimes difficult to find the one that's right for you.
On the one hand, there are so-called "mechanical" contraceptives:
On the other hand, there are so-called "hormonal" contraceptives, which are widely operated.
There are two main types of hormonal contraception: combined oestroprogestogenic contraception and microprogestogenic contraception alone.
Oestroprogestogenic contraception works by inhibiting ovulation and comes in a variety of forms.
The oral pill form is taken every day, 21 days out of 28. Withdrawal haemorrhage (false menstruation) may occur during the week in which the pill is taken. If women do not wish to experience bleeding, they can decide to take a continuous series of 21-pill packs.
Ideally, you should always take the tablet at the same time. If you forget to take the tablet, you may be allowed up to 12 hours to do so. If this period is exceeded, you should still take the tablet and use emergency contraception if you have had unprotected sex in the previous 5 days. You will also need to protect any deferrals for the following 8 days.
Oestroprogestogenic contraception also exists in other forms: as a patch to be changed every week, three weeks out of four, and as a vaginal ring to be changed every 3 weeks with a 7-day break every three weeks. These methods of administration are useful for patients with compliance problems but are not reimbursed.
When started on the first day of your period, oestroprogestogenic contraception is immediately effective. It can be started at any time during the cycle, but will only be effective after taking it for 8 days. Tolerance varies from patient to patient. It may cause nausea, breast swelling, migraines, or increased appetite; it is generally taken for three months before deciding whether it is suitable contraception or not.
The main disadvantage of oestroprogestogenic contraception is its arterial and venous vascular risk, which is highest in the first year of use and for 3rd and 4th generation pills, as well as for the patch and ring.
As a result, it is contraindicated if you have a personal or family history of venous thrombosis, biological thrombophilia or an arterial event (heart attack, stroke), if you suffer from migraines with aura, if you have had diabetes for more than 20 years or if it is unbalanced, and if you have high blood pressure. Similarly, if you have several risk factors, including age > 35, active smoking, obesity, or hypercholesterolaemia, this contraception is contraindicated.
In all cases, when starting oestroprogestogenic contraception, blood pressure should be checked and blood should be taken after three months of fasting to check blood sugar and cholesterol levels.
Progestin-only contraception is also available in several forms and has the advantage of not increasing the risk of venous thrombosis or arterial events (except for the intramuscular injectable form, which is rarely operated).
The progestin-only pill is a tablet to be taken continuously every day. It works by suppressing ovulation and also causes a thickening of secretions from the cervix (entrance) of the uterus, preventing the passage of spermatozoa. The main side-effect of this pill is bleeding: 1/3 of women experience uncontrolled bleeding or spotting on the pill, which can be disabling; 10% of women stop menstruating altogether on the pill, while the others have regular cycles.
The pill can also cause acne and breast pain.
Micro-progestin contraception also exists in the form of an implant, a small rod the size of a match, placed under the skin under local anaesthetic in the non-dominant arm and which delivers small continuous doses of progestins to inhibit ovulation. The implant is highly effective and can be left in place for up to 3 years. Its side effects are similar to those of the pill but vary from patient to patient.
Lastly, micro progestogen contraception is also available in the form of an intrauterine delivery system (IUD) containing levonorgestrel, which has mainly a local action (little passes into the bloodstream) and works by thickening cervical secretions and atrophying the uterine lining. As a result, most patients experience little or no menstruation with the hormonal IUS. There are two sizes, one suitable for patients who have never had children, called Kyleena, and another reserved for patients who have already given birth, called Mirena. It is highly effective and can be left in place for up to 5 years.
Although the burden of contraception falls mainly on women, male contraceptive methods are currently being developed.
As a result, non-hormonal or thermal methods (heated briefs, andro-switch), which are thought to reduce the number of sperm produced, are beginning to be operated. However, these methods are not recognised by the World Health Organisation (WHO).
Finally, for those who so wish, permanent contraception (sterilisation) for women or men is possible from the age of 18, after a 4-month period of reflection.
In women, it consists of a tubal ligation carried out by laparoscopy (three small holes are made in the abdomen and the tubes are tied up, thus preventing spermatozoa from traveling up the tubes to fertilise an egg).
In men, this involves a vasectomy or section of the vas deferens, preventing the release of spermatozoa into the spermatic fluid during ejaculation.
Dr Noémi Amsellem