The ins and outs of long term contraception, what’s still unknown, and the future of male contraceptives
For lots of us, sex is a great thing. Among many things, it’s pleasurable and can help us feel connected to people. But what doesn’t often feel great about sex is the side effects of preventing pregnancy. Many people have heard a horror story or two about someone trying a form of contraception; whether a pill, the Depo Provera injection, or a type of implant, only to have it significantly impact their quality of life.
For instance, using the Jadelle, a contraceptive implant inserted in the upper arm, can result in irregular bleeding. You can go months without a period, and then… Hello, Aunt Flo turns up without warning. This basically means you are subjecting your pastel clothes and favourite underwear to a game of Russian roulette every time you wear them. Irregular bleeding is pretty annoying, but when using contraception, it doesn’t typically signal anything sinister. What might be more concerning are the mental health symptoms that can begin when using contraception. Experiencing depressive thoughts, low mood, or any undesirable side-effect for more than two to four weeks after starting new contraception should be something you see your doctor about as soon as possible, says Dr. Wendy Burgess, a senior lecturer in obstetrics and gynaecology.
There has been a multitude of large, rigorous studies that have tested the effectiveness and effects of all kinds of contraception currently available in Aotearoa. These studies show that some people experience various things, from weight changes to bloating. These side effects are primarily the result of having a hefty dose of the hormone progesterone. These studies also show that there is an association between taking the contraceptive pill and symptoms of depression. This means that the pill and depression are linked, not necessarily that the pill causes depression—science can’t prove that without a randomised controlled trial. Unfortunately, it’s impossible to tell why the Mirena, an intrauterine contraceptive device, gives you sore boobs, your friend back pain, and your sister nothing at all.
The fact that the Family Planning nurse or your doctor can’t tell you how a type of contraception will specifically impact you is a gap in contraception research. This gap is challenging to fill because everyone’s bodies are so different. Dr. Burgess helped me conceptualise this by referring to the range of symptoms people can experience when they have a period. For some people, a period means that they will bleed for a few consecutive days in a month. For others, their period means seven or more days of pain and being confined to their bed. What biologically happens during a person’s period is the same, yet how that manifests in physical and mental symptoms is highly variable. Likewise, contraception operates the same in every person, but other effects, apart from preventing pregnancy, differ across individuals.
Finding what contraception works best for you can be taxing and frustrating. Like those of us who have gone through this process, Dr. Burgess wishes that a simple blood test could be done to identify what contraceptive would be the least symptomatic for a particular person. Often, the best a health professional can do is help you find contraception that doesn’t induce the symptoms you’re not willing to live with. In the case of the oral contraceptive pill, it might be switching to a pill with different hormone ratios. In the case of long-acting reversible contraceptives (LARCs), it might mean changing to a different form altogether, i.e., from the Mirena to the Jadelle. Dr. Burgess recommends LARCs over a daily pill because they take away the human element of needing to remember to take it at the same time every day.
According to Dr. Burgess, using a period tracker app is the best way to see if your contraception is causing symptoms like low mood. (Sometimes, it can be hard to tell amongst everything else happening in our lives.) Many free ones are available, like Flow, Clue, and Period Tracker app. A person can record all sorts of information, not just bleeding days. This information can help identify patterns in your symptoms. You can also show this information to your doctor to help them give you the best advice.
I agree that this information is pretty anti-climatic (pun intended). Turns out there are very few things we can do to change the situation apart from doing a PhD and conducting the research ourselves or protesting about the bias in the academe. But at least there are studies showing that contraception has no long-term impacts on a person’s fertility. Dr. Burgess says that once one stops contraception, a person’s period should return to how it was always going to be.
Some other good news is that we are closer than ever to male contraceptives becoming available. There are plans to begin a trial in Australia that will hopefully replicate the positive findings of those done in the US. Aotearoa is more likely to adopt male contraception once it has been tested in Australia because of the similarity in the rules of conducting research. One reason the development of male contraception has been slow is that clinical trials have had to be stopped. Trials have been stopped when men have reported experiencing low mood and other symptoms women typically experience on contraception. This has been the case even when the men said they would continue despite these symptoms… I’ll let you make up your mind about that.
Four types of male contraception are currently being tested around the world. The one Dr. Burgess thinks is most likely to become available in Aotearoa the soonest is a topical gel. This gel is applied daily by the person to their upper arm—Dr. Burgess has no idea why it’s a gel and needs to be applied to the arm. She guesses it has something to do with the psychology of pharmacology. The second option is an oral contraceptive pill. The gel and the pill work similarly to the combined oral contraception that females can use. Instead of having oestrogen and progestin, they contain testosterone and progestin. They stop testosterone from being produced and, therefore, sperm production.
The third and fourth options are non-hormonal. One is an injection being tested in India. The injection contains a polymer that blocks the vas deferens, the tube that transports sperm from the testes to the urethra. This will last about 15 years but can be reversed at any time with another injection containing a substance that dissolves the polymer. The fourth kind of male contraception has been trialled for two years, and so far, no one has gotten pregnant. This kind of contraception operates similarly to the third, except the polymer dissolves after one year. These injections would occur under local anaesthesia.
Contraception is an excellent thing for people who want to have sex but don’t want a baby. Even though there is so much we still don’t know, it’s exciting that new solutions are on the way—especially ones that might make the burden of contraception more equal.