Samantha Johnson

Cassel

ENG 1201

28 April 2019

Birth Control: Pros and Cons

In 1960, the Food and Drug Administration (FDA) approved the first oral

contraceptive, marking the beginning towards the advancement of women’s rights and

granting them agency over the course of their reproductive lives. Since then,

contraceptives have evolved to include men contraceptives. The use of hormonal and

non-hormonal contraceptives is today the accepted route for the control of the

population. The ease of access to contraception has resulted in far-reaching and

profound consequences and has changed the landscape of global society, family

formations, and gender dynamics. However, beyond the socio-economic sphere, are

concerns over the safety and effects of contraceptives on health. While contraceptives

have become a widely used means for birth control following their effectiveness,

skeptics argue that they result in health complications including cardiovascular disease,

metabolic effects, and neoplastic disease.

There are 15 known and approved birth control methods. They include implants

such a Nexplanon, Progestin that includes Liletta, Mirena, and Skyla, Copper IUD –

Paragad, and The Shot – Depo Provera (“Your Birth Control Choices” 1). Others are

pills, progestin-only pills, patches such as Ortho Eva, rings such as Nuva-ring, external

and internal condoms, withdrawal, diaphragm, fertility awareness, spermicide, and

emergency contraception pills. Each of these methods has its pros and cons.
 An implant, or Nexplanon, is a small thin rod, the size of a matchstick placed under

the skin on the upper arm by the health care provider. (Parenthood, 2019). Once

implanted, the implant releases hormones (progestin) that prevent the individual from

getting pregnant by causing changes in the lining of the uterus and cervical mucus to

keep the sperm from joining an egg. The implant can remain active for up to five years

and is considered a “get it and forget it” form of birth control (Parenthood n.p.). Two

types of injectables exist, Noristerat (NET) and Depo-Provera (DMPA) (Heffron et al.

200). They prevent pregnancies by thickening cervical mucus, inhibiting ovulation, and

altering the endometrial lining.

The debate over whether injectable contraceptives cause cancer continues.

Epidemiological studies by the World Health Organization found no correlation between

cancer and the use of implants. However, other studies indicate the possible

development of breast cancer and endometrial cancer from using injectable

contraceptives (Kanunitz et al. 477). Among the reported metabolic effects of using

injectable contraceptives include a rise in triglyceride levels, cholesterol, and changes in

blood pressure and insulin (Kanunitz et al. 477). In addition, women with injectable

implants report amenorrhea or irregular unpredictable bleeding episodes. Up to 30

percent of these women report irregular menstrual cycles during the first year of use,

́ z 39). Nonetheless,
while 50 percent of women eventually become amenorrhearic (Dıa

the occurrence of heavy bleeding is rare and is lighter than normal.

No evidence exists that correlates injectables and infertility. However, studies

indicate that the ovulation process may be inhibited for up to nine months after the last

injection (Mishell et al. 1046). Nonetheless, injectables can prevent a woman from
contracting the pelvic inflammatory disease by altering the cervical mucus. Moreover,

injectable contraceptives have been shown to prevent endometrial and ovarian cancers.

Injectables and implants have a common side effect of disturbance to the menstrual

cycle. No other side effects have been shown to exist following the use of implants.

IUDs or intrauterine devices can either be copper based or hormonal. They are

inserted into the uterus and work to prevent conception by a variety of means. They can

be medicated or non-medicated and include inert Lippes Loop, Cooper IUD, or

ParaGard, releases a small amount of copper into the uterus thus preventing the sperm

from reaching and fertilizing an egg. In the event the egg is fertilized, the IUD stops the

egg from implanting on the uterus lining. Similar to an implant, an IUD can last up to 5

years. Elsewhere, a hormonal IUD also known as Mirena released progestin into the

uterus to prevent the sperms from fertilizing the egg. It does this by causing the cervical

mucus to thicken so that sperms cannot reach the egg. It too can last up to 5 years.

IUDs are among the advanced forms of birth control. According to Burkman, they

are highly effective at preventing intrauterine pregnancies with a failure rate of less than

6 percent (43). Burkman posits that they are used by over 79 million women around the

world, 58 million of them living in China. However, despite their popularity IUD’s have

health risks that cannot be ignored. Among these risks are the development of the

pelvic inflammatory disease, tubal infertility, risk of septic abortion or spontaneous

abortion, and uterine perforation (Burkman 44). In 1989, Stenberg observed that the use

of the now discontinued Daklon Shield contributed to high mortality rates; today,

however, mortality from the use of IUDs is at 1 to 2 deaths per 100,000 (219).
 Grimes found IUDs to increase the risk of pelvic inflammatory disease (98). The

author posited that although the pelvic inflammatory disease was an STD, women who

use IUDs were found to be at an increased risk of developing STDs. The author found

the risk of contraction of the disease because of bacteria introduced into the uterus

during insertion. Other risks associated with the use of IUD include spontaneous

abortion, which occurs in 50 percent of women with IUD implants (Rouse et al. n.p.).

According to Rouse, nulliparous women experience an increased risk of tubal infertility,

especially if they have a history of IUD use. Concurringly, spontaneous abortion can

occur if a pregnancy occurs in a woman with an IUD implant (French et al. 140). If the

IUD is left in place, septic aborting can occur in the second trimester and can be fatal to

the IUD user (Burkman 48).

Barrier methods have become popular for their ability to prevent STIs and STDs

such as HIV. As a means of contraception, barriers, which include condoms,

diaphragms, and sponges, are common among women following their effectiveness.

However, their use is dependent on the motivation and compliance of the user, and as a

result, failure tests are high than when using implants or injectables. As a method of

birth control, condoms are effective. When properly used, condoms can achieve a high

rate of success in preventing pregnancies and stopping the user from passing on or

contracting diseases such as herpes, chlamydia trachomars, and HIV. They are useful

in reducing the transmission of organisms present in semen such as trichomonas

vaginitis, hepatitis B virus and Neisseria gonorrhea. Benefits of using condoms include

low cost of birth control compared to other forms, no side effects on the woman, can be
used immediately after birth, can protect against STIs, and for female condoms, they

can be inserted hours before intercourse.

Sponges, on the other hand, are round devices made of soft foam containing

spermicide. They are inserted into the vagina where they cover the cervix. They are

recorded to be less effective on women who have given birth. While sponges have

numerous benefits, they have their downside as well. According to the American

College of Obstetricians and Gynecologists (ACOG), advantages of sponges include

ease of obtaining them, the lack of side effects on a woman’s natural hormones, enough

spermicides on each sponge to last 24 hours repeated use, and the lack of any effect

on breast milk (n.p.). Downsides to the use of sponge include the risk of contracting HIV

if used with multiple partners, the possibility of causing vaginal burning and irritation,

and the risk of developing toxic shock syndrome (American College of Obstetricians and

Gynecologists n.p.).

Diaphragms too are effective contraceptives. They are dome-shaped silicone

devices that are fitted inside the vagina to cover the cervix. They, however, must be

used with spermicide. There are two types of diaphragms, which the American College

of Obstetricians and Gynecologists classifies as the individual diaphragm and the one

size diaphragm. According to the association, the former must be fitted by a healthcare

professional while the latter fits most women. Notably, diaphragms neither protect the

user from contracting HIV or STIs. The advantages of diaphragms as listed by the

American College of Obstetricians and Gynecologists include little or no side effects on

the user’s natural hormones, diaphragms do not affect the milk supply of the user, and it

can be inserted hours before sex. Among the downfalls of diaphragms increased risk of
contracting HIV from an infected partner, may cause virginal burning, increases the risk

of developing urinary tract infection as well as toxic shock.

The impact of family planning is evident on societal, familial, and interpersonal

levels. However, the discussion over the long-term use of hormonal contraceptives

lingers. Non-hormonal forms of contraceptives including condoms, sponges, and

diaphragms have little or no side effects except the increased risk of contracting the

disease from a partner. The safety of using hormonal birth control may depend on an

individual’s risks, age, and medical history. Nonetheless, scholars suggest the

possibility of incurring adverse outcomes following their prolonged use.

Sabatini, Caggiano, and Rabe conducted research to understand the effects of

hormonal contraception on women where they classified the risks as mild, moderate

and adverse. The authors discovered that a majority of women on birth control pills

experienced no side effects at all. However, some reported having breakthrough

bleeding or spotting, dermatologic problems, low libido, mood changes, weight gain,

breast tenderness and headaches (131). The authors found mild and transitory

disturbances as common attributes of the first cycles of hormonal contraception but

disappeared thereafter. The authors summed up the mild effects of using hormonal

contraceptives to include pursuits of skin eruptions, gastrointestinal and the

development of bronchial problems as well as cardiovascular problems. The patients

under review were also found to have dermatologic problems and vascular

manifestations of HCs.

Moderate adverse effects highlighted by Sabatini, Caggiano, and Rabe include

migraines leading to stroke, Vascular symptomatology complications such as Budd-

Chiari syndrome and the Peliosis Hepatis, vomiting, pruritus, anorexia, rash asthenia,

weight loss without fever, and abdominal pain. Women in the study were also found to

develop low levels of estrogen leading to jaundice among those that took COCs

developed cholesterol levels leading to cholecystectomy. Meanwhile, hormonal

contraceptives were found to have adverse effects that include cardiovascular

complications, blood hypertension, myocardial infarctions, stroke, and arterial accidents.

The authors found other severe effects of hormonal contraception to include the

development of angioedema, ophthalmologic effects, and vasculitis.

In light of these findings, it is conclusive that prolonged use of hormonal

contraceptives eventually has adverse effects on the user. In this regard, it is advisable

for people to use alternative means of contraception that includes natural

contraceptives, blockers, and other means such as withdrawal. Clearly, oral

contraceptives should be avoided by all women especially those with thromboembolic

complications since they are at risk of developing pulmonary hypertension,

Eisenmenger syndrome, rhythm disturbances, reduced ventricular function, severe

arterial hypertension, infectious complications (endocarditis) or hyperlipidemia.

Furthermore, the use of hormonal contraceptives was shown to lead to Budd-Chiari

syndrome, focal nodular hyperplasia, as well as adenoma. The best form of

contraceptive is, therefore, non-hormonal though the user will require implementing

other measures to protect themselves from contracting STDs and STIs.

 Works Cited

American College of Obstetricians and Gynecologists. Barrier Methods of Birth

Control: Spermicide, Condom, Sponge, Diaphragm, and Cervical Cap.

ACOG, 22 Mar 2019, acog.org/Patients/FAQs/Barrier-Methods-of-Birth-

Control-Spermicide-Condom-Sponge-Diaphragm-and-Cervical-

Cap?IsMobileSet=false
Burkman, Ronald T. "Transdermal hormonal contraception: benefits and risks."

American journal of obstetrics and Gynecology 197.2 (2007): 134-e1.

́ z, Soledad. "Contraceptive implants and lactation." Contraception 65.1 (2002):

Dıa

39-46.

French, Valerie A., and Philip D. Darney. "Implantable Contraception." The

Handbook of Contraception. Humana Press, Cham, 2016. 139-164.

Grimes, David A. "Intrauterine devices and pelvic inflammatory disease: recent

developments." Contraception 36.1 (1987): 97-109.

Heffron, Renee, et al. "Pharmacokinetic, biologic and epidemiologic differences in

MPA-and NET-based progestin-only injectable contraceptives relative to

the potential impact on HIV acquisition in women." Contraception 99.4

(2019): 199-204.

Kaunitz, Andrew M., JoAnn V. Pinkerton, and JoAnn E. Manson. "Hormonal

contraception and risk of breast cancer: a closer look." Menopause 25.5

(2018): 477-479.

Rouse, Caroline E., et al. "Spontaneous abortion and ectopic pregnancy: Case

definition & gIUDelines for data collection, analysis, and presentation of

maternal immunization safety data." Vaccine 35.48Part A (2017): 6563.

Sabatini, Rosa, R. Cagiano, and T. Rabe. "Adverse effects of hormonal

contraception." Journal für Reproduktionsmedizin und Endokrinologie-

Journal of Reproductive Medicine and Endocrinology 8.1 (2011): 130-156.