The 30 something contraception conundrum
The Pill has been around for more than 50 years, and condoms are widely available for purchase. Yet, for Irish couples (and singles), preventing pregnancy still isn't exactly easy.
We Irish have never been great at talking about the birds and the bees. Whether it's a hangover from a time when couples had to get married to do the bold thing, or a lasting shame from having to sneak "French Letters" into the country, it's hard to say.
Now though, with talk of a wireless contraceptive chip lasting 16 years being developed in Massachusetts, and the Pill for men finally on the horizon, one might presume that in this day and age, we've got avoiding pregnancy nailed. In reality though, finding a method that works and won't leave you feeling awful is more difficult than you might think.
In my own experience, at 32, I've yet to find a method of contraception that gives me reassurance and peace of mind, yet doesn't make me feel generally crap. I've tried numerous different varieties of the Pill over the years but, eventually, all have ceased to suit. From extreme bloating to migraines, insomnia and anxiety issues, I'm now fearful of large doses of hormones entering my body on a near constant basis, whether in Pill , coil or injection form. However, I'm not prepared to simply rely on barrier methods either. And let's not forget – crisis pregnancies don't only happen to teenagers.
I'm not alone. "I came off the Pill three months ago as it was causing havoc in my everyday life," says Carol, 29. "My cycle was regular as clockwork, but for at least 10 days every month, my stomach would swell up two sizes larger than my regular shape – for a third of the month, I'd be wearing size 16 jeans rather than my normal size 12, meaning I had two wardrobes, and a major pain in the bum with it all. I also had headaches, ferocious mood swings and sore breasts and, in all honesty, was a nightmare for my husband to live with. However, we aren't planning on having a family any time soon and I just don't feel comfortable relying on condoms. They've broken on me too many times before, resulting in me taking the morning after pill. If that's going to happen, I may as well be on the everyday Pill!"
There are urban myths that you shouldn't take the Pill over 30, but it's fine if you don't smoke and have normal blook pressure. It appears there is something of a grey area if knowledge surrounding thirty-somethings (and older) who don't want to have a baby, but are perhaps worried about long-term methods affecting fertility.
There appear to be many options and lots of information available, but the fact of the matter is that, when it comes to contraception, it's a case of trial and error. Doctors can make suggestions on what might suit you based on past experiences, but our bodies are changing all the time and what might have worked five years ago may not now.
It sounds simple on paper – give something a go and see how you get on. But when the reality is extended battles with PMS, lack of sleep, hormonal acne and headaches, all when you're trying to live your already crowded, busy life, it can be incredibly stressful.
With that in mind, we've asked the experts and broken it down – instead of a scientific overview of what's available, we found out what is advisable for those who've been having issues, and what effects they'll have (if any) on the long-term ability to conceive.
There are 16 different brands on the market, each containing a different ratio of hormones. Dr Shirley McQuade, Medical Director at the Well Woman Centre, says most women rely on recommendations from friends rather than medical advice: "I always ask my patients if they have a brand in mind because, most often, they'll have talked to friends about what they are using and what the side effects are. All oral contraceptives are now so similar so there's not much difference between them anyway."
According to research from the HSE, six out of 10 Irish adults have concerns about how safe it is to use the contraceptive pill over a long period of time. Unless you're over 35 and/or a smoker, these fears may well be unfounded. But if, like me, you feel the brand you are on is having an adverse reaction, it might be wise to try another variety, or take a break and rely on barrier methods like condoms.
Other methods like the implant and the progesterone only Mini Pill have been deemed safe for those who can't take an oestrogen-heavy contraception like the Pill, and are worth talking to your doctor about.
You've probably heard the horror stories about punctured wombs, but internal methods of contraception are gaining popularity in women in their 30s and Dr Henchion, Medical Director at Irish Family Planning Association, has seen a huge increase in younger women coming to the clinic requesting them. She explains: "Periods become lighter and in some cases disappear and, as they are inserted for five to 10 years, they offer a safe long-term solution to someone who knows they don't want to conceive in the foreseeable future."
These long-term methods are popular with women in their 30s and 40s because they don't have to remember to take something every day, and can largely forget about their presence. They're expensive, around €150, so suit those with more stable income.
Don't fancy something being implanted in your uterus? Try the implant which is put into your arm and is suitable for those who can't tolerate a lot of oestrogen.
If needles make you squeamish, the injection probably isn't the contraceptive for you, but Dr Henchion says many women who try it feel it makes the least amount of impact on their mood.
Another good choice in terms of oestrogen sensitivity and for those over 35, but be warned – if you suffer bad side effects, they aren't quickly reversible, and the injection can also decrease bone density, according to information compiled by the HSE Crisis Pregnancy Programme.
The ring and patch
Dr McQuade says both the vaginal ring and patch are gaining popularity and she's seeing increasing numbers of women requesting them: "They're extremely popular with cabin crew, nurses and women who do shift work because you don't have to keep track of when you are taking your contraception. Plus, with the vaginal ring there are less nuisance side effects like breast tenderness and headaches."
However, it may be possible to feel the ring when having sex, and it can come out – could that be the biggest passion killer of them all?
Condoms and the diaphragm are two of the oldest methods of contraception but are the least popular, according to Dr Henchion: "There's still a stigma attached to condoms and many women won't carry them." Twenty-four per cent of adults surveyed by the HSE attested that women who carry condoms may seem "easy" – perhaps ridiculous in this era?
If you both have a clean bill of sexual health, you may be very reluctant to wholly rely upon condoms.
Many couples worry about these seemingly more old fashioned methods not working due to delicacy or incorrect use, and that worry alone can dampen the mood. Still, condoms in particular are becoming more sophisticated – will we ever get over the fear of them breaking, or feeling like we're 19 again, even in a long-term relationship? And what happens if you get stuck without one?
Not ideal of course, but perhaps the safest method if you're worried about your hormonal function.
Natural birth control is gaining popularity and a small percentage of women are now using ovulation charts and devices like Persona to plan and prevent pregnancy. However, Dr McQuade warns this is only suitable for women who have regular menstrual cycles. Dr Henchion believes that, without the use of an ovulation device, it's actually an unsafe option. "Studies have found that ovulation occurs at different times of the month, even for a woman with a regular 28-day cycle, so there's no way to calculate safe days," she explains. Since the start of the recession, both Dr Henchion and Dr McQuade have seen an increase in the number of women coming to them for emergency contraception because they are practising the withdrawal method.
Over to him
We know what the options are for women, but what about men in long-term relationships? Surely in 2014 the onus is as much on the man to prevent pregnancy, but what can be done? and is the mythical male Pill a goer for an Irish bloke? Doug Whelan weighs in ...
For most Irish men, the various methods of contraception available to women are topics we only engage with in passing. It's mostly the business of her and her doctor. But when you're in a long-term relationship, you begin to learn what a complicated and impactful choice it is for your partner, and you begin to wonder why indeed the entire weight of responsibility is placed on the female.
All men have ever had to deal with is condoms. It's a binary system: wearing one is safe, not wearing one is not. Hormones and medical history don't come in to it.
I can understand the stigma that exists; if a girl is carrying condoms on a night out, does that mean she's promiscuous? No, it means she's conscientious.
Besides, it's her business. She's hardly going to go around the nightclub using "I've got condoms" as a chat up line.
The male contraceptive pill is an interesting development on the horizon. We're all eager to show commitment to equality, but if it has taken us decades to get to the point of it existing, how long will it be before society recognises the male pill as a reliable option? Be it on a one-night stand or in a committed relationship, what woman would hear a man say, "It's OK, I'm on the Pill" and be fully comfortable that contraception is dealt with?
The onus should not be on the woman alone but, after a lifetime of being told it's her responsibility, would she be willing and able to relinquish that responsibility?
We're going to find out one way or the other, but the male pill is not a solution when it comes to preventing unwanted pregnancy; just another on the ever growing list of possible options.
First published in INSIDER Magazine, exclusive to Thursday's Irish Independent