The misconceptions and facts every woman needs to know about contraceptives

Navigating the world of family planning can feel like a maze. This article sheds light on common concerns women raise during consultations, tackling frequently asked questions with straightforward answers.

It often feels like the weight of family planning rests on women's shoulders. Are there really no other options for men besides condoms and vasectomy?

This is a common frustration, and the truth is, options for men remain limited. Beyond condoms, vasectomy (which is permanent), and withdrawal, reliable male contraceptives are still largely in the research phase.

Also read: For Kilifi women, family planning requires a husband’s permission

While hormonal pills, gels, or reversible procedures are being studied and show promise, they aren't widely available yet. Biologically, it is more complex to safely suppress the daily production of millions of sperm compared to a woman’s monthly egg release. So, for now, the burden does often feel female-centered.

 Why aren't female condoms as common as male condoms?

Female condoms are effective for both pregnancy and sexually transmitted infections (STI) prevention, but several factors limit their popularity. Male condoms are far more accessible, easier to find, and typically less expensive. Additionally, widespread use has made people more familiar and comfortable with male condoms, whereas female condoms require practice with insertion and can feel different.

Intrauterine contraceptive device (IUD) insertion can be pretty uncomfortable. Why don’t we usually get anesthesia or stronger painkillers?

You’re not alone — many women experience significant discomfort. The procedure is often described as quick, lasting only a few minutes, with pain likened to strong menstrual cramps that pass rapidly. While this may be true for some, others find it excruciating. Because it is so brief, many clinics don’t offer local anesthesia. Sometimes, the numbing injection itself can be more painful and time-consuming than the insertion. Some women manage with oral painkillers like ibuprofen taken beforehand. It’s definitely worth discussing pain management with your doctor, especially if you have a low pain threshold.

Does my partner need to agree for me to get my tubes tied (Bilateral Tubal Ligation-BTL)?

 Legally and ethically, the decision is yours alone. Your partner's consent is not required. However, doctors often encourage couples to discuss it as it is a permanent decision that affects both partners. Open communication can help avoid future conflict.

Are there any serious long-term side effects of getting my tubes tied?

Tubal ligation is generally very safe. Long term, your periods should remain the same, and it does not cause early menopause or affect sexual desire. The key things to remember are that reversal is difficult and often unsuccessful, so it is best for those who have completed their family. Also, there is a rare chance of ectopic pregnancy if conception does occur, which requires urgent medical attention.

Which is the ‘best’ family planning method for me?

There is no one-size-fits-all answer. The best method suits your life, health, and reproductive goals. Because options affect people differently, you cannot rely on others’ experiences. Unfortunately, there is no way to predict how a method will affect you beforehand; it can take some trial and error. Your doctor is the best person to help explore safe options based on your health profile and preferences.

Are contraceptives generally safe?

For most women, yes. They have been extensively studied, and the benefits of preventing unplanned pregnancies usually outweigh the small risks. Your doctor plays a crucial role in selecting the safest method by considering your medical history and lifestyle. It is not something a quick online search can determine.

Can using contraception lead to infertility or problems conceiving later?

No, contraceptives generally do not cause permanent infertility. Fertility usually returns relatively quickly after stopping most methods. Some methods, like certain injections, might delay fertility for a few months, but they don't damage your long-term ability to conceive. If you have trouble conceiving afterward, it's best to consult a doctor to explore other potential causes.

Do contraceptives increase my risk of developing cancer?

It's a valid concern, but most contraceptives are safe. In fact, some can reduce the risk of certain cancers, like ovarian and endometrial cancer. There is a very small increased risk for some other cancers in women who already have risk factors, but overall, the benefits for most users outweigh the risks. Your doctor can help assess your personal situation.

Can I use emergency contraceptive pills (like P2) often? What happens if I do?

Emergency pills are for occasional use only, not as a regular method. Using them frequently can disrupt your cycle, leading to irregular or heavier periods, temporary hormonal imbalances, and reduced effectiveness if used repeatedly within the same cycle. They don't cause infertility, but for consistent protection, a regular method is the way to go.

What about monthly herbal contraceptive pills, like Sophia?

There is no strong scientific evidence that they are reliable or safe for preventing pregnancy. They can have unpredictable effectiveness, potentially interfere with hormones, and carry risks of unknown side effects, including damage to the liver or other organs.

Also read: When love meets planning: The case for shared parenthood decisions

For reliable pregnancy prevention, it's best to stick to well-studied methods. Herbal does not always mean safe.

Which birth control methods are best after having a baby?

If you're breastfeeding, avoid estrogen-containing pills early on as they can impact milk supply and increase blood clot risk. Progestin-only pills, implants, IUDs (hormonal or copper), and injections are usually safe choices. Your doctor will guide you based on your health and breastfeeding status.

If my periods stop while I'm on birth control, where does the blood go?

It doesn't accumulate anywhere. Hormonal methods simply thin the uterine lining so there's little or no blood to shed. It's completely safe and doesn't harm your uterus or future fertility.

Can I get pregnant even if I'm using contraception?

No method is 100 per cent effective, but some are highly reliable. Implants and IUDs are over 99 per cent effective. Methods that require daily attention like pills, condoms, and patches are more likely to fail due to inconsistent use.

Do contraceptives affect my sex drive?

For most women, there's no noticeable change. Some may experience a slight increase or decrease, but libido is influenced by many factors such as stress, relationships, and health, not just contraception. If concerned, discuss it with your doctor.

 How soon after stopping contraception can I get pregnant?

It depends on the method. With pills, implants, and IUDs, fertility usually returns immediately. Injections like Depo-Provera can sometimes take months (up to 18) to resume. If you experience long delays, seek medical advice.

Do contraceptives protect against STIs?

Most don't. Only condoms offer protection against infections like HIV, gonorrhea, and chlamydia. For dual protection, use condoms alongside another contraceptive method.

Will I gain weight from contraceptives? Can they help me lose weight?

Most contraceptives have minimal impact on weight. Injectables like Depo-Provera are an exception. Some women may gain a few kilos. No method is proven to cause weight loss. If weight is a concern, talk to your doctor about switching methods or focusing on lifestyle.

Can contraception be used for health benefits other than preventing pregnancy?

Absolutely. Contraceptives are often prescribed for medical reasons. They can help with heavy or painful periods, manage endometriosis, improve acne and Polycystic Ovarian Syndrome symptoms by regulating hormones, and even reduce menstrual migraines. Your doctor may consider these added benefits when choosing a method for you.

How long can I safely use contraception?

Most methods are safe for long-term use, provided they remain appropriate for your health. Regular check-ins with your doctor are important to monitor blood pressure and other conditions that may emerge over time. An exception is the Depo-Provera injection, which is generally recommended for breaks after five 
years of continuous use due to potential bone density changes.

 I'm interested in permanent contraception (like BTL), but I'm young. What's the process?

In Kenya, the age of consent is 18. For permanent methods, doctors prioritise ensuring you fully understand that the decision is irreversible. Research shows regret is more common in younger women or those without children. Thorough counselling about long-term consequences and discussing reversible long-acting options is key. If, after careful counselling, you still wish to proceed, it can be done. Sometimes, involving a counsellor or psychiatrist helps ensure the decision isn't influenced by temporary situations or trauma.

Dr Okemo is a consultant obstetrician/gynaecologist at Aga Khan University Hospital, Nairobi