Battle of the birth control

Image: RNZ/Holly Davies.

Birth control. Needed, of course. But so inconvenient? Completely.

Because don’t you just love the personality-bending pills and excruciating IUD insertions with the world’s longest list of side effects? Seriously, with all this new tech coming out, surely someone out there can make a better alternative than what we’ve got. And when abstinence isn’t an option sometimes, there’s the big bad world of contraception waiting for you.

And it’s not so great.

Side effects of hormonal contraception like the pill can include negative mood changes, an increased risk of depression, weight gain, hair loss, migraines, missed periods and weirdly enough, even changes to your literal eyeballs. Long-term, it can slightly increase the risk for cardiovascular problems and cancer.

For many girls, the pill is their first experience with birth control, given its widespread availability.

Aspiring midwife and University of Otago student Caitlin van Miltenburg had been on the pill since she was 15 to combat her very irregular and heavy periods. Eventually she switched to a very strong pill called Ginet as her acne got worse.

“[The pill] was amazing at clearing up my skin but I didn’t realise that it made me gain heaps of weight, and I was constantly lethargic and exhausted needing to nap daily” she said.

That particular pill, Ginet, is a combination pill with both oestrogen and progestogen which is more common than progestogen-only pills. In most cases, it’s recommended to only be used for up to three months, but van Miltenburg ended up on it for two years.

On the more long-term, low-maintenance side of contraception, IUDs are pretty good alternatives. Depending on which IUD you get, they’re all valid for at least 3 years and up to 12 for some. There’s two versions of IUDs - hormonal IUDs and copper IUDs. The former has similar side effects as the pill while the latter makes periods more irregular, heavier and includes harsher cramps. Both have the infamously painful insertion which results in up to a week or more of cramping.

Of course, there’s horror stories all over TikTok about IUD insertions with one user, Holly Smallwood, experiencing labour contractions and dilation when her doctor placed the IUD on a nerve. She described it as, “easily the worst pain” she's ever experience, and passed out multiple times before the IUD was extracted 45 minutes later.

But even while IUD insertions are generally extremely painful, the pain typically only lasts a week or so, and after that it’s good for a few years.

Van Miltenburg switched from the pill to a Mirena IUD as, “it had much lower hormone levels to rebalance my body and didn’t require any of the admin of remembering to take the pill daily and renewing subscriptions.”

Having done mammoth amounts of research, she was “very, very scared of the pain people described,” but her experience was nothing like that.

“It’s the best decision I made as it’s contraception without ever having to think about it and my heavy periods are completely gone for 5 whole years! No regrets and is definitely the best contraceptive method for me.”

Unfortunately, for a lot of contraception, the responsibility falls squarely on the females’ side of the relationship with the slight exception of condoms.

When asked about his thoughts on contraception, UC Student, James* said that condoms were fine. “I personally don’t get the whole ‘it doesn’t feel the same with it on,’ like just grow up and stop pressuring women to have unprotected sex” he said.

“I always wear them [condoms] no matter if the girl is on the pill or not, it’s just safer”.

Healthline states that low-maintenance forms of birth control like IUDs and implants are 99.9% effective compared to hormonal pills which are in theory 99% effective, but when typically used,  drop down to being between 91% and 93% effective. In terms of how reliable condoms are, “pretty much completely effective” is a bit of a reach, as Healthline believes condoms are only 86% effective with typical use, but with perfect use are 97% effective.

Methods of birth control outside of the pill, IUD or condoms are typically less common because of their lowered effectiveness. The UC Health Centre offers Depo-Provera shots as another contraception alternative, which is an injection that women receive every three months. Healthline says the shot is 94% effective with typical use, and of course, comes with those pesky hormonal side effects.

However, this option is fairly uncommon as the shot can temporarily affect fertility as it may take up to 18 months to get pregnant.

There are so many options out there but when contraception battles it out over who’s best, there’s no clear winner. No matter which one you choose, they’re all just a little bit shit.

*name has been changed for anonymity purposes