THE GOAL OF CONTRACEPTION
The goal of contraception is to stop future pregnancies. ‘Failure of contraception’ simply means having babies whilst using regular contraception.
Vasectomy has the lowest failure rate. (Remember to continue contraception until you get the all-clear after your post vasectomy sample!).
All forms of contraception can fail, particularly condoms and the pill. 326 Australian women were interviewed about unexpected pregnancy in a 2018 study. Just 41% were using contraception at the time of the pregnancy, and of these:
- 64% were using the contraceptive pill
- 27% of couples were using condoms
- 9% were using ‘the rod’ (hormoneal device that is inserted in the upper arm)
CONTRACEPTION – YOUR CHOICES
Couples often chose vasectomy as their preferred choice of long term contraception for one of two reasons:
- Your female partner is experiencing side effects of hormonal contraception
- You want the lowest chances of another pregnancy
The following table gives an overview of the pros and cons of each form of contraception – including the failure rate.
|Risk of Pregnancy PER YEAR||Main Benefits||Main Risks||Issues|
|Combined Pill||9% per year (normal use)||Low Failure Rate, can reduce period bleeding, can have cycles back-to-back. Often Beneficial for conditions like acne or hirsutism.||Deep Vein Thrombosis & Cardiovascular Risk Factors to evaluate include Body mass index, Smoking, Migraine with aura, Family history, increasing age, high BP, Cholesterol, Diabetes, kidney disease etc.||Can forget to take the pill.|
|Progestogen Only Pill||9% per year (normal use)||Used as a 2nd line oral contraceptive when the combined pill is not recommended. No increased cardiovascular or thrombotic risks.||Australian licensed mini pills need to be taken in a 3 hour window each day.||The minipill is unforgiving when forgotten – failure rates are high.|
|Progestogen Injection||6% per year||No increased cardiovascular or thrombotic risks. Periods often disappear completely within 12 months.||Progestogenic side effects are usually manageable but women may sometimes report weight gain, mood or changes. Periods often erratic to start with.||3 monthly visits to your doctor & practice nurse to get the injection. Need a pregnancy test if late for your next injection.|
|Progestogen Implant (rod)||0.05% per year||Periods often disappear completely within 12 months.||Persistent bleeding beyond 6 months in around 15% of women may require the implant to be removed.||3 yearly implant in the inner side of the left upper arm.|
|Intrauterine Device – Mirena||0.2% per year||Periods usually disappear completely within 12 months – often good for heavy or painful periods.||Risk of uterine perforation is around 1 in 1000. Rarely infection or migration of the device.||5 yearly re-insertion. Few GPs currently provide this service & most women need a referral to a gynaecologist.|
|Condom, Cap, Ring||Condom 18% Cap 12%||Caps, Diaphgragm & Vaginal Ring.||no systemic risks. Higher rate of failure than many other methods of contraception.||Suits only a few women and couples – comes down to personal preference & guidance on use from a health practitioner.|
|Female Sterilisation||0.5% lifetime risk||Low failure rate at around 1 in 200||Higher failure rate & risks (surgical + Anaesthetic) than The Snip.||Day Case in a hospital.|
|Vasectomy||1 in 3000 lifetime (after test)||The lowest failure rate. Men can get involved!||Post vasectomy discomfort affects around 1 in 50 guys.||The most important thing is to continue contraception until you get the all-clear after the semen analysis.|