In 1960, the pill was a revolution. The scientists Gregory Pincus and Carl Djerassi realized the research which at the beginning of the 20th century began with animal experiments. "Anovlar" was the first pill in the German speaking world.
Despite of headwind by doctors and the church (papal decree of 1968) the pill became prevalent as contraceptive. Today, 54% of all Austrians use the pill and worldwide the number of users is estimated at 60-80 millions. [1] [2]
Since then, several new hormonal contraceptives such as injection, vaginal ring, hormone rod, loop and patch have appeared. They differ in user friendliness, reach, price, certainty and side effects.
As to modes of action, the two most important hormones, estrogen and gestagen are used separately or combined. They suppress ovulation and prevent that an ovum settles down in the uterus. [3] Additionally, gestagen can block the cervix by means of a mucus plug in order to prevent sperm from reaching the uterus. [4]
Advantages: hormonal contraceptives are that they are secure and easy to use. Pill and patch enable women to regulate their menstrual cycle. Additionally, menstruation is often weaker and more regular and complexion is better. [3] [4]
Disadvantages: possible thromboses, stroke, gain in weight, reduced libido, acne, depression, increased cancer risk, sickness and headache make the pill less attractive. These side effects vary according to hormones, type of application and depending on the woman. However, it's always an interference with the natural hormone balance. [REPRODUCTION] [4] [5]
Fun fact: according to a survey, strippers gain most during their fertile days. In case they take hormonal contraceptives, on average they earn $ 80 less each shift. ($ 193 with pill versus $ 276 without) [6]
Protection: hormonal contraceptives is quite high when used correctly. Misuse like oblivion of intake or change of patch etc. can increase the rate of unwanted pregnancies. [2]
Hormonal contraceptives are not a protection against venereal diseases. [4]
Pearl index*: 0.05-0.3; in case of misuse up to 8.
Pill
The combined oral contraceptive pill consists of estrogen and gestagen and is ingested on a daily basis during 21 days. In the following 7 days of intermittence, menstruation sets in. Instead, the minipill contains only gestagen but the time slot of intake is a lot shorter (plus/minus 3 hours for minipill versus plus/minus 12 hours for normal pill). [4] [7]
Reach: entire body
Pearl index*: 0.3 [2]
Costs in Austria: 7-15€ per month [7]
Hormone spiral
From the outside this spiral looks like a copper IUD [INTRAUTERINE DEVICES]. It's provided with a cylinder which emits gestagen. The hormona spiral is very safe and is used during 5 years. 9% of all Austrians use this contraception. [2]
Reach: uterus and cervix
Pearl index*: 0.2 [2]
Costs in Austria: 400-500€ per 5 years [8]
Vaginal ring
This is a flexbile plastic ring which is placed in the vagina and emits estrogen and gestagen. The ring remains in the vagina during 3 weeks and is taken out for the following 7 days when menstruation sets in. In case the ring slips out of the vagina, it can be replaced within 3 hours without any problems. It can cause irritations in the vagina. [4] [9]
Reach: vagina, cervix, uterus
Pearl index*: 0.3 [2]
Costs in Austria: 19€ per month [9]
Hormone rod/Implanon
A hormone-carrying plastic rod (4 cm long and 2mm thick) is inserted under the skin of the upper arm and remains there for up to 3 years. It's not visible but palpable from the outside. [4] [10]
Reach: entire body
Pearl index*: 0.05 [2]
Costs in Austria: 300-400€ per 3 years [10]
3-month injection
Within the first 5 days of menstruation a gestagen injection is given by a doctor. This procedure is repeated every three months. The disadvantage is a disturbed cycle, since menstruation is absent during the first 4 to 8 weeks. [4]
Reach: entire body
Pearl index*: 0.3 [2]
Costs in Austria: 30€ per 3 months [11]
Contraceptive patch
This transdermal patch (4.5 x 4.5 cm) is applied to the skin which releases estrogen and gestagen hormones into the bloodstream. The patch has to be changed every week and after the third time menstruation sets in during the break. It can be placed on the belly, abdomen, back or upper arms. [12] However, the breasts should be omitted since the tissue reacts in a very sensitive way on sex hormones. [13]
Reach: entire body
Pearl index*: 0.3 [2]
Costs in Austria: 50€ per 3 months [12]
*The Pearl index (PI) is used as a statistical estimation of the number of unintended pregnancies in 100 woman-years of exposure. A PI of 85 or 90 corresponds to no birth control methods used. A lower Pearl index represents a lower chance of getting pregnant. The Pearl Index can change depending on studies and observations. [14]