Table 3 The frequent methods for contraception [38,39,40]

Hormonal methods

Implant

The implant is a progestin-coated silicone rod that is implanted in the woman’s upper arm by the medical professional. The progesterone in the silicone rod being released slowly prevents normal ovulation and thickens the mucus at the entrance to the uterus so that sperm cannot pass through

The implant has a high contraceptive efficiency for up to 3 years. It does not disturb sexual life during this period and allows a rapid recovery of fertility after removal. However, its earlier use may cause a reduction in menstrual blood flow or even amenorrhoea, as well as a localized sensation of abnormality on insertion, which requires professional handling. Caution should be taken in patients with severe liver disease and those at risk of blood clots

Patch

The patch is attached to the lower abdomen, buttocks, or upper body, where the oestrogen and progesterone are absorbed into the body through the skin, inhibiting the production of FSH and LH, thus preventing normal ovulation as well as thickening the mucus secreted at the entrance to the uterus, thus making it more difficult for sperm to pass

Compared to the implant, the patch is easy to operate and does not require professional assistance, while the fertility is recovered more quickly. Performed once a week, but with a lower contraceptive efficiency

Injector

The synthetic depot medroxyprogesterone acetate (DMPA) is used to achieve contraception by intramuscular injection, preventing normal ovulation as well as thickening the mucus secreted at the entrance to the uterus, thus making it more difficult for sperm to pass

DMPA has a remarkable contraceptive efficacy and can be administered to relieve menstrual pain and prevent diseases such as ovarian and endometrial cancers. However, patients need to be injected every three months and may experience progesterone-like symptoms with initial use. Secondly, the recovery of fertility needs to wait for 18 months after stopping use. Caution should be taken in patients at risk of blood clots

Progestin-only pill

The progestogen-only pill contains the hormone progesterone, which thickens the mucus at the entrance to the uterus and alters the endometrium, preventing the entry of sperm into the uterus and fertilization

The progestogen-only pill is suitable for most women, but needs to be taken every day and may cause progestogen-like symptoms on initial use

Combined oral contraceptives

The combination of estrogen and progestin administered orally can prevent normal ovulation and also makes the mucus secretion from the uterine entrance sticky, more difficult for sperm to pass through

The contraceptive is highly effective when taken correctly and the combined oral administration for suitable age up to 50 years old facilitates to reduce painful menstrual periods. However, the initial use may cause strong progestin-like symptoms, e.g., breast tenderness, weight gain, reduced libido, especially in patients at risk of blood clots

Vaginal ring

The vaginal ring is a plastic drug delivery platform for estrogen and progesterone that is placed in the vagina. The vaginal wall absorbs the released hormones, thereby inhibiting ovulation and controlling menstruation

The contraceptive effect may be not immediate and the ring is not easily fixed in the vagina, Besides, the pregnant and patients at risk of blood clots should be cautious to use it

Intrauterine contraception

Hormonal-IUD

The IUD is divided into hormonal-IUD and Cu-IUD. Hormonal-IUD consists of plastic and progestin (e.g. LNG), which is slowly released after it is inserted into the uterus by the medical professional. Hormones can thicken the mucus entering the uterine mouth, prevent sperm from passing through, and thin the uterine wall, making it difficult for fertilized eggs to implant. Copper IUD consists of plastic and copper. Copper is toxic to sperm and changes endometrium, making it difficult for fertilized eggs to implant

The IUD provides good contraceptive effectiveness, which can be effective for 5 to 10 years. The administration has no effect on normal sexual life and the rapid recovery of fertility after removal can be achieved. However, the initial use of the device may cause side effects such as menstrual pain, irregular bleeding, and breast pain

Cu-IUD

Barrier methods

Condom

The condom works as a physical barrier, worn on the penis or inserted into the vagina during sex, preventing body fluids from passing

It works well when used correctly and can prevent the spread of sexually transmitted diseases. Improper use or condom breakage can lead to unwanted pregnancy, and latex has allergic potential

Spermicide

Spermicide in various forms (e.g. foam, gel, cream, film, suppository, or tablet) is placed in the vagina to kill sperm that are released into the vagina

Spermicide can be easily operated without significantly interrupting the sexual experience. However, it is poor contraceptive effectiveness

Fertility awareness

Fertility awareness refers to avoiding sexual intercourse during the time of the menstrual cycle when the woman is most fertile

No requirement for contraception during intercourse, but a higher rate of unwanted pregnancy than other methods

Withdrawal

The withdrawal refers to the removal of the penis from the vagina before ejaculation to prevent the release of sperm into the vagina

This method has a satisfying sexual experience, but has a higher rate of unwanted pregnancy because the male body fluid may still contain sperm before ejaculation

Lactational amenorrhea

A lactational amenorrhea method is a form of temporary contraception in which a woman who gives birth to the fetus does not have a menstrual period, meaning that ovulation does not occur

The method can be used only if three conditions are met: (1) less than 6 months after childbirth, (2) amenorrhea, and (3) fully breastfeeding

Sterilization

Tubal ligation

Sterilization is a medical treatment that permanently prevents pregnancy by blocking the pathway for ejaculation or sperm–egg binding through the vas deferens or tubal ligation

Sterilization provides permanent contraception with high safety and a low risk of unwanted pregnancy. However, it is relatively difficult or impossible to restore fertility after sterilization

Vasectomy