Adapted from “New Dimensions in Women’s Health” by Linda Lewis Alexander & Judith H. LaRosa
Many factors enter into the contraceptive decision-making process. These factors include fertility awareness and an understanding of risks, benefits, and complications associated with contraceptive methods.
An understanding of the female menstrual cycle is essential as foundation for understanding contraceptive issues. In addition to facilitating decision making about contraceptives, knowing when she is fertile helps a woman when conception is desired, and knowing her body facilitates the recognition of any abnormal reproductive health changes that may be present.
One of the most important changes during the menstrual cycle is the fluctuation of various hormones from the anterior pituitary and the ovaries. The cyclical variations in these hormones are reflected in the biological alterations throughout the cycle. Some of the changes that occur as a result of these cyclical hormones are fluctuations in basal temperature patterns and variations in the type of cervical mucus produced. Many women are able to relate these manifestations to their fertility cycles. Methods of fertility awareness include the calendar method, basal body temperature, and cervical mucus or ovulation method. Some couples use the fertility awareness methods as contraceptive techniques, and others use them to time intercourse for pregnancy.
For a woman who absolutely does not wish to become pregnant, fertility awareness methods for contraception have inherent liabilities. The overall effectiveness of these methods will perhaps improve as technological advances evolve and have greater ovulation predictability. Timing of ovulation is not the only critical dimension of fertility awareness. Because sperm are able to survive 48 to 72 hours in the female reproductive tract, intercourse before ovulation is not necessarily free from pregnancy risk.
Women are concerned about the risks to their health that result from using contraceptives. Some experts argue that a comparison of the relative safety of different contraceptives must include a consideration of the risk of illness or death associated with any unplanned pregnancies that occur when a contraceptive method fails. Risks may be direct, as in possible circulatory disorders associated with birth control pills, or indirect, as in an unwanted pregnancy. Risks vary among the various methods. Condoms and other barrier forms of contraception are unlikely to carry any long-term risks to their users. A difficulty is assessing any long-term risk associated with some methods, such as birth control pills, is that they have been in the Untied States only since 1960, and thus a full generation of American women have not yet used them.
Just as there are risks associated with contraceptives, there are benefits associated with their use as well. The most obvious and direct benefit is protection from pregnancy. Birth control pills may actually protect users from ovarian cancer and cancer of the lining of the uterus. Barrier methods offer some protection from sexually transmitted diseases. In contraceptive decision making, the benefits and risks of any technique must be carefully considered within the individual unique needs of the couple making the decision.
A contraindication is a specific medical condition that renders a course of treatment inadvisable or unsafe that might otherwise be recommended. Possible contraindications for the birth control pill, for example, could be a history of thrombophlebitis (blood clots). The Food and Drug Administration (FDA) requires that birth control pill and IUD users receive an information packet that defines risks and benefits that can be expected.