How does the contraceptive ring work? What to do if you forget your pill? Many questions surround contraception, especially when we discover our sexuality and that we have few people with whom to discuss these intimate questions. The supply of contraceptives has grown, concerns about hormones have grown. So, how do you choose the most suitable contraception?
On the occasion of the publication this thursday of SOS contraception *, a practical guide that reads like a comic book, 20 minutes asked his author,
Marie-Laure Brival, obstetrician-gynecologist and former head of the
Lilac maternity. She lists five prejudices to be overcome.
Contraception would make you infertile
“This is very wrong: by definition, contraception is reversible! », Storm Marie-Laure Brival. The gynecologist takes as proof the high number of pregnancies that occur after a single forgetting of the pill. And list three causes that would explain this still widespread cliché. “First, women can say to themselves ‘if it’s blocking my ovaries, it can have long-term consequences.’ Moreover, the professional body is not exempt from reproaches. For a long time, gynecologists have prescribed women to stop the pill so that their ovaries resume their normal functioning to avoid being infertile. “
Third reason: “when women decide to have a child, it should happen the following month. If it takes time, we have to find a cause, so it’s the pill. No: we must explain that it can take up to a year to get pregnant without it being a problem. “
The pill would be the most effective contraception
It is very safe in theory, much less in reality. Because of frequent forgetfulness (thinking every day about your pill at a fixed time for twenty years requires a certain discipline). “The three most effective contraceptives in practice are the implant (which delivers a microprogestogen and lasts three years), the hormone IUD, then the copper IUD, Marie-Laure Brival list. The pill is ultimately the least effective of effective contraception! “
This is why the gynecologist considers it necessary to think carefully and to dialogue before prescribing the pill to a teenage girl. “Some will take it very seriously,” she admits. But it is a period of instability, of refusal. Sexuality, often started in secret, complicates regular intake: some teens leave their pill with a friend… and this leads to losses and forgetfulness. However, 16 or 17 years old is an extremely fertile age! “.
Hormones could kill you
It is not just the pill that relies on chemistry: the implant, the ring, the patch will also release hormones to block the cycle. “This combination of synthetic hormones has side effects”, introduces the gynecologist. The most important is a higher risk of developing a venous thrombosis or of having clots in the arteries (stroke or infarction). A very low risk (and less than during pregnancy, for example). “Even close to zero when there is no contraindication and the prescription is well done”. On the other hand, we must not deny other effects. “We have always brushed aside the side effects on libido. The whole question is the risk / benefit balance. “
Marie-Laure Brival is moved to meet a youth “anti pill”, whereas it has long been synonymous with freedom for women. For the gynecologist, “the swing back is excessive, it is not a question of throwing it away! On the other hand, she is pleased that the High Authority for Health advised in 2012 to
prefer 1st and 2nd generation pills and no longer reimburses those of the 3rd and 4th generation, which are more dangerous.
The intrauterine device (IUD) would be dangerous and limited to mothers
Logically, with contraception without risk of forgetting for five to ten years and without hormones, one would expect to see a boom in demand for copper IUDs (or IUDs) in the realm of the pill. Especially since “with the green movement, women are asking more and more questions about chemistry,” adds the author. Gold, according to the barometer on French women and contraception, in 2016, 60% of women aged 15 to 19 used the pill. And only 4.7% of 20-24 year olds chose the copper IUD.
The latter makes a slight breakthrough among young women, “but the prejudices around the IUD are strong!” Regrets Marie-Laure Brival. However, the copper IUD is 99% effective. There are no more pregnancies [y compris extra-utérines] with the IUD than with the pill. »But for a long time, we heard that it was contraindicated, because this contraception increased the risk of infection… which could make sterile. And was therefore not recommended for women without children.
“There is no contraindication for adolescent girls, provided they are screened for STIs before the break,” reassures Marie-Laure Brival. This is the age when there are the most asymptomatic versions of the chlamydia. If this is the case, there is a risk of developing an infection in the tubes. But this danger lasts only for three weeks after the break. After that, the IUD does not increase the risk of infection. “
The gynecologist insists: the IUD is a contraception recommended from the moment the woman makes this choice. Which requires a little teaching from the doctor to present its operation and its contraindications: “intrauterine fibroids, severe period pain, irregular cycles where the patient cannot stand the IUD.” “
Contraception would be a women’s story
Society places the burden of contraception on women. “But historically, it was men who used the withdrawal, then the condom [inventé en 1855 !], nuance the gynecologist. Medical contraception has finally put men aside. “A trend that could fade with greater equality in the couple and the arrival on the market of male contraception? Not sure…
“The male pill exists and it works just like women. But at the moment, it seems out of the question for men to put up with the side effects. Especially since there is always a confusion between sexual potency and stopping the production of sperm. The fact remains that between heated briefs, vasectomy and hormones, the choice extends. “But it remains marginal,” recognizes Marie-Laure Brival. Who dares, in his book, a little call of the foot: “It is up to you, perhaps, ladies and gentlemen who read this guide, to shake things up! “
* “SOS contraception – The keys to understanding your body and choosing the right contraception”, by Marie-Laure Brival, First Editions, 12.95 euros.