Written by Vivian
I read a facebook post where the creator of the post – a married woman – was talking about the different contraceptive methods she has tried using after having her last child and how none of them seemed to work for her body. In the post, the woman talked about using Implanon — a kind of implant — and complained about experiencing severe heartache and spine pain. The comments that followed were mostly from women who agreed with her and it looked like the Implanon was a common enemy. The complaints ranged from weight gain, irregular and longer periods, painful cramps, continuous spotting, bleeding after sex, hyperpigmentation, etc. One particular woman complained of slumping and someone replied under the comment that the same happened to their sister but unfortunately, she died. With the Intrauterine Device (IUD), there weren’t many complaints. Most of the commentators agreed that it was good but the downside is the constant infections you get from using it. One thing that stood out for me in the comment section was women insisting on men using contraceptives too, so that the heavy load of avoiding pregnancy won’t be on women alone.
Wikipedia defined birth control (also known as contraception, anti-conception, and fertility control) as the use of methods or devices to prevent unintended pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century. Planning, making available, and using human birth control is called family planning.
There are different birth control methods but for this article, I will be discussing popular long-term birth control methods – implants, Intrauterine Device (IUD), pills, and for men, vasectomy.
Implant
Also known as a contraceptive implant, is a tiny, thin rod about the size of a matchstick that’s inserted into your arm. The implant releases hormones into your body that prevent you from getting pregnant and can last up to 2-5 years. The good news is that it isn’t permanent, you can remove it anytime or when you decide to have a child and you’ll still be able to get pregnant quickly.
Intrauterine Device (IUD)
The IUD is a small piece of flexible plastic shaped like a T inserted in the uterus through the vagina. The IUD prevents pregnancy by changing the way sperm cells move so they can’t get to an egg. One of the good sides of the IUD is it can serve as an emergency contraceptive, too. This works when you have unprotected sex while ovulating. It’s effective within 5 days of unprotected sex. There are 5 types of IUDs and they are divided into hormonal and non-hormonal. For the hormonal, there are Mirena, Kyleena, Liletta, and Skyla. These hormonal IUDs use progestin to prevent pregnancy. Mirena and Liletta last up to 8 years, Kyleena for 5 years and Skyla for 3 years.
For the non-hormonal type, which is also known as copper, there’s only one called Paragard. This IUD is wrapped in copper which repulses the sperm, thereby making it impossible for the sperm to get to the egg. The Paragard IUD is effective for up to 12 years.
Birth Control Pills
Birth control pills are medicines you take everyday — 1 pill a day — to prevent pregnancy. The pills contain hormones that help with the prevention of pregnancy. Aside from preventing pregnancy, the pills also help reduce heavy menstrual cramps. The birth control pills have two types: the combination pills and the progestin-only pills.
Vasectomy
This is also called male sterilisation. Planned Parenthood referred to it as a simple surgery done by a doctor in an office, hospital, or clinic. The small tubes in your scrotum that carry sperm are cut or blocked off, so sperm can’t leave your body and cause pregnancy. The procedure is very quick, and you can go home the same day. And it’s extremely effective at preventing pregnancy— almost 100%.
There are other long-term contraceptive methods that I didn’t mention like the vaginal ring, sterilisation, etc. Here’s a twitter thread about them.
I started using the IUD in January 2022 after I had unprotected sex while I was ovulating. I used an emergency contraceptive pill immediately but that was after I discovered from a friend who works in a reproductive health centre, that emergency contraceptive pills are ineffective when ovulating. This friend advised me to get the copper IUD as it’s the only contraceptive — including the Mirena and Liletta IUDs — that can stop the sperm from fertilising the egg as long as it’s done within 5 days of unprotected sex. It worked, and I didn’t get pregnant (even though sometimes, I like to think I’m infertile). Being on the IUD has been a journey so far. Sometimes I love it; sometimes I hate it. When I first got it, my period became light and short and my cramps became mild. After six months, it started to show its real colour. My period became irregular; last August, I spotted everyday till my period came in September. It was as if the spotting marked the beginning of a new phase; a phase I dreaded. My cramps went back to being painful and I started feeling nauseous again during my period. My period remains short but I still bleed heavily on the first days.
I was considering switching to an implant but when I came across the facebook post, I changed my mind. I have decided to continue using the copper IUD. I feel it’ll eventually get used to my body.
In Nigeria, contraceptives, especially long-term ones, are frowned upon. Contraceptives are believed to cause infertility in women and so women are advised against it. According to Wikipedia, “some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable”. But I spoke to these 6 women who shared with me their experiences and journey with long-term contraceptive methods.
Juliet Nnaji, a writer and a poet, spoke to me about her experience with the implant. She told me she has been using the implant for almost 3 years. She shared with me how at first, she was menstruating non-stop and would spot for days after her period. She also told me about the effects the hormones from the implant had on her body. “It also affected my hormones because I had a breast cancer scare. I think I saw, like a kind of lump. I went for a screening and it was nothing to be scared of. Right now, water is coming out of my breasts and I have gone to the hospital to find out why, and I am being told that I have a lot of progesterone which is causing the water in my breasts”, she said. She added that her periods are now regulated and her cramps have reduced but she’s considering switching to the hormonal IUD.
Similar to that of Juliet, Yinka walked me through her journey of using an implant. Yinka told me she has been using the implant for more than 3 years and is currently on the second one. I asked her about the pros and cons of the implant. In her words, “the pros include not getting pregnant. I don’t have to worry about anything beyond remembering to replace it every 3 years. In the beginning, I stopped having periods which was amazing. After about 3 months, they came back but were pretty irregular. For the cons, my skin became really oily and I started breaking out which I never had in the past. So I’m on my second implant and when I got towards the end of the first one — middle of year 2 — I started having longer periods of bleeding and heavier periods — 10-12 days — as well as residual spotting.”
Going back to the Implanon, Chidinma told me how she had it for 2 years but removed it in 2021. She shared with me how the implant helped her with her weight gain journey as she was under 50kg before she had the implant. She also said she didn’t have to worry about her period for a while. Talking about the downsides of the Implanon, she said, “the hormones messed with my moods and emotions. I had recurrent yeast infections that the doctors did not link to the Implanon until I did my own research and stumbled on a chat site. I had to put myself on a diet to regulate my hormones. At some point, I got scared that it might affect my ability to have kids later, plus my periods were not regular before then. My partner also moved out of town so I took it out so my body could heal.” When asked how long it took her body to heal, she replied by saying, “It took almost a year to get back my regular periods.” She further added that she might have some inherent hormonal issues that were exacerbated by the Implanon and will not be using any hormonal contraceptives again.
I was also able to talk to Funmi, who has been using the hormonal IUD for a year and is considering taking it out. She told me she liked it at first because it made her period short and light, unlike before when she used to have heavy clumps on the first and second day of her period. It also reduced her cramps, although she said she gets random cramps on some days. But she said as time went on, the spotting became non-stop. “As I’m talking to you right now, I have been spotting since 22nd of February and on the 20th of March, I didn’t see anything so I was glad that it had stopped. That’s already a month. And then 22nd of March, I started spotting again. It just gave me a break of two days, like I can’t go a day without wearing a tampon or pad or pantyliner”, she said. When asked about the effect of the hormones on her mental health, she opened up to me about her struggle with depression since she started using the IUD. “Like in 30 days, I think I might have less than 5 days that I’m normal, happy, I want to get up and get things done.” She ended by telling me she hasn’t had unprotected sex since she started using the IUD, so she can’t tell if it’s 100% safe from pregnancy.
For Ms Nneka, she’s currently using a copper IUD which she started in 2021. From our discussion, she told me it increased the length of her period and made her cramps worse but she likes the safety it brings. She also opened up to me about having issues the first time she started using it because it wasn’t inserted properly. To probe further, I asked what her experience was like with the gynaecologist. She replied saying, “the first gynaecologist did it terribly. The string was almost coming out of my vagina. I went to a government hospital to have it re-inserted. They had experienced gynaecologists and since it was re-inserted, I have not had any issue.”
Adanna has been using the pills on and off since 2016. She opened up to me about her reasons for using it, “I started because I was dating someone and just needed an extra ‘no babies sticking here’ layer to our sex life.” Speaking on her journey with using the pills, she said, “It took a while to find one that works for me personally, but presently I’m on Meuri and I’m happy with it. But I found it’s also great for my cycle. I have a very irregular cycle and as I’ve aged it’s gotten more sporadic. With some months having a heavy flow and very painful cramps and some just being a drop or two over 3 days. Prior to finding this particular one, I had instances where I stopped because I’d feel off — mentally depressed, nauseous for months, physically unwell — which was why I’d go off the pill and allow my body to cleanse and filter out the hormones for a few months. I’ve only ever used the pill. I prefer it because it’s not ‘permanent’ so to speak, and it’s fairly easy to find one that suits me. The idea of an IUD or injection just seems too commital to me and I prefer to have the choice of ‘breaking up’ with my contraceptive if need be. Also I’m a B Cup and the pill makes my boobs look great so I love that for me.”
