As teenage pregnancies continue to rise, adolescent girls and young women (AGYW) need to know which contraceptive – oral or injectable – is best for them. This is despite a shortage of injectable contraceptives in the country, as revealed in the latest Stop Stockouts Survey.

In South Africa, two injectable contraceptives are on offer – Noristerat (a two-monthly regimen) and Depo-Provera (given every three months). 

These are the most widely used forms of birth control in the country.

Pros and cons: Oral vs injectable

Both have advantages and disadvantages. Dr Tim Berios, a private Obstetrician and Gynaecologist consulting at Netcare Umhlanga Medical Centre, explained the positives and negatives. 

“A gynaecologist might recommend Depo-Provera if you don’t want to take a birth control pill daily. Or want to avoid using oestrogen and have health problems such as anaemia, seizures, sickle cell disease, endometriosis or uterine fibroids,” he said.

According to Berios, the benefits of Depo-Provera include:

• No daily action is required
• Less frequent menstrual cramps and less pain with menstrual blood flow and; 
• A smaller risk of endometrial cancer.

He however warned that Depo-Provera isn’t appropriate for everyone. 

Your gynaecologist might discourage the use of Depo-Provera if you have:

• Unexplained vaginal bleeding or breast cancer
• Liver disease
• Sensitivity to any component of Depo-Provera
• Risk factors for osteoporosis
• A history of depression and;
• A history of heart attacks or strokes.

Berios also said that after stopping Depo-Provera, it might take 10 months or more before you begin ovulating again. It also does not protect against sexually transmitted infections.

Noristerat similar to Depo-Provera

According to Berio, Noristerat is similar to Depo Provera when weighing up effectiveness, and the advantages and disadvantages.

The most commonly reported Noristerat side effects are:

• Spotting or breakthrough bleeding
• Delayed period
• Irregular or heavier bleeding
• Weight gain, headaches
• Dizziness and/or nausea and;
• Skin reactions (such as pain, rash and/or itching at the injection site).

Though the above is the most widely used form of contraception in South Africa, young adolescent girls still have some concerns about it.

Access barriers

Myths, misinformation and misperceptions also hurt injectable contraceptives as a choice.

According to a study on barriers to contraceptive use among AGYW, perceived side effects influence the choice of contraception.

A total of 19 focus group discussions with 185 AGYW aged 15–24 years living across five provinces in SA were conducted as part of the HERStory 1 Study. 

“Perceived side effects of modern contraceptives, especially injectable contraceptives, appear to be the major barrier to contraceptive access and use among AGYW”, the study stated.

Participants of the study shared some of their concerns about injectable contraceptives. The most common side effects described by AGYW included weight gain or weight loss, bleeding, absence of menstrual period, and body changes. 

“The injection damages you, and there are dangers associated with using contraceptives”,  said one participant.

“Both injections and tablets damage a person inside. You don’t get periods for some time and might not have for a few years,” another participant said. “Sometimes the injection comes out immediately, without you noticing, and then you become pregnant just like that.”

Switching contraceptives isn’t dangerous.

According to Dr Malika Patel, Head of the Reproductive Unit at the University of Cape Town (UCT), switching contraceptives is not dangerous.  

“It is when someone uses a contraceptive that is contra-indicated or not the most suited that it becomes dangerous”, she said.

For example, if there is a woman who tends to develop blood clots, she should not be on the combined oral contraceptive”, said Patel.

Patel also said that there are many factors that women need to consider before switching and finding a contraceptive that works for them. She said that when you want to switch contraceptives, you should speak to your healthcare provider to discuss issues you may have. 

Finding the right option

“They need to see how long they want to use contraception for (short term or long term).  

Patel said there are a few questions that need to be answered. They include: “Are they comfortable with taking a pill every day, or would they rather do an injection every two or three months? Would they opt for a method where the contraceptive is placed and removed when it has expired or when they want to conceive?”

She continued: “For example, the implant, once inserted, can last for three years. The copper intra-uterine device, on the other hand, can last for five years.”  

According to Patel, when you stop taking oral contraceptives, the natural cycle kicks in again. And if you were using them for purely contraceptive reasons, you will immediately resume fertility again. 

Making the switch

“If a contraceptive is not working for you, you should speak to your healthcare provider, and you can stop or switch whenever you want to,” said Patel.

However, it is not advisable to stop and start combined oral contraceptives at short intervals.  

Patel also said that if a woman or adolescent girl wants to switch more than once, it depends on how long they have been on the current contraceptive. 

When it comes to the risk of pregnancy, Patel says that it is advisable to use condoms or barrier contraception for the first seven days since making the switch. 

Side effects

Side effects are a big concern for many adolescent girls and women who want to switch.

“The most common side effect is bleeding. There are some conditions where certain contraceptives are completely contra-indicated,” she said. 

If women have pre-existing conditions, they should speak to their healthcare provider and decide on the safest and most effective contraception. – Health-e News