Hormonal and surgical methods

Hormones as a method

The monthly cycle of a woman is controlled by hormones. A method that gives hormones from outside can change the cycle. Such methods use progestogens (substances that act like progesterone) alone, or progestogens together with estrogens.

Oral contraceptives: the pills

NCERT describes the pills in this way.

• They contain a small amount of progestogen alone, or progestogen with estrogen.
• A woman takes one pill every day for 21 days, starting preferably within the first five days of the menstrual cycle.
• After a gap of 7 days, during which menstruation takes place, the same pattern is repeated, for as long as she wants to prevent a pregnancy.

How do the pills work?

• They prevent ovulation.
• They prevent implantation of an embryo.
• They change the cervical mucus, so that the entry of sperms is slowed or stopped.

Saheli is a pill of a different kind. It is non-steroidal, which means that it has no steroid hormone. It is a once a week pill with very few side effects, and it works well as a contraceptive. It was developed at the Central Drug Research Institute in Lucknow.

You should find that the pill days are days 1 to 21, and that the last 7 days of the pack have no pill.

Injectables and implants

Progestogens alone, or with estrogen, can also be given as injections, or as an implant placed under the skin. They act like the pills, but their effect lasts for a much longer time.

Emergency contraceptives

Sometimes a pregnancy must be avoided after unprotected coitus, for example after rape. A progestogen, or a progestogen with estrogen, or an IUD, can be used within 72 hours of coitus. These are called emergency contraceptives. They are for an emergency, not for regular use.

Surgical methods

Surgical methods are called sterilisation. They are meant for a partner who does not want any more children, so they are called terminal methods. The surgery blocks the path of the gametes.

• Vasectomy (male). A small part of each vas deferens is removed or tied, through a small cut on the scrotum. Sperms can no longer pass to the urethra. The testes still make hormones, and the male still ejaculates, but the semen has no sperms.
• Tubectomy (female). A small part of each fallopian tube is removed or tied, through a small cut in the abdomen or through the vagina. The ovum can no longer meet the sperms.

These methods are very effective. Their reversal is very poor, so a person must be sure before choosing them.

Side effects

Some users of hormonal methods have side effects, for example nausea, abdominal pain or irregular bleeding. Whether a method is right for a person is a matter for a qualified doctor. This is why the pills, the injections and the IUDs are given under medical care.

Try it in Python

The program builds one pack of the pill and counts the days.

Practise with new numbers

Common mistakes

• Saying that the pill is taken for 28 days. The pills are taken for 21 days. Then there is a gap of 7 days.
• Saying that menstruation takes place while the pills are taken. It takes place in the gap.
• Saying that the pill only stops ovulation. It also stops implantation and changes the cervical mucus.
• Mixing up vasectomy and tubectomy. Vasectomy is the male method and cuts the vas deferens. Tubectomy is the female method and cuts the fallopian tubes.
• Saying that sterilisation is easy to reverse. NCERT says that reversibility is very poor.
• Saying that emergency contraceptives are used within a week. The window in NCERT is 72 hours.

Remember these

• Pills: progestogen alone, or progestogen with estrogen. One a day for 21 days, a gap of 7 days. They prevent ovulation and implantation, and change the cervical mucus.
• Saheli: a non-steroidal pill taken once a week.
• Injections and implants: progestogen alone or with estrogen, with an effect that lasts much longer.
• Emergency contraceptives: within 72 hours of coitus.
• Vasectomy: vas deferens, cut on the scrotum. Tubectomy: fallopian tubes, cut in the abdomen or through the vagina. Reversal is poor.

Check yourself

Try each one on your own first. If you are stuck, open a hint. Then check with Show the answer.

1. How are the pills taken, according to NCERT?

2. Give two ways in which the pills prevent a pregnancy.

3. What is special about Saheli?

4. Within how many hours of coitus can an emergency contraceptive be used?

5. Which part is cut in a vasectomy, and which part in a tubectomy?

References

• NCERT (2023). Biology, Textbook for Class XII, chapter 3, Reproductive Health.
• World Health Organization and Johns Hopkins Bloomberg School of Public Health (2018). Family Planning: A Global Handbook for Providers, 3rd edition, chapters on pills, injectables, implants, emergency contraception and sterilisation.