Contraception: Picking a Method That Works for You
We all had that one sex ed class in high school where we learned how to put a condom on a banana. As fond as our memories of that time may be, many of us have since found that our contraceptive needs have gotten a bit more sophisticated. Here to give you the lowdown on your options, including which methods are available in China and which you may need to go back home to get, is Beijing United Family Hospital (BJU) Chair of Obstetrics Dr. Dalice Marriott.
Contraception with Chinese characteristics
For a country that has taken birth control very seriously throughout its one-child policy era, China actually has more limited birth-control options than you might expect. This may be because of a lack of demand. Over her four years of practicing in China, Dr. Marriott’s has noticed that Chinese women can be reluctant to take the contraceptive pill because they have the impression that it will affect their fertility once they go off it. IUDs and other birth-control devices are also often treated with suspicion, as many women had them placed in the early one-child policy days and couldn’t have them removed.
So, if Chinese women aren’t using what we might consider conventional methods to prevent unwanted pregnancies, what are they doing? “Termination is very common,” says Dr. Marriott. “It’s not uncommon to see people who have had several terminations before they have a pregnancy.” She warns, however, that there are definite complications associated with multiple terminations. They’re also painful, both physically and emotionally, and take time out of your life that you could be spending more productively. Rather than leaving it up to chance and relying on terminations if you do fall pregnant, you might want to consider taking control of your own fertility and finding a reliable form of contraception that works for you.
Quality over quantity
In terms of what’s actually available in China, the options can be rather basic. “There have been a lot of scandals in China over the years regarding medications and vaccinations and things of that sort,” says Dr. Marriot. “The BJU Pharmacy tries in particular to make sure they know where the medicine is coming from and to make sure that there is quality control at that place. For that reason, we are somewhat more limited in what we have available.” While it may feel restrictive, you can at least trust that you’ll be getting a quality-assured product or medicine.
So, what is on offer? “There are pills, we have intrauterine devices, and we also administer the implant. Otherwise, there are condoms,” explains Dr. Marriott. “So, that’s a limited list. We don’t have the patch, we don’t have the vaginal ring, and we don’t have the injection – so we’re basically down to about half of what is available in other countries.”
Your options
The contraceptive pill
If you’re from the West, you may be used to having dozens of brands of the contraceptive pill to choose from. Unfortunately, BJU can only offer a handful, all of which are combined estrogen and progesterone pills: Diane-35, Yaz, Mercilon, or Yasmin. If your favorite brand isn’t on that list and you don’t want to switch, you can try getting a large prescription every time you’re home. If you’re new to the pill and are happy to try our options, then you’re still in good hands. “I can usually find a pill that will work for a patient,” assures Dr. Marriott. Each brand has slightly different effects, and so she tries to make sure that her patients get the right one based on how they may react.
Started a new brand and aren’t loving it? Don’t worry. “It can take three months for your body to settle out on the pill and for some of the initially annoying side effects to go away,” explains Dr. Marriott. That’s why she suggests trying to stick with one brand for at least three months before trying something else. “If you come back before your prescription runs out and you don’t like that pill, we can talk about your issue so we can change to the right pill. Again, there’s not that many choices, but those four all have different levels of estrogen and types of progesterone, so you can go up and down depending on what you need.”
COST: The price range for a month’s supply of the pill is RMB 100 to 200. You’ll need a prescription from a doctor to get the pill at BJU. A basic consultation with a gynecologist for existing patients starts at RMB 1,100 and gets more expensive the longer the consultation lasts and the more complex your issue. If you want to reduce your costs, you can ask your doctor for a prescription for more than one month’s supply of the pill at a time.
The IUD
“The IUD is ultimately my favorite form of contraception,” says Dr. Marriott. The IUD (or intrauterine device) is a small, T-shaped contraption that a doctor fits into your uterus, where it prevents pregnancy for five to 10 years. “It’s over 99% effective depending on which type you pick, and you don’t have to think about it. Because they’re so effective and they’re reversible, it ends up being very nice for most people,” she says. Some people dislike the thought of having something in their uterus but, if you can get over this, you might find it to be a safe and convenient option.
Image courtesy of Mirena, Bayer
At BJU, we offer the copper IUD and the hormonal IUD (the very popular Mirena, which is manufactured by Bayer). Copper IUDs can cause heavier and more painful periods, but can be used for 10 years. Hormonal IUDs are effective for five years and can make your periods lighter and less painful but cause irregular bleeding or spotting.
Image courtesy of Mirena, Bayer
COST: Getting an IUD involves one consultation with your doctor and one procedure to place the device. Then, there's the cost of the device itself. If you’re a new patient, if your doctor needs to get tests done to make sure the IUD is suitable for you, or if you have any complications during the procedure, it may cost more for you to get an IUD. Otherwise, altogether, it will likely cost you around RMB 5,000-6,000 to get one.
The implant
This final option is a small device called Implanon (also called Nexplanon in some countries). It's a small, thin, flexible rod that is implanted under the skin of the arm, where it can prevent pregnancy for three years. While it can be quite convenient and non-invasive for some users, many find that their bleeding becomes so irregular that it negatively affects their lives.
Image courtesy of Nexplanon, Merck
“I’ve taken way more out than I have ever put in because people just don’t like the bleeding profile on the Implanon,” says Dr. Marriott. “It’s very effective and cramping isn’t so much of an issue – so it’s not that you have more pain or anything like that – it’s really just completely unpredictable bleeding.” Dr. Marriott adds that she is happy to discuss this method with patients as she believes that everyone should understand all their options – but her experience has shown her that many people struggle with the implant’s side effects.
Image courtesy of Nexplanon, Merck
COST: As is the case for getting an IUD, getting an implant involves one consultation and one procedure. Then, there’s the cost of the device itself. If you’re a new patient, if you may require extra time in your initial consultation, or if you need extra tests before your doctor can determine how safe it is for you to use the implant, you should expect to pay more to get an implant. If all goes well, it will cost you around RMB 4,000-5,000 altogether.
Time to go home
While these options are perfectly sensible and you may well find something here that you love, you may also have been crazy about the patch or the vaginal ring that you used back home. These are two practical and effective options that some people do very well with. Both involve a repeating cycle of three weeks of use followed by a patch-free or ring-free bleeding week.
While some people get skin irritations from the patch and a small portion of vaginal ring users get more yeast infections or bouts of bacterial vaginosis, both methods have many loyal fans. If you want to use either one, you can consider getting a year-long prescription from your doctor back home or in Hong Kong and refilling it whenever you go back. If you’re a big fan of the injection, however, you’re out of luck. The contraceptive injection is not available for use in China and you can’t get it here.
Finding the right fit
Still not sure which one is right for you? Book an appointment with your gynecologist to discuss things further. “There are multiple forms of contraception, and contraception really comes down to being comfortable with whatever it is,” says Dr. Marriott. “When someone comes in and wants contraception, I’ll sit down and talk to them about all their options because I want to make sure that they understand what’s available.” Unless you’re in a stable and monogamous relationship, however, Dr. Marriott will suggest using condoms to prevent pregnancy as well as STDs before talking about other pregnancy-prevention methods.
If it ain’t broke, don’t fix it!
Once you find the right method for contraception that you feel great on, then you’re set! “If you are happy with it, and it’s working well for you, I don’t see a reason to stop,” says Dr. Marriott. “Some people think, ‘Oh my god I’ve been on the pill for five years and I need to go off of it for a while – but I don’t want to get pregnant right now.’ Really, there’s no evidence to support that the pill, for prolonged use, does anything bad – if anything, it actually protects against ovarian cancer. So, if you’re using something for contraception for a while and it works for you, just because it’s been there for a while doesn’t mean you should stop it,” she says. So keep calm, and carry on!
Dr. Dalice Marriott is BJU's Chair of Obstetrics. She is board-certified by the American Board of Obstetrics and Gynecology. She speaks English, German, and Spanish. To make an appointment with her, please call the BJU Service Center at 4008-919191.
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