In France, in 2016, 71.9% of women were concerned by contraception ¹ and more than 7 in 10 women (71.8%) used a medical method (pill, intrauterine device, implant, patch, ring, tubal sterilization, vasectomy of the spouse).

For a long time frozen, the contraceptive regimen gradually evolved over the years.

But contraception is above all a personal, intimate choice, and whatever the method, it must be chosen by mutual agreement between the woman and her gynecologist or midwife (authorized to deliver all means of contraception).

It must be the subject of reflection and must be based on the expectations and needs of each woman, in correlation with his state of health, his lifestyle, while balancing the benefits and risks of each method .

In any case, the woman must have the last word regarding her contraceptive and not be imposed by anybody (medical staff, spouse, parents), her choices.

The most popular methods of puberty at age 20

The condom is generally the first contraceptive used by girls: it is popular with 45.6% of 15-19 year olds (45.6%) sometimes in combination with the pill (in 16.0% of cases).

The pill is recommended for young people because it provides excellent efficiency (91% in practice, 99.7% in theory according to the site choisirsacontraception.fr) when it is taken in time and it does not interact with some drugs. In addition, there is very little risk of complications for adolescent girls and young women. It is besides acclaimed by 60.4% of the 15-19 years and 59.5% of the 20-24 years old.

Each pill is dosed with estrogen and progesterone. The dosage is usually defined after maintenance and medical examinations. Attention, the pill is usually contraindicated in case of cardiovascular problems . That's why more than five cigarettes a day, Dr. Atlan strongly advises the pill to a patient, whatever his age.

Other contraceptive methods are not optimal, whether they are the new hormonal contraceptives: the ring (difficult to handle), the implant (which causes the absence of periods or bleeding), and the patch (seeing and who risks to take off); or the traditional means: spermicidal eggs (not reliable enough, and the technical gesture to be done before the report is embarrassing at the psychological level), and the IUD (the uterus is too small for the very young).

To proscribe absolutely for the 15-20 years: the natural methods like withdrawal, calendar, observation of the cervical mucus, taken of temperature or abstinence in fertile period. These are absolutely unreliable.

Credit: solidarites-sante.gouv.fr

From 20 years to the first child: pill and IUD mostly prescribed

The pill is not dangerous (despite the mistrust of it since the case of the 3rd and 4th generation pills ).

There is no contraindication to taking the pill for 15 years provided you are followed regularly, which means that you have to go once a year to the gynecologist. Certainly, it is better to stop the pill when you become single again. But stopping it for 3 months and taking it back is no problem.

The contemporary anxiety "it's not natural, so it's bad for my body" is totally unjustified, and the misconception " it lowers fertility" is a stupidity according to the doctor.

And if some women have difficulty getting pregnant, it's not because they have taken the pill for 15 years, is that e st harder to get pregnant at age 33 to 26.

The copper IUD is very appropriate. Once again, stop at misconceptions: it is wrong to believe that those who have no children are more prone to post-IUD infections than others. It can now be used in almost all women, even girls who have not yet had children since there is a smaller version adapted to their uterus. A method that can also be used in emergency contraception .

It is a small mechanical device that causes inflammation of the uterine lining, thus preventing implantation of the egg. Once laid, we do not feel it and for 3 years, we need more to think about nothing, it's total freedom . Its only (slight) disadvantage: it increases the abundance of the rules. There remains the psychological problem of the "foreign body", which displeases some.

And the other hormonal methods?

• The patch, to stick on the bottom of the belly or on the buttocks is to change every week.

• The ring, to be inserted into the vagina as a tampon (easier to put than the female condom, huge and scary), is to change every 3 weeks and you have to think about it.
  They both broadcast hormones locally and have the same contraindications as the pill.

• As for the implant, which acts in the same way as the other two, it must be known that it lasts 3 years. It must be placed and removed in a surgical environment.

Which contraceptives to favor from the first child to the menopause?

The hormonal IUD , which locally diffuses progesterone and, like the copper IUD, is physically and psychologically comfortable, reduces or even eliminates menstrual bleeding, which may be significant for some.

The progestin-only pill , which is taken daily at set times (with a maximum of 3 hours of shift), can be used immediately after delivery and during breastfeeding, or in cases of contraindications related to estrogen ( diabetes for example).

The spermicidal eggs and the female condom are indicated for reasons of "alternation" of contraceptive responsibility (a sudden blow, a blow me).

Ovulation tests upside down , it works but it is very expensive and it assumes the abstention of reports for at least 17 days a month!

The natural method of taking temperature is so unreliable that it should be recommended only to women who accept the possibility of pregnancy: in at least 30% of cases, the curve is not interpretable. It must be regulated like a clock and very motivated, for example for ethico-religious reasons.

Permanent contraceptive methods are for women who do not want to have children anymore. There are two: "tubal ligation" (or tubal sterilization, which consists of obliterating a segment of each of the two tubes) and hysteroscopy (insertion of a device in the fallopian tubes for "butcher"). In both cases, the goal is to prevent ova and sperm from reaching the uterus. Be careful, these methods require a lot of thought given their irreversible and definitive nature.

¹ Public Health Barometer Report France 2016: inpes.santepubliquefrance.fr/CFESBases/catalogue/pdf/1806.pdf