Contraceptive Choices for Vegans

Dr Deborah Lee explores options for contraception for vegans

I was surprised to find there are so many vegans in the UK. Between 2014-2019, numbers have quadrupled, and vegans currently make up just over 1% of the population. By 2025, it's estimated that one-quarter of the population will be vegetarian or vegan.
This is important in any request for contraception because vegans are more limited in their contraceptive choices. Enquiring about a patient's diet is not a routine part of a sexual health consultation. I would like to raise awareness of this issue and help ensure vegan women get the best contraceptive advice.

What is veganism?

The Vegan Society defines veganism as - "a philosophy and a way of living which seeks to exclude – as far as possible and practicable – all forms of exploitation of, and cruelty to, animals for food, clothing, or any other purpose; and by extension, promotes the development of animal-free alternatives for the benefit of animals, humans and the environment. In dietary terms, it denotes the practice of dispensing with all products derived wholly or partly from animals."

What issues does veganism pose for contraception?

The UK Medicines agency (June 2019) issued information on common animal-derived excipients in medicines. Lactose, which derives from cow's milk, is present in all currently available contraceptive pills. Magnesium stearate originates from animal sources including fish, chicken, and eggs, and is also present in some contraceptive pills. Vegan women may wish to avoid these products.

The vegan philosophy also precludes taking any medicines or using any products which have been tested on animals. All prescription drugs, including contraceptive products, have been tested on animals. However, some women may abide by the clause in the vegan definition, which states they should avoid any animal products - "as far as possible or practicable." Therefore, some women may be more open to a wider variety of options.

Which contraceptive options may be suitable?

All currently available contraceptive pills in the UK contain lactose, hence these are unlikely to be suitable options for most vegans.

Lactose-free contraceptive methods are listed below. (UK Medicines Agency - February 1 2019), although all of these will have been tested on animals.

• Barrier methods - condoms, caps, and diaphragms
• Intra-uterine devices (IUDs), and levonorgestrel-releasing intrauterine systems (LNG-IUS),
• Mirena, Kyleena, Levosert, and Jaydess
• Contraceptive patch - Evra
• Injectable contraception - Depo-Provera, Noristerat, and Sayana Press,
• Contraceptive Implant - Nexplanon
• Vaginal rings - NuvaRing, and SyreniRing

Non-hormonal contraception for vegans – these may contain other excipients

There are various specific points to note for vegans about non-hormonal contraception –

• Condoms – Latex condoms sometimes contain casein, which comes from cow's milk. Vegan-friendly condoms are natural rubber condoms.
• Caps and diaphragms - Acceptable for vegans if made of silicone but should be used with a vegan spermicide.
• Natural family planning – An option for strict vegans.
• Sterilization – Their personal beliefs may justify permanent sterilisation, for either them or their partner.

Do vegans require any specific contraceptive/medical care?

Although the vegan diet may indeed have health benefits, it tends to be deficient in iron, vitamin B12, and calcium. See the NHS website for useful dietary information

The Vegan Society provides a list of suitable B12 supplements for anyone who cannot get enough B12 from their diet.

Vegans tend to have a lower BMI than those who eat animal products. They are also at higher risk of bone loss and osteoporotic fractures after the age of 50.

Details of vegan vitamin D, and calcium and vitamin D, products can also be found on the Specialist Pharmacy Service (SPS) website.

Final thoughts

Good medical healthcare necessitates respecting a patient's autonomy. By taking note of their vegan principles, we can help patients follow their chosen philosophy and assist them by providing the correct advice for their contraceptive and reproductive healthcare.