Your Guide to Contraception

I was in NHS recently to find the right contraception methods for me. A brochure has been handed to me and I thought I should write it here to use it as a reference whenever I need.

YOUR GUIDE TO CONTRACEPTION

Helping you choose the method of contraception that is best for you

This article shows the available contraceptive methods, explains how they work, how effective they are and the main advantages and disadvantages. The figures quoted in this article for how well each method works are based on extensive independent research.

Contraception needs to be used until the menopause. That is, until a woman has not had a period for two years if aged under 50, and for one year if over 50. This advice may be different for women using hormonal contraception.

There are many methods of contraception to choose from and it is worth taking the time to find out more about each one so that you can choose contraception that suits you.

Emergency contraception: If you have had sex without contraception, or think your method might have failed, there are different types of emergency contraception you can use.

• The emergency contraceptive pill, Levonelle – can be taken up to three days (72 hours) after sex. It is more effective the earlier it is taken after sex. It is available with a prescription or to buy from a pharmacy.
• The emergency contraceptive pill, ellaOne – can be taken up to five days (120 hours) after sex. It is only available with a prescription.
• An IUD – can be fitted up to five days after sex, or up to five days after the earliest time you could have released an egg (ovulation)

Ask your doctor, nurse or pharmacist about getting emergency pills in advance, just in case you need them.

Methods with no user failure – methods that do not depend on you remembering to take or use them.

CONTRACEPTIVE INJECTION

Effectiveness:

Over 99 per cent effective. Less than four women in 1,000 will get pregnant over two years

How it works:

Releases the hormone progestogen which stops ovulation, thickens cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus (womb) to prevent a fertilised egg implanting.

Advantages:

• Lasts for 12 weeks (Depo-Provera), eight weeks (Noristerat) or 13 weeks (Sayana Press).
• You can use it if you are breastfeeding.
• You don’t have to think about contraception for as long as the injection lasts.

Disadvantages:

• Periods may stop, be irregular or last longer.
• Periods and fertility may take time to return after stopping the injection.
• Some women gain weight.

Comments:

• The injection cannot be removed from the body so any side-effects may continue for as long as it works and for some time afterwards.
• Not affected by other medicines, diarrhoea or vomiting.

IMPLANT

Effectiveness:

Over 99 per cent effective. Less than one women in 1,000 will get pregnant over three years

How it works:

Small flexible rod put under the skin of the upper arm. Releases the hormone progestogen. It stops ovulation, thickens cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus to prevent a fertilised egg implanting.

Advantages:

• Works for three years but can be taken out sooner.
• You don’t have to think about contraception for as long as the implant is in place.
• When the implant is removed your fertility will return to normal.

Disadvantages:

• Periods may stop, be irregular or last longer.
• Acne may occur, or worsen.
• It requires a small procedure to fit and remove it.

Comments:

• Put in using a local anaesthetic and no stitches are needed.
• Tenderness, bruising and some swelling may occur.
• You should be able to feel the implant with your fingers, but it can’t be seen
• Some medicines may stop the implant from working.

INTRAUTERINE SYSTEM (IUS) JAYDESS AND MIRENA

Effectiveness:

Over 99 per cent effective. Less than one women in 100 will get pregnant over five years.

How it works:

A small T-shaped plastic device which slowly releases the hormone progestogen is put into the uterus. It thins the lining of the uterus to prevent a fertilised egg implanting and thickens the cervical mucus which makes it difficult for sperm to meet an egg.

Advantages:

• Mirena works for five years.
• Jaydess works for three years.
• Both can be taken out sooner.
• You don’t have to think about contraception for as long as the IUS is in place.
• With Mirena periods usually become lighter, shorter and sometimes less painful.
• When the IUS is removed your fertility will return to normal.

Disadvantages:

• Irregular bleeding or spotting is common in the first six months.
• Periods may stop altogether.
• Very small chance of getting an infection during the first 20 days after insertion.
• May get ovarian cysts.
• Insertion can be uncomfortable.

Comments:

• If fitted after 45 Mirena can stay in place until the menopause.
• Women are taught to check the IUS is in place.
• Mirena can be helpful for women with very heavy and/or painful periods.
• A check for any existing infection is usually advised before an IUS is put in
• Not affected by other medicines.

INTRAUTERINE DEVICE (IUD)

Effectiveness:

Over 99 per cent effective. Less than two women in 100 will get pregnant over five years

How it works:

A small plastic and copper device is put into uterus. It stops sperm reaching an egg, and may also stop a fertilised egg implanting in the uterus.

Advantages:

• Works as soon as it is put in.
• Can stay in 5-10 years depending on type, but can be taken out at any time.
• You don’t have to think about the contraception as long as the IUD is in place.
• When the IUD is removed your fertility will return to normal.

Disadvantages:

• May not be suitable for women at risk of getting a sexually transmitted infection.
• Periods may be heavier or longer and more painful
• Very small chance of getting an infection during the first 20 days after insertion.
• Insertion can be uncomfortable.

Comments:

• If fitted after 40 it can stay in place until the menopause.
• Women are taught to check the IUD is in place
• A check for any existing infection is usually advised before an IUD is put in
• Not affected by other medicines.

FEMALE STERILISATION (TUBAL OCCLUSION)

Effectiveness:

The overall failure rate is about one in 200. This is a permanent method, suitable for people who are sure they never want children or do not want more children.

How it works:

The fallopian tubes are cut, sealed or blocked by an operation. This stops the egg and sperm meeting.

Advantages:

• It cannot easily be reversed.
• Once the operation has worked, you don’t have to think about contraception.
• Periods are unaffected.

Disadvantages:

• All operations carry some risk, but the risk of serious complications is low.
• There is a small increased risk of ectopic pregnancy if female sterilisation fails.
• You will need a general or local anaesthetic.

Comments:

• Should not be chosen if in any doubt, and counselling is important.
• You may experience discomfort or some pain for a short time after sterilisation. It is important to rest and avoid strenuous activity for a while after the procedure.

MALE STERILISATION (VASECTOMY)

Effectiveness:

About one in 2,000 male sterilisations fail. This is a permanent method, suitable for people who are sure they never want children or do not want more children.

How it works:

The tubes (vas deferens)that carry sperm from the testicles to the penis are cut, sealed or tied.

Advantages:

• It cannot easily be reversed.
• Once the operation has worked, you don’t have to think about contraception.
• Usually performed under a local anaesthetic.

Disadvantages:

• Contraception must be used until a semen test shows that no sperm are left. This can take at least eight weeks.
• Some men may experience ongoing testicle pain but this is not common. Treatment for this is often unsuccessful.

Comments:

• Should not be chosen if in any doubt, and counselling is important.
• You may experience discomfort or some pain for a short time after sterilisation. It is important to rest and avoid strenuous activity for a while after the procedure.

Methods with user failure – methods you have to use and think about regularly or each time you have sex. Must be used according to instructions.

CONTRACEPTIVE VAGINAL RING

Effectiveness:

Over 99 per cent effective if used according to instructions. Less than one women in 100 will get pregnant in a year.

How it works:

A small, flexible, plastic ring put into the vigina releases estrogen and progestogen. It stops ovulation, thickens cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus to prevent a fertilised egg implanting.

Advantages:

• You don’t have to think about it every day.
• It is not affected if you vomit or have diarrhoea.
• Can make periods regular, lighter and less painful.
• It is easy to insert and remove.

Disadvantages:

• Not suitable for very overweight women or smokers over 35 years.
• Low risk of serious side-effects such as blood clots, breast and cervical cancer
• Can be temporary side-effects including increased vaginal discharge, headaches, nausea, breast tenderness and mood changes.

Comments:

• Women must be comfortable with inserting and removing it.
• Ring is used for three weeks out of four
• Some medicines can make it less effective
• Breakthrough bleeding and spotting may occur in the first few months.

CONTRACEPTIVE PATCH

Effectiveness:

Over 99 per cent effective if used according to instructions. Less than one women in 100 will get pregnant in a year.

How it works:

A small patch stuck on the skin releases two hormones, estrogen and progestogen. It stops ovulation, thickens cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus to prevent a fertilised egg implanting.

Advantages:

• You don’t have to think about it every day.
• It is not affected if you vomit or have diarrhoea.
• Periods will usually become more regular, lighter and less painful.
• It improves acne for some women

Disadvantages:

• Not suitable for very overweight women or smokers over 35 years.
• Low risk of serious side-effects such as blood clots, breast and cervical cancer
• Can be temporary side-effects such as headaches, nausea, mood changes, and breast tenderness.
• Possible skin irritation.

Comments:

• May be seen
• New patch is used each week for three weeks out of four.
• Some medicines can make it less effective.
• Breakthrough bleeding and spotting is common in the first few months.

COMBINED PILL (COC)

Effectiveness:

Over 99 per cent effective if used according to instructions. Less than one women in 100 will get pregnant in a year.

How it works:

Contains two hormones – estrogen and progestogen. It stops ovulation, thickens cervical mucus to prevent sperm reaching an egg and thins the lining of the uterus to prevent a fertilised egg implanting.

Advantages:

• Usually makes periods regular, lighter and less painful.
• Reduces risk of cancer of the ovary, uterus and colon.
• Suitable for healthy non-smokers up to the age of 50.
• When you stop using the combined pill your fertility will return to normal.

Disadvantages:

• Not suitable for very overweight women or smokers over 35 years.
• Low risk of serious side-effects such as blood clots, breast and cervical cancer.
• Can be temporary side-effects such as headaches, nausea, mood changes and breast tenderness.

Comments:

• Missing pills, vomiting or severe, long-lasting diarrhoea can make it less effective.
• Some medicines can make it less effective.
• Breakthrough bleeding and spotting is common in the first few months.

PROGESTOGEN – ONLY PILL (POP)

Effectiveness:

Over 99 per cent effective if used according to instructions. Less than one women in 100 will get pregnant in a year.

How it works:

Contains the hormone progestogen, which thickens cervical mucus to prevent sperm reaching an egg. In some cycles it stops ovulation.

Advantages:

• Can be used by women who cannotuse estrogen.
• Can be used by women who smoke and are over 35.
• You can use it if you are breastfeeding.

Disadvantages:

• Periods may stop, or be irregular, light, or more frequent.
• May be temporary side-effects such as acne, breast tenderness, weight change and headaches.
• May get ovarian cysts.

Comments:

• It needs to be taken at the same time each day.
• Not effective if taken over three hours late (12 hours for Cerazette) or after vomiting or severe, long-lasting diarrhoea.
• Some medicines may make it less effective.

MALE CONDOM

Effectiveness:

98 per cent effective if used according to instructions. Two women in 100 will get pregnant in a year.

How it works:

Made of very thin latex (rubber) or polyurethane (plastic) it is put over the erect penis and stops sperm from entering the vagina.

Advantages:

• Free from contraception and sexual health clinis and young people’s services, and some general practices and GUM clinics, and sold widely.
• Can help protect from sexually transmitted infections.
• No serious side-effects.
• Additional spermicide is not needed or recommended.

Disadvantages:

• May slip off or split if not used correctly or is the wrong sie or shape.
• Man needs to withdraw as soon as he has ejaculated and before the penis goes soft, being careful not to spill any semen.

Comments:

• Must be put on before the penis touches the woman’s genital area.
• Oil-based products damage latex condoms, but can be used with polyurethane condoms.
• Available in different shapes and sizes.
• Advised to use extra lubricant when using condoms for anal sex.

FEMALE CONDOM

Effectiveness:

Over 95 per cent effective if used according to instructions. Less than one women in 100 will get pregnant in a year.

How it works:

Made of soft thin polyurethane which loosely lines the vagina and covers the area just outside, and stops sperm from entering the vagina.

Advantages:

• Can be put in any time before sex.
• Can help protect both partners from sexually transmitted infections.
• Oil-based products can be used with female condoms.
• No serious side-effects.
• Additional spermicide is not needed or recommended.

Disadvantages:

• Need to make sure the man’s penis enters the condom and not between the vagina and the condom.
• May get pushed into the vagina.
• Not as widely available as male condoms.

Comments:

• Use a new condom each time and follow the instructions carefully.
• Sold online and in some pharmacies and free from contraception and sexual health clinics and young people’s services, and some general practices and GUM clinics.

DIAPHRAGM/CAP WITH SPERMICIDE

Effectiveness:

Diaphragms and caps are 92-96 per cent effective when used with spermicide. Between four and eight women in 100 will get pregnant in a year.

How it works:

A flexible latex or silicone device, used with spermicide, is put into the vagina to cover the cervix. This stops sperm from entering the uterus and meeting an egg.

Advantages:

• Can be put in any time before sex.
• You only have to use it when you have sex.
• No serious health risks.

Disadvantages:

• Extra spermicide is needed if you have sex again
• Some people can be sensitive to spermicide
• Can take time to learn how to use correctly.

Comments:

• You need to use the correct size.
• You may need a different size after you have had a baby, miscarriage or abortion.
• Needs to be left in for six-hours after sex.

NATURAL FAMILY PLANNING

Effectiveness:

If used according to teaching and instructions, up to 99 per cent effective. Up to one woman in 100 will get pregnant in a year.

How it works:

The fertile and infertile times of the menstrual cycle are identified by noting the different fertility indicators. This shows when you can have sex without risking pregnancy.

Advantages:

• No physical side-effects.
• No chemicals or physical products are used.
• Gives a woman a greater awareness of her body.
• Can also be used to plan a pregnancy.

Disadvantages:

• Need to avoid sex or use a condom at fertile times of the cycle.
• It takes 3-6 menstrual cycles to learn effectively.
• You have to keep daily records.

Comments:

• Persona is a small handheld computerised monitor with urine test sticks, which measure hormonal changes. Persona predicts the fertile and infertile times of the menstrual cycle. If used correctly it can be 94 per cent effective.