YOUR CONTRACEPTION
Where do I start?
Contraception is really important as it prevents you from getting pregnant. Condoms are the best method to protect against sexually transmitted infections (STIs). Different methods suit different people, so it is a good idea to look at the different options and find out about their effectiveness, advantages and disadvantages before making a decision. When considering contraception, there's a lot of information to take in but with all the different options available, you're sure to find a long-term method of birth control that suits you.
Contraceptives fall into two main types:
Barrier methods designed to stop sperm getting into the womb, where it may fertilise the egg.
Hormonal methods that temporarily alter the way your reproductive system works.
There are less sophisticated methods of avoiding pregnancy, for example the withdrawal method, however these are much more risky.
Please note that information relating to the effectiveness of contraceptive methods is based on the method being administered according to the product label.
Hormonal methods
The combined pill
The combined pill contains two hormones, an estrogen and a progestin which prevent your body from releasing an egg each month.
You must see a doctor or nurse to be prescribed the pill, they will take your full medical history in order to find the pill which is best suited to your body. There are a number of different types of the combined pill. Not every type of pill will suit everyone so it is worth discussing different options with your doctor.
How effective are they?
If the combined pill is used properly, it is 99.97% effective (0.3 in 1000 women will get pregnant per year) 1-6
What are the advantages?
The combined pill is one of the most effective reversible forms of birth control available to women today and is also the method used most widely. The pill contains hormones that prevent pregnancies in different ways, but a woman can get pregnant again once she stops using it. In addition to protecting against unwanted pregnancy, the pill makes your periods more regular, reduces pre-menstrual complaints, period pains and cramps and gives you lighter periods. Some pills can have a positive effect on your skin and hair. The pill also has been proven to have important health benefits. For example it improves symptoms of endometriosis and polyscystic ovarian syndrome, and it offers protection against ovarian cancer and cancer of the womb.9
What are the disadvantages?
Some women may have minor side effects when they first start taking the pill, but usually these subside during the first months of use. Side effects can include bleeding between periods, headaches and breast tenderness. Some brands of combined pills contain a higher dose of estrogen. If you are on this type of pill and are suffering from side effects, it might be helpful to ask your doctor if you can switch to a low-dose estrogen pill.
Very rarely, a few women might suffer from thrombosis, but this is very uncommon and much rarer than the risks of thrombosis unconnected with the use of hormonal contraception. The risk of thrombosis depends on a number of factors, including family history, age and body weight, and increases if a combination of risk factors are present. The link between thrombosis and the pill is far less strong than for other risk factors, for example not using contraception and being at risk of pregnancy.9 Using the pill may contribute to a slight increase in the risk of having breast cancer but this risk is very small.10
This version of the pill contains only one hormone, a progestin. It works in a different way from the combined pill, mainly by thickening the mucus at the entrance to the womb, which makes it difficult for sperm to get through. With certain brands of progestin-only pill it may also prevent ovulation in some women. You take one pill every day until all the pills in the pack are finished. Then you start a new pack the next day. This means taking pills during a period and no gap between packs. There are different types of progestin available.
How effective are they?
If the progestin-pill is used properly, it is 99.6% effective (4 in 1000 women will get pregnant per year).1-6
What are the advantages?
The progestin-only pill offers a highly reliable form of birth control to women who cannot tolerate estrogens.
What are the disadvantages?
It's really important to take the progestin-only pill at the same time each day or it may not work. Again, it is worth discussing the different options with your doctor to find out what works best for you and your lifestyle. The margin for error is around three hours with the older type and 12 hours with the newer progestin-only pill. Periods may be irregular, with some bleeding between periods, especially for the first few months. On the other hand, some women experience no bleeding at all with the progestin-only pill.
An IUS contains a progestin instead of copper or other metals. The hormone is released very gradually into the uterus and it prevents pregnancy by thickening the mucus in the neck of the uterus, making it difficult for sperm to enter. It also has local effects on the uterus. In some women it also intermittently prevents ovulation. It generally takes a healthcare professional less than five minutes to position the IUS and it can stay in place for up to five years, but should you want to discontinue using it, it can be removed at any time.
How effective is it?
The IUS is 99.9% effective (1 in 1000 women will get pregnant per year).1-6
What are the advantages?
The IUS provides a reliable long-term contraceptive option. After the IUS has been removed, fertility levels will return rapidly to normal. After some months of adaptation, periods are usually lighter, shorter and less painful or there may be no bleeding at all. It also offers some protection against pelvic infections and cancer of the uterine lining.
What are the disadvantages?
Periods may be irregular with some bleeding in between periods and in some women also after the first three months. Initial occurrence of headaches, breast tenderness or nausea are possible. Insertion may be difficult and may be associated with some pain and bleeding. The IUS is not the method of choice in women who have not yet given birth.
This is a hormonal method of contraception, which is given by injection either once a month or once every three months.
There are different forms of injectables available including progestin-only and combined, which include estrogen and progestin. The injection works by preventing ovulation through the slow release of hormones into the body. They also act to thicken mucus around the neck of the womb making it difficult for sperm to enter. The injections are given by your doctor, nurse or family planning clinic so you have to remember to attend your appointment.
One-month injectable
How effective is it?
The one-month injection is 99.97% effective (0.3 women in 1000 will get pregnant per year).1-6
What are the advantages?
The injection is a semi-long-acting hormonal method providing effective contraception without the need for a daily dose of treatment.
What are the disadvantages?
Some women find that their periods become irregular on this method, or stop altogether and some women put on weight. Some women may also experience headaches, dizziness and spotty skin. Regular periods and fertility may take up to a year to return after stopping injections. The one-month injectable containing progestin only is suitable for women who can not tolerate estrogen or who are breast-feeding.
Three-month injectable
How effective is it?
The three-month injection is 99.97% effective (0.3 women in 1000 will get pregnant per year).1-6
What are the advantages?
The injection is a semi-long-acting hormonal method providing effective contraception without the need for a daily dose of treatment. The available three-month injection containing only progestin is suitable for women who can not tolerate estrogen or who are breast-feeding.
What are the disadvantages?
Some women find that their periods become irregular on this method, or stop altogether and some women put on weight. Some women may also experience headaches, dizziness and spotty skin. Regular periods and fertility may take up to a year to return after stopping injections.
This is a tiny flexible tube (some brands consist of two tubes) impregnated with the hormone progestin, which is inserted just under the surface of the skin on the inside of your upper arm. This is done under a local anaesthetic. Implants have to be put in by a trained doctor or nurse. The hormone is released in tiny doses over a three year period, after which, it is taken out and a new one inserted. This method works by inhibiting ovulation and by thickening the mucus in the neck of the womb to make it difficult for sperm to enter. Fertility will return to normal after it is removed.
How effective is it?
The implant is 99.95% effective (0.5 women in every 1000 will get pregnant per year)7
What are the advantages?
The implant is suited for women who want long-term contraception. It is also suitable for women who are breast-feeding and those who do not tolerate estrogen. It may reduce heavy, painful periods.
What are the disadvantages?
Removal can sometimes be awkward. There can be temporary side effects such as skin irritations at the application site, irregular bleeding, headaches, mood changes and breast tenderness, but usually these subside after the first few months. Some women may put on weight and some find that their periods become irregular after the first year. Some may also notice an effect on their skin.
This is a small square stick-on patch, impregnated with the hormones estrogen and progestin which are slowly released through the skin. It is affixed to the buttocks, stomach or upper body, avoiding breasts, and has to be changed once a week for three weeks. On the fourth week, no patch is worn. The patch works by preventing ovulation (the release of an egg from the ovary) and thickening the mucus around the neck of the womb, making it difficult for sperm to enter.
How effective is it?
The patch is 99% effective when used properly (10 women in every 1000 will get pregnant per year)1-6
What are the advantages?
The patch does not have to be taken on a daily basis and provides an alternative form of combined hormonal contraception to the combined pill.
What are the disadvantages?
The patch that is currently available is non-transparent, so is visible. Some women may have side effects when they first start wearing the patch, but usually these subside after about 12 weeks. They can include bleeding between periods, skin irritations, headaches and breast tenderness.
The vaginal ring is a flexible ring approximately two inches in diameter. It is inserted into the vagina by the woman and held in place by the muscles in the vaginal wall. It is kept in place for three weeks, and then removed by the woman for a one week break. Following the week break, a new vaginal ring is inserted.
The vaginal ring provides an alternative form of contraception with a low hormone dosage which is used only once every four weeks. It contains estrogen and progestin combination.
How effective is it?
The vaginal ring is 99% effective when used properly (10 women in every 1000 will get pregnant per year).1-6
What are the advantages?
The ring provides an alternative form of contraception with a low dose of hormones. It may also help to make periods more regular, lighter and may reduce cramping.
What are the disadvantages?
It can cause vaginal irritation, discomfort or discharge. It may also cause nausea, and breast tenderness. Some women may be able to feel it.
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- Organon. NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) 2001. Available at: http://www.nuvaring.com
- Ortho-McNeil Pharmaceutical Inc. Ortho Tri-Cyclen Lo tablets (norgestimate/ethinyl estradiol) 2002. Available at: http://www.orthotricyclen.com
- Ortho-McNeil Pharmceutical Inc. Ortho Evra (Norelgestromin/ Ethinyl estradiol transdermal system) 2001. Available at: http://www.orthoevra.com.
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- http://info.cancerresearchuk.org/cancerstats/types/breast/riskfactors
