Contraception Guide. What’s Available?

Posted on Sep 2 2020 - 9:00am by Ashlea Curley

There are many reasons women go on some form of contraception. Aside from trying to prevent pregnancy, contraception can help to regulate periods, alleviate pain and discomfort during menstruation, and manage other symptoms such as acne and mood swings. As we all have very different needs and lifestyles, we need to find a form of contraception suitable for purpose. And with around 15 different types available through the NHS, there are plenty of options.

In this article we take a look at 9 of the most common forms available through the NHS and what they can offer. Sometimes finding a suitable contraception can take trial and error. If you don’t think the form you’re on is complimentary, there’s been a lifestyle change, or you’re looking at this with fresh eyes for the first time, be sure to get in touch with your local family planning clinic to talk through these and the many other options available.

The combined pill 

the combined pill

The pill, as it is simply know, is a small tablet that you swallow daily. It is made of artificial oestrogen and progesterone hormones designed to prevent your ovaries from releasing an egg. It is important to take the pill at the same time each day for it to be effective. You take this for 21 days and then have a 7 day break for your body to ‘rest’/ have a period, before repeating this cycle.

The pill is said to be 99% effective against pregnancy but if you miss taking your pill, have sickness, or take a course of antibiotics, you’ll need to use other forms of contraception. If you do miss a pill, follow the instructions on your packet to know what to do next.

The known side effects of the pill include headaches, nausea, breast tenderness and mood swings. It can also increase blood pressure and has been linked to breast cancer. The many benefits to the pill include: lighter, regular, and reduced pain during your periods, it reduces cancer of the womb, ovaries and colon, it reduces PMS, acne, fibroids, ovarian cysts and non-cancerous breast disease. The flexibility of the pill means you can forgo your break to prevent periods on holidays or special occasion.  Bear in mind, taking more than two packets will allow the womb lining to break and spot bleeding may occur.

There are actually many different types of combined pill and the clinician will put you on the most appropriate based on your lifestyle, current menstruation patterns and family history. Once off the pill it can take around two to three months for some women’s menstrual cycle to go back to normal. Doctors say women can start trying for a baby straight away but advise to wait for your periods to be regular to understand your cycles.

The progestogen-only pill

The POP is a tablet similar to the pill but only contains the hormone progestogen. This pill is designed for women of any age who can’t take contraception that uses oestrogen. This could be because of family history, a history of migraines, or your own risk of cancer. Additionally, it is commonly prescribed to women who smoke, have high blood pressure, blood clots or are overweight.

The progestogen-only pill should be swallowed every day at the same time with no breaks in-between. There are two versions of this pill where you have a window of 3 or 12 hours to take your pill. If you take the pill later than advised, it may not be effective or could induce a period.

Like the pill, it can also reduce the symptoms of premenstrual syndrome and painful periods. However, women taking POP may have irregular periods, making them lighter and more frequent, or they may completely stop. This may cause concern for some women as they will never know when to expect their period.

POP has been known to be the cause of fluid-filled cysts on your ovaries which are usually not harmful and go away without treatment but some women do experience pelvic pain. It may also be linked to breast cancer, like any type of hormonal contraception, all of which is discussed with you when reviewing your options for contraception. As highlighted, your personal and family medical history is considered in the decision.

Once you’ve stopped taking POP you can get pregnant right away but it’s best to wait for your periods to be regular. It can take up to nine months for periods to regulate but this can be quite common. Any concerns you have about the POP should be discussed with your medical practitioner.

The contraceptive injection

This is a form of POP but as an inject-able. This is typically done through a muscle in your bottom every 8-14 weeks (depending on the treatment given).

This contraception is used to thicken the mucus in the cervix to prevent sperm from reaching the womb, by slowly releasing the progestogen hormone. It also thins the womb making it unable to release a fertilised egg. The injection can be 99% effective and protects against cancer of the womb and pelvic inflammatory disease.

Depo-Provera is the commonly used injection because of its many benefits. These include: being unaffected by medication and ideal for people who forget to take the pill. Additionally, it affects the regular flow of your period, making them irregular or stop completely.

The injection is known to affect the oestrogen levels in your body and can lead to the thinning of the bones. This does not affect most women, but if you or your family suffer from osteoporosis it may increase your risk. Once off the injection, your fertility levels should be back to normal within three to six months. However, this depends on how long you were taking the injections, and how regular your periods are. Doctors advise to try for a year before worrying.

The contraceptive implant

The implant is a small, thin, flexible tube of 4cm which is inserted under the skin of the upper arm, which releases progestogen into the body. It lasts for three years and then gets replaced, but can easily be removed anytime by a doctor if it unsuitable for any reason. Once the implant is removed, your fertility should return to normal straight away.

The implant has some major advantages to your health by protecting against pelvic inflammatory disease, and some protection against cancer of the womb. It is also known to reduce heavy and painful periods after the first year of use.

The implant can affect the flow of your period; based on current statistics, 20% of women will have no bleeding at all and 50% will have infrequent or prolonged periods. Other side effects include headaches, acne, nausea, mood swings and loss of sex drive.

The contraceptive patch

The patch is a sticky patch that is 5x5cm and delivers oestrogen and progesterone hormones into your body. Each patch lasts for one week and is changed for three weeks with a week off. You can apply the patch anywhere on your body, expect the breasts and irritated skin. The bottom is ideal as this is covered the majority of the time. It can be worn in the shower, bath or pool, but if it does come off you should replace it with another one and follow the instructions.

The patch is beneficial for those who forget to take their combined pill and is still effective if you vomit or have diarrhoea as it does not need to be absorbed by the stomach. It can help with premenstrual symptoms and make periods lighter and regular. It can also reduce the risk of ovarian, womb and bowel cancer, and reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease. However, it can cause skin irritation, itchiness and soreness, and bleeding between periods during the first few months. Women also get mild side effects such as headaches, nausea, breast tenderness and mood changes.

If you’re a smoker, diabetic or have high blood pressure it can increase your risk of blood clots and is not advisable for anyone who suffers with migraines. Doctors are still working on the patch’s long-term results as it is one of the newest forms of contraception, having been introduced in early 2000s. If you forget to wear a patch for over 48 hours, your body will no longer be protected against pregnancy. However, it can take a few months for your menstrual cycle to return to normal.

IUD (intrauterine device/coil)

Contraception options

There are plenty of options when it comes to contraception so if you don’t feel like you’re getting on with what you’ve got, talk to your doctor.

The coil is a small T-shaped device that is inserted into your womb to prevent pregnancy. Instead of releasing hormones, it releases copper which affects the fluids in the womb and fallopian tubes to stop sperm surviving.

Once fitted, an IUD can last for five to ten years, though can be removed at any time by a doctor with your fertility returning to normal instantly. An IUD can be fitted at any time during your menstrual cycle but you will need an internal examination to determine the size and position of your womb to ensure the IUD can be fitted correctly. Following insertion, your doctors will teach you how to check if your IUD is in the correct place. It is very unlikely it will come out of place, but if it does, you will not be protected and should see your doctor straight away.

The main advantage of using an IUD is that there are no links to cancer of the cervix of endometrial cancer. However, it can change the flow of your periods making them heavier, longer or more painful. An IUD can also cause vaginal bleeding and pain, and can cause damage to the womb, cause pelvic infections and ectopic pregnancy.

IUS (intrauterine system/hormonal coil)

An IUS is a small T-shaped plastic device that is inserted into your womb. Much like an IUD, the IUS only contains progestogen and can last up to five years. You will need an examination to determine the size and position of your womb before insertion.

An IUS may be useful for those with heavy periods as it can make periods lighter and shorter, and may stop completely after the first year. Your fertility will return to normal once the IUS is removed.

There is also no evidence that it will make you put on weight, or increase the risk of cervical or ovarian cancer, or cancer of the uterus. However, it is common for women to experience irregular bleeding and spotting within the first six months, but this is something that should decrease over time. Similarly to the IUD, the IUS can cause unharmful cysts on the ovaries and cause bleeding and pain, as well as pelvic infections, and ectopic pregnancy.

Vaginal ring

The vaginal ring is a small, soft plastic ring, that is 4mm thick and 5.5cm in diameter. It is placed inside the vagina and releases oestrogen and progestogen. You will be required to change your vaginal ring every 21 days.

Advantages of the vaginal ring include the reduced risk of ovarian, uterus and colon cancer, as well as fibroids, ovarian cysts and non-cancerous breast disease. It can also help with premenstrual symptoms and makes periods lighter, regular and less painful. However, there may be spotting and bleeding during the first few months and can cause side effects such as discharge, headaches, nausea and mood swings. There are also some uncommon serious side effects such as developing a blood clot or having a heart attack or stroke. Once you stop using the vaginal ring you will be unprotected from pregnancy within three hours.

The contraceptive diaphragm

This is a reusable form of contraception that is inserted into the vagina before sex. It is to be used with spermicide to kill sperm and left in the vagina for six hours. However, it is only 92-96% effective and you need to be fitted for the correct size by a doctor or nurse. The diaphragm can provide some protection against STIs but it is highly recommended that you use additional contraception.

Although using a diaphragm means you are in control of your contraception, it means you aren’t as protected as with other methods and you will likely need to interrupt sex to put it in. It can also cause cystitis and irritation to women and their sexual partners. Doctors say you should not leave a diaphragm in for more than 30 hours at which point the spermicide will wear off and you will not be protected against pregnancy.

The method you’re on now, may not be suitable for life

Any type of contraception has its risks and symptoms and one method may be more favourable over another. When you are looking to review your contraception, speak to your GP or family planning nurse to determine which may be the most suitable for you. They will go through yours and your families medical history to assess your risk factors and recommend the most appropriate method for you. This should be followed with a review after a trial period where you can discuss any of your concerns. It is also worth noting that the method you’re using now may not be suitable for life. So, if you feel like your moods are changing, your skin is affected, your periods change, speak to your medical practitioner for advice. You should talk to your GP to find out what works best for you and your health before taking anything.

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