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Key facts

What is contraception and why is it used?

Contraception (or birth control) includes a variety of methods used by men and women who are sexually active to prevent pregnancy.

There many different types of contraceptives. A person makes a choice depending on a number of factors including:

their medical history

their sexual relationship/s

the effectiveness of the contraceptive

how easy the contraceptive is to use

the cost of the contraceptive

the availability of the contraceptive

the protection offered by the contraceptive against sexually transmitted infections (STIs).

Not all forms of contraception provide protection against STIs. The best way to reduce the risk of STIs is to use barrier protection such as condoms and dams (a dam is a thin piece of latex placed over the anal or vulval area during oral sex). Condoms can be used for oral, vaginal and anal sex to help prevent the spread of some infections.

Who needs contraception?

If a girl or woman is sexually active and has periods she can become pregnant. If she does not want to become pregnant then she (or her partner) will need to use contraception.

A woman does not need contraception if she:

is not sexually active

has had a hysterectomy or had her ovaries removed

has reached menopause, it is safe to stop using contraception when:

she is over 50 years of age and has not had a period for more than one year

she is under 50 years of age and has not had a natural period for more than two years. Until this time, while fertility decreases quite quickly swiftly, pregnancy is still a possibility.

Contraception types, effectiveness, benefits and risks

The main forms of contraceptives are:

physical barriers and devices

hormonal (oral, implant and injection) methods

fertility awareness based contraception

sterilisation/permanent contraception

emergency contraception

other methods.

Barrier methods

A male condom is a latex (polyurethane) sheath which is rolled onto the erect penis before sex, to prevent semen entering the vagina. It:

is 82 - 98% effective for preventing pregnancy

needs to be put on before contact between the penis and the vagina and a new one should be used every time a man has sex

can be used with spermicide to increase effectiveness

can reduce the risk of STIs

is widely available

is relatively cheap.

A female condom is a latex sheath with a ring at each end, which is placed inside the vagina before sex to collect semen. It:

is 75 - 95% effective for preventing pregnancy

can reduce the risk of STIs

is not as widely available as the male condom.

A diaphragm is a soft, dome-shaped silicone cap with a flexible rim, which is placed inside the vagina before sex, to cover the cervix and stop sperm getting into the uterus. A diaphragm should be fitted for the right size by a doctor or nurse. It requires instructions for use, can be tricky to fit correctly. It:

is 88 - 94% effective

can be used with or without spermicide.

Hormonal contraception: pills and rings

There are two hormones called oestrogen and progesterone that may be in contraceptives. These hormones are usually made by the ovaries and by using them in contraceptives, they change the way the hormones work and the messages they send. This usually stops the growth and release of an egg (ovulation) from the ovary every month and makes the fluid at the opening of the womb thicker which makes it harder for sperm to get into the uterus.

Combined oral contraceptive pill (COC Pill) or ‘the pill’

The combined pill is an oral contraceptive taken daily made from oestrogen and progestogen. Each pack contains a mixture of hormone pills and sugar pills, usually either 21 days of hormone pills and 7 days of sugar pills or 24 days of hormone pills and 4 days of sugar pills. When a woman takes the sugar pills she will have a period.

What’s good about it?

the pill is 91 - 99% effective.

the pill may help with heavy and/or painful periods

the pill may reduce the chance of ovarian or uterine cancers

the pill may help with acne

a woman can choose to skip periods or time periods with some pills (e.g. if going away).

What’s not so good about it?

a regular prescription is needed

the pill needs to be taken daily to be effective

the pill does not give protection against STIs

side effects of the pill may be: regular spotting; sore breasts, headaches, bloating, mood swings but many of these often settle after a few months.

Who shouldn’t use it?

women with high blood pressure that is not well controlled

women with diabetes that is not well controlled or who have complications

women at risk of blood clots

women who have or have had breast cancer or uterine cancer

women with some liver problems

for some women over 35 years of age the pill may not be recommended e.g. those who smoke

women who have headaches such as migraines; they should discuss this with their GP

What else?

The pill may not work as well in women on some epileptic medication, some antibiotics and St. Johns Wort (a herb).

The pill may not work if a woman has diarrhoea or vomiting.

What happens if a woman misses a pill?

If a woman forgets the pill and is more than 24 hours late taking it, she is at risk of getting pregnant and will need additional contraception, such as condoms, for the next 7 active pill days.

If a woman forgets the pill and has had sex she should use emergency contraception (see below).

Women should talk to a health care provider for more information.

Progestogen only contraceptive pill or ‘the mini pill’

The mini pill is an oral contraceptive taken daily with no sugar pills.

What’s good about it?

is 91 - 99% effective

can be used by most women

is a better option for women who suffer migraines, smoke or have high blood pressure

The pill may not work as well in women on some epileptic medication, some antibiotics and St. Johns Wort.

The pill may not work if a woman has diarrhoea or vomiting.

What happens if you miss a pill?

If a woman forgets the pill and is more than 3 hours late taking it, she is at risk of getting pregnant and will need additional contraception such as condoms for the next 7 active pill days.

Women should talk to a health care provider for more information.

If a woman forgets the pill and has had sex she should use emergency contraception (see below).

Contraceptive vaginal ring (NuvaRing)

The contraceptive vaginal ring is made of soft plastic and slowly releases low doses of the hormones oestrogen and a progestogen (similar to the COC Pill) into the vagina and then into the blood stream. A woman inserts the ring into the vagina herself. It remains in place for three weeks, is removed so the woman has a period and replaced a week later.

for some women over 35 years old it may not be recommended e.g. those who smoke.

Hormonal contraception – implants and injections

Contraceptive ‘rod’ implant (Implanon)

The contraceptive rod-shaped implant (Implanon) is inserted under the skin on the inside of the upper arm. It slowly releases a low dose of progestogen hormone into the blood stream and needs to be replaced every three years. The implant works by preventing ovulation (the release of an egg each month) and changing the cervical mucus making it harder for sperm to enter the uterus.

What’s good about it?

is 99.9% effective for three years

is suitable for most women

is cheap

can be easily removed if it doesn’t suit a woman

is good for painful periods

is not necessary to remember to take a pill every day

is not affected by diarrhoea or vomiting.

What’s not so good about it?

needs to be inserted by a doctor under local anaesthetic

may change a woman’s bleeding pattern (25% of women will have no period, 20% of women have prolonged bleeding)

offers no protection against STIs

can have side effects such as: regular spotting, sore breasts, headaches, bloating, mood swings and skin.

Who shouldn’t use it?

women who have had breast cancer

women with a history of blood clots, stroke, heart disease and liver disease (they will need to discuss with their doctor).

Contraceptive injection – Depot

The contraception, Depot is an injection given into a muscle every 12 weeks.

What’s good about it?

is 94 - 99.8% effective

often stops periods

means no-one will know you are using it

is not necessary to remember to take a pill every day

is helpful for painful periods.

What’s not good about it?

A woman needs to remember to have an injection every 12 weeks.

There may be a short delay to return to normal cycle after the injection is stopped so may take longer to get pregnant.

If it is used for more than 2 years, it can cause thinning of the bones although this returns to normal after stopping the injections.

Who shouldn’t use it?

women who have had breast cancer

women with a history of blood clots, stroke, heart disease and liver disease (they will need to discuss with their doctor).

IUD (intrauterine device)

There are two kinds of IUD or intrauterine devices one is hormonal called Mirena and one is a copper IUD.

Mirena is a small T-shaped piece of plastic with a nylon string at the end. It is placed inside the uterus/womb by a doctor and can stay there for five years. It slowly releases a low dose of progestogen hormone into the uterus. It stops sperm meeting an egg and prevents an egg from implanting/sticking to the lining in the womb.

What’s good about it?

It:

is more than 99% effective in stopping pregnancy

is very good for painful and heavy periods

can be removed easily

lasts for a long time.

Also:

20 - 50% of women have no period

a woman doesn’t need to remember to take a pill every day.

What’s not so good about it?

can be uncomfortable to insert especially if a woman has never had a baby born vaginally

needs a specially trained doctor to put it in

can increase the risk of infection in the womb in the month around insertion, especially if the woman is at high risk of STIs or changes partners often

can cause light spotting /bleeding for first few months.

Who shouldn’t use it?

women with a malformed uterus, current genital infection, pelvic inflammatory disease, postpartum endometritis or infected abortion in the last 3 months

women with ongoing high risk of STIs

some women with blood clots, stroke, heart disease, liver disease (they will need to discuss with their doctor)

women who have had breast cancer.

What else?

The Mirena should be replaced every 5years.

A Copper IUD is a small device made from copper and plastic that is fitted by a doctor inside the uterus/womb. It stops the sperm from reaching the egg and prevents an egg from implanting/sticking to the lining of the womb. It does not release hormones.

What’s good about it?

It is more than 99% effective in stopping pregnancy.

It can be removed easily.

A woman doesn’t need to remember to take a pill every day.

What’s not so good about it?

can make periods heavier

can be uncomfortable to insert especially if a woman has never had a baby born vaginally

needs a specially trained doctor to put in

can increase the risk of infection in the womb in the month around insertion, especially if the woman is at high risk of STIs or changes partners often.

Who shouldn’t use it?

women with a malformed uterus, current genital infection, pelvic inflammatory disease, postpartum endometritis or infected abortion in the last 3 months

women with an ongoing, high risk of STIs.

What else?

An IUD should be replaced every 5 years.

Fertility awareness based contraception

This method of contraception does not rely on the use of hormones, barriers or or devices. It includes any methods that use an awareness of the fertile time of the menstrual cycle, so that a woman can then avoid sexual intercourse to prevent pregnancy. These methods require education from experts and can be much less reliable than other forms of contraception.

Emergency contraception

This is not a type of contraception that is used as a woman’s regular contraception but can be used if a woman has unprotected sex and wants to avoid becoming pregnant.

The emergency contraception pill contains the hormone progestogen and can be bought at a chemist without a script from the doctor. It can be taken up to 5 days after unprotected sex but it is most effective if taken in the first 24 hours. If it is taken in the first 72 hours (3 days), it prevents about 85% of expected pregnancies. It can still be taken up to 96 days after unprotected sex but won’t be as effective.

The emergency contraception pill can make women feel sick so they may need tablets for nausea.

It is important for a woman to use a reliable form of contraception to prevent unplanned pregnancy.

Permanent contraception

Tubal ligation (tying) is often known as ‘getting your tubes tied’. It’s a surgical procedure for women, usually done under general anaesthetic, which blocks the fallopian tubes so that the egg cannot get from the ovary to the uterus and the sperm can’t get to the egg. It doesn't affect the periods, menopause, libido or sexual desire. Pregnancy is possible (for about 5 women in every 100 who have had their tubes tied) but it is very unlikely.

Risks of a laparoscopy (surgery through small incisions in the abdomen) are: damage to the bowel, bladder or blood vessels, infection of cuts in the skin and anaesthetic risks.

Who is it not good for?

women for whom surgery is a risk:

those who have had lots of previous abdominal/pelvic surgery,

those who are obese

those who have a risk for anaesthetic e.g. they have had previous strokes.

Vasectomy is a surgical procedure for men; it blocks the tube (the vas) that carries sperm from the testicles to the penis. The chances of pregnancy after having a vasectomy are around one in 1,000. The operation doesn’t interfere with a man’s sexual desire or his ability to reach orgasm. This is a quick procedure that can be done under local anaesthetic or with the man asleep.