Contraception

Hi Readers!

Did you know that without the use of contraception, 85 women in every 100 will get pregnant in 1 year. (UCL)

Contraception is a choice and a right. You need to choose the method that works best for you. We will go over multiple contraception choices in the article, but I highly suggest you speak to your doctor before making that choice, ensuring that the method you choose is appropriate for your body based on your medical history. 

You also need to remember that while most of these contraception methods help prevent pregnancy, they do not protect against STIs! Please be mindful of this. It is also suggested that you use these contraceptives in combination with the condom. 

Implant

Fewer than 1% of women will get pregnant in one year. (UCL)

The implant is a small piece of plastic that is put under the skin of the arm. It contains the hormone progestogen, which hormone is very similar to the oestrogen your body produces. It lasts for up to 3 years, but can be taken out at any time

Benefits:

• It’s extremely good at preventing pregnancy
• Very convenient; it doesn’t interrupt sex
• Menstruation can be lighter and less frequent
• It helps to make menstruation less painful
• It can help you deal with pre-menstrual symptoms (PMS)
• Often suitable for people who can’t take oestrogen

Risks:

• A small injection of local anaesthetic is needed to put it under the skin
• Irregular bleeding can be a nuisance (1 in 5 women) (UCL)
• Some women get side effects like mood changes and changes in sex drive
• No protection against STIs

IUS

Fewer than 1% of women will get pregnant in one year. (UCL)

The hormonal coil (IUS) is made of plastic and releases a small amount of progestogen. It is inserted into the womb by a doctor or nurse and lasts up to 5 years. The IUS can be a great help for heavy or painful periods. 

Benefits:

• Lasts up to 5 years 
• No need to remember pills or patches
• It doesn’t interrupt sex
• It is extremely good at preventing pregnancy
• Menstruation is usually lighter and less painful
• It is a low level of a very safe hormone
• Often suitable for people who can’t take oestrogen
• It’s usually quick and easy to take out
• Can help with pre-menstrual symptoms (PMS)

Risks:

• The procedure can be painful
• Some have irregular bleeding
• The IUS can come out (1 in 20)
• STI check needed before putting it in
• No protection against STIs
• Can cause mood changes, skin problems or breast tenderness

Rare risks:

• Can go through the wall of the womb when it’s put in (fewer than 1 in 1000)
• Pregnancy outside the womb (ectopic pregnancy) – possible but very rare

Copper Coil (IUD)

Fewer than 1 in 100 women will get pregnant in one year.

The Copper Coil (IUD) is made of plastic and copper. It’s put into the womb by a doctor or a nurse and lasts 5 to 10 years. The method is popular as it has no hormones

Benefits:

• It doesn’t interrupt sex
• It doesn’t contain hormones
• No need to remember pills or patches
• Lasts 5 to 10 years
• It is usually quick and easy to take out
• It is extremely good at preventing pregnancy
• Almost all women can use the IUD (speak to your GP)

Risks:

• Can make menstruation heavier and more painful
• Having it fitted can be painful
• The IUD can come out (1 in 20) 
• STI check needed before putting it in
• No protection against STIs

Rare risks:

• IUD can go through the wall of the womb when it is put in (fewer than 1 in 1000)
• Pregnancy outside the womb (ectopic pregnancy) – possible but rare

Injection

3 in 100 women can get pregnant in one year when using depo injections.

The injection (or depo) is given as an injection into the buttocks or thigh every three months. It contains a hormone called progestogen. It is long-lasting and convenient, it can stop periods temporarily 

Benefits:

• It doesn’t interrupt sex
• It helps to make periods lighter and less painful
• Most women (7 in 10) have no periods
• Often suitable for people who can’t take oestrogen
• It’s extremely good at preventing pregnancy
• It protects against cancer of the womb

Risks:

• It’s an injection, which some people dislike
• May cause irregular bleeding
• Weight gain is fairly likely (3kg in 2 years)
• Possible changes in mood and sex drive
• Not suitable for someone who definitely wants a regular period
• It can take several months to wear off
• No protection against STIs

Combined Pill

8 in 100 women can get pregnant in one year while using the combined pill.

The combined pill (“the pill” as most people call it) is taken daily and usually with a week off, once a month, to allow menstruation to happen. It contains 2 hormones, which are similar to women’s own hormones. Easy to start and stop, but can be difficult to remember to take

Benefits:

• Easy to take; one pill a day
• It doesn’t interrupt sex
• The pill is good at preventing pregnancy
• It helps to make menstruation lighter and less painful
• Menstruation will usually be very regular
• Easy to know and to control when menstruation will come
• The pill can help with acne and spots
• Some users notice enlargement of their breasts
• It protects against womb and ovarian cancer
• Protects against pelvic inflammatory disease

Risks:

• Can be difficult to remember to take the pill
• No protection against STIs

Possible side effects:

• Spotting (bleeding in between periods)
• Nausea
• Sore breasts
• Changes in mood or sex drive
• Feeling more hungry
• Blood clots in the legs or lungs (1 in 5,000 women)

Mini Pill 

8 in 100 women can get pregnant using the mini-pills.

The progestogen-only pill (mini-pill) is taken every day without any breaks. It contains a hormone which is very similar to one of the hormones produced by a woman’s body. It needs to be taken at the same time every day.

Benefits:

• Easy to take; one pill a day, every day
• It doesn’t interrupt sex
• It’s good at preventing pregnancy
• Under the user’s control
• It’s out of the system quickly once stopped
• Often suitable for people who can’t take oestrogen
• It can help with heavy or painful periods
• It may mean that periods stop (temporarily)
• Can be used when breastfeeding

Risks:

• Can be difficult to remember 
• No protection against STIs

Possible side effects:

• Irregular bleeding
• Headaches
• Sore breasts 
• Changes in mood
• Changes in sex drive

Patch

8 in 100 women will get pregnant in one year while using patches.

The patch is a square sticker like a thin plaster. It contains 2 hormones (oestrogen and progestogen) which are very similar to women’s own hormones. The patch is changed once a week

Benefits:

• Easy to use; change once a week
• It doesn’t interrupt sex
• The patch is good at preventing pregnancy
• It helps make periods lighter and less painful
• Periods are usually very regular
• Easy to know and control when a period will come
• The patch can help with acne
• Some users notice some enlargement of their breasts
• It protects against womb & ovarian cancer and pelvic inflammatory disease

Risks:

• It can be hard to remember when to change
• No protection against STIs
• Only available in a light colour making it visible on many women

Possible side effects:

• Spotting (in between periods)
• Nausea
• Sore breasts
• Changes in mood or sex drive
• Increased appetite 
• Blood clots in the legs or lungs (1 in 5,000) 

The Ring

9 in 100 women will get pregnant in a year while using vaginal rings

The vaginal ring is a soft plastic ring put in the vagina. It releases oestrogen and progestogen, which are similar to the women’s own hormones. The ring must be changed every 3 weeks with a week off

Benefits:

• Easy to use; one ring lasts 3 weeks
• It doesn’t interrupt sex
• The ring is good at preventing pregnancy
• It helps to make periods lighter and less painful
• Periods will usually be very regular
• Easy to know and to control when a period will come
• The ring can help acne
• Some users notice some enlargement of their breasts
• It protects against womb & ovarian cancer and pelvic inflammatory disease

Risks:

• Need to remember to change it once a month
• No protection against STIs

Possible side effect

• Spotting 
• Nausea
• Sore breasts
• Change in mood or sex drive
• Feeling more hungry
• Blood clots in the legs or lungs (1 in 5,000)

Condoms

15 in 100 women will get pregnant in one year when using a condom during sexual activity

There are two different types of condoms, male condoms that are worn on the penis and female condoms which are placed inside the vagina. Condoms are made from very thin latex, synthetic nitrile, polyisoprene or polyurethane and can be used for vaginal, oral and anal sex. For men, the size and fit of condoms are important so that they are comfortable and don’t break or slip off. That being said, condoms are very stretchy and can expand.

Benefits:

• Easy to obtain; clinics provide them for free
• Available without the need to see a doctor, nurse or healthcare professional 
• Protect against STIs
• Gives men and women control over whether and when to have a baby
• They may it easier to clean up after sex

Risks:

• Condoms can interrupt sex
• Condoms may reduce pleasure for either or both parties
• It can be difficult to ask men to wear condoms
• Some men worry about condoms and erections
• Condoms need some skill; knowing how to stop condoms breaking or slipping off

Diaphragm

16 in 100 women will get pregnant in one year while using the diaphragm.

Diaphragms and cervical caps are cups made of silicone. It is put at the top of the vagina, to cover the cervix (neck of the womb). It’s used with spermicide (a cream that kills sperm). It is necessary to check if it’s in the right place before sex

Benefits:

• Most women can use a diaphragm or cap
• They are hormone-free
• They can be put in up to 3 hours before sex
• They offer some protection against STIs
• Can have sex more than once with a diaphragm or cap in place (with extra spermicide) 
• Skin to skin contact

Risks:

• Diaphragms and caps are less effective than other methods
• Technique needs a bit of practice
• Need to be put in before intercourse
• They need to be left in for 6 hours after sex
• The spermicide can be messy
• Some spermicides can increase the risk of HIV transmission 

Fertility Awareness 

25 in 100 women will get pregnant in one year using natural methods.

Fertility Awareness (natural family planning) is a way of predicting ovulation to work out when pregnancy is more likely. This method involves recording signs of fertility such as body temperature, thickness of fluid in the vagina and calculating fertility from menstrual cycle dates. Fertility awareness can be very effective (with daily monitoring).

Benefits:

• Non-hormonal method
• There are no side effects
• The method involves learning how the body works
• Skin to skin contact
• Acceptable in most religions and cultures
• Can be useful when trying to become pregnant

Risks:

• It can be tricky to learn and takes a few months to monitor patterns
• May have a higher risk of pregnancy
• Daily monitoring is needed (temperature, thickness of fluid in the vagina)
• Illness, stress or travel can make it hard to interpret signs
• Unprotected sex must be avoided on the most fertile days
• No protection from STIs
• To work best, it should be thought by a qualified fertility awareness teacher, nurse, GP

Withdrawal 

27 in 100 women will get pregnant in one year when using the withdrawal method.

The withdrawal method (pulling out) is when a man pulls out before he ejaculates.

Benefits:

• No need to see a doctor, nurse or healthcare professional 
• Free 
• No hormones
• Acceptable for women whose religion or culture forbids other methods

Risks:

• Requires extreme self control and body awareness of the man
• It’s not a very reliable way of preventing pregnancy
• There can be small deposits of sperm before orgasm (ejaculation)
• Some people find withdrawal unsatisfying for sexual pleasure
• Difficult to do it every time

Now that I have peaked your curiosity in this subject, I strongly recommend you read on the different methods in more detail on public health websites (NHS, etc.) to learn more about side effects, how they work, etc. You should also consult your GP as some methods may not be the right fit for you depending on your medical history.

If you would like to make an appointment to discuss your decision making process and the side effects of these methods please email me at depetrillojulia@gmail.com

Be kind to one another!

Julia, Sexologist