February 20th 2018
Sex & Gynae
The modern woman’s guide to contraception
February 12th 2018 / 1 comment
Out of all the contraception options out there, which one’s right for you? Dr Anita Sturnham explains the factors that you should bear in mind when making your choice
A woman can get pregnant if a man’s sperm reaches one of her eggs (also known as ova). Contraception works by stopping the sperm from meeting the egg by keeping them apart or by stopping release of eggs from the ovaries in the first place.
There are 15 methods of contraception available in the UK, which includes 2 options for men and 13 for women. It's important to take the time to find out about each one so that you can choose the contraception that suits you best.
Before making your decision you might want to think about the following factors:
- Whether you (or a partner) want to become pregnant fairly soon, many years away or not at all. Some contraceptive methods, such as the contraceptive implant can take up to 18 months before your fertility returns, while others such as the coil or pill allow pretty rapid return to fertility within a few days of stopping.
- How you (and a partner) want contraception to suit your lifestyle. Busy chaotic lifestyles may not suit the pill method, as forgetting pills can increase the risk of unplanned pregnancy.
- Whether you (or a partner) want to use the method every day, every time you have sex or less often. Methods such as the coil or the implant allow you to have long-term contraceptive cover without needing to worry about taking a pill every day.
Your answers can help to influence your decision about what contraception to use. You can get confidential advice about contraception from your GP surgery or sexual health clinic.
So, which form of contraception is right for you? I often find it helpful to discuss contraceptive options by dividing them into the following categories.
1. Methods that protect against STIs
Condoms are the only type of contraception that will protect you against both pregnancy and Sexually Transmitted Infections (STIs).
You can get condoms that are worn on the penis, such as those made by HANX, and condoms that are worn inside the vagina (femidoms).
They are sometimes referred to as ‘barrier’ methods because they provide a barrier between you and your partner’s genitals.
2. Methods you need to think about every time you have sex
Condoms and female condoms will protect you from STIs and pregnancy. Diaphragms and caps are methods that are inserted into the vagina and they will only protect against pregnancy – not STIs.
Diaphragms are dome-shaped rubber devices that fit into the vagina and over the cervix.
Cervical caps are smaller and need to be put directly onto the cervix.
Both must be fitted by a trained doctor or nurse on the first occasion.
3. Methods you need to think about every day
We have two types of contraceptive pill available, the combined pill and progestogen-only pill.
For them to work, you need to take your contraceptive pills as instructed by the nurse or doctor.
a) The combined pill
It works in three ways:
- It stops ovulation. As it stops an egg from being released, it cannot be fertilised.
- It makes it harder for the sperm to reach the egg by forming protective mucus to block the sperm from reaching the fallopian tubes and the eggs.
- It makes the lining of the uterus (womb) thinner so that a fertilised egg cannot implant.*
You take the combined pill every day for 21 days, followed by a break. During this time most women will get a withdrawal bleed.
Fertility returns as soon as stopping the pill.
If taken correctly, it can be more than 99% effective. This means that less than one woman in 100 who uses the combined pill as contraception will get pregnant in one year.
b) The progestogen-only pill
This contains one hormone rather that two. It's also called the mini pill
The progestogen-only pill works by:
- Thickening the mucus in the cervix, which stops the sperm reaching an egg.
- It can stop ovulation, depending on the type of progestogen-only pill you take.
If taken correctly, it can be more than 99% effective. This means that fewer than one woman in 100 who use this form of contraception will get pregnant in one year.
You take one pill around the same time every day, with no break between packs. You must take the progestogen-only pill at the same time each day – if you take it more than three hours late (or 12 hours late if you take a desogestrel pill, such as Cerazette) it may not be effective.
The progestogen-only pill can be used by women who can't use contraception that contains oestrogen – for example, because they have migraines, heart disease, blood clots or are overweight.
Once we turn 35 years, the combined pill has greater risk of side-effects, so this is a safer alternative in this age group.
Your periods may stop or become lighter, irregular or more frequent.
Side-effects may include spotty skin and breast tenderness – these should clear up within a few months.
You take one pill at the same time every day with no break. When you first take the pill, choose the time of day that suits you best. Then take it at the same time every day until you finish the packet. You then start the next packet straight away.
c) Natural family planning
This method uses a woman’s natural cycle to work out when she is in the most fertile phase of her cycle and avoid unprotected sex during this time. This method can be tricky as cycle lengths can vary so much.
4. Methods that may help heavy periods
If you have heavy or painful periods, all of the methods below can help. This is because they release hormones (progestogen and/or oestrogen) into your body that can help to stabilise and regulate your hormones and control the build up of the lining of the uterus /womb, which can affect the heaviness and length of your period etc.
None of these methods will protect you from STIs but all will prevent pregnancy.
a) Combined pill (as above)
b) Contraceptive patch- the contraceptive patch, also called Evra, is a small beige patch applied to the skin like a plaster.
It must be replaced weekly and can still be worn when swimming, exercising, and in the bath. It releases the same hormones as the combined pill into the bloodstream through the skin and works the same way by stopping ovulation, thickening the mucus around the cervix, which makes it harder for sperm to get through, and making the lining of the womb thinner so that a fertilised egg cannot implant.
c) Intrauterine system (IUS) - this is a small, T-shaped plastic device about the size of a matchstick that is inserted into your womb (uterus) by a specially trained doctor or nurse.
The IUS releases a progestogen hormone into the womb. This thickens the mucus from your cervix, which makes it difficult for sperm to reach an egg. It also thins the womb lining so that it's less likely to accept a fertilised egg. It may also stop ovulation (the release of an egg) in some women.
The IUS is a long-acting reversible contraceptive (LARC) method. It works for five years or three years, depending on the type, so you don't have to think about contraception every day or each time you have sex. You can use an IUS whether or not you've had children.
The IUS can make your periods lighter, shorter and in some cases they completely stop. It can be taken out at any time by a specially trained doctor or nurse and your fertility quickly returns to normal.
5. Methods that last months or even years
These methods are sometimes referred to as long-acting reversible contraception or LARC. None of them with protect you from STIs but they will prevent pregnancy.
a) Copper coil (Intrauterine device)
This is a small T-shaped copper/plastic device that is inserted via the vagina and sits in the neck of the womb.
It works by having an irritant effect on the womb rather than by using hormones, making it a popular choice for women who want to avoid hormones. This works by stopping the sperm and egg from surviving in the womb and may also prevent a fertilised egg from implanting in the womb.
The IUD is a long-acting reversible contraceptive (LARC) method. This means that once it's in place, you don't have to think about it each day or each time you have sex. The IUD can stay in place for 5-10 years depending on the type of device used. Some women get bloating, and heavier periods when this is first fitted but this normally settles down.
b) Intrauterine system (IUS) - as above
c) Contraceptive implant
The contraceptive implant is a small flexible tube about the size of a pin that's inserted under the skin of your upper arm. It's inserted by a trained professional, such as a doctor, and lasts for three years.
The implant stops the release of an egg from the ovary by slowly releasing progestogen into your body. Progestogen thickens the cervical mucus and thins the womb lining. This makes it harder for sperm to move through your cervix and less likely for your womb to accept a fertilised egg. It can be used up until the menopause.
d) Contraceptive injection
This involves an injection being given into the buttock region every 12 weeks by your doctor or contraception nurse. It contains a slow release form of the hormone progesterone, which thickens the mucus in the cervix and also thins the lining of the womb, like other progesterone methods. There are three types of contraceptive injections in the UK: Depo-Provera, which lasts for 12 weeks, Sayana Press, which lasts for 13 weeks and Noristerat, which lasts for eight weeks.
Side-effects can include changes in mood, skin, headaches and bloating. Periods may be heavier, lighter or even stop. Side-effects normally settle within a few months.
Fertility can take up to 12-18 months to return. This method is safe and effective and often a popular choice for those who think they may miss their oral pills.
6. Permanent methods
Female sterilisation is carried out by blocking or sealing the fallopian tubes, which carry eggs from the ovaries to the uterus (or womb). Vasectomy or male sterilisation involves cutting the tubes that carry sperm from the testicles to the penis. Neither method will protect you from STIs but both will prevent pregnancy.
If a woman decides she wants a permanent method of contraception, she may consider sterilisation. Options include tubal occlusion, where the tubes that transport the eggs are clipped or hysteroscopic sterilisation where implants and used to block the fallopian tubes.
Both methods are very difficult to reverse so this needs to be carefully considered. It can be a fairly minor operation, with many women returning home the same day. Sterilisation is usually carried out using tubal occlusion.
This is where the tubes that carry sperm from a man's testicles to the penis are cut, blocked or sealed.
This prevents sperm from reaching the seminal fluid (semen), which is ejaculated from the penis during sex. There will be no sperm in the semen, so a woman's egg can't be fertilised.
Vasectomy is usually carried out under local anaesthetic and takes about 15 minutes.
Dr Anita Sturnham is a GP, TV Doctor and healthcare and skincare specialist. Her clinic is located at 48 Wimpole St, London, W1G 8SF.