The pros and cons of alternatives to the Pill

There are currently two methods of contraception available for men and 13 for women. However, despite this wide variety the pill continues to reign supreme. Year-on-year data from the Office for National Statistics shows that the percentage of women taking the pill barely waivers. Indeed, of women using at least one form of contraception, more than a third take a pill – 34%, while the IUD, IUS, injections and implant come in at just 7%, 2%, 4% and 2% respectively.

Experts suggest this unfailing popularity for the pill is largely born out of a lack of information combined with myths and misconceptions regarding other forms of contraception. “A lot of women have the idea that IUD, IUS and also injectables can affect future fertility in the long term, and there is really no evidence for that” says Dr Cynthia Graham, senior lecturer in health psychology at the University of Southampton.

When picking contraception a much more rounded approach should be encouraged. “Each method of contraception has pros and cons,” says GP Dr Caroline Robertson. “There’s not one form that is the gold standard. Ultimately, it depends on the person's age, if they’re sexually active, how many partners they have, if they’re breastfeeding etc. A method that is convenient and effective for somebody in their 20s won’t necessarily be a good form of contraception for somebody later in life. You need the whole picture before you can make a fully informed decision.

“What is possible though is to do some research into the variety of methods available and assess beforehand what might work best for your lifestyle. For example, the pill might be the most common form of contraception taken in the UK, but essentially its effectiveness is entirely reliant upon a person taking it regularly - so if you’re forgetful or disorganised it’s probably not the best option for you.”

When deciding upon what contraception might work best for you there are a number of things to keep in mind:

• Whether you (or a partner) want to become pregnant fairly soon, many years away or not at all.
• How you (and a partner) want contraception to fit into your lifestyle.
• Whether you (or a partner) want to use the method every day, every time you have sex or less often.

To help give you a more complete perspective we’ve rounded up the most commonly used contraceptive methods available and broken down the facts and figures to bring you an essential cheat sheet of information. So, read up and choose wisely.

Contraceptive injection

Best suited to: Young women who don’t want to have to remember to take contraception. It's also good if you’re breastfeeding.

Effectiveness: Over 99%. Less than one woman in 100 will get pregnant in a year.

How it works: The injection releases the hormone progestogen which stops ovulation, thickens cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus (womb) to prevent a fertilised egg implanting.

Advantages:

• Lasts for between 8-12 weeks depending on which one you get.
• May protect against cancer of the uterus, and offers some protection from pelvic inflammatory disease.
• You don’t have to think about contraception for as long as injection lasts.

Disadvantages

• Periods may stop or become irregular/longer.
• Periods and fertility make take time to return after stopping the injection.
• Some women gain weight.
• Some women report having headaches, acne, mood changes and breast tenderness.
• The injection cannot be removed from the body so any side effects may continue for as long as it works for some time afterwards.

Implant

Best suited to: Young women who don’t want to have to remember to take contraception.

Effectiveness: Over 99%. Less than one woman in 1,000 will get pregnant over three years.

How it works: A small flexible rod is put under the skin of the upper arm, which releases hormone progestogen. It stops ovulation, thickens cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus to prevent a fertilised egg implanting.

Advantages

• Works for three years but can be taken out sooner.
• You don’t have to think about contraception for as long as the implant is in place.
• When the implant is removed your fertility will return to normal.

Disadvantages

• Periods may stop, be irregular, or longer.
• Acne may occur.
• Some women report having mood changes and breast tenderness.
• It requires a small procedure to fit and remove it.
• Some medicines may stop the implant from working.

MORE GLOSS: Fertility Facts: 15 things you need need to know about getting pregnant

Intrauterine System (IUS)

Best for: Women who are looking to space babies, those who suffer from difficult periods. Also a useful method for those later in life - IUS can be used right up until menopause.

Effectiveness: Over 99%. Less than one woman in 100 will get pregnant over five years.

How it works: a small T-shaped plastic device, which slowly releases the hormone progestogen, is put into the uterus. This thickens the cervical mucus to prevent sperm reaching an egg, which thins the lining of the uterus to prevent a fertilised egg implanting and may stop ovulation.

Advantages

• Works for five years but can be taken out sooner.
• Periods usually become lighter, shorter and sometimes less painful.
• You don’t have to think about contraception for as long as the IUS is in place.
• When the IUS is removed your fertility will return to normal.

Disadvantages

• Irregular bleeding or spotting is common in the first six months.
• Periods may stop altogether.
• Some women report having acne, headaches and breast tenderness.
• Very small chance of getting infection during the first 20 days after insertion.
• May get ovarian cysts.

Diaphragm/cap with spermicide

Best for: People who aren’t too worried about getting pregnant or those who have infrequent sex.

Effectiveness: Latex types are 92-96% effective if used correctly. Between four and eight women in 100 will get pregnant in a year. Silicone caps are less effective.

How it works: A flexible latex or silicone device, used with spermicide, is put into the vagina to cover the cervix. This stops the sperm from entering the uterus and meeting an egg.

Advantages

• Can be put in any time before sex.
• You only have to use it when you have sex.
• No serious health risks.

Disadvantages

• Putting it in can interrupt sex.
• It always needs to be put in before sex, so spontaneity is difficult.
• Extra spermicide is needed if you have sex again.
• Some people can be sensitive to spermicide.
• Cystitis can be a problem for some diaphragm users.
• Can take time to learn how to use correctly.

Intrauterine Device (IUD)

Best for: Women who are established with partner with periods that are easily managed.

Effectiveness: Over 99%. Less than one woman in 100 will get pregnant in a year. Older IUDs have less copper and are less effective.

How it works: A small plastic and copper device is put into the uterus. It stops sperm reaching an egg, and may also stop a fertilised egg implanting into the uterus.

Advantages

• Works as soon as it is put in.
• Can stay in 5-10 years depending on type, but can be taken out at any time.
• You don’t have to think about contraception for as long as IUD is in place.
• When the IUD is removed your fertility will return to normal.

Disadvantages

• May not be suitable for women who are at risk of getting a sexually transmitted infection.
• Periods may be heavier or longer and more painful.
• Very small chance of getting an infection during the first 20 days after insertion.
• A small increased risk of ectopic pregnancy if the IUD fails.

Combined Pill

Best for: People who are organised, those who want to regulate periods and also beneficial for some people with acne.

Effectiveness: Over 99% if taken according to instructions. Less than one woman in 100 will get pregnant in a year.

How it works: It contains two hormones - estrogen and progestogen. It stops ovulation, thickens cervical mucus to prevent the sperm reaching an egg and thins the lining of the uterus to prevent a fertilised egg implanting.

Advantages

• Often reduces bleeding, period pain and premenstrual symptoms.
• Protects against cancer of the ovary, uterus and colon and some pelvic infections.
• Suitable for healthy non-smokers up to the menopause.
• When you stop using the combined pill your fertility will return to normal.

Disadvantages

• Not suitable for very overweight women or smokers over 35 years old.
• It only works when taken - meaning its efficacy relies entirely upon the person regularly taking the pill.
• Very low risk but serious side effects may include blood clots, breast cancer and cervical cancer.
• Can be temporary side effects such as headaches, nausea, mood changes and breast tenderness.

Progestogen-only Pill

Best for: Women who can’t take pill and women who are postnatal or breastfeeding.

Effectiveness: Over 99% effective if taken according to instructions.

How it works: Contains the hormone progestogen, which thickens the cervical mucus to prevent sperm reaching an egg and thins the lining of the uterus to prevent a fertilised egg implanting. In some cycles it stops ovulation.

Advantages

• No serious side effects.
• Can be used by women who cannot use estrogen.
• Can be used by women who smoke and are over 35.
• You can use it if you’re breastfeeding.

Disadvantages

• Periods may stop, or be irregular, light, or more frequent.
• May be temporary side effects such as acne, weight change and headaches.
• A small increased risk of ectopic pregnancy if it fails.
• May get ovarian cysts.
• It needs to be taken at the same time every day.
• Not effective if taken over three hours late or after vomiting, or severe, long-lasting diarrhoea.

Male Condom

Best for: Helping with STI’s, but they are recommended to be used alongside additional contraception such as the pill.

Effectiveness: 98% if used according to the instructions. Two women in 100 will get pregnant in a year.

How it works: Made of very thin latex (rubber) or polyurethane (plastic). It is put over the erect penis and stops sperm from entering the vagina.

Advantages

• Free from contraception, sexual health and GUM clinics, young people’s services, some general practices and sold widely.
• Can help protect both partners from some sexually transmitted infections, including HIV.
• No medical side-effects.

Disadvantages

• Putting it on can interrupt sex.
• It may slip off or split if not used correctly or is the wrong size or shape.
• Man needs to withdraw as soon as he has ejaculated and before the penis goes soft, being careful not to spill any semen.

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