NHS Leadership

Choosing A Contraceptive

There are many different types of contraceptive methods and each woman will have to decide on which suits her and her needs best. Some methods can be taken in emergencies or have a longer lasting affect than others, some to be taken orally daily, or it could be an implant that does not need your attention every day. Other factors to consider while thinking about contraceptives are age, health and any family history, any medication that you are currently taking and whether you smoke. Finding the one most suitable for you is very important and the first one that is chosen may not be the best option. It is very much trial and error. Here, we will guide you through some of the methods available and where to get them.

 

The Pill

 

The pill is often described as the combined pill, where it has a concentrated dose of two female hormones; oestrogen and progestogen, which creates an uninhabitable setting for both the sperm and the egg. First of all it works by making the body think that ovulation has already happened when in fact no egg has been released and then it makes it harder for sperm to reach the egg in the womb by thickening the mucus found in the neck of womb. Then another barrier is created to stop any fertilised egg attaching itself on the womb by making the womb lining thinner. One pill must be taken orally each day at the same time for 21 days. Then have a 7 day break where no pills should be taken during which you will get a bleed. Then continue with a new packet of 21 days. Some oral contraceptive medications have dummy pills for the 7 day break so that you maintain your dosing regimen.

 

Advantages vs disadvantages:

 

Advantages

 

1. Can help with heavy or painful period relief
2. Regulates your period
3. It is 99% effective
4. No evidence of making women gain weight
5. Risk of ovarian cysts, fibrosis and non-cancerous breast diseases could be reduced  
6. Is known to reduce acne and some skin conditions
7. Can reduce extra bodily hair growth

 

Disadvantages

 

1. Misuse, late or missing a pill can lead to it becoming less effective.
2. Side effects
3. Bleeding when the pill is interrupted
4. Can create some mood swings and tender breasts
5. Not suitable for smoking women over the ages of 35
6. Effectiveness can be interrupted by other medications
7. Does not protect against STI’s (make sure you use a condom).

 

You must of course read the patient leaflet before use for more information. You can find a list of different pills here.

 

The Mini pill/ Progestogen-only Pill

 

This pill works in a similar way to how the combined pill works, however the difference here is there is only one hormone in this pill. This is prescribed where the combined pill does not work for you, if you are over 35 and smoke or have a history of high blood pressure and blood clots. The progestogen hormone prevents ovulation. The mucus in the womb is thickened making sperm penetration more difficult. The packet contains 28 pills, one must be taken at the same time every day for 28 days, and then with no break a new packet of 28 days must be started. Again, the interruption of pills could lead to it being less effective, so make sure you are taking them at the same time every day. To complicate matters even more, there are two types of progestogen- only pills. The 3-hour pill gives a 3 hour leeway for the next day’s pill to be taken and the 12 hour one works likewise.

 

Advantages vs. disadvantages:

 

Advantages

 

1. It can be used even when breastfeeding
2. Does not have oestrogen (a hormone found in the combined pill, vaginal ring and contraceptive patch)
3. Can be used at any age, even when smoking and over 35

Disadvantages

 

1. Can reduce PMS (premenstrual syndrome)
2. Your period may be interrupted, making it heavier, lighter, irregular or even none existent all together
3. Acne, breast tenderness, mood swings, migraines, cysts on ovaries and weight gain may be some on the side effects
4. Effectiveness can be interrupted by other medications,
5. Does not protect against STI’s (make sure you use a condom).

 

Further information about the progestogen-only pill is found here.

 

Condoms

 

There are two types: one for females one for males. Both work roughly in the same way. Except the female version must be placed inside the vagina and looks larger.

 

• You only have to think about it when you plan to have sex. Unlike a pill where you must remember to take every day
• Condoms are the only protection against STIs, including HIV, gonorrhoea and chlamydia as well as unwanted pregnancy
• Can be used just before sex so is useful for unplanned sex. Female condoms can be put in place up to 8 hours before sex
• Can be enjoyable to use for couples
• Widely found in many sizes, shapes and flavours.

 

If a condom splits during sex then you may need to take emergency contraception. You can find out more about the morning after pill here.

 

The Contraceptive Patch

 

As any other contraceptive or medication, your health and your family’s health history must be taken into account. This patch works in a similar way to the combined contraceptive pill, where two hormones are released into the skin and absorbed through your pores instead of having to worry about taking a pill each day and at the times. This may have different positive and negative effects for each woman and must be considered as a case to case basis, although they are very similar to the combined pill, here is a list of pros and cons to consider:

 

Advantages & disadvantages:

 

Advantages

1. Works even when throwing up or when you have severe diarrhoea
2. Does not interrupt sex
3. You will only need to change once a week - so, 6 out of 7 days you will not have to think about it,
4. Risk of ovarian cysts, fibrosis and non-cancerous breast diseases could be reduced

 

 

Disadvantages

1. May not be very well concealed
2. Will not protect against STI’s (make sure you use a condom)
3. Some women may get an irritation in the area where the patch has been.

 

 

The contraceptive implant

 

Like the mini pill, the implant emits only one type of hormone, progestogen, working in the same way where mucus in the womb is thickened making sperm penetration more difficult and the lining of the womb is thinned not allowing a fertilised egg to attach should there be one. The implant itself is a small tube inserted by a trained nurse or a doctor just under the skin on the inside of your arm, and protects you from unwanted pregnancies for three years if inserted correctly.  This implant is over 99% effective and is very practical for women who know they do not want a pregnancy in the next 3 coming years. A doctor or trained nurse can also easily remove it if a pregnancy is desired with your normal fertility returns quite promptly.

 

Advantages & disadvantages:

 

Advantages

 

1. You will not have to think about unwanted pregnancies or contraception for 3 years
2. It is small and under the skin so virtually undetected
3. Can reduce period pains and make them lighter, and help with clearing acne after the first year
4. Protected against pelvic Inflammatory disease and womb cancer
5. Can breastfeed while having the implant

 

Disadvantages

 

1. Will not protect against STI’s so you must use a condom
2. Some side effects like mood swings, depression, nervousness and nausea
3. Requires a small surgery to insert, change, or remove the implant.

 

 

Please seek a medical consultation to help you decide which contraception is more suitable for your needs. If you have the oral medication prescribed then you can get the medication online every three months so long as you agree to have a check-up with your GP or other healthcare provider once a year. If you need emergency contraception then you can get this from your local or online from specialist clinics for next day delivery.