As a woman, taking steps not to become pregnant is something that most of us have to consider at some stage of our lives. There are many different options available each with medical and lifestyle factors to take into consideration, but broadly speaking, there is an option available to suit the needs of most of us.
The main factor I discuss with patients in GP practice is firstly, no method is 100% effective and each method needs to be used correctly for them to work optimally; in other words, there is no point liking the idea of taking the pill, if you're the sort of person who has a tendency to forget to take it! I'm going to take you through all the most common methods to help you find the one you think suits you best, you can then chat to your own GP about the options in more detail.
What Options Are There?
There are five main groups of contraceptives available:
Barriers methods: Condoms, caps and diaphragms.
Hormonal methods: These are short-acting methods using hormones taken as pill, patch or a ring.
Long-acting reversible contraceptives: LARCs include intra-uterine contraceptive devices (also known as the coil), injections and implants.
Sterilisation: This is a permanent method for males and females.
Natural methods: The riskiest method in the sense that it relies on you opting to have sex during the least fertile time in your cycle.
Let's explore the most popular…
Combined Oral Contraceptive Pill
• This is the classic “pill.” It is as popular today as ever.
• It contains two synthetic female hormones: oestrogen and progesterone.
• A pill is taken every day for 21 days then you have a seven-day break, this is your withdrawal bleed.
• It helps ease heavy and painful periods.
• Very effective.
• User dependent—you need to remember to take it!
• Not suitable for everyone. Your doctor will assess your suitability before prescribing it. Risk factors include family history of breast cancer, venous thrombosis (blood clots in legs/lungs), migraine, obesity and smoking.
• Also known as the “mini pill.”
• Often used as an alternative in women who are unable to take the combined oral contraceptive pill.
• This is due to its less serious risk profile.
• It can be safely prescribed to women who have migraines, smokers, women over 35, obese women and it can even be safely used in women who are breastfeeding.
• The main drawback is you need to take it at the same time each and every day, religiously, in order for it to be effective.
• It's common for women to experience irregular bleeding for the first three months.
• In some cases, your periods may stop completely after this time.
• Common side effects of progesterone-only contraceptives include weight gain, mood changes, skin breakouts and headache.
Long-Acting Reversible Contraceptives (LARCs)
• Contain synthetic progesterone hormone.
• No oestrogen, so it can be safely used in women who the oral contraceptive pill is unsuitable for.
• Very effective.
• Injection is needed every eight to 13 weeks depending on which injection is used.
• Good for women who forget to take pills.
• Like the progesterone-only pill, you may need three months for irregular bleeding to settle down.
• Women often experience lighter periods or their periods completely stop.
• As with the progesterone-only pill, the injection may also cause the common progesterone-based side effects.
• It can take some time for your periods to fully return to normal after stopping the injection, which may affect your fertility in the short term.
This is a small rod-shaped device that is inserted under the skin, typically in your upper arm. It slowly releases a synthetic progesterone hormone. Like the injection and POP, it only contains progesterone, so the same pros and cons above apply. Once the implant is removed your periods quickly return to normal.
Intra-Uterine Contraceptive Device
The IUCD is also known as the copper coil. It is a tiny device that is inserted into the uterus, where it stays for 5-10 years. Unlike the hormonal methods described above, which prevent pregnancy by blocking ovulation, the coil works by preventing implantation of a fertilised embryo.
The main advantages include:
- It's very effective.
- It’s a long-term method that is not user–dependent; so it’s ideal for women who forget to take pills.
- There are NO hormones involved, so there are none of the troublesome hormonal changes in your body that can happen with hormonal based contraceptives.
- The main drawback is the copper IUCD can make your periods heavier and more painful; therefore it should be avoided in women who experience this.
This is a tiny plastic device containing a synthetic progesterone hormone. Like the IUCD, it is inserted into the uterus and provides its contraceptive effect by preventing implantation. The main advantages:
• In terms of contraception, it is extremely effective.
• It is also used as a first-line treatment in gynaecology to treat painful and heavy periods.
• Like other methods of contraception using the progesterone hormone in isolation, it can make periods lighter or in many cases, stop altogether. However, the other less favourable effects of progesterone-only contraception, like weight gain, skin problems and mood swings are much less likely because much less of the hormone gets into the bloodstream, and most of it is confined to the uterus.
• It needs to be replaced after five years.
• Contraception is often more confusing than you think.
• As women, it's important we all take the time to do a little bit of research and reflect on your lifestyle and personal preferences before committing to one type.
• Unfortunately, they all have pros and cons.
• That said, most women can find one that suits them well.
Final note: All the options I discussed above only protect you against pregnancy, not sexually transmitted diseases. It is only our friend the condom and other barrier methods that can do this special role.