From the implant to the pill, help choosing the right contraception for you.
Contraceptive methods are designed to prevent unwanted pregnancy. If used correctly, you can have sex without the worry of getting pregnant or getting someone else pregnant.
With 15 different methods of contraception currently available in the UK, including thirteen for women and two for men, it can be tricky deciding which one works best for you.
To help you make an informed decision about contraception, Dr Juliet McGrattan offers her expert advice on everything from hormonal contraceptives to sterilisation:
Which contraceptives are available?
The following contraceptives are available for free in the UK from the NHS and can be divided into the following groups:
• Long acting reversible contraceptives
Long-acting reversible contraceptives (LARCs) need to be administered less than once a month and include implants, injections, IUS and IUD.
• Barrier contraceptives
Barrier contraceptives are designed to prevent the sperm from reaching the egg, and include condoms and diaphragms.
• Oral hormonal contraceptives
Sterilisation is a permanent contraceptive method and includes a vasectomy for men and a laparoscopic sterilisation for women.
• Natural family planning
Family planning involves identifying the phases during your menstrual cycle that you are fertile you can plan or avoid pregnancy. Fertility awareness methods should be taught by an expert.
❗ Most methods of contraception won’t protect against sexually transmitted infection (STI), so if you have sex with a new partner, always use a condom.
Which contraceptive is right for you?
Your ideal contraception will depend on your health and circumstances, and you may need to try several different types before you find the right one.
The right contraceptive for you may change as you age. What suited you perfectly when you were 18 may not be what is best for you when you are 47. It is important to keep an open mind. Remember that what didn’t suit your friend may be ideal for you and vice versa.
There are a number of factors to consider when deciding which contraceptive is right for you; these can include medical reasons, personal preferences or even religious beliefs. For example, women with high blood pressure or increased risk of deep vein thrombosis may not be offered hormonal contraceptives. You also need to consider if and when you are planning to get pregnant as this can influence your choice too.
⚠️ If you are sexually active and don’t use any contraception, there’s an 80 per cent chance you will become pregnant within a year. Using a form of contraceptive will decrease the chances of you getting pregnant if used correctly.
How effective any contraceptive will be is dependent on your age, how often you have sex and whether you follow the instructions correctly. To help you make an informed decision, read our guide to the contraception options that available in the UK:
Long acting reversible contraceptives
Once you have had a long-acting reversible contraceptive (LARC) fitted, You won’t need to think about using a contraceptive every single day (or every time you have sex). LARC are very effective and if administered correctly are 99 per cent effective.
There are three main types of long-acting reversible contraceptives – injections, implants and intrauterine devices:
Injections work by releasing the hormone progestogen for up to 12 weeks. Your periods may change – you may stop having periods completely or they may be lighter, irregular, heavier or last longer. You should see your doctor if you are having problems with heavy prolonged bleeding.
It’s important to make sure you have your injection when it is due. If you miss one or are late having your next injection, you may not be protected.
2. Contraceptive implant
The contraceptive implant works by releasing the hormone progestogen for three years. This stops the ovaries releasing an egg each month, thickens the mucus in the cervix and makes the lining of the uterus thinner, therefore decreasing the chances of an egg being fertilised.
The implant is a small flexible rod, the size of a matchstick that is placed just under the skin in the inner area of the upper arm. A local anaesthetic is used to numb the upper arm area before the implant is administered. It is similar to having an injection. You will be shown how to feel the implant with your fingers, so you can check that it is in place.
The contraceptive implant side effects: your periods may change after the implant is in place – you may stop having periods completely or they may be lighter, irregular, heavier or last longer. You should see your doctor if you are having problems with heavy prolonged bleeding.
Contraceptive implants available in the UK: Nexplanon.
3. Intrauterine devices
Intrauterine devices are small devices that are inserted into the uterus. There are two types – intrauterine devices (IUD) and intrauterine systems (IUS). IUDs are sometimes referred to as the coil or a copper coil because most of the original IUs were coil-shaped.
The IUD does not contain a hormone, it slowly releases copper which prevents sperm from surviving in the cervix. It may also stop a fertilised egg from implanting in the womb. IUD can also be used for emergency contraceptive if inserted up to five days after unprotected sex.
An IUS works differently to IUDs, these release the hormone progestogen which makes the lining of the uterus thinner, so it’s less likely to accept a fertilised egg. An IUS may also stop ovulation. An IUD or IUS must be fitted by a trained doctor or nurse. Intrauterine devices can last between 5 to 10 years depending on the type.
IUD side effects: your periods may change after the IUD or IUS is in place. With an IUD you will maintain your normal cycle but you may find your periods are a little heavier. With an IUS you may stop having periods completely after the first year of use, you may experience lighter, irregular periods or spotting for the first six months.
Barrier contraceptives are designed to prevent the sperm from reaching the egg. There are two types of barrier contraceptives: condoms and diaphragm.
Condoms are 98 per cent effective if used correctly according to the instructions. However, the effectiveness can be reduced by the following:
- If the condom slips off or splits.
- The wrong type or size of condom is used, or it is not fitted correctly.
- The condom is damaged, by sharp finger nails or jewellery, or by using oil-based products such as body lotions.
- If you use oil-based lubricants with latex or polyisoprene condoms.
❗ Condoms are the only form of contraceptive that will protect against sexually transmitted diseases.
Vaginal diaphragms are circular domes made of silicone with a flexible rim. They fit inside the vagina and cover the cervix. Diaphragms work by stopping sperm from meeting an egg. Diaphragms are 92-96 per cent effective if used correctly with a spermicide that kills sperm. They need to be left in place for at least six hours after sex.
Diaphragm side-effects: your periods will not be affected by using a diaphragm.
Oral hormonal contraceptives
There are two types of oral contraceptives, the combined hormonal pill and the progestogen only pill. Your doctor will be able to advise you on which type of pill is most suitable after looking at your medical history, lifestyle and general health.
1. The combined hormonal pill
The combined pill contains two hormones – oestrogen and progestogen. There are many different variations of the combined pill, containing different amounts of the two hormones. Examples include: Microgynon, Levest, Cilest and Yasmin.
The combined pill is not suitable for some women, your doctor will discuss your medical history and look at any family history of certain conditions such as heart disease, diabetes, high blood pressure, blood clots, migraines and breast cancer. It is only suitable for healthy women, who don’t smoke and don’t have other medical conditions that mean you cannot take the pill. The combined pill should only be used up to the age of 50.
Advantages of taking the combined pill:
- It can help improve acne and premenstrual or menopausal symptoms in some women.
- It may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease
- It decreases the risk of cancer in the ovaries, uterus and colon.
- It usually makes the periods more regular, lighter and less painful.
Disadvantages of taking the combined pill:
- It is only effective if you remember to take it regularly.
- It can take a few months for your period cycles to settle down. You may experience spotting and breakthrough bleeding in the first few months of taking the pill.
- It increases the risk of deep vein thrombosis and pulmonary embolism.
- There is a very small increased risk of myocardial infarction (heart attack) and stroke.
- There is a small increased risk of breast cancer and if used for over five years, of cervical cancer. The risks reduce after stopping the pill.
- Its effectiveness can be reduced by certain enzyme-inducing medications including some anti epileptic drugs specific antibiotics.
- Temporary side effects during the first few months, these will include headaches, feeling sick, breast tenderness and mood changes. If these don’t improve within the first three months, then your doctor may change the type of pill you are taking.
The hormone combination of oestrogen and progesterone can also be delivered in a vaginal ring (which sits high in the vagina) or by a skin patch. Patches need to be changed weekly. Rings remain in place for three weeks. Both rings and patches are used for three weeks out of every four in the same way that the combined pill can be used. The advantages, disadvantages and side effects are similar to the combined pill.
2. The progestogen only pill
POPs work by thickening the cervical mucous making it difficult for sperm to pass into the uterus and reach the egg. Some POPs also stop ovulation (egg release from the ovary).
Most women can use the progestogen only pill and it can be useful for those that cannot take the combined pill due to medical conditions.
Advantages of taking the progestogen only pill:
- It can be used at any age, but is more useful for women over 35, especially if they smoke.
- It can be used during breastfeeding.
- It can help with painful periods and premenstrual symptoms.
- It does not contain oestrogen.
- You can fall pregnant quickly once you stop a POP.
Disadvantages of taking the progestogen only pill:
- You have to remember to take it at the same time each day.
- Your periods can change, you may experience irregular, light, more frequent, longer lasting bleeding or your periods may stop altogether.
- Some women develop small ovarian cysts. These are not dangerous and don’t need to be treated or removed and usually disappear. However, some women may experience pelvic pain because of these cysts.
- Increased risk of ectopic pregnancy if you become pregnant whilst taking a POP. Symptoms of ectopic pregnancy include sudden or unusual pain in your lower abdomen.
- Its effectiveness can be reduced by certain enzyme-inducing medications including some anti epileptic drugs specific antibiotics.
❗If used as directed, both the combined and the progestogen only pill are 99 per cent effective. If the pill is not used according to the instructions, about nine in 100 women may get pregnant in one year.
The pill side-effects: both the combined and progesterone only pills contain hormones that have the potential to give you side-effects. Alongside the problems mentioned in the disadvantages above you may experience changes to your skin, mood and alterations in your bleeding patterns. There is no clear evidence that either type of pill causes weight gain or affects your sex drive.
Sterilisation is a permanent contraceptive method, so is only suitable for men and women who definitely don’t want to have children (or any more children). You may want to have some counselling and advice from a healthcare professional before deciding whether this is the right option for you, as sterilisation is not reversible.
Sterilisation is not routinely recommended as long acting reversible contraceptives are just as effective as sterilisation, less invasive and you can change your mind if you do decide to have children.
1. Male sterilisation – vasectomy
Sterilisation for men is referred to as vasectomy and involves having surgery to cut and seal the tubes that carry sperm from the testicles to the penis. A vasectomy is usually carried out under local anaesthetic, which means that it can be done within a few hours as a day care procedure, without needing to stay in hospital overnight. Samples of semen need to be tested following the vasectomy to make sure that all the sperm have gone. This can take up to 12 weeks. There are two types of vasectomies:
- Conventional vasectomy: the conventional vasectomy is the traditional method that involves having two small cuts in the skin on the sides of the scrotum and dissolvable stitches.
- No-scalpel vasectomy or minimally invasive vasectomy: a minimally invasive vasectomy (MIV) involves having a tiny hole in the punctured into the scrotum to seal or tie the tubes. There are no stitches with this method and is said to be less painful and have less complications than the conventional vasectomy. The is now the preferred type of vasectomy.
❗ Having a vasectomy is a permanent contraceptive, however you can have a surgical procedure to reverse a vasectomy. Speak your healthcare provider for information.
2. Female sterilisation – laparoscopy
Female sterilisation involves a small operation referred to as a laparoscopy – this involves making a small cut near the belly button or just above the pubic hairline. The fallopian tubes are accessed by inserting long, thin instruments that have a light and camera. The fallopian tubes are then blocked either by using clips or rings, or by tying or cutting.
Sterilisation is only offered to women over 30 who have already had children and don’t want any more, although it is not used routinely as long-acting reversible contraceptives are just as effective.