A guide to contraception
English
There are currently many different types of contraception
available. This leaflet gives some basic information on all of them
and will help you decide which method you might be interested
in. You should then talk about your options with a doctor or
contraception and sexual health nurse.
Most contraceptives can be issued free of charge by your General
Practitioner (GP) or a community sexual health service clinic. You will be
asked about your personal and family medical history, this will help the
doctor or nurse advise which method of contraception would suit you best.
Hormonal contraceptives
These methods include the combined oral contraceptive pill; the contraceptive patch; the combined
vaginal ring; the progestogen-only pill; the progestogen-only injection; the progestogen-only implant
and progestogen-only intrauterine system. All of these methods work by releasing female hormones,
which prevent pregnancy by:
l Stopping ovulation.
l Thickening cervical mucous to stop sperm from meeting an egg.
l Thinning the lining of the womb to stop an egg implanting.
You may experience some minor temporary side effects when you first start to use a hormonal
contraceptive. These side-effects can include: headache, nausea and breast tenderness. However,
these symptoms usually subside as your body adjusts to the contraceptive. Some women find that
their appetite may increase making them feel hungry and likely to eat more. However, if you have a
healthy balanced diet and keep active, you are unlikely to experience any significant weight gain.
Combined oral contraceptive pill
The combined pill should be taken one per day for 21 days followed
by 7 days with no pills. You then start another 21 days of pills
followed by a 7 day break. This routine is repeated every month.
If you decide to use this method, the doctor or nurse will explain
in more detail how to follow the routine and what to do if you are
late or forget to take pills. It is important to take the pill correctly to
prevent pregnancy.
Advantages
3 It is a very effective form of contraception if taken correctly.
3 Bleeding, period pain and pre-menstrual tension may be reduced.
3 It may protect against cancer of the ovary and womb.
3 Your natural fertility usually returns to normal soon after stopping
the pill but there can be some delay.
Disadvantages
8 It is not suitable for smokers over 35 – there is a significantly
increased risk of heart disease.
8 It may not be suitable if you are overweight.
8 It may not be suitable if you have other medical problems e.g. heart or circulatory disease, raised
blood pressure, severe migraine. You must tell the doctor or nurse about any such problems.
8 It may be less effective if vomiting occurs within two hours of taking the pills or if severe diarrhoea
occurs at any time.
8 Some medicines make it less effective.
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Contraceptive patch
This is the same as the combined contraceptive pill except that the
hormones are absorbed through the skin. It is a small, thin patch
(approximately 5cm x 5cm) normally worn on the upper arm,
buttock or lower abdomen. You wear one patch for 7 days, using
a new patch each week for three weeks and then have one week
free. You then repeat the same routine of patches for three weeks
followed by a patch free week.
Advantages
3 You only have to remember to change the patch once each week – some people may find this
easier to remember than taking pills every day.
3 Unlike the pill, it is not affected by vomiting or diarrhoea.
Disadvantages
8 Same as the combined pill (see page 4).
Vaginal ring
This is the same as the combined contraceptive pill except
that the hormones are absorbed through the vagina. It comes
in the form of a small flexible ring which you will be taught
to insert into the vagina. You place a ring in the vagina for
3 weeks and then have one week free. You then repeat the
same routine.
Advantages
3 You only have to remember to change the ring once every
three weeks.
3 Unlike the pill, it is not affected by vomiting and diarrhoea.
Disadvantages
8 It is not suitable for smokers over 35 – there is a significantly increased risk of heart disease.
8 It may not be suitable if you are overweight.
8 It may not be suitable if you have other medical problems e.g. heart or circulatory disease, raised
blood pressure, severe migraine. You must tell the doctor or nurse about any such problems.
8 It may be less effective if vomiting occurs within two hours of taking the pills or if severe diarrhoea
occurs at any time.
8 Some medicines make it less effective.
3
Progestogen-only pill
The progestogen-only pill (sometimes known as the mini-pill) is
an oral contraceptive pill, which is taken every day, ideally at the
same time. With this pill there is no 7 day break – once you start,
you continue to take a pill every day. This pill only contains one
hormone i.e. a progestogen.
If you decide to use this method, the doctor or nurse will explain in
more detail how to follow the routine and what to do if you are
late or forget to take pills. It is important to take the pill correctly to prevent pregnancy.
Advantages
3 There are few serious side-effects.
3 Can be used by women who are unable to use the combined contraceptive pill because of medical
problems.
3 It can be taken by women over 35 who smoke.
3 Your natural fertility usually returns to normal soon after stopping the pill but there can be some delay.
3 It is a suitable method of contraception if you are breastfeeding.
Disadvantages
8 You may have irregular menstrual bleeding or menstruation may stop when using this method.
8 It may be less effective if pills are taken late.
8 It may be less effective if vomiting occurs within 2 hours of taking pills or if severe diarrhoea occurs
at any time.
Contraceptive injection
This is an injection of a progestogen-only
hormone. The one we use in the United
Kingdom (UK) is Depo-Provera. It is injected
deep into the muscle of the buttock, upper arm
or thigh and is usually given every 12 weeks.
There is another form of injection, Noristerat,
which is given every 8 weeks. This is not
commonly used in the UK. If you have been
using it in another country we will recommend
changing to Depo-Provera.
Advantages
3 It provides reliable long-term contraception provided repeat injections are on time.
Disadvantages
8 You may have irregular menstrual bleeding or menstruation may stop when using this method.
8 Your fertility may take some months to return to normal after stopping use of the injection.
8 Some research suggests that long-term use of the injection may increase the risk of osteoporosis
(thinning of the bones) later in life. The evidence is conflicting. Your doctor or nurse will discuss
any concerns you may have about this.
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Implant
The implant is a small flexible tube (about 4cm
long), which is inserted under the skin of your
arm by a suitably trained doctor or nurse.
Advantages
3 Is effective for up to 3 years but can be
removed at any time by your doctor or nurse.
3 Your natural fertility rapidly returns to normal
when the implant is removed.
Disadvantages
8 You may have irregular menstrual bleeding or menstruation may stop when using this method.
Intrauterine systems (IUS)
The IUS is a small T-shaped plastic device, which is placed into the womb by a
specially trained doctor or nurse. The fitting procedure will be explained to you
more fully by your doctor or nurse.
The risk of pelvic infection associated
with this method is directly related to
your risk of having been exposed to any
sexually transmitted infection (STI).
Any concerns about this will be discussed
with you and you can choose to have
tests to exclude STIs if you think that it
is appropriate.
Advantages
3 It is effective for five years but can be taken out at any time by your doctor or nurse.
3 Your periods may be much lighter, shorter and usually less painful.
3 You don’t have to think about contraception as long as the IUS is in place.
Disadvantages
8 You may experience irregular bleeding or spotting for the first three to six months after the device
has been fitted.
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Non-hormonal types of contraceptive
Intrauterine device (IUD)
This is a small plastic and copper device, which is placed into the
womb by a specially trained doctor or nurse. When used as a longterm method of contraception, the main way an IUD works is by
preventing sperm from surviving in the cervix, uterus or fallopian
tubes, thereby preventing sperm from reaching an egg.
The risk of pelvic infection associated with this method is directly
related to your risk of having been exposed to any sexually
transmitted infection (STI). Any concerns about this will be
discussed with you and you can choose to have tests to exclude
STIs if you think that it is appropriate.
Advantages
3 It is effective as soon as it is fitted.
3 It can stay in for 5 to 10 years but can be removed at any time by
a doctor or nurse.
3 If fitted after the age of 40 it can stay in until the menopause.
Disadvantages
8 You may experience periods which become heavier, longer or
more painful – the majority of women have no problems.
Diaphragms and caps with spermicide
Diaphragms and caps are barrier methods of contraception,
which fit inside your vagina and cover the cervix and work by
stopping sperm from entering the womb and the spermicide kills
any sperm. Diaphragms are dome shaped and are made of thin,
rubber with a flexible rim. Both diaphragms and caps need to be
used with a spermicide.
Advantages
3 You only have to use it when you have intercourse.
3 There are no serious health risks.
Disadvantages
8 It can take time to learn how to use it properly.
8 You need to regularly check to ensure that the diaphragm is
not damaged.
8 Also needs to be checked if you lose weight or have a baby.
6
Male condom
The male condom is a barrier method of contraception, which
is made of very thin rubber or plastic. When fitted properly, the
condom stops sperm from entering the vagina. It is put on an erect
penis prior to any genital contact. The doctor or nurse can teach
you how to use a condom properly.
Advantages
3 There are a variety to choose from, they can be purchased from
many retail outlets and are free from contraception and sexual
health clinics.
3 They give some protection from sexually transmitted infections –
including HIV.
3 They are a simple method of contraception which men can take
responsibility for.
Disadvantages
8 Can only be placed on a penis once it is erect, so can interrupt sex.
8 They can slip off or split.
8 To avoid any leakage of semen, the penis should be withdrawn from the vagina soon after
ejaculation.
NB: If you are worried about possible condom failure, remember to think about emergency
contraception (see page 8).
Female condom
This a soft plastic sheath which lines the vagina and the area just
outside and works by stopping sperm entering the vagina.
Advantages
3 They give some protection from sexually transmitted infections –
including HIV.
Disadvantages
8 Putting it in can interrupt sex.
8 Need to make sure the man’s penis enters the condom.
8 May get pushed too far into the vagina.
8 With some types, extra spermicide is needed if you have sex again.
NB: If you are worried about possible condom failure, remember to think about emergency
contraception (see page 8).
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Female and male sterilisation
Sterilisation should be seen as a permanent form of contraception involving a surgical procedure
and should only be considered if you are sure you don’t want any more children and have fully
considered all other methods of contraception.
Although very effective there is still a possibility of failure of both male and female sterilisation. This
risk is much less with male sterilisation. Both methods can be reversed but the success of this is not
good and there would be no guarantee of getting pregnant. An effective but reversible method of
contraception may be more appropriate.
l In men: the tubes that carry sperm from the testicles to the penis are cut, sealed or blocked.
l In women: the tubes that carry eggs from the ovaries to the uterus are cut, sealed or blocked.
Advantages
3 For men the operation is simple and quick and usually performed under local anaesthetic.
3 There is no evidence of any long-term adverse health effects.
Disadvantages
8 For men, it takes a few months to become effective and an alternative method of contraception
should be used until then.
8 There can be discomfort and pain for some time after sterilisation.
8 Female sterilisation requires a general anaesthetic and is an invasive surgical procedure.
Emergency contraception
If you have had sex without using any contraception and are concerned about the risk of becoming
pregnant you should consider using emergency contraception. Currently there are two methods of
emergency contraception available:
lH
ormonal: There are now two types of emergency contraceptive pills. Both consist of a single pill
which should be taken as soon as possible after unprotected sex. However one (Levonelle 1500®)
can be taken up to 72 hours after the risk, whilst the other (ellaOne®) can be taken up to 120
hours after the risk. The doctor or the nurse will discuss with you and help you to decide which
may be more appropriate for you in the circumstances. Emergency contraception is available
free of charge from your General Practitioner, any Contraceptive and Sexual Health Clinic,
Genitourinary Medicine Clinic or any Accident and Emergency Clinic. It may be purchased from
most Pharmacies but only if you are over 16 years of age. A limited number of Pharmacies may be
able to provide one or other form of pill free of charge for women of any age.
l Copper
intrauterine device (IUD): This is the most effective method of emergency contraception
but means fitting a small device into the womb.
This guide is available in alternative formats such as large print and in the following languages:
Arabic; Czech; Farsi; Latvian; and Mandarin.
Alternative language versions can be downloaded at:
www.liverpoolhps.nhs.uk/resource-centre/alternative-language-health-information.aspx
Alternative format versions are available on request. Please contact the Equality and Diversity
Team on 0151 295 3041 or [email protected]
Publication date: October 2012
Review date: October 2014
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© 2012 Liverpool Health Promotion Service • www.lhps.org.uk