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Contraception: What are the options

There’s something for everyone these days! Here’s a guide to what’s available.

Contraception Options

Whether you’re looking for your first method of contraception or you want a change from what you’re currently using, there’s something for everyone these days – whatever your age or whether or not you’ve already had children.

There are 15 types of contraception available on the NHS. These are free of charge – even if you’re under 16 – from contraception clinics, sexual health or genitourinary medicine (GUM) clinics and some general practices and young people’s services. 

Arming yourself with as much information as possible about the different types of contraception before making an appointment with your GP or clinic is, however, a good idea. Also remember that no one method is right for everyone. So if you try something and it isn’t quite right for you, go back to your GP or clinic and ask to try another. 

Here’s a guide to what’s available, including how they work, how effective they are and a few pointers to help you decide which might suit you.


Long-acting reversible contraceptives

Long-acting reversible contraceptives (or LARCs) need to be administered less than once a month. This means you don’t have to worry about taking a pill every day or using contraception each time you have sex.


Contraceptive injection


What is it?

This injection releases the hormone progestogen into your bloodstream. The most common type used in the UK is called Depo-Provera, which lasts for 13 weeks. Occasionally an eight-week injection is given, called Noristerat. The injection is usually given in the buttocks, but some women prefer to have it in their upper arm.


How does it work?

The injection releases progestogen steadily over a period of 8 or 13 weeks. This stops you ovulating, which means you don’t release an egg each month. Progestogen also makes it difficult for sperm to move through the cervix – the entrance to the uterus (womb) – by thickening cervical mucus and thinning the lining of the uterus so that a fertilised egg is less likely to be implanted there.


How effective is it?

It’s more than 99 per cent effective if used correctly each time. This means that fewer than one in 100 women will get pregnant in a year when using the contraceptive injection correctly.


Pros and cons

You don't have to think about contraception until your next jab is due – though if you don’t have a repeat injection before the current one expires, it can become ineffective. It also protects against cancer of the uterus and pelvic inflammatory disease.

The contraceptive injection can affect your periods, making them more irregular, longer, shorter or heavier, or making them stop altogether. It can also cause side effects including headaches and mood swings. And once you stop having the injections it can take up to a year for your fertility to return to normal.


Is it right for you?

The contraceptive injection may be ideal for younger women who don't want to have to remember to take a pill every day and who don't want to start a family in the near future. And like other methods that only release progestogen it’s an option worth considering if you can’t use birth control that releases oestrogen.


Contraceptive implant


What is it?

The implant is a small flexible tube that’s placed under the skin of your upper arm and lasts for three years. The implant currently used in the UK is called Nexplanon. It’s fitted within a few minutes and can also be removed at any time by a specially trained doctor or nurse.


How does it work?

It releases progestogen into your bloodstream and works in the same way as the contraceptive injection.


How effective is it?

The implant is more than 99 per cent effective.


Pros and cons

Once you’ve had the implant fitted you can forget about contraception for three years. Then if you change your mind and have it taken out your natural fertility will return to normal quickly.

It could also make your periods stop altogether or make them irregular, heavier or longer. During the first few months it can cause temporary side effects such as headaches, nausea, mood swings and breast tenderness. It can also cause acne.


Is it right for you?

The contraceptive implant may be just the thing for women who want to forget about taking daily contraception for up to three years at a time but who still want the option of being able to start a family fairly quickly.
 

IUS (intrauterine system)


What is it?

The IUS is a plastic t-shaped device that is fitted into the uterus, where it releases progestogen. It can help stop you getting pregnant for three to five years. There are two brands of IUS used currently in the UK, called Mirena and Jaydess.


How does it work?

The IUS releases progestogen directly into the uterus. This makes your cervical mucus thicker and the lining of your uterus thinner – both of these things help prevent pregnancy. It doesn’t stop ovulation in most women, but some may find they don’t release an egg each month.


How effective is it?

When inserted correctly it’s more than 99 per cent effective.


Pros and cons

Once it’s in place you don’t have to think about it. But if you want to have it taken out, you can do so at any time and your normal fertility will return really quickly (it is in fact possible to become pregnant straight after having an IUS removed).

Having an IUS fitted can also make your periods very light and short or stop them altogether. However, some women may experience side effects such as headaches, acne and breast tenderness, plus there's a small chance of getting an infection after having it fitted. Irregular bleeding or spotting is also common during the first six months.


Is it right for you?

If you have heavy and/or painful periods, having an IUS fitted may be an ideal solution if you also need a form of contraception that you don’t have to think about from day to day.
 

IUD (intrauterine device)


What is it?

A tiny device made of plastic and copper that's placed in the uterus, the IUD is also sometimes called a coil.


How does it work?

Releasing copper into the uterus affects the cervical mucus, making it more difficult for sperm to reach an egg. Releasing copper also helps stop fertilised eggs from implanting themselves into the lining of the uterus.


How effective is it?

When fitted correctly IUDs are more than 99 per cent effective.


Pros and cons

This is a fit-and-forget method that lasts from five to 10 years – though you can have it taken out at any time (after having it removed your fertility returns to normal straight away).

However, some women find having it fitted can be a bit uncomfortable, plus there's a small risk you could get an infection afterwards. It could also make your periods heavier, longer and more painful during the first three to six months, and you may also experience spotting or bleeding between periods.


Is it right for you?

It’s definitely worth considering if you want a long-lasting form of contraception but you don't want to use hormones because of the side effects (acne, headache, breast tenderness, for example). Meanwhile if you're 40 or older an IUD can stay in place until you reach the menopause or find you no longer need to use contraception
 

Hormonal contraceptives

As well as LARCs other forms of contraception use hormones too. However, because they’re not long-acting you have to think about using them more often. These methods also have to be used correctly and consistently to be effective. This group includes the most common form of contraception used by women in the UK – the pill.


Combined pill


What is it?

The combined pill is a tablet that contains the hormones oestrogen and progestogen that's taken every day for 21 days followed by a seven-day break.


How does it work?

The combined pill prevents pregnancy by stopping ovulation. The hormones also create conditions that make it difficult for sperm to reach an egg or for a fertilised egg to implant itself in the uterus.


How effective is it?

If taken correctly the combined pill is more than 99 per cent effective.


Pros and cons

The combined pill usually relieves the symptoms of PMS and makes your periods lighter, shorter and less painful. It can reduce your risk of cancer of the ovaries, womb and colon, and may also protect against pelvic inflammatory disease. Sometimes it can also reduce acne.

While it has many advantages, taking the combined pill has been linked to an increased risk of some serious health conditions including that of developing a dangerous blood clot. It’s also been linked to an increased risk of breast cancer and can increase your blood pressure. Side effects are also possible, especially when you first start taking it. These include breast tenderness, headaches, nausea and mood swings.


Is it right for you?

If you have period problems or PMS, taking the combined pill could bring you some much-needed relief. But you’ll almost certainly be advised against taking it if you’re 35 or older, a smoker, very overweight or if you have migraines, high blood pressure or have had a blood clot or stroke. It may also not be suitable if you keep forgetting to take it regularly,
 

Mini pill


What is it?

Unlike the combination pill the mini pill only contains progestogen (which explains why it’s also called the progestogen-only pill or POP). However, you have to take it every day without a break between packs. Some have to be taken within three hours of the same time each day, while others must be taken within a 12-hour window.


How does it work?

The mini pill works by making it difficult for sperm to reach an egg and for a fertilised egg to become implanted. Most types of mini pill don't stop you ovulating – the exception is the Desogestrel mini pill.


How effective is it?

If taken correctly it’s 99 per cent effective. According to the family planning charity FPA, in typical use – that is, when it’s not always used correctly – it’s around 91 per cent effective.


Pros and cons

Unlike the combined pill you can take the mini pill if you’re over 35 and even if you smoke. It’s also suitable for those who want to take a daily pill but can’t use oestrogen-based methods.

The mini pill can also make your periods stop or become lighter, more frequent or irregular. It can also sometimes cause side effects, such as acne, mood changes, headache, nausea, vomiting and breast tenderness. Some women find they get spotting between periods when taking the mini pill. Thankfully in most cases side effects tend to improve after a few months.


Is it right for you?

If you like the idea of taking a contraceptive pill but you can’t use oestrogen, the mini pill could be the ideal solution. However, you must be able to remember to take it on time every day.
 

Contraceptive patch


What is it?

This sticky patch releases oestrogen and progestogen into your skin. You can put it on almost any part of your body as long as it’s not on your breasts or in a place where it could get rubbed off by clothing. Each patch lasts for a week – you use three patches in a row, then you have a week off.


How does it work?

The hormones in the patch work exactly the same to prevent pregnancy as those in the combined pill.


How effective is it?

If you use the patch correctly it’s more than 99 per cent effective.


Pros and cons

The patch offers all the benefits of the combined pill. You can even wear it in the bath and to go swimming, or while playing sports. It can also be helpful if you have heavy or painful periods. It may offer some protection against cancer of the ovaries, womb and colon too.

Like the combined pill, the patch shouldn’t be used by certain women, including those who are 35 or older and those who weigh 14 stone or more. It may raise your blood pressure and cause temporary side effects, such as headaches, breast tenderness and mood changes. And because it sticks to your skin the patch can cause irritation, itching or soreness. There’s also a very small risk of developing a blood clot or breast cancer if you use the patch.


Is it right for you?

If you use the combined pill but are having problems remembering to take it every day, the patch may be an ideal alternative. The patch may also be suitable if you have period problems as it can make them more regular, lighter and less painful.
 

Contraceptive ring


What is it?

Called NuvaRing, this is a transparent, flexible ring that’s placed inside your vagina where it releases oestrogen and progestogen into your system. You take it out after three weeks, then seven days later you put a new one in (you’re still protected against pregnancy during those seven days).


How does it work?

The hormones released by the ring work in the same way as those in the combined pill and the patch.

How effective is it?   The ring is more than 99 per cent effective if used correctly.


Pros and cons

The ring is easy to insert and remove, and once in place you can't feel it. It also offers all the benefits of the combined pill. However, some women may experience the same side-effects associated with the combined pill too, while a few may also have a vaginal discharge.


Is it right for you?

If you can take the combined pill but you want a method that only needs replacing once a month, the contraceptive ring may be what you’re looking for.
 

Barrier methods

While LARCs and hormonal contraception offer protection against pregnancy, they don’t protect against sexually transmitted infections (STIs). The best way to make sure you’re protected against STIs is to use condoms or a diaphragm or cap with spermicide as well as condoms.
 

Condoms (male and female)


What are they?

Sheaths made from latex or polyurethane – the male version goes over an erect penis whereas the female condom fits inside the vagina.


How do they work?

Both male and female condoms work by stopping sperm reaching and fertilising an egg.


How effective are they?

When used correctly the male condom is 98 per cent effective while the female condom is 95 per cent effective (though with typical use they’re 82 per cent and 79 per cent effective respectively). However, only use male or female condoms that have the CE mark or the BSI Kitemark on the packet, as these have been tested to high safety standards.


Pros and cons

Condoms don't cause side-effects because they don't contain hormones. Male condoms are also widely available (female condoms are less so). But the most important advantage of condoms is that they also protect against STIs.

One problem often associated with condoms is that they can be difficult to use, particularly the female condom. Both types can split if you don’t use them properly, and you have to think about using them before each time you have sex (though the female condom can be put in at any time before intercourse).

Male condoms can also sometimes slip off during sex, and some people may also have an allergy to those that are made of latex (though non-latex male condoms are also available). 


Are they right for you?

If you’re not in a regular relationship and you need protection against STIs, condoms may be your best choice. However, since using condoms properly isn’t always simple, it’s often recommended that you use them alongside another form of contraception if you also want to avoid getting pregnant.
 

Diaphragm/cap


What are they?

Diaphragms are slightly bigger than caps, but both are circular silicone domes that are inserted into the vagina before sex.


How do they work?

Both the diaphragm and the cap cover the cervix and stop sperm getting to an egg. Whichever one you chose it should be used with a spermicide, a gel that kills sperm. You insert your diaphragm or cap before having sex, but it should be left in place for at least six hours afterwards.


How effective are they?

When used correctly and with spermicide both are 92 - 96 per cent effective at preventing pregnancy.


Pros and cons

Both guard against STIs but only if you also use condoms. But there's a knack to putting them in properly, and it can take some time to learn how to use them correctly. And if you have an unusually shaped or positioned cervix, the diaphragm or cap may not be suitable for you. 

Some women also get cystitis – a bladder infection – when using a diaphragm or cap. And if you lose or gain more than half a stone in weight, or if you have a baby, miscarriage or abortion, you may need to be fitted with a new one.


Are they right for you?

If you’ve already had a family and don't want to take hormones, the diaphragm/cap with spermicide is an option. However, they’re not very popular these days – according to the Office for National Statistics, fewer than one per cent of women say they use one (i).


Permanent methods of contraception

If you’re certain you don’t want any or any more children, you may want to consider a permanent method of contraception, which means you no longer have to think about protecting yourself against pregnancy.


Sterilisation (male and female)


What is it?

Sterilisation is a permanent method of contraception. However, male sterilisation (vasectomy) can sometimes be reversed, though reversing female sterilisation isn’t easy. Either way, a reversal operation isn’t likely to be funded by the NHS.


How does it work?

In male sterilisation the tubes that carry sperm are cut or sealed. The procedure is usually carried out under local anaesthetic. Female sterilisation is an operation that blocks or seals the fallopian tubes, which carry eggs from the ovaries to the uterus. Female sterilisation can be carried out under general or local anaesthetic.
 

How effective is it?

Both male and female sterilisation are more than 99 per cent effective at preventing pregnancy.


Pros and cons

Once sterilised, contraception is something you never have to worry about again. Long-term health effects are rare, and sterilisation doesn’t affect your hormone levels. If you’re a woman, this means you’ll still have periods.

However, as with all surgical procedures there is a small risk of complications, including infection. There is also a chance your tubes could rejoin, which means you could become pregnant (or make your partner pregnant) – but this happens very rarely.


Is it right for you?

It could be if you’re certain you don't want any or any more children, and if you don’t mind having a minor operation. You’re also more likely to be accepted for sterilisation if you’re 30 or older and have had children.
 

Emergency contraception

If you’ve had unprotected sex or if your contraception has failed – if you’ve missed taking a pill, for instance, or you’ve used a condom that subsequently split – you can still prevent an unwanted pregnancy by using emergency contraception.


What is it?

Emergency contraception comes in two forms – the morning-after pill, called Levonelle or ellaOne, or the IUD.


How does it work?

The Levonelle pill contains levonorgestrel, a man-made version of the hormone progesterone produced naturally by your ovaries. This works by either stopping or delaying ovulation. The ellaOne pill contains ulipristal acetate, a chemical that prevents progesterone from working properly. As a result, an egg isn’t released or its release is delayed.

The emergency IUD, on the other hand, doesn’t use any hormones but releases copper to stop an egg being fertilised or implanting itself in your uterus.


How effective is it?

You have to take the Levonelle pill within three days of having sex and the ellaOne pill within five days of having sex to prevent pregnancy.  In both cases, the sooner you take it, the more effective it will be.

According to the NHS the emergency IUD is the most effective method of emergency contraception, with fewer than one per cent of women using it becoming pregnant. However, it must be fitted up to five days after you have unprotected sex or up to five days after the earliest time you could have ovulated.


Pros and cons

The emergency contraceptive pill is widely available – you can get it from contraception clinics, sexual health or GUM clinics, most pharmacies, some doctors surgeries, most NHS walk-in clinics and minor injuries units, some young people’s clinics, and some hospital A&E departments.

There aren’t any long-term side effects, but it could make you feel sick or give you a headache or stomach pain, and your next period may not come at the usual time.

The IUD, on the other hand, must be fitted by a nurse or doctor. But after you’ve had it fitted you can keep using it as an ongoing method of contraception


Natural family planning

Called natural because it doesn’t involve hormones or physical products to prevent pregnancy, natural family planning is also side effect free and acceptable to all faiths and cultures.


What is it?

Also called fertility awareness, natural family planning can not only help you avoid but also plan pregnancy, as the method helps you to pinpoint when you’re fertile and when you’re infertile.


How does it work?

This method works by plotting the times of the month when you’re fertile and when you’re not. You learn how to record fertility signs such as your body temperature and your cervical secretions, and these help you identify when it’s safe to have sex without getting pregnant, and when you’re most likely to conceive. To learn the method, you need a qualified fertility awareness teacher, who you can find at a fertility awareness clinic in your area.


How effective is it?

If you learn how to do it and practise it correctly, natural family planning can be up to 99 per cent effective.


Pros and cons

There are no physical side-effects to worry about, and once you’ve learned how to do it, you shouldn’t need any further help from your doctor or any other health professionals.

However, learning the method can take a while, which means you have to use another method of contraception such as condoms until you’ve mastered it. You’ll also have to use another method of contraception if you want to have sex during your fertile time but don’t want to get pregnant. Natural family planning can also be tricky at times, as things like illness, stress and travel can affect your fertility signs.


 

References:

  1. Contraception and Sexual Health, Office for National Statistics. Avaliable online: https://data.gov.uk/dataset/7d82e0e2-4533-4c0d-bfc1-7ecd1a3c674d/contraception-and-sexual-health


Disclaimer: The information presented by Nature's Best The Pharmacy is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.