Contraceptive Options
Combined contraception -
the pill, patch and vaginal ring
The combined oral contraceptive pill (COCP) contains both oestrogen and a progestogen. It suppresses a woman's normal menstrual cycle and stops her from ovulating (releasing an egg). It can very effective if taken appropriately. As well as being a contraceptive it can be useful for managing painful, heavy or irregular periods. It may taken in a variety of ways to suit the patient. You may take a break every month and will usually get a withdrawal bleed (like a light period) during the break, or you may choose to take a break every few months. Alternatively, it may be taken continuously in which case you will not get regular bleeds. If you get a breakthrough bleed it is best to take a 4 day break at this stage.
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It is a popular contraceptive to start with - it may be easily stopped if doesn't suit. Like any hormonal contraceptive there is a risk of side-effects such mood changes, spots, breast tenderness, reduced libido.
There are a small proportion for whom the pill is not suitable, for example women who have a clot in the leg, breast cancer, or who get migraines with aura.
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Combined oestrogen and progestogen can be delivered in 2 other forms - a patch ('Evra') which is worn on the skin and changed every week, or a soft, slim plastic ring ('NuvaRing') which is placed in the vagina by the woman and changed every 3 weeks. Like with the pill, a break may be taken after every 3 patches or every ring, or they may be used continuously, with or without a break every few months.
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Learn More about Combined Hormonal Contraception.
The Mini-Pill
This is a pill containing just progestogen. It has a safer risk profile than the combined pill. It is taken every day. It works in a few different ways to prevent pregnancy, but the main way is that it prevents ovulation. The bleeding pattern may be unpredictable, especially during the first few months. Some women may get a lot spotting, while others will eventually have no period at all. It is safe to use during breast-feeding and can be started 6 weeks after giving birth.
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Learn More about the Mini-Pill.
Depo-Provera
This is a progesterone-only contraceptive, given as an injection into the muscle every 3 months. It is a very effective contraceptive and suppresses ovulation. There can be a delay of a year in return to fertility after stopping. The bleeding pattern may be unpredictable, especially during the first few months. Some women may get a lot spotting, while others will eventually have no period at all.
It can affect bone density, though this usually returns to normal after stopping. However, we tend not to use it for longer than 2 years at a time. It can also cause weight gain.
Learn More about Depo-Provera.
Implanon
This is a progesterone-only contraceptive, inserted under the skin of the arm. It lasts for 3 years. It is the most effective form of contraception. The bleeding pattern may be unpredictable, especially during the first few months. Some women may get a lot spotting, while others will eventually have no period at all. In 20% of women, the bleeding won't settle and they end up getting it removed early.
There is a small procedure involved in getting it inserted and removed. Local anaesthetic is used, and there can be a small scar and bruising along with a risk of infection. It can be a good option for women who think they won't always remember to take a pill every day.
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Learn More about Implanon.
Hormonal coils
These are 3 different hormonal coils available, the Mirena, Kyleena and Jaydess. There are progesterone-only and vary in the amount of hormone they release. They are all used for contraception, and the Mirena for heavy periods and as the progesterone component of HRT aswell (alongside oestrogen). For the purposes of contraception they can be used for 8 years, 5 years and 3 years respectively. In women age 45 or over at the time of insertion, the Mirena can be kept until menopause (up to 10 years). For heavy periods Mirena can be used as long as it is working, and for HRT the Mirena is licensed for 5 years only. They are placed inside the cavity of the women by the doctor. This can be an uncomfortable procedure, but most women tolerate it well. They will usually result in light or no periods, though the bleeding pattern can be unpredictable for the first few months. They are not just for women who have had babies. There is a risk of pelvic inflammatory disease if the woman has an undiagnosed STI when it is inserted, so we usually do an STI screen if there is any risk of an STI.
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Learn More about Hormonal coils.
Non-hormonal contaception
The T-shaped copper coil may be used as a non-hormonal contraceptive for 5 years or 10 years, depending on which model is used. It doesn't usually change the pattern of the periods, but can make them last longer, be heavier and more painful. It may also be used as an emergency contraceptive for up to 5 days after unprotected intercourse.
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Like the hormonal coils they are inserted by the doctor and the procedure can be uncomfortable. They are suitable who don't want to use hormonal contraception for whatever reason, or in women who can't use hormonal contraception, for example if they have had breast cancer.
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The new Ballerine intrauterine ball was recently launched. It is a different shape to all previous coils, in that it is shaped like a ball rather than being T-shaped. The insertion device is smaller than any other intra-uterine device, making the procedure less uncomfortable. It has a slightly higher expulsion rate compared to other coils, moreso in younger women (regardless of whether they have had pregnancies).
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Learn More about Non-Hormonal Coils.
Emergency contraception
There are two different tablets that can be used for emergency contraception if a woman has had unprotected intercourse. Which one is used depends on a number of factors such as how long since the unprotected intercourse, where the women is in her cycle and whether she has used emergency contraceptive already during that cycle. Both pills work by delaying ovulation so will not work if the women has already ovulated that cycle. They are both available without prescription, so your pharmacist should be able to advise you, but we are happy to advise and prescribe if you would prefer this.
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The copper coil may also be used as an emergency contraceptive for up to 5 days after unprotected intercourse. The women may then chose to keep it for ongoing contraception or it may be removed the next month.
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Learn More about Emergency Contraceptives.
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