Contraceptive choices

Contraceptive Choices
This leaflet gives a brief summary of the methods of contraception. A more detailed leaflet isavailable for each of the methods.
All the methods of contraception listed below are effective. However, no method is 100% reliable. The reliability foreach method is given in percentages. For example, the contraceptive injection is more than 99% effective. Thismeans that less than 1 woman in 100 will become pregnant each year using this method of contraception. Whenno contraception is used, more than 80 in 100 sexually active women become pregnant within one year.
The effectiveness of some methods depends on how you use them. You have to use them properly or they donot work as well. For example, the combined oral contraceptive pill (COCP) - often referred to as 'the pill' - ismore than 99% effective if taken correctly. However, if you miss a pill or have vomiting then it becomes lesseffective. Other user-dependent methods include barrier methods, the progestogen-only contraceptive pill(POCP) and natural family planning.
Some methods are not so user-dependent and need to be renewed only infrequently or never. These methodsinclude the contraceptive injection, contraceptive implant, intrauterine contraceptive devices (IUCDs) - alsoknown as 'coils' - and sterilisation.
What are the different methods of contraception? When you choose a method of contraception you need to think about: How effective it is.
Possible risks and side-effects.
Plans for future pregnancies.
Personal preference.
If you have a medical condition, or take medicines that interact with the method.
(COCP)
This is often just called the pill. Between 3 and 90 women in 1000 using the pill will become pregnant each year.
The difference is due to how well the woman uses the pill. It contains oestrogen and progestogen and works
mainly by stopping egg production (ovulation). It is very popular. Different brands suit different people.
Some advantages - it is very effective. Side-effects are uncommon. It helps to ease painful and heavyperiods. It reduces the chance of some cancers.
Some disadvantages - there is a small risk of serious problems (eg, blood clots). Some women haveside-effects. You must remember to take it. It can't be used by women with certain medical conditions,such as uncontrolled high blood pressure.
(POCP)
This used to be called 'the mini-pill'. It contains just a progestogen hormone. It is commonly taken if the COCP is
not suitable, such as in breast-feeding women, smokers over the age of 35 and some women with migraine. It
works mainly by causing a plug of mucus in the neck of the womb (cervix) that blocks sperm. It also thins the
lining of the womb, making it less likely the egg will implant. One type (Cerazette®) stops ovulation. This makes it
extremely effective if used properly . The older type of POCP is not quite as effective. Between 3 and 90 women
in 1000 using the POCP will become pregnant. If it is used well you have less chance of becoming pregnant
(about 3 in 1000).
Some advantages - less risk of serious problems than the COCP.
Some disadvantages - periods often become irregular. Some women have side-effects. Most typesare not quite as reliable as the COCP.
This contains the same hormones as the COCP, but in patch form. Between 3 and 90 women in 1000 willbecome pregnant using it. The contraceptive patch is stuck on to the skin so that the two hormones arecontinuously delivered to the body. There is one combined contraceptive patch available in the UK, called Evra®.
Some advantages - it is very effective and easy to use. You do not have to remember to take a pillevery day. Your periods are often lighter, less painful and more regular. If you have vomiting ordiarrhoea, the contraceptive patch is still effective.
Some disadvantages - some women have skin irritation. Despite its discreet design, some womenstill feel that the contraceptive patch can be seen.
This also contains the same hormones as the COCP. These hormones have effects on your body which preventyou from becoming pregnant. It is a flexible, see-through ring which is just over 5 cm in diameter. It sits in yourvagina for three weeks and then you have one week without it. After exactly one week, you put a new ring intoyour vagina. It is about as effective as the COCP at preventing pregnancy.
Some advantages - it is effective and easy to use. You do not have to remember to take a pill everyday. If you have vomiting or diarrhoea, the contraceptive vaginal ring is still effective. Your periods arevery regular.
Some disadvantages - some women (and their partners) feel it during sex. It may irritate your vaginaand cause soreness or discharge.
Barrier methods
These include , the, diaphragms and caps. They prevent sperm entering the
uterus. If used correctly, about 2 women in 100 will become pregnant. In normal (not perfect) use, 20 women in
100 will become pregnant. Other barrier methods are slightly less effective than this.
Some advantages - there are no serious medical risks or side-effects. Condoms help to provideprotection from sexually transmitted infections. Condoms are widely available.
Some disadvantages - they are not quite as reliable as other methods. They need to be used properlyevery time you have sex. Male condoms occasionally split or come off.
(eg, Depo-Provera® and Noristerat®)
These contain a progestogen hormone which slowly releases into the body. It is very effective. Between 2 and 60
women in every 1,000 using it will become pregnant after two years. It works by preventing ovulation and also has
similar actions as the POCP. An injection is needed every 8-12 weeks.
Some advantages - it is very effective. You do not have to remember to take pills.
Some disadvantages - periods may become irregular (but often lighter or stop altogether). Afterstopping, there may be a delay in your return to normal fertility for several months. Some women haveside-effects. You cannot undo the injection, so if side-effects occur they may persist for longer than 8-12 weeks.
(eg, Nexplanon®)
An implant is a small device placed under the skin. It contains a progestogen hormone which slowly releases into
the body. Around 1 woman in 2,000 using the implant will become pregnant each year. It works in a similar way to
the contraceptive injection. It involves a small minor operation using local anaesthetic. Each one lasts three
years.
Some advantages - it is very effective. You do not have to remember to take pills.
Some disadvantages - periods may become irregular (but often lighter or stop all together). Somewomen develop side-effects but these tend to settle after the first few months.
(IUCD)
A plastic and copper device is put into the womb. It lasts for five or more years. Between 6-8 women in 1000 will
become pregnant with one year of use of this method. It works mainly by stopping the egg and sperm from
meeting. It may also prevent the fertilised egg from attaching to the lining of the uterus. The copper also has a
spermicidal effect (kills sperm).
Some advantages - it is very effective. You do not have to remember to take pills.
Some disadvantages - your periods may become heavier or more painful. There is a small risk ofserious problems.
(IUS)
A plastic device that contains a progestogen hormone is put into the uterus. The progestogen is released at a
slow but constant rate. Around 2 women in 1000 will become pregnant with one year of use of this method. It
works by making the lining of your womb thinner so it is less likely to accept a fertilised egg. It also thickens the
mucus from the neck of your womb. Is also used to treat heavy periods (menorrhagia).
Some advantages - it is very effective. You do not have to remember to take pills. Periods becomelight or stop altogether.
Some disadvantages - side-effects may occur as with other progestogen methods such as thePOCP, implant and injection. However, they are much less likely, as little hormone gets into thebloodstream.
Natural methods
This involves fertility awareness. Around 150 women per 1000 will become pregnant using this method. It
requires commitment and regular checking of fertility indicators such as body temperature and cervical
secretions.
Some advantages - no side-effects or medical risks.
Some disadvantages - it is not as reliable as other methods. Fertility awareness needs properinstruction and takes 3-6 menstrual cycles to learn properly.
The lactation amenorrhoea method is suitable for the first six months after having a baby, if you are only breast-feeding and do not have a period. 2 women in 100 will conceive during that six months using this method.
Sterilisation
This involves an operation. It is very effective but this can vary from surgeon to surgeon. (male
sterilisation) stops sperm travelling from the testes.prevents the egg from travelling along the
Fallopian tubes to meet a sperm. Vasectomy is easier, as it can be done under local anaesthetic. These methods
are often used when your family is complete. You should be sure of your decision as they are difficult to reverse.
Some advantages - it is very effective. You do not have to think further about contraception.
Some disadvantages - it is very difficult to reverse. Female sterilisation usually needs a generalanaesthetic.
This can be used if you had sex without using contraception. Or, if you had sex but there was a mistake withcontraception. For example, a split condom or if you missed taking your usual contraceptive pills.
Emergency contraception pills - are usually very effective if started within 72 hours of unprotected sex.
The emergency contraception pill can be bought at pharmacies or prescribed by a doctor. It workseither by preventing or postponing ovulation or by preventing the fertilised egg from settling in thewomb.
An IUCD - this is inserted by a doctor or nurse and can be used for emergency contraception up tofive days after unprotected sex.
This leaflet is just a brief account of each method of contraception. All these methods have their own detailedleaflet for more information. Or you can ask your practice nurse, doctor or pharmacist if you want more detailedinformation about any of these methods.
Tel: Helplines (England, Scotland and Wales) 0845 122 8690, (Northern Ireland) 0845 122 8687 In Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M. ContraceptiveTechology: Twentieth Revised Edition. New York NY: Ardent Media, 2011.
, Faculty of Sexual and Reproductive Healthcare (2010) Faculty of Sexual and Reproductive Healthcare (2010) Faculty of Sexual and Reproductive Healthcare (2011 updated August 2012); NICE CKS, June 2012; NICE CKS, November 2011 Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical
conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its
accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
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