Contraception

Welcome to this festive article about contraception. Why is it festive? I hear you cry. Well, September is by far the busiest month for new babies. Why? Because lots of you are making the most of the festivities under the mistletoe! That’s right, September is nine months on from Christmas, with September 26th being the most popular birthday. If you’re planning for the pitter-patter of tiny feet, great. But if you would rather avoid an extra surprise this Christmas, let’s talk about contraception.

There are lots of contraceptive options available, but not all of them might be suitable for you depending on other aspects of your health. Your GP or family planning clinic are well-placed to discuss your options on an individual basis, but here is an overview of the most popular available options.

Condoms

Condoms are, importantly, the only type of contraception to prevent both pregnancy and sexually transmitted infections (STIs). You can catch an STI at any age, and in fact STIs in those aged over 45 have increased quite a lot, especially in men.

When used correctly, male condoms are 98% effective against pregnancy. Oil based lubricants can damage condoms and should be avoided, and it’s important to make sure condoms haven’t exceeded their use-by date and to check that they have the BSI kitemark and CE mark on the packet. If the condom has a teat at the end, pinch it before rolling over the penis to squeeze the air out.

Female condoms are also available which are placed inside the vagina and prevent sperm from getting to the womb. They are 95% effective when used correctly and also protect against STIs.

Combined Oral Contraceptive Pill (COCP)

The OCP contains artificial versions of oestrogen and progesterone; the hormones that are naturally produced by your ovaries. It is over 99% effective when taken correctly, and works by preventing ovulation and preventing sperm from meeting an egg (by making the lining of your womb thin, and by increasing cervical mucus). You normally take a pill each day for 21 days before having a 7-day break when you have a withdrawal bleed, however, it is often possible to take the pill without a break or with a shorter break. This type of pill isn’t suitable for everyone, for example, if you are over 35 and smoke, or if you have certain medical conditions such as a migraine with aura, a history of blood clots, or breast cancer. But for others, it can be effective at making periods lighter and less painful, and even helping acne. Generally, at age 50 the risks of taking this method of contraception outweigh the benefits, and it is advised to switch to something else.

Progesterone Only Pill (POP, or ‘mini pill’)

The POP, like the COCP, contains progesterone. However, it doesn’t contain oestrogen. This means that it is suitable for more people (for example if you’re over 35 and smoke, or if you have migraine with aura). If taken correctly, it is also over 99% effective. However, you must take this pill at the same time each day. If you are more than 3 hours late in taking it (or 12 hours for desogestrel) it may not be effective and with ‘typical use’ of this type of pill, for this reason, it may only be 91% effective in practice. You take one pill each day without a break, and might notice that you stop having regular periods. Some women have no bleeding, some have light bleeding, and some have more frequent bleeding or spotting. Desogestrel works by suppressing ovulation, whereas other POPs work by thickening cervical mucus. Desogestrel is now available over the counter from your pharmacy.

Contraceptive Implant

The contraceptive implant is a small rod-shaped device that is inserted under the skin in your arm in a small procedure using local anaesthetic. It contains progesterone, which is slowly released into your bloodstream. It prevents pregnancy for 3 years. It is over 99% effective, and means that you don’t have to remember to take a pill each day, which is really useful if you’re forgetful! It works by preventing ovulation, thickening cervical mucus and by making the lining of the womb thin. You might notice that your periods stop, they continue as normal, or you might have irregular bleeding.

Intrauterine Device (‘coil’) or Intrauterine System

An intrauterine device (or copper coil) is a small copper and plastic device inserted into the womb in a small procedure. It slowly releases copper to prevent pregnancy by altering cervical mucus and preventing implantation, for between 5 and 10 years. If inserted correctly, it is more than 99% effective. You might get some irregular bleeding, particularly in the first 3-6 months.

An intrauterine system is a small T-shaped plastic device that is put inside your womb and releases progesterone to prevent pregnancy. It lasts between 3-5 years depending on the brand, and one of the better-known brands is the Mirena® which lasts for 5 years. This is actually one of the first-line treatments for heavy periods, so you’ll likely find your periods are lighter, shorter or non-existent! It works by thickening your cervical mucus, thinning the womb lining and in some people it prevents ovulation.

Contraceptive Injection

The most common contraceptive injection is the Depo-Provera® which is given every 13 weeks, either in your bottom or upper arm. It is more than 99% effective if used correctly. You do need to remember to have your injection, but it can be easier to remember than a daily pill. You might get regular periods, or irregular bleeding and the bleeding could be lighter or heavier than usual. It can take up to 1 year for your fertility to return to normal after removal, so might not be the best option if you want a baby in the near future. It works by releasing progesterone to prevent ovulation, thickening cervical mucus and thinning the lining of your womb. The Depo-Provera® injection can cause thinning of the bones, so after two years it is generally recommended to have a chat with your doctor to see if the benefits of using it still outweigh the risks, and likewise when you reach the age of 45. It is not really recommended for use over the age of 50 for this reason.

Sterilisation or Vasectomy

Female sterilisation is an operation that permanently prevents pregnancy by blocking the fallopian tubes. It can be performed under general or local anaesthetic and is over 99% effective. You’ll still have periods as you would normally. There is a small risk of complications, such as bleeding, infection, or damage to other organs.

A vasectomy cuts or seals the tubes that carry sperm, which is a permanent procedure to prevent pregnancy. It is a 15-minute procedure that is normally carried out under local anaesthetic and is over 99% effective. You still have to use other forms of contraception for 8-12 weeks after the procedure until you have produced 1 or 2 semen specimens to confirm that the sperm is no longer in the semen.

All women can stop using contraception at the age of 55 as the chances of getting pregnant naturally at this age are very rare. However, please remember that you are still at risk of getting STIs and only condoms can protect against STIs.

Hopefully, this has given you something to think about this Christmas before getting merry under the covers. And remember, if your contraceptive method has failed (like if your condom split, or you forgot your pill), you can speak to your GP, pharmacist or family planning clinic to get emergency contraception.
Merry Christmas!

Dr Hannah Missen