Contraception
Looking to start or switch birth control but unsure what’s available or which one would suit you best?
Dr Elise Dallas, GP with a special interest in women’s health, breaks down the different types of contraception.
Combined hormonal birth control
Combined hormonal contraceptives (CHC) are available as:
- Tablets (also commonly called ‘the pill’) - sometimes taken daily with a 7 day break where you’ll have a period, other times taken back to back for a few months depending on what you decide after speaking to a clinician
- Patches - you place a new patch on your skin each week, for 3 weeks out of every month
- Vaginal rings - put a new one inside the vagina once a month
Effectiveness
When taken correctly and consistently, the failure rate is less than 1%.
Benefits
These contraceptives are very popular as they often give you lighter, less painful and predictable periods, so these are great options for people with:
- Heavy or painful periods
- PMS (premenstrual syndrome)
- Endometriosis
- Symptoms of polycystic ovary syndrome (PCOS)
- Acne
Plus, did you know CHCs may alleviate menopausal symptoms, so may be prescribed instead of HRT up to the age of 50 years!
CHCs use may be associated with some health benefits such as reduced risk of ovarian, endometrial (womb) and colorectal cancer, reduced menopausal symptoms and maintaining bone mineral density in premenopausal females under the age of 50 years.
Side effects
CHCs can have some more common side effects that typically improve after a few months, including:
- Nausea
- Breast tenderness
- Bloating
- Mood changes
There is no evidence that CHCs can make you gain weight.
There’s increasing evidence linking the pill to depression, so it’s important to pay close attention to how you’re feeling - physically and mentally - in the first few months you’re on the medication - as changing to a different pill can improve this.
Although CHC’s reduce the risk of some cancers, they can increase the risk of breast and cervical cancer. The overall risk is very small and reduces with time after stopping the CHC.
Other serious potential side effects include blood clots and an increased risk of heart attack and stroke. These events are very uncommon but important to know about and discuss with a clinician, to weigh up the risks for you as an individual.
CHSs aren’t usually recommended if you are over 35 years and smoke, have migraines with auras, or current vascular disease, breast cancer or high blood pressure. People on CHC need their blood pressure monitored annually.
Progesterone only birth control
The progestogen-only method of contraception includes the:
- Progestogen-only pill (mini-pill)
- Intrauterine systems (IUS, for example the Mirena coil)
- Progestogen-only implant
- Progestogen-only injection
Progestogen-only contraceptives offer a suitable alternative to combined hormonal contraceptives when women cannot or should not take oestrogen.
Typical side effects of all these contraceptives can include spotty skin, breast-tenderness, mood changes and headache - but these clear up within a few months for many people.
The mini pill
There are 2 different types of progestogen-only pill:
- One that needs to be taken within 3 hours of the same time every day e.g. Micronor, Norgeston
- The other needs to be taken within 12 hours of the same time every day e.g. Cerazette
This contraceptive needs to be taken every single day, without a break.
Progesterone only pills (the mini pill), can make periods stop or become lighter, irregular or more frequent.
They’re a great option for those breastfeeding or whilst waiting for longer acting contraception, such as the coil, to be fitted. Plus they only take 2 days to start working.
Intrauterine system (IUS)
This option provides a highly effective ‘fit and forget’ solution.
Placed by a health care provider into the womb, it works by releasing the progestogen levonorgestrel, which thins the lining of the uterus, thereby reducing the amount you bleed and amount of pain you may have during your period. Some women stop having menstrual periods entirely.
It is often a great choice for those with heavy menstrual bleeding and conditions that cause pelvic pain, such as adenomyosis and endometriosis.
The Mirena is the only IUS licensed to be the progestogenic component of oestrogen-only HRT (hormone replacement therapy) which is needed to protect the endometrium.
Because its action is directly inside the womb, side effects are commonly less than the other progesterone only methods.
IUS’s are safe and can be left in place for up to 5 years and can be removed at any time with no effect on fertility.
The implant
Nexplanon® is currently the only progestogen-only implant licensed for use in the UK. It is inserted by a health care provider into your arm and is effective within 24 hours of insertion.
It is the most effective method of contraception available - better even than sterilisation!
It may improve symptoms of painful, heavy bleeding but irregular bleeding is the most bothersome side effect.
While it prevents pregnancy for at least 3 years (whilst the hormone is slowly absorbed into the body), it can be removed at any time with no effect on fertility.
The progestogen injection (‘the Depo’)
Otherwise known as medroxyprogesterone acetate (DMPA), Depo-Provera and Sayana Press are long-acting progestins given by injection once every 3 months, the former into a muscle, the latter under the skin.
After stopping the injection, it may take up to 18 months for fertility to return to normal, hence it should not be used by those wishing to conceive in the next year or so.
When it comes to the ‘Depo’, the potential negatives include: weight gain, bone mineral density loss and a delay in normal fertility returning. The positives are that: it provides a low-risk, highly effective, convenient method of contraception that (after possible irregular bleeding in the first 6 months) makes most people using it period free!
Non-hormonal birth control
Intrauterine devices (IUD), commonly called ‘coils’
The copper-containing IUD is the non-hormonal method of LARC and is suitable for women of any age, whether they’ve had children or not.
Some women have a heavier menstrual period or more cramps during their period while using a copper IUD.
They can remain effective for at least 10 years, but can be removed at any time with no effect on fertility.
Fertility Awareness Methods
Fertility Awareness Methods (FAM) include apps like Natural Cycles, which work by monitoring your fertility signs, such as cervical secretions and basal body temperature, to find out when during the month you can have sex with a reduced risk of pregnancy.
FAM can be up to 98% effective with perfect use, but is thought to be more in the region of 76 to 88% with typical use, depending on which method you use.
Some things also affect fertility signs such as regularly travelling through different time zones, breastfeeding and irregular bleeding - so this could be a method for women who wouldn't find falling pregnant a significant problem.
Barrier methods
Barrier contraceptives prevent sperm from entering the womb.
Barrier contraceptives include the condoms (male and female), diaphragm and cervical cap.
Male condoms are less effective than some other contraception methods but are effective when used consistently and correctly, and are the only contraception to provide significant protection against some sexually transmitted infections (STIs).
Permanent birth control
This is a procedure that permanently prevents you from becoming pregnant or having children.
Tubal ligation (for women) and vasectomy (for men) are the two most common permanent birth control procedures.
These procedures are permanent, and should only be considered after you discuss all available options with a health care provider and if you are certain you wish to permanently prevent pregnancy.
Looking to start contraception or thinking to switch?
Our clinicians can help you with your decision, prescribe it for you or signpost you in the right direction of where you can get long acting reversible contraception.
The information provided is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of a doctor with any questions you may have regarding a medical condition. Never delay seeking or disregard professional medical advice because of something you have read here.