Please note: this article is for information only. It does not replace advice from your GP or other medical professional. If, after reading this article you have any general questions about using contrception, then please ask in the sexual health forum.
Did you know that there are 15 methods of contraception available on the NHS?
Don’t worry if you didn’t; an overwhelming 92% of us are unaware of the range of options available. Different methods suit different people—there is no one-size-fits-all with contraception. That’s why it’s important to explore the best option for you with your nurse or GP.
Your chosen contraception protects against pregnancy, but don’t forget, using condoms and contraception together is the only way to protect yourself and your partner against both unintended pregnancy and STIs.
There are two kinds of emergency contraceptive pill. Levonelle has to be taken within 72 hours (three days) of sex, and ellaOne has to be taken within 120 hours (five days) of sex. The sooner you take emergency contraception, the less likely it is that you will become pregnant. Both work by preventing or delaying ovulation (release of an egg). If you vomit or experience diarrhea within 3 hours of taking Levonelle or ellaOne, you'll need to take another pill or have the IUD fitted as soon as possible.
Possible side effects include:
- tummy ache
- breast tenderness
- ‘spotting’ of blood
The intrauterine device (IUD), also known as a coil, works by stopping the sperm and egg from surviving in the womb or fallopian tubes. It may also prevent a fertilised egg from implanting in the womb. You can get it within 120 hours (five days) of sex. There are different types of IUD, some with more copper than others. IUDs with more copper are more than 99% effective. If you use the IUD as emergency contraception, it can be left in as your regular contraceptive method. Some women who use the IUD as a regular method of contraception find it can make their periods longer, heavier, or more painful.
Note: you can only buy the morning after pill from a pharmacy if you're 16 or over. If you're under 16 then you need to go to your doctor or sexual health clinic. Some community pharmacies will run patient group directions where they can provide it to people under 16, and it's free! It's definitely worth checking to see if you're local pharmacy provides this service. A lot nicer than the £25-£30 it'll cost you otherwise!
Condoms are the only form of contraception that protect against pregnancy and STIs, including HIV. They are relatively expensive in shops (around £5 for a box), but can be obtained for free from Brook centres or your local family planning clinic. They can also be obtained for free at various places around universities and colleges where they are given away for free.
Condom boxes always carry leaflets explaining how they should be stored and put on.
- Always check the 'use by' date. A condom that is out-of-date is not an effective one.
- Check that they are European and have been certified. There should be a mark on the packaging.
- Open the foil package with your fingers, not your teeth. Do this gently so that you don't risk damaging it
- Check the condom is intact.
- Tie a knot in the end and dispose in a waste bin. They do not flush down toilets.
- Dispose of them before going to sleep, condoms do go pop when you stand on them.
- Condoms are not recyclable.
- Do not reuse condoms.
- Wearing two does not improve your chances of preventing pregnancy and STDs. In fact, the friction makes them more likely to tear.
Currently, there is only one brand of female condom available in the UK, called Femidom. Female condoms are made from thin, soft plastic called polyurethane (some male condoms are made from this too), and are are 95% effective. They are worn inside the vagina to prevent semen getting to the womb.
The combined pill contains two hormones, oestrogen and progestogen. The hormones in the pill prevent your ovaries from releasing an egg (ovulating). They also make it difficult for sperm to reach an egg, or for an egg to implant itself in the lining of the womb. The pill can also be used to treat painful periods, heavy periods, premenstrual syndrome (PMS), and endometriosis.
Pills are based on 28-day cycles. Sometimes you’ll get 21 pills in a pack with an instruction to take all of them then take 7 pill-free days for a bleed. Some contain 21 “active” pills and 7 sugar pills just to serve as reminders.
The progestogen-only pill (sometimes abbreviated to POP and also known as the mini-pill) contains the hormone progestogen, and works by thickening the mucus in the cervix, which stops sperm reaching an egg. Newer progestogen-only pills contain desogestrel.
You take a pill every day, with no break between packs of pills, and this form of contraception can be over 99% effective. You must take the progestogen-only pill at the same time each day. If you take it more than three hours late—or 12 hours late if you take a desogestrel pill, such as Cerazette—it may not be effective.
The leaflet in you pack details what to do if you miss a pill, however, here’s a quick rundown.
If you have missed one pill, don’t freak out. Take it as soon as you remember, even if you’re taking it the next day at the same time as the pill for that day. If you want to be super careful, take extra precautions such as the condom for the next week.
If you have missed more than one, especially near the beginning or end of your packet, you ought to use extra protection during sex. If you’ve already had sex without a condom, consider emergency contraception.
The pill can generally be affected by:
- Diarrhoea and vomiting
- Epilepsy medication
- St Johns Wort
Note: St John's Wort can interfere with more than just the pill. Consult the information leaflet that came with your contraception if you're on the pill or patch, and ask your GP, nurse, or call NHS 111 if you're on the implant or injection.
Possible side effects:
- Diarrhoea, constipation, nausea, vomiting or abdominal pain
- Breast tenderness/swelling
- Fluctuation in sex drive
- Weight changes
- Depression/mood swings
- Irregular brown patches on the skin
- Alteration of bleeding
- Problems wearing contact lenses
- Infrequent or no periods after stopping the pill
Obviously, side effects will vary between the 23 brands available, and of course, the millions of women taking them. The more serious side effects are more likely if you’re a big migraine sufferer or you smoke tabacco. You can be at a higher risk of thrombosis and clots if you are on the pill. You are also at an increased risk of breast cancer, which is why you should check your breasts monthly. The pill can protect against certain cancers of the womb and possibly the bowel. It can also help with acne.
There are three types of contraceptive injections in the UK: Sayana Press, which lasts for 13 weeks, Depo-Provera, which lasts 12 weeks, or Noristerat, which lasts 8 weeks. The injection contains progestogen, which thickens the mucus in the cervix, stopping sperm reaching an egg. It also thins the womb lining and, in some, prevents the release of an egg.
The contraceptive injection is more than 99% effective, and is useful for women who can't use contraception that contains oestrogen. It's not affected by medication either. Side effects can include:
- weight gain
- mood swings
- breast tenderness
- irregular bleeding
The injection can't be removed from your body, so if you have side effects they'll last as long as the injection and for some time afterwards.
- Your periods may become more irregular or longer, or stop altogether (amenorrhoea). Treatment is available if your bleeding is heavy or longer than normal—talk to your doctor or nurse about this.
- It can take up to one year for your fertility to return to normal after the injection wears off, so it may not be suitable if you want to have a baby in the near future.
- Using Depo-Provera affects your natural oestrogen levels, which can cause thinning of the bones.
You should not have the injection if you suffer, or have suffered, from:
- cancer of the breast or uterus
- unexplained bleeding of vagina
- a heart attack or stroke
- severe depression
- active liver disease
For further information, explanation on how to get it and how it's put in and personal experiences see The Contraceptive Implant
The implant has been met with heavy scepticism, with one type even being taken off the listing because it caused so much scarring. This is Norplant. Some of you might still have it in, but it’s been discontinued in the UK.
The main type now is Implanon. It’s a small, flexible tube that is about the same size as a Kirby grip, containing progestogen. It releases it steadily into the bloodstream from the comfiness of your upper arm. It lasts for three years. [Norplant for 5].
It basically does what most contraceptives in the body do; thicken mucus around your cervix, thins your uterine lining and also prevents egg release [and therefore bleeds, in time]
When it is put in [usually first day of period], you are likely to be given a local anaesthetic, then have the implant injected. You will probably be bruised and sore for a few days. You’ll be able to feel and fiddle with it, but resist that temptation for a while! You will be protected from the word go!
When you’re getting it removed, it is cut out. You can get another one popped in right away if you want. However, if you want it permanently removed, you must use condoms during the week before it is removed, because sperm can live inside you for 7 days, and you lost protection as soon as the implant is taken out.
You ought to have a check up after the first three months, then just once a year providing you’re not having problems.
The Good Stuff
• The implant really is the most effective form, at over 99% pregnancy prevention
• It’s not like you have to remember to do anything!
• It does not interfere with sex.
• You still breastfeed
• It is good for those who can’t take oestrogen for whatever reason
• It can be removed if you have trouble with it, and you can get pregnant right after removal
• It offers protection against pelvic inflammatory disease.
The Bad Side
• It can go a few ways; you could have irregular bleeding, no bleeding at all, or prolonged bleeding for a while. This is annoying, but it can’t harm you
• Your usual headaches, spots, dizziness, weight gain, sore boobies
• Very rarely, infection in the site
• It can be difficult to remove. There have only been 2 or 3 cases of migration, though
• Harmless ovarian cysts, with a little pelvic pain
• Mood swings
• No STI protection [duh]
Don’t get it if you are suffering or have suffered from
• Liver disease
• Unexplained bleeding from the vagina
• Cancer of the reproductive organs
• Heart attacks or strokes
Or if you could be pregnant
This patch [amusingly] comes in three different colours, and you pick the one that matches your skin tone the best. [or whatever goes with your outfit, I guess]
They’re about 5x5 cm, and you splat them on your upper arm, shoulder or bottom for a whole week. It should be changed on the 8th day for three weeks and then you should give yourself a patch free week. DON’T put it on your breasts or broken skin. Just don’t.
It acts just the same as the pill, in that oestrogen and progestogen are pumped into your system, thickening the cervical mucus, and preventing egg release. You’re protected right away if you take it on the first day of your period.
Protects you and stays on even when you’re a hardcore swimmer.
You don’t need to remember to take a pill every day.
It’s 99% effective.
It is not affected by diarrhoea or vomiting
The patch has had its fair share of bad press recently. But it shouldn’t harm you if you’ve gone through the right channels to get it, and aren’t suffering from certain conditions/diseases mentioned below.
Obviously there’s the obligatory risk of skin/headache problems and the fact that it will not protect you from STIs.
You can gain or lose weight, have mood swings and get a little bit of skin irritation.
People can see it [and say OMFG SLUT ]
Then there’s the increased risk of certain cancers and thrombosis/clotting
Yes, it can fall off – but you ought to be able to reapply it.
Do not use this if:
• you think you might be pregnant
• you are breastfeeding
• you smoke and are over 35
You have or have had • thrombosis (blood clots) • a heart abnormality or circulatory disease, including raised blood pressure • severe migraines or migraines with aura • breast cancer • active liver/gall bladder disease • diabetes • unexplained bleeding from your vagina
This is pretty newish, and it's not really as mainstream over here as the pill and whatnot (it is not currently available on the NHS in the UK), but it's a pretty novel idea. In layman's terms, it's a flexible ring that you put in the vagina [much like a diaphragm] and you leave it there for 3 weeks [21 days] as is the normal cycle, and then remove it for your seven day bleed. www.nuvaring.com can give you their lowdown on it.
The website is pretty unhelpful when it comes to asking whether you can "run nuvarings together" as is possible with the pill. That is something you'd have to take up with your doctor.
It contains oestrogen and progestin just like your average pill.
You don't have to remember a pill every day
It's 99% effective
8/10 men can't feel it during intercourse. [although I guess it sucked for the 20% who could]
You don't really feel it and it can't get "lost"
Spotting is dead rare
It's low dosage and steady release mean less hormonal ups and downs
The common side effects are:
Vaginal infections and irritation
Upper respiratory tract infection
Change in appetite
Abdominal cramps and bloating
Breast tenderness or enlargement
Irregular vaginal bleeding or spotting
Changes in menstrual cycle
Temporary infertility after treatment
Spotty darkening of the skin, particularly on the face
Intolerance to contact lenses
So it's much like other hormone based contraceptives.
It is a silicone/rubber flexible dome that is inserted into the vagina before sex. It has to be left inside for about 6 hours after sex to ensure sperm cannot pass through the cervix. Spermicidal jelly must be used with it to kill any that gets past the diaphragm.
It may be embarrassing to have one fitted, the doctor/nurse has to feel inside the vagina, to see where the cervix is, and how wide it is. Several sizes of diaphragms may be tested (placed inside you and the doctor/nurse feels around) before the right one is chosen.
It can be inserted hours before sex - so sex does not have to be postponed whilst the diaphragm is prepared. Before sex begins, additional spermicide does need to be reinserted.
• It protects against some STIs and is 92-96% effective against pregnancy
• It’s good for you regardless of your medical conditions [except if you're allergic to rubber/silicone]
• When inserted correctly, it cannot be felt by either partner.
• You have to have it fitted by a doctor/nurse first time around.
• It can interrupt passion.
• You have to use it in conjunction with spermicidal jelly.
• You have to leave it in 8 hours after sex [otherwise the little guys will fight their way in]
• It can cause cystitis.
• If you put on weight/miscarry/abort you have to get it refitted.
The Intra-Uterine System
Whilst it sounds like a hot new car feature, it’s actually a T shaped contraption that is fitted up there by a doctor or nurse. It releases small amounts of the hormone progestogen to thin the lining of your uterus so fertilised eggs cannot implant in it. It also thickens the cervical mucus to make it harder for sperm to get through.
It’s not generally a “young persons” contraceptive device. It’s more suited to women who have had children, really, though it is possible to have one even if you have no kids. They take about 15 minutes to put in – but I suggest some painkillers before, since it can be uncomfy
• It lasts for 5 years
• It’s 99% effective
• It can lighten your periods [yaaay]. In fact, Mirena is commonly recommended as a treatment for heavy periods.
• The hormone levels are low and mainly localised to the uterus, so if you have had problems with hormonal contraceptives in the past, this could suit you.
The down side
• It can move out of place and become less effective – so regular checkups are needed, and you need to make sure you know how to check the threads that hang down from it
• No STI protection
• You can get irregular bleeding, breast tenderness and skin problems at first
• You can be subject to harmless cysts, but with a little pelvic pain
• Occasionally infections up to 20 days after insertion can occur
• Perforation of the womb [this is totally rare, albeit serious] and may require surgery
• Don’t go for this if you’ve had strokes, thrombosis, cancer of your reproductive organs, or if you are currently suffering from an STD.
• If you are very sensitive to hormones, you may still suffer from hormonal side effects - headache, mood changes, low sex drive etc - especially in the first few months after insertion
• Your partner may be able to feel the threads during sex. If this is the case, you can have them trimmed.
These are all general, reversible forms of contraception. The next step up is the more permanent solutions of vasectomies and tube tying. Tube tying itself is only 99% effective anyway, and way ahead of most of our time right now, so let’s not get into that right now.
Still got a question about contraception? Ask it in the sexual health forum or see your GP or Family Planning clinic.