Fiona's Blog: Contraception – what options are there and which is right for me?
Whether you’ve been on the pill since 14 or you’ve got no experience with it, many people don’t seem to realise that there are far more contraceptive options that you know of. Once you realise how many options you have, it can be quite overwhelming figuring out which one is right for you. Hopefully this blog post and the resources at the end will help you make an informed decision!
This post is going to be a lot more formal than most of my other posts, and a lot of the info or more info can be found on the NHS website which I will have linked at the end of this, but I wanted to create this blog anyway to create a sort of master post of information.
To make this slightly less overwhelming I am splitting this post into two posts, this week will be hormonal contraception and then the next post will cover non-hormonal contraception.
So you can skip to whatever one interests you, here is a list of what I will be speaking about:
- The combined pill
- The progesterone only pill
- The patch
- The implant
- The injection
- The IUS
First of all, the aim of hormonal contraception is to prevent any sperm from reaching an egg in the uterus, some do this through preventing the release of an egg (ovulation), others thicken the mucus in the cervix to stop sperm from reaching the egg.
The Combined Pill
Beginning with one of the most well-known forms of hormonal contraception, the combined pill is taken orally and prevents ovulation. It contains the hormones oestrogen and progesterone. If used correctly the combined pill is 99% effective, it should be taken at the same time every day (which basically includes setting about 10 alarms on your phone to remember to take it, or at least that has been my experience). Some medications can make the pill less effective, so it is important to speak to your doctor about this if you are taking any medication. The pill can have minor side effects such as nausea, headaches, breast tenderness and mood swings. In very rare cases it can have severe side effects such as blood clots and cervical cancer. It does not protect against STIs.
If you have endometriosis, heavy or very painful periods or PMS the combined pill can help. If you are pregnant, smoke and are older than 35, stopped smoking less than a year ago and are older than 35 or are extremely overweight you should not take the pill. This also applies if you have any history of blood clotting, breast cancer, gallbladder or liver disease among other things.
If you are sick or have diarrhoea the pill may lose effectiveness (basically any illness where things are coming out of your body in ways they shouldn’t, you should be careful!).
The combined pill has 3 different types. They all have really complicated names that I didn’t even know of before writing this blog post, but the more you know, right?!
- The first is the monophasic pill. Each pill has the same amount of hormone in it. This is taken for 21 days, then the user will take no pills for 7 days, in which they will most likely experience a withdrawal bleed, which is similar to a period bleed.
- The second is the phasic pill. It has two or three different sections, all of which have different doses of hormones, in a similar fashion to the monophasic pill this is taken for 21 days and then a 7-day break follows. It is vital that these pills are taken in the correct order.
- The final type of combined pill is the every day pill (at least this ones name is easy to remember). This pill has 7 inactive pills and 21 active ones. A pill is taken each day for 28 days without a break. Here it is also vital to take the pills in the right order. While taking the 7 inactive pills you may experience a withdrawal bleed.
If you have just had a baby, been pregnant or had a miscarriage you will receive special guidance for when you can start taking the combined pill.
The Progesterone Only Pill
This pill thickens the mucus in the cervix and, as the name suggests, contains only progesterone, unlike the combined pill. As with the combined pill, it is 99% effective if used correctly, though in “real life” (the way most women take it), it is around 92% effective. Side effects of this pill can include spotty skin and breast tenderness, though this should only last a few months, it can also affect the regularity of your periods, or they may stop all together. This pill does not protect against STIs and can also be made less effective by certain medications.
If you are sick or have diarrhoea the pill may lose effectiveness.
There are two types of progesterone only pill.
- the 3-hour progesterone only pill must be taken within three hours of the same time each day.
- the 12-hour progesterone only pill must be taken within twelve hours of the same time each day.
Both of these pills need to be taken for all 28 days of your cycle with no break.
Hormone-wise, the patch is quite similar to the combined pill and works in much the same way, the difference being that the hormones are released into the body through the skin. Each patch lasts one week, you change the patch each week for 3 weeks and then have a week without. Side effects of the patch can include headaches and a raised blood pressure. In rare cases people can develop blood clots. The patch does not protect against STIs. Certain medications can make the patch less effective.
As with the combined pill, if you are pregnant, smoke and are older than 35, stopped smoking less than a year ago and are older than 35 or are extremely overweight you should not take the pill. This also applies if you have any history of blood clotting, breast cancer, gallbladder or liver disease among other things.
The contraceptive implant is a small flexible plastic rod that is placed under the skin in your upper arm. This can be done by your GP, who will put a local anesthetic on your arm, before making a small incision and inserting the implant. In a similar fashion, if you need to have the implant removed the process would be the same. It sounds incredibly scary and daunting but I have been told by many that it really actually isn’t that bad. I don’t have personal experience with it but I am inclined to believe them. Remember if you are nervous then tell your nurse, usually they are really lovely and will be happy to explain anything you are nervous about and do whatever they can to make this process easier for you!
It is over 99% effective and once it is there you don’t have to think about it for three years. It works by releasing the hormone progesterone into your bloodstream, which prevents ovulation.
It can affect the regularity of your periods and could make them lighter or heavier, it could also make them stop all together. Other side effects can include mood swings, acne, headaches, nausea and breast tenderness. As with the others, some medication can make the implant less effective. The implant does not protect against STIs.
The contraceptive injection releases the hormone progesterone into your bloodstream, which prevents ovulation. It is more than 99% effective. The injection will usually be administered in your bottom but can also be given in the upper arm (if you are scared of needles, if it’s in your bottom you can’t actually see it go in which can be a plus for some!). There are two types of the injection, one lasting 8 weeks, the other lasting 13 weeks. Unlike all other hormonal contraceptive methods so far, the injection is not affected by other medication you may be taking.
Side effects of the injection can include breast tenderness, weight gain, headaches, mood swings and irregular bleeding. Your periods may become lighter or heavier, shorter or longer or they may stop all together. The injection does not protect against STIs. It can take up to a year for your fertility to return back to normal after stopping the injection, meaning it may not be suitable if you plan on having a child in the near future.
Using the Depo Provera injection (which lasts for 13 weeks), affects your natural oestrogen levels, which can cause your bones to thin out, though it will not increase your risks of breaking a bone. For most women this is not a big problem, as the bones will repair themselves after stopping the injection and so far, no long term problems have been detected. Those who have a history of osteoporosis should however speak to a doctor first. Many doctors will recommend not being on the injection for more than 2 years at a time to prevent long term damage to the bones.
There is also a new form of the injection, called the Sayana Press. This lasts 13 weeks, but instead of receiving it from a doctor or nurse, you are taught how to administer it yourself (which again, to me at least, sounds terrifying but it can have a lot of benefits and take away the pressure of having to go to the doctor’s office and show a nurse your bottom ever 3 months. It’s also not as scary as it sounds once you know how it works).
The IUS (intrauterine system)
This is a small T-shaped plastic device that is inserted into the womb (uterus) by a doctor or nurse. It releases the hormone progesterone, which thickens the mucus in the cervix and is effective for 3 to 5 years. It is more than 99% effective when inserted correctly and can be removed by a doctor or nurse at any time.
It can make periods lighter or stop them all together, which could be helpful for people suffering from heavy or painful periods. Side effects can include mood problems, skin problems or breast tenderness. The IUS does not protect against STIs. In rare cases, your uterus could reject the IUS causing it to move, you may have an increased risk of pelvic infection and very rarely the IUS could create a small hole in the womb.
The insertion can be quite painful, though you can get a local anesthetic to help with this. The appointment should take no more than 20 minutes, the insertion itself shouldn’t be longer than 5 minutes. The vagina is opened up like during a smear test and the system is inserted into the womb through the cervix.
Many experience period-like cramps for a few hours after insertion. This pain can be helped by taking painkillers. After 3 to 6 weeks you will need to return to the doctors for a check up appointment, to make sure the IUS is in the correct position. This is an important appointment because if it isn’t in the correct position it won’t be as effective!
You may not be able to receive the IUS if you have a history of liver disease, breast cancer, cervical or womb cancer, an untreated STI or pelvic infection. Other problems with your vagina, womb or cervix can also prevent insertion (i.e. Vaginismus).
So that about sums it up in terms of the hormonal contraceptive options that are out there, hopefully that has given you a good idea of what options you have. Next time I will be talking about non-hormonal options which there are fewer of, so the post won’t be quite as long as this one!