Contraception

Last updated 06 May 2016 — Last reviewed 02 December 2013

There are many different methods of contraception to avoid pregnancy including the oral contraceptive pill (OCP), the mini-pill, a condom, an intrauterine device (IUD) such as Mirena, an Implanon rod, the natural family planning method and more permanent measures such as tubal ligation and vasectomy for men. The way each method works including the pros and cons is discussed.

Contraception to avoid pregnancy is recommended from the time you start to become sexually active until at least one to two years after menopause (one year after your last period). 

Permanent contraception is a choice for couples who have completed their families.

The risk of sexually transmissible infections (STIs) is a lifelong issue and needs to be considered for all new relationships and in your choice of contraception.

Contraception options

Combined oral contraceptive pill (COCP) – ‘The Pill’

oral contraceptive pill

How it works Pros Cons

Two hormones, oestrogen and progesterone, in the Pill:

  • prevent the release of an egg 
  • change the lining of the uterus
  • prevent sperm entering by thickening the mucus at the entrance of the cervix (the lower, narrow part of the uterus)

The Pill can:

  • regulate the menstrual cycle
  • improve pre-menstrual syndrome (PMS) and some menopausal symptoms
  • possibly decrease risk of endometrial and ovarian cancer

(Breast cancer risk is still being investigated)

Disadvantages include:

  • a small risk of clotting, heart attack and stroke
  • smokers over 35 years should not use the Pill as there is a greater risk of heart attack and blood clots in the legs or lungs

Healthy women who are non-smokers, have normal blood pressure, are not diabetic and have no increased risk of blood clots can continue on the COCP up until menopause. There is no absolute rule on the age it should be stopped, but keep in mind it may mask the onset of menopause.

Progestogen-only pill – the ‘mini-pill’

How it works Pros Cons
  • A very small dose of progestogen
  • It works by thickening the mucus in the cervix to prevent sperm entering the uterus
  • Highly effective in women older than 40 due to their naturally declining fertility
  • Because it doesn’t contain oestrogen, the mini-pill doesn’t carry the same risks as the combined pill – especially for smokers
  • Can be used in women who are breastfeeding
  • It must be taken at the same time every day (within 3 hours of your normal time)
  • It may result in irregular periods

Condom

How it works Pros Cons
The fine rubber or plastic sheath is worn on an erect penis, catches sperm and stops it reaching the egg. Condoms are good for women in new relationships, as they are the only contraception that protects against sexually transmissible infections.
  • Condoms have a 5-10% failure rate
  • Vaginal discomfort and erectile dysfunction may cause difficulties

Mirena®  Progestogen – IUD

How it works Pros Cons
  • The Mirena® contains a slowly releasing progestogen –  levonorgestrel –  that stops pregnancy
  • It does not stop ovulation –approximately 75% of women continue to ovulate
  • The IUD thickens the cervical mucus, so that the sperm can’t reach an egg
  • It thins the lining of the uterus, making it unfavourable for implantation
  • Inserted into the uterus through the vagina (with or without anaesthetic)
  • Once inserted, you need to check once a month to make sure it is still in place by feeling for a string coming out of your cervix
  • Periods are likely to involve less blood loss and discomfort
  • After approx.12 months of having the Mirena in, you may not have a period at all
  • It lasts up to 5-7 years, depending upon the woman’s age at insertion
  • It is easily removed
  • Irregular spotting and bleeding can continue indefinitely in a very small number of women
  • Some women may also get progestogen-related side effects such as:
    • bloating
    • sore breasts
    • weight gain
    • acne

Copper intra-uterine device – IUD

How it works Pros Cons
  • Inserted into the uterus through the vagina (with or without anaesthetic)
  • Once inserted, you need to check once a month to make sure it is still in place by feeling for a string coming out of your cervix
  • The IUD is toxic to sperm and also stops a fertilised egg from settling in the uterus
  • A copper-containing IUD is very effective as a medium-term, non-hormonal contraceptive
  • It lasts 5 years (MultiloadR) to 10 years (TT380R) – but the IUD lifespan doubles if it is inserted after the age of 40
  • It is easily removed
  • It can also be used as an emergency contraceptive if inserted within 120 hours (5 days) of intercourse
Heavier, painful bleeding can be a side effect.

Implanon – ‘the rod’, a three year contraceptive implant containing etonogestrel

How it works Pros Cons
  • The implant stops the production and release of eggs by releasing the hormone estonogestrel slowly and continuously
  • It also thickens the mucus around the cervix to stop sperm from entering the uterus
  • The matchstick-sized plastic rod is inserted under the skin of your inner upper arm by a doctor after a local anaesthetic
  • It can be felt under the skin but is unlikely to be seen
  • Progestogen only
  • Inexpensive
  • Lasts for 3 years
  • Menstrual irregularities can occur, particularly in the first three months with subsequent cessation of periods in 20% of women
  • 18% of women experience enough bleeding abnormalities to have the implant removed
  • Some women may experience:
    •   acne
    •   breast tenderness
    •   mood changes

Nuva Ring – Contraceptive hormonal vaginal ring

How it works Pros Cons
  • A small, soft, silastic (pliable plastic) ring containing low dose oestrogen and progestogen
  • It is self-inserted into the vagina and remains there for three weeks (including during intercourse) then removed
  • A new ring is inserted one week later, at the end of the 4 week-cycle
As well as its ‘set and forget’ convenience, there may also be less hormonal side effects than the oral contraceptive pill.

Disadvantages include:

  • a small risk of clotting, heart attack and stroke
  • smokers over 35 years should not use the ring as there is a greater risk of heart attack and blood clots in the legs or lungs

Diaphragm & cap

How it works Pros Cons
  • Diaphragms and caps (not available in Australia) are ‘barrier methods’ as they are placed inside the vagina to cover the entrance to the uterus, stopping sperm from reaching the uterus
  • A diaphragm is a shallow dome of thin rubber that is held in place by the pelvic muscles
  • A cap is a firm, cup-shaped device which fits over the cervix by suction
  • These products are left inside the vagina for six hours or longer after sex,so the sperm die without reaching the egg
  • Drug free contraception
  • Can be used with short notice
  • They may be more effective if used with a spermicide cream/gel, which kills or disables sperm
 
  • Not as reliable as some other contraceptive methods
  • Some women find them difficult to insert and therefore risk incorrect placement
  • Insertion and removal may increase the risk of urinary tract infection
  • Spermicide is no longer available in Australia because of the link with mucosal irritation and increased susceptibility to STIs and HIV
 

Postinor emergency contraception - the 'morning after pill'

How it works Pros Cons
  • Often called the ‘morning after pill’, Postinor reduces the chance of pregnancy after unprotected sex
  • The sooner it is taken (within 24 hours of unprotected sex), the more effective it will be
  • It must be taken within 5 days
  • It works by delaying the release of an egg from your ovary, or by reducing egg development – it does not prevent implantation of a fertilised egg
  • After use it is important to keep using other contraception until your next period
If it fails to work, it is not harmful to the pregnancy and embryo.
  • It does not protect against sexually transmissible diseases
  • It can only be used for emergency situations
  • It must be used as soon as possible after the event

Natural family planning method

monitoring ovulation

How it works Pros Cons

Your ‘fertile window’ can last from 5 days before ovulation to 5 days after ovulation (sperm can survive for up to 5 days). After ovulation, your basal temperature rises about half a degree celsius. This approach uses your temperature to indicate when ovulation has taken place so you know when you have less chance of becoming pregnant. 

You take your temperature:

  • every morning to identify your basal temperature (your body’s lowest temperature)
  • over a number of menstrual cycles so you can predict the days you are likely to ovulate
  • Doesn’t require the use of any medications
  • Is a quick simple method of contraception
 

Disadvantages include:

  • greater risk of getting pregnant than other forms of contraception
  • relies on taking an accurate temperature reading daily

  • it does not predict ovulation, rather when ovulation has already taken place
  • you are not protected from sexually transmissible infections (STIs)
  • you may need to use another form of contraception during your ‘fertile window’

Surgical options

>Tubal ligation (’tubes tied’ Surgery can be done through ‘keyhole’ surgery in your lower abdomen and requires a general anaesthetic. It’s immediately effective, however there are small risks of injury to blood vessels, the ureters (the tubes that connect the kidneys and bladder), or the bowel.
Blocking fallopian tubes with coils (Essure device)
  • Tiny metallic coils are inserted into the fallopian tubes through a hysteroscope (a telescope inserted into the uterus via the vagina) by a specially-trained gynaecologist under a local or general anaesthetic
  • The device stops pregnancy by scarring and blocking the tubes. Other contraception isn’t necessary once the device is confirmed to be in place – this occurs when an x-ray is done three months after insertion
Vasectomy

A vasectomy is a permanent option for men where the tubes carrying sperm to the penis are cut, with no effect on other functions. It is usually done under local or general anaesthetic. It is not immediately effective – a follow-up semen analysis at three months is required to check for effectiveness. There is also a very small risk of injury to the testicles and long-term testicular pain.

This method is very popular in Australia, particularly if you feel you no longer want children.

Finding an ideal contraceptive will depend on your health, relationship needs and future plans, such as whether you have decided not to have children or do not wish to have any more children.

There are many options available and it is a personal choice best made in a discussion with your doctor.

Options for contraception will depend on your individual situation, including whether you need protection from pregnancy and/or protection from sexually transmissible infections (STIs).

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at December 2013.

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