Contraception

Last updated 06 May 2016 — Last reviewed 22 October 2013

There are many different types of contraception available to prevent pregnancy. They have different ways of working and some will be better than others depending on a women’s medical history.

What is contraception & why is it used?

Contraception (or birth control) is a variety of methods used by men and women who are sexually active to prevent pregnancy.

There are many different types of contraceptives. A person chooses contraception depending on a number of things including:

  • their medical history
  • how effective it is
  • how easy it is to use
  • the cost
  • availability
  • their sexual relationship/s
  • the protection offered against sexually transmissible infections (STIs)

The main forms of contraceptives are:

  • physical barriers and devices
  • hormonal (oral, implant and injection) methods
  • sterilisation/permanent contraception
  • emergency contraception
  • other methods

Protection against sexually transmissible infections (STIs)

Not all forms of contraception provide protection against STIs. The best way to reduce the risk of STIs is to use barrier protection such as condoms and dams (a thin piece of latex placed over the anal or vulval area during oral sex). Condoms can be used for oral, vaginal and anal sex to help prevent the spread of some infections.

Who needs contraception?

If a girl or woman is sexually active and has periods she can become pregnant. If she does not want to become pregnant then she (or her partner) will need to use contraception.

A woman does not need contraception if:

  • she is not sexually active
  • she has had a hysterectomy or had her ovaries removed
  • she has reached menopause, it is safe to stop using contraception when:
    • she is over 50 years of age and has not had a period for more than1 year
    • she is under 50 years of age and has not had a natural period for more than 2 years – until this time, while fertility decreases quite quickly swiftly, pregnancy is still a possibility

Contraception types, effectiveness, benefits & risks

Barrier methods

Male condom: a latex (polyurethane) sheath which is rolled onto the erect penis before sex, to prevent semen entering the vagina.

male condoms

It:

  • is 82-98% effective for preventing pregnancy
  • needs to be put on before contact between the penis and the vagina and should be used every time a person has sex
  • can be used with spermicide to increase effectiveness
  • can reduce the risk of STIs
  • is widely available
  • is relatively cheap.

Female condom: a latex sheath with a ring at each end, which is placed inside the vagina before sex to collect semen.

It:

  • is 75-95% effective for preventing pregnancy
  • can reduce the risk of STIs
  • is not as widely available as the male condom.

Diaphragm: is a soft, dome-shaped silicone cap with a flexible rim, which is placed inside the vagina before sex, to cover the cervix and stop sperm getting into the uterus. A diaphragm should be fitted for the right size by a doctor or nurse. It requires instructions for use, can be tricky to fit correctly.

It:

  • is 88-94% effective
  • can be used with or without spermicide

Hormonal contraception: pills & rings

There are two hormones, called oestrogen and progesterone, that may be in contraceptives.. These hormones are usually made by the ovaries and by using them in contraceptives, they change the way the hormones work and the messages they send. This usually stops the growth and release of an egg (ovulation) from the ovary every month and makes the fluid at the opening of the womb thicker which makes it harder for sperm to get into the uterus.

Combined oral contraceptive pill (COC Pill) or ‘the pill’

The combined pill is an oral contraceptive taken daily made from oestrogen and progestogen.. Each pack contains a mixture of hormone pills and sugar pills, usually either 21 days of hormone pills and 7 days of sugar pills or 24 days of hormone pills and 4 days of sugar pills. When a woman takes the sugar pills she will have a period.

What’s good about it?

  • The pill is 91-99% effective
  • The pill may help with heavy and/or painful periods
  • The pill may reduce the chance of ovarian or uterine cancers
  • The pill may help with acne
  • A woman can choose to skip periods or time periods with some pills (e.g. if going away)

What’s not so good about it?

  • A regular prescription is needed
  • It needs to be taken daily to be effective
  • It does not give protection against STIs
  • Side effects may include regular spotting; sore breasts, headaches, bloating and mood swings – but many of these often settle after a few months

Who shouldn’t use it?

  • Women with high blood pressure that is not well controlled
  • Women with diabetes that is not well controlled or who have complications
  • Women at risk of blood clots
  • Women who have or have had breast cancer or uterine cancer
  • Women with some liver problems
  • May not be recommended in some women over 35 years old e.g. those who smoke
  • Women who have headaches, such as migraines, should discuss with their GP

What else?

  • The pill may not work as well in women on some epileptic medication, some antibiotics and St. Johns wort
  • The pill may not work if a woman has diarrhoea or vomiting

What happens if a woman misses a pill?

  • If a woman forgets the pill, and it is more than 24 hours late, she is at risk of getting pregnant and will need additional contraception such as condoms for the next 7 active pill days
  • Women should talk to a health care provider for more information
  • If a woman forgets the pill and has had sex she should use emergency contraception (see below)

Progestogen only contraceptive pill or ‘the mini pill’.

The mini pill is an oral contraceptive taken daily with no sugar pills.

What’s good about it?

It:

  • is 91-99% effective
  • can be used by most women
  • is a better option for women who suffer migraines, smoke or have high blood pressure
  • can be used by women who are breastfeeding
  • can be used by older women

What’s not so good about it?

It:

  • needs to be taken at the same time each day (within 3 hours)
  • needs a regular prescription
  • offers no protection against STIs
  • may cause side effects such as irregular bleeding/spotting, bleeding between periods, sometimes no periods, sore breasts, headaches, bloating and mood swings

Who shouldn’t use it?

  • Women with current or past breast cancer
  • Women with some liver problems

What else?

  • The pill may not work as well in women on some epileptic medication, some antibiotics and St. Johns wort
  • The pill may not work if a woman has diarrhoea or vomiting

What happens if you miss a pill?

  • If a woman forgets the pill, and it is more than 3 hours late, she is at risk of getting pregnant and will need additional contraception such as condoms for the next 7 active pill days
  • Women should talk to a health care provider for more information
  • If a woman forgets the pill and has had sex she should use emergency contraception (see below)

Contraceptive vaginal ring (NuvaRing)

The contraceptive vaginal ring is made of soft plastic and slowly releases low doses of the hormones oestrogen and a progestogen (similar to the COC pill) into the vagina and then into the blood stream. A woman inserts the ring into the vagina herself. It remains in place for three weeks, is removed so the woman has a period and replaced a week later.

What’s good about it?

It is:

  • 91-97% effective
  • easier than remembering to take a pill daily
  • easy to insert (like a tampon)

What’s not so good about it?

It:

  • needs a regular prescription
  • offers no protection against STIs
  • may cause side effects such as regular spotting; sore breasts, headaches, bloating and mood swings

Who shouldn’t use it?

  • Women with high blood pressure that is not well controlled
  • Women with diabetes that is not well controlled or have complications
  • Women at risk of blood clots
  • Women who have or have had breast cancer or uterine cancer
  • Women with some liver problems
  • Women who have migraines or headaches with neurological symptoms
  • May not be recommended is some women over 35 years old e.g. those who smoke

Hormonal contraception – implants & injections

Contraceptive ‘rod’ implant (Implanon)

The contraceptive rod-shaped implant (Implanon) is inserted under the skin on the inside of the upper arm. It slowly releases a low dose of progestogen hormone into the blood stream and needs to be replaced every three years. The implant works by preventing ovulation (the release of an egg each month) and changing the cervical mucus making it harder for sperm to enter the uterus.

What’s good about it?

It is:

  • 99.9% effective for three years
  • suitable for most women
  • cheap
  • can be easily removed if it doesn’t suit a woman
  • good for painful periods
  • not necessary to remember to take a pill every day
  • not affected by diarrhoea or vomiting

What’s not so good about it?

It:

  • needs to be inserted by a doctor under local anaesthetic
  • may change a woman’s bleeding pattern (25% of women will have no period, 20% of women have prolonged bleeding)
  • offers no protection against STIs
  • can have side effects such as regular spotting, sore breasts, headaches, bloating, mood swings and skin problems 

Who shouldn’t use it?

  • Women who have had breast cancer
  • Women with a history of blood clots, stroke, heart disease and liver disease (will need to discuss with their doctor)

Contraceptive injection – Depot

The contraception Depot is an injection given into the muscle every 12 weeks.

What’s good about it?

It:

  • is 94-99.8% effective
  • often stops periods
  • means no-one will know you are using it
  • is not necessary  to remember to take a pill every day
  • is helpful for painful periods

What’s not good about it?

  • Need to remember to have an injection every 12 weeks
  • May be a short delay to return to normal cycle after the injection is stopped so may take longer to get pregnant
  • If used for more than 2 years can cause thinning of the bones, although this returns to normal after stopping the injections

Who shouldn’t use it?

  • Women who have had breast cancer
  • Women with a history of blood clots, stroke, heart disease and liver disease (will need to discuss with their doctor)

IUD (intrauterine device)

There are two kinds of IUD or intrauterine device one is hormonal called Mirena and one is a copper IUD.

Mirena is a small T-shaped piece of plastic with a nylon string at the end. It is placed inside the uterus/womb by a doctor and can stay there for five years. It slowly releases a low dose of progestogen hormone into the uterus. It stops sperm meeting an egg and prevents an egg from implanting/sticking to the lining in the womb.

What’s good about it?

  • More than 99% effective in stopping pregnancy
  • Very good for painful and heavy periods regular
  • 20-50% of women have no period
  • Don’t need to remember to take a pill every day
  • Can be removed easily
  • Lasts for a long time

What’s not so good about it?

  • Can be uncomfortable to insert especially if never had a baby born vaginally
  • Needs a specially trained doctor to put in
  • Can increase the risk of infection in the womb in the month around insertion, especially if the woman is at high risk of STIs or changes partners often
  • Can have light spotting /bleeding for first few months

Who shouldn’t use it?

  • Women with a malformed uterus, current genital infection, pelvic inflammatory disease, postpartum endometritis, infected abortion in the last 3 months
  • Ongoing high risk of STIs
  • Some women with blood clots, stroke, heart disease, liver disease (will need to discuss with their doctor)
  • Women who have had breast cancer

What else?

  • The Mirena should be replaced every 5 years

Copper IUD is a small device made from copper and plastic that is fitted by a doctor inside the uterus/womb. It stops the sperm from reaching the egg and prevents an egg from implanting/sticking to the lining of the womb. It does not release hormones.

What’s good about it?

  • More than 99% effective in stopping pregnancy
  • Can be removed easily
  • Don’t need to remember to take a pill every day

What’s not so good about it?

  • Can make periods heavier
  • Can be uncomfortable to insert especially if never had a baby born vaginally
  • Needs a specially trained doctor to put in
  • Can increase the risk of infection in the womb in the month around insertion, especially if the woman is at high risk of STIs or changes partners often

Who shouldn’t use it?

  • Women with a malformed uterus current genital infection, pelvic inflammatory disease, postpartum endometritis, infected abortion in the last 3 months
  • Women with an ongoing, high risk of STIs

What else?

  • The IUD should be replaced every 5 years

Fertility awareness based contraception

This method of contraception does not rely on the use of hormones, barriers or or devices. It includes any methods that use an awareness of the fertile time of the menstrual cycle, so that a woman can then avoid sexual intercourse to prevent pregnancy. These methods require education from experts and can be much less reliable than other forms of contraception discussed.

Emergency contraception

This is not a type of contraception that is used as a women’s regular contraception but can be used if a woman has unprotected sex and wants to avoid becoming pregnant. 

The emergency contraception pill is a pill containing the hormone progestogen and can be bought at the chemist without a script from the doctor. It can be taken up to five days after unprotected sex but it is most effective if taken in the first 24 hours. If it is taken in the first 72 hours (3 days), it prevents about 85% of expected pregnancies. It can still be taken up to 96 days after unprotected sex but won’t be as effective.

The emergency contraception pill can make women feel sick so they may need tablets for nausea.

It is important for a woman to use a reliable form of contraception to prevent unplanned pregnancy.

Permanent contraception

Tubal ligation (tying) is often known as ‘getting your tubes tied’. It’s a surgical procedure for women usually done under a general anaesthetic that blocks the fallopian tubes so that the egg cannot get from the ovary to the uterus and the sperm can’t get to the egg. It doesn't affect the periods, menopause, libido or sexual desire. Pregnancy is possible (about 5 women in every 100 who have had their tubes tied), but is very unlikely.

Risks

  • Risks of a laparoscopy: damage to bowel, bladder, blood vessels, infection of cuts in the skin, anaesthetic risks

Who is it not good for?

  • Women for whom surgery is a risk
  • Women who have had lots of previous abdominal/pelvic surgery
  • Women who are obese
  • Women who have a risk for anaesthetic e.g. they have had previous strokes

Vasectomy is a surgical procedure for men that blocks the tube (the vas) that carries sperm from the testicles to the penis. The chances of pregnancy after having a vasectomy are around one in 1,000. The operation doesn’t interfere with a man’s sexual desire or his ability to reach orgasm. This is a quick procedure that can be done under local anaesthetic or with the man asleep

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 October 2013.

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