Contraception - the basic options
Most consultations about contraception can take up to half an hour. I think it's important that you understand each option and carefully consider which is best for your situation. This article will discuss each contraception option and what you need to know about each one. As always - everyone is individual and the advice here may not be suitable to your needs based on your family history and your own medical history and you should discuss this with your GP.
Understanding fertility and your cycle is one way of preventing conception. This is called the ‘billings method’ or avoiding ovulation however it is the least effective ( 76%) form of contraception there is. I therefore don’t recommend this as a primary form of contraception. It results in more than 18 pregnancies per 100 women per year.
Condoms are the next form of contraception which I recommend to everyone. On their own they are not the best at preventing pregnancy (approximately 82% effective due to user errors) They do however prevent sexually transmitted diseases such as herpes, chlamydia and gonorrhea which no other form of contraception does. If you want to know more about STIs/STDs - stay tuned for an article on just that!
Most women will be commenced on the combined oral contraceptive pill ( COCP) or ‘the pill’. This is a medication with oestrogen and progesterone which overrides your natural cycle and gives you more control. It comes in various forms and doses so it’s important to chat to your GP about which would best suit you. The pill must be started when you get your next period to ensure you are not pregnant at the time of commencing the OCP. You must use extra precautions ie; condoms. Until you know that the pill is working correctly usually 21 days of active pills when you initially start a new pill. This form of contraception is 91% effective when taken correctly. Which means taking daily within a 24 hour window. It will result in more than 9 pregnancies per 100 women in a year if not taken correctly.
The active pills contain the hormones and you will notice that there are 4-7 ‘sugar’ or ‘non-active’ pills, which will induce a period or withdrawal bleed to mimic your natural cycle. Some people like to skip this period but others like to have a period to ensure they are not pregnant or to continue to shed the lining of the uterus.
Understanding how the COCP works to prevent pregnancy is important so you know what to do if you miss a pill. The pill prevents you from ovulating, thins the lining of the uterus and thickens cervical mucous to prevent sperm entering the cervix to fertilise eggs. If you miss a pill and these methods aren’t working there will be a chance that you could fall pregnant and you are required to take the pill as soon as you remember to do so.
Some of the common side effects of the COCP include possible weight gain, headaches, mood changes, skin change ( good and bad) and nausea/ stomach upset. Not everyone will experience the same side effects. It is important that you maintain a healthy weight range and review your BP while on the OCP. You should not smoke and if you have a family history of stroke or blood clots or a personal history of migraines with aura you should discuss this further with your GP as it may be unsafe to continue on COCP.
There is another oral pill that you can take called the ‘mini pill’ or Progesterone only pill (POP)
Depot medroxyprogesterone acetate (DMPA) is the 3 monthly progesterone only contraception that is given by injection into your arm. This has been a long term favourite for some women. It can come with the side effect of irregular periods or spotting. It is not recommended long term due to its effect on increasing risk of osteoporosis. It can take a while for fertility to return for some women on depot as it may last longer in your system. It is considered 94% effective when given on time. You may be asked to do a pregnancy test prior to each injection, especially if you are late in coming for your appointment.
The Nuva Ring is a progesterone only device that is inserted into the vagina every 4 weeks. It is removed and replaced monthly. This form of contraception is 91% effective when used correctly. I find women either love the idea of this or cringe. It can present with many similar side effects mentioned above including irregular spotting but may not cause as many systemic side effects such as weight gain and headaches.
Long acting reversible contraceptives or LARCs are now the most effective forms of contraception. The idea being that they work long term and as soon as they are removed fertility returns.
The first is Implanon an implant that is inserted in the upper non-dominant arm under local anaesthetic. It is a soft and flexible rod and slowly releases a small amount of hormone over 3 years, after this it will need to be replaced. The Implanon side effects can include, weight and mood changes, headaches, nausea and irregular periods. It is very effective in preventing pregnancy as you don’t need to remember to take a pill every day or present for your injection every 3 months so I highly recommend this for teenagers and anyone who is very busy and really doesn’t want to fall pregnant.
Mirena, an intrauterine device ( IUD) is also another ‘set and forget’ method of contraception. It is a ‘T’ shaped device that is inserted into the uterus. Here it slowly releases hormones in very small amounts for up to 5 years. It has 2 small strings that extend into the vagina which allows for its removal. The Mirena is a more ‘localised’ form of contraception and as such may not have some of the more systemic side effects however it can still cause mood changes and irregular periods. Some women will find that after 12 months their periods are non-existent or at least they should be lighter and shorter in duration.
The Copper IUD is much the same as the Mirena however it contains no hormones and lasts for up to 10 years depending on which one you choose. This is a good option for anyone trying to avoid hormones and pregnancy long term.
Sterilisation is the most permanent of all contraception forms and it includes, male sterilisation (vasectomy) and tubal ligation or occlusion. These forms are considered permanent and irreversible however pregnancy can still occur in special circumstances under specialist intervention. Both require surgical intervention and consent to ensure you are informed about the permanent effects.
This is definitely a summary and you can see why most consults need more than 15 mins to discuss unless you have preferences or have done some research of your own. Remember that each person is different and factors such as family history or other conditions may dictate which contraception you can and can’t use. We are always happy to discuss your situation in depth so please don’t hesitate to bring a list of questions or concerns and we can go through these as needed.
Please see www.familyplanningallianceaustralia.org.au for further information and advice.
If this article has brought up any questions at all please make an appointment to discuss with me or your GP. This information is from my own research and experience and other doctors' opinions on what is or isn’t required may differ and is not necessarily wrong. Each patient is very different and your own needs will be different to others as we individualise your care.
Dr Hannah Bourke
MBBS, FRACGP, DIP. CHILD HEALTH
Caring, honest, calm and genuine, Dr Hannah is here for all your health needs.
