Choosing and using contraception

by Dr Deborah Lee, Dr Fox Online Pharmacy
 
Are you confused about contraception? There are so many choices, it may seem overwhelming. Perhaps you are unsure what to do?

Read on below, and I will outline the benefits of contraception below. There’s also a lot of fake news about contraception online. So, I’ll also dispel some common contraceptive myths.
 
What is contraception?
Contraception is any device, procedure, medication, or behaviour that allows a woman to stop herself from getting pregnant. Using contraception means the woman is in control of her fertility, and does not need to be constantly worrying about an unplanned pregnancy.
 
There are two key facts you need to be assured of. Firstly, that contraception is always reversible. It never causes a permanent loss of fertility. Secondly, it also works before fertilisation takes place, so it is not causing an abortion. This also applies to emergency contraception (both the copper IUD and the morning after pill).
 
Decades of research has confirmed that all currently available methods of contraception are safe. For the vast majority of women, using contraception will cause benefit and not harm.

So, what are the benefits of contraception?
Here’s a list of some of the benefits of contraception below.

Using contraception

• Prevents an unplanned pregnancy, and having to deal with the consequences of these pregnancies – miscarriage, ectopic pregnancy, abortion, and live births – all of which have consequences for female health.
• Treats heavy, painful periods and iron-deficient anaemia.
• Improves symptoms of gynaecological conditions such as endometriosis and polycystic ovarian syndrome (PCOS).
• Is a treatment for premenstrual disorder (PMS) and premenstrual dysphoric disorder (PMDD)
  Reduces the risk of ovarian and endometrial cancer.
• Using condoms carefully and consistently reduces the risk of STIs and lowers the risk of pelvic inflammatory disease (PID).
• By timing, controlling, and spacing pregnancies allows women to complete their education, work, and avoid living in poverty.

What are the different types of contraception?
I’ve listed below, all the currently available contraceptive methods in the UK. These are arranged with the most effective method at the top of the list, and in descending order of reliability.
 
All are available free of charge on the NHS. To find out more, see your GP or attend your local Sexual Health Clinic. Some methods are available at our local pharmacy. You can also purchase contraception from an online pharmacy.
 
Note that the male condom is one of the least safe methods of contraception. In the first year of use, as many as 18 out of 100 couples would expect to become pregnant, using a male condom. This compares to less than 1 in 100 using a long-acting method of contraception, such as a coil or an implant.

• Etonogestrel contraceptive implant – Nexplanon
• Levonorgestrel intrauterine system (LNG IUS) – ‘the hormone coil’
• Copper intrauterine device (IUD)
• Female sterilisation
• Vasectomy
• Injectables – Depo provera
• Combined oral contraceptives
• Progestin-only pill
• Contraceptive patch – Evra
• Hormonal vaginal contraceptive ring  – NuvaRing
• Lactational Amenorrhea (breastfeeding)
• Diaphragm or cervical cap
• Sponge
• Male condom
• Female condom
• Spermicides
• Fertility awareness-based methods
• Withdrawal
• Emergency Contraception
  • Copper IUD (intrauterine device/coil)
  • Emergency contraceptive pills (’the morning after pill’)

How to choose a contraceptive method
Start by reading about the current methods of contraception and see what appeals to you the most. Take a look at the NHS website, Contraceptive Choices, or Brook which is specifically designed for young people.
 
In the past, women most frequently started by using the combined pill or condoms. However, these days, other methods including Long-acting Reversible Contraception (LARC) methods are popular choices and can be used as a first choice. LARC methods include the implant, intrauterine device (IUD) or intrauterine system (IUS), and injection. Once initiated, these methods continue to work without you having to do pretty much anything at all, and will prevent 99% of unplanned pregnancies.  The implant, for example, is even more effective than sterilisation!
 
The patch and the vaginal ring are hormonal methods like the pill, but the hormones are delivered through the skin with the patch, and through the vaginal wall with the ring. The patch is changed once a week and the vaginal ring once a month. It’s important to choose a method that means using it is likely to fit in with your lifestyle.
 
The next step is to see your GP or make an appointment at the Sexual Health Clinic. The doctor or nurse will take a full history to ensure you are medically suitable for whatever method you decide.
 
They will discuss how to use it, the pitfalls, and possible side effects. All methods can cause some side effects, but these are generally mild and often settle within the first few months.
 
You may need to try a few different methods before you settle on the right one for you. Also, a woman’s contraceptive needs change over her lifetime., for example, after childbirth, when breastfeeding and in the perimenopause. Its quite normal to chop and change your contraception until you find something that feels right for you.
 
Dispelling myths about contraception
The following are common untruths about contraception. Each statement is false – or in the case of the pill and cancer, only partly true.
 
Contraception causes infertility – FALSE. Research studies have confirmed that the pregnancy rate in the 12 months after stopping in those using any method of contraception is around 83%. This is the same conception rate found in women not using any form of contraception for 12 months. The rate was similar for women who had used hormonal methods such as the pill, as well as those who had used an IUD or an implant.
 
Undiagnosed STIs such as chlamydia and gonorrhoea cause infertility. It’s vital that all sexually active women attend for STI screening. Most STIs have no symptoms. You only know you are infected if you have a test. If you’ve never been screened, I highly recommend you make an appointment at the Sexual Health Clinic.
 
Contraception causes weight gain – FALSE. Unfortunately, women tend to gain weight as they get older, even if they don’t use hormonal contraception. Numerous research studies have shown no significant change in weight in women using any method of contraception, except for a possible link with the contraceptive injection Depo Provera.

Sometimes, hormones can make women feel bloated, so they may feel like they are putting on weight even though they are not.  The UK has an obesity crisis, and many women are gaining weight not because of their contraception, but because of the pressure of living in an obesogenic environment, eating the wrong diet,  and not taking enough physical exercise.
 
Contraceptive pills are all the same – FALSE. Contraceptive pills have undergone major changes in the past 60 years since the pill was first developed. The type and dose of oestrogen and progesterone have changed enormously to improve safety and reduce side effects. There are now more than 30 brands of combined and progesterone-only pills. Your doctor/nurse can advise on which might be best suited for you.
 
You need to have a break from contraception – FALSE. Your body does not need breaks from contraception. In fact, a break from contraception is a high-risk for an unplanned pregnancy. In Victorian times, women had very few periods as they were always pregnant or breastfeeding! Your body is happy resting and not ovulating, and this includes extended and continuous pill-taking (running pill packs together), which often result in no periods at all.
 
The pill causes cancer – Only partly TRUE. Evidence shows that the pill slightly increases the risk of breast and cervical cancer, but substantially lowers the risk of ovarian and endometrial (uterine)cancer.
 
Young women are at low risk of breast cancer. In a large Danish study of 1.8 million oral contraceptive users, the authors concluded 1 extra case of breast cancer for every 7,690 taking the combined pill for one year. All women using hormonal contraception should examine their breasts regularly and report any suspicious findings. Hormonal contraception should be viewed in terms of its benefits versus its risks.
 
In terms of cervical cancer, there is no increased risk for under 5 years of use (FSRH). The risk increases after this time, but is lost 5 years after stopping. The important thing is to have regular cervical smears when taking the pill, and report any bleeding in between periods.
 
The combined pill lowers the risk of ovarian cancer by 50%. This reduced risk is present while taking it and for 30 years after stopping. Similarly, the combined pill lowers the risk of endometrial cancer by 30%, and this risk reduction continues for many years after stopping.
 
Emergency contraception is causing an abortion – FALSE. Emergency contraception (the morning after pill) always works before ovulation. Therefore, it cannot be working after fertilisation has taken place. Ulipristal acetate (EllaOne) works by preventing the surge in luteinising hormone (LH) that precedes the extrusion of the oocyte (egg) from the follicle. Levonorgestrel (Levonelle) also delays the LH surge and delays ovulation. This is why the timing of EC is crucial. If ovulation has already occurred, EC may be ineffective.
If you have unprotected sex and do not want to become pregnant, you need to seek help immediately – don’t delay.
 
An IUD can travel up to the heart – FALSE. The IUD is placed inside the uterus (womb). Doctors and nurses who insert coils (IUD/IUSs) are specially trained to do this safely. There is a 1 in 1000 risk of a coil perforation at the time of fitting – meaning the coil passes through the wall of the uterus (womb) into the pelvic cavity. It cannot pass from the abdominal cavity into the thorax (chest) and travel to the heart. The risk of perforation is a very small risk. However, it is vital to attend for your 6 week check after a coil insertion to be sure that the threads are visible, which usually means the coil is correctly sited.
 
Final thoughts
Contraception has changed the world. Nowadays, women enjoy a full sex life, without the fear or shock of an unplanned pregnancy. By being in control of their fertility, you can finish your education, go to university, gain work experience, establish your career, and have a better earning potential and improved quality of life.

Do not be afraid of contraception – contraception is your friend. There are 15 different methods, so there has to be something out there to suit everyone!
 
For more information
NHS – Methods of contraception
The College of Sexual and Reproductive Healthcare (COSRH) – Contraceptive Choices
Brook – Contraception what works for you