A guide to your contraception options

Finding the contraception that works for you isn’t always easy. Some women experience side-effects from certain types of birth control, while others need a method that is easy to adhere to. Thankfully, there are plenty of different contraception options, so you will be able to find the one that’s right for you. Read this guide to understand the contraceptive methods that are currently available to you.

• Combined oral contraceptive pill
• Mini pill
• Hormonal IUD
• Copper IUD
• Contraceptive implant
• Tubal ligation (sterilisation)
• Vaginal ring
• Condoms
• Natural family planning

Combined oral contraceptive pill (The pill)

‘The pill’ is a daily tablet and is a very popular contraceptive choice. It’s over 99% effective at preventing pregnancy if taken properly (i.e. at the same time every day), but it’s common for people to forget to take the pill or take it late, which reduces its effectiveness to around 93%. The contraceptive effects aren’t immediate – it takes 7 days before the pill works, and if you miss a day, you need to take it properly for 7 days before it is effective again.

The pill contains two hormones – oestrogen and a synthetic version of progesterone called progestogen. By changing the hormone balance in your body, the pill stops you from ovulating and also makes the mucus in your cervix thicker, which prevents sperm from entering your uterus.

There are various brands of the pill, each with a different ratio of hormones. You may need to try a few different types to see what one works well with your body, particularly if you experience side-effects such as nausea, breast tenderness, breakthrough bleeding or mood changes or depression.

Many women don’t experience any side-effects and actually find that the pill makes their period more bearable (shorter, regular and lighter) and that it clears up acne. The pill can also help to manage symptoms of PCOS and endometriosis.

Because the pill is associated with an increased risk of some serious health problems, a doctor will determine if you are suited to this method of contraception. Women who are breastfeeding should not use the combined pill.

Progestogen-only pill (The mini pill)

Known as the mini pill, the progestogen-only pill is a daily tablet that prevents pregnancy by changing the hormone levels in your body. Progestogen prevents pregnancy by creating a thicker layer of mucus at the cervix (thus stopping sperm from entering the uterus) and by changing the lining of the uterus so that a fertilised egg cannot implant in it. When taken at the exact same time every day, which can be difficult, the mini pill is over 99% effective, but with typical use it’s more like 93%.

As the name suggests, this pill only includes progestogen and not oestrogen. Women who have difficulty with contraceptive methods that contain oestrogen (e.g. the combined pill) may be better suited to the progestogen-only pill. Compared to the combined pill, the mini pill has fewer side-effects and may be used while breastfeeding. Some women experience spotting between periods or have periods further apart than normal while using the mini pill, and you may also notice skin changes or mood changes initially, but these usually settle with time.

You’ll need to talk to a doctor to see if you can take the mini pill.

Hormonal intrauterine device (IUD) (Mirena)

Often referred to by its brand name ‘Mirena’ in Australia, the hormonal IUD is a small T-shaped device made of plastic. The device sits in the uterus and releases progestogen, which prevents pregnancy by thickening the cervical mucus and changing the uterus lining. It sometimes also stops the ovary from releasing an egg.

The Mirena works in the same way as the mini pill but, because forgetting to take tablets isn’t an issue, it’s the most effective reversible contraception available – being over 99.5% effective at preventing pregnancy. There are minimal side-effects, it may be used while breastfeeding, and there’s the added benefit that it makes bleeding lighter or stops periods completely.

Once in place in the uterus, the hormonal IUD lasts up to 5 years but can be removed at any time. The device has a fine thread attached to it that allows you to check that it is in place and makes taking it out easier. Apart from when you check that it’s in place, you shouldn’t be able to feel the IUD.

You’ll need to talk to a doctor to see if the Mirena is an option for you and if so, it will need to be inserted by a doctor (usually a gynaecologist).

Copper intrauterine device (IUD)

The copper IUD is a very small coil made of copper and plastic that sits in the uterus. The copper prevents pregnancy in two ways –  it makes sperm unable to survive in the womb, and it also causes changes in the uterine lining that prevent a fertilised egg from being able to attach and start a pregnancy.

Being over 99% effective at preventing pregnancy, the copper IUD is one of the most effective methods of contraception and it has the major benefit of lasting for 5–10 years without you needing to do anything. When in place, the IUD usually cannot be felt by you or your partner during sex. However, there is a piece of thread that lets you check that it is in place, which also makes it easy for a doctor to remove when necessary.

There are minimal side-effects associated with the copper IUD and it’s a great choice for women who prefer a non-hormonal contraceptive option. Some women experience heavier bleeding and cramping for the first few months, but in most cases this resolves.

The IUD needs to prescribed by a doctor, and a doctor (usually a gynaecologist) will place the device in the uterus through the vagina. You’ll also need to visit a clinic to have the IUD removed or replaced.

Contraceptive implant (Implanon)

The contraceptive implant is a thin plastic rod roughly 4 cm long that is inserted under the skin of the inside of the upper arm. It works the same way as the mini pill and hormonal IUD to prevent pregnancy – by releasing progestogen, which increases cervical mucus and stops the ovary from releasing an egg. The Implanon is over 99% effective.

The implant is a good option for women wanting a long-lasting contraceptive option where they don’t need to do anything – it lasts for 3 years, but can be removed at any time in a quick procedure. Around 20% of women will have no period with the implant and others may have irregular periods. Most women tolerate it well but some experience weight gain, acne and mood changes and may choose to have it removed.

Tubal ligation (sterilisation)

A laparoscopic (keyhole) surgical procedure known as tubal ligation can stop you from being able to conceive. You may have heard this referred to as ‘having your tubes tied’ – in reality, the surgeon either places permanent clips on the fallopian tubes (so eggs cannot travel down the tube to be fertilised in the uterus) or removes the fallopian tubes completely (so eggs cannot travel between the ovary and uterus). Removal of fallopian tubes has been associated with a reduced risk of developing cancer.

The effects are immediate after surgery and there is nothing you need to do going forward to prevent pregnancy. In addition, there are no long-term side-effects after surgery – however, the usual risks associated with any surgical procedure do apply. It’s important to note that around 1 in 400 times the surgery is performed it is ineffective.

If your fallopian tubes are removed it is permanent and irreversible. When clips are used, a tubal ligation can be reversed and your chance of having a baby will be around 50%. Because of this, tubal ligation is generally reserved for older women who are sure that they do not want to have any (or any more) children.

Vaginal ring (NuvaRing)

The vaginal ring is a small, flexible, plastic ring that you insert high into your vagina, similar to inserting a tampon. You can think of it like the combined pill, but instead of taking a daily tablet, the ring releases oestrogen and progestogen over 3 weeks. For the fourth week of your cycle, you remove the ring to allow a monthly bleed. Most women don’t feel it, but some women do struggle to keep it in place. If used properly, you shouldn’t feel it during sex.

This method has the same benefits, side-effects, potential health problems and effectiveness at preventing pregnancy as the combined pill – it’s 99% effective with perfect use, but with typical use this drops to around 93%.

In Australia, the brand name of the vaginal ring is the NuvaRing. It’s not PBS-listed, so it is a more expensive contraceptive option. However, some women opt for this method if they struggle to take the pill every day but can remember to change the ring after 3 weeks. The NuvaRing needs to be prescribed by a doctor – you pick it up from the pharmacy and insert it at home yourself.

Condoms

Condoms don’t need an explanation – I’ll just state that they are 98% effective at preventing pregnancy when used correctly, but with typical use this reduces to around 85%. Condoms have the added benefit of reducing the risk of STIs.

Fertility awareness

In 2018, it’s probably unsurprising that there are apps that can be used for tracking your fertility. But you may be surprised to learn that an app has been approved by the FDA as an effective birth control. Natural Cycles requires you to measure your temperature at a set time each day and input that into the app to track your ovulatory cycle. The app then lets you know whether you are fertile that day, so you know when to avoid sex or use other protection (in which case the effectiveness at preventing pregnancy will depend on that particular method).

Natural family planning has no side-effects and, if used perfectly (i.e. sex is avoided on ‘fertile’ days), the method has around the same rate of effectiveness as the pill. However, fertility awareness as a form of contraception won’t be ideal for everyone. It’s particularly ineffective for those with irregular periods and if you are unlikely to be able to abstain on the recommended days.

A gynaecologist can assess which of these contraception options is suitable for you

So there you have it – there are many different contraceptive options that you can use if you wish to avoid becoming pregnant. From long-term methods that alter hormones to temporary barrier methods, what works for each woman is different and will likely change over time.

If you want further advice on your contraception options or specific advice about what you should use if you have an existing medical condition, call (03) 9418 8299 or book online to make an appointment.