How To Choose The Right Contraception For Your Body
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No Contraception Is 100% Effective
“Traditional methods such as the combined pill only work as well as the women who are taking them. This is why the perfect use and typical use failure rates are so different. You will see the perfect use failure rate of the combined pill, for example, quoted as less than 1%, but these stats are taken from clinical trials in which women are very well supervised and almost never miss a pill. In fact, in everyday use, forgetting pills and not following the pill rules is common. This means the typical use failure rate of the combined pill is more like 8%. That's a high failure rate – it means one in every 12.5 women every year can expect to have an unplanned pregnancy on the pill. Therefore, methods of contraception that can be fitted and forgotten, and require very little input on your part, are now highly recommended. These include the injection, implant and coil. These methods have the same failure rates for perfect and typical use – of less than 1%.” – Dr Deborah Lee, GP at Doctor Fox Online Pharmacy
Your Life Stage May Factor Into It
“A good starting point when it comes to contraception is to think how much you are looking to prevent a pregnancy. Would a pregnancy be a disaster right now, or a high risk? Or perhaps you’re thinking you may like to be pregnant one day, but not right now? Your contraception needs change across the course of your reproductive life. Younger women are more fertile and at a higher risk of pregnancy, however women over 40 may be more likely to be at risk if they were to get pregnant. After childbirth, your fertility returns at 21 days. Even if you want another baby, it’s recommended to wait at least 12 months to conceive again as there is increased risk in the future pregnancy if spaced too closely together. While fertility levels decline after the age of 40, pregnancy at this age is riskier, and contraception is needed for two years after your last period if you’re under 50. If your family is complete, sterilisation is an option, but the implant and coil are more effective and can help with heavy periods, which are more common at this stage in life.” – Dr Nikki Kersey, community sexual & reproductive health speciality trainee at Liverpool Women’s NHS Foundation Trust
The Pill Can Be A Case Of Trial & Error
“Since the pill was first marketed in 1962, there have been major changes in its formulation. There are now numerous combinations of synthetic oestrogen and progesterone, at different doses and in different regimes. This has happened to improve pill safety and reduce side effects. Women vary enormously in their response to hormones and often need to try several pill brands before they find the right one for them. Side effects are common – they include nausea, headaches, breast pain, mood swings and irregular bleeding – but they tend to settle over the first three months of use.” – Deborah
It's Worth Sticking With A Pill For Three Months
“Most women will start on a combined pill that contains 30mcg of oestrogen – such as Microgynon – and the progesterone levonorgestrel, as this is thought to have the lowest risk of serious complications such as deep vein thrombosis. If you experience side effects, the first step is to work out if they are caused by the oestrogen or the progesterone. Then, the appropriate hormone can be changed. Oestrogenic side effects include nausea, headaches and breast tenderness, while progestogenic side effects include acne, bloating, mood swings, irritability, breast tenderness and irregular bleeding. If the side effects are due to oestrogen, you can swap to a lower-dose pill, such as Mercilon or Femodette. If progesterone is to blame, try a pill with a different form of progesterone, such as Marvelon or Femodene. Each time a pill is swapped this should be done carefully so as not to risk a pregnancy and the new pill should be continued for at least three months to see if things have improved.” – Deborah
You Shouldn’t Rely Solely On Condoms
“27% of UK women use condoms as a regular form of contraception. The male condom may be the only way to obtain STI protection, but it has a high typical user failure rate of around 12%, which means one in eight women would expect to become pregnant over the course of 12 months. This is unacceptably high for young fertile women for whom a pregnancy would be a disaster. This is why young women are advised not to rely on the male condom to stop them from getting pregnant but to choose another contraceptive method which is not likely to let them down. For example, LARC methods (like the coil and implant) are very suitable for young people, easy to use, with vanishingly low failure rates.” – Deborah
The Copper Coil Is Another Hormone-Free Option
“The copper coil is a small, T-shaped device that lasts for up to ten years. It works to prevent pregnancy by releasing tiny amounts of copper into the womb. This works to prevent sperm and egg meeting, and stop a fertilised egg implanting itself into the womb. Because of this, the copper coil is also a form of emergency contraception which can be fitted after unprotected sex. This non-hormonal contraception method could work for you if you don’t want to have to remember to take a contraceptive every day or every time you have sex. However, more period cramps, vaginal discharge and heavier periods are common side effects. With the hormonal coil, periods are usually lighter, shorter and less painful so it's a great option for anyone wanting help with heavy or painful periods.” – Dr Mel Davis-Hall, medical director at The Lowdown
The Implant Is A Reliable Choice
“The implant is over 99% reliable in terms of preventing a pregnancy – in fact, it’s one of the most effective options. It can be fitted and forgotten about for three years. It’s safe for most women, including those who can’t use the combined pill, and for those who have just given birth or are breastfeeding. However, as a progesterone-only method, it can affect menstrual bleeding. In one study, 20% of women had no periods at all, 7% had frequent bleeding and 18% had irregular bleeding. Those with abnormal bleeding patterns early on had a 50% chance their bleeding pattern would improve over the next 12 months. Being unhappy with bleeding is the most common reason for women requesting the removal of the implant.” – Deborah
The Injection Can Take Several Months To Wear Off
“The injection is a good option if you forget to take pills and suitable if you can’t take oestrogen. It works by changing your hormones to prevent ovulation, thickening cervical mucus to prevent sperm from reaching an egg should one be released, and keeping the lining of the uterus thin, so if an egg were to be fertilised, it wouldn’t be able to grow. The injection often stops periods, making it a good choice for those with endometriosis, although it’s not the best choice if you are planning a pregnancy soon, as it can take several months to wear off. It also doesn’t protect against STIs, can cause weight gain and can temporarily reduce bone density during use.” – Dr Frankie Jackson-Spence, in association with Femfresh
Many Contraceptives Have Other Benefits
“The pill can reduce heavy and painful periods, and can be used as a treatment for endometriosis and PCOS. Extended use of the pill is now encouraged, meaning pill packs are taken continuously to avoid the seven-day break. This reduces side effects such as headaches, which may occur in the pill-free interval, and makes the pill more effective. If you struggle with acne, try Yasmin, which contains oestrogen that can improve breakouts, as well as a form of progesterone that counteracts the effects of testosterone, which plays a part in acne.” – Deborah
Breastfeeding Will Naturally Protect You Against Pregnancy
“The hormones involved in breastfeeding inhibit ovulation. If you want to rely on this as a method, you need to be fully breastfeeding – feeding every four hours and every six hours in the night, without exception – and not using formula, and not experiencing any form of bleeding that could imply the return of your period. Your baby also must be less than six months old. If you can answer yes to these points, this method of contraception is 98% effective. If you've just had a baby this 2% chance may be too high for comfort – ideally, you need to give your body time to recover from the rigours of pregnancy before going through it again. Most GPs will encourage breastfeeding mums to use a progesterone-only pill or the coil, injection or implant.” – Deborah
Get Support
“If you’re at all confused, chat to your local sexual health clinic, which can be a great source of information and advice. Many clinics will also provide implant and coil fitting and emergency contraception. Most pharmacists will also be able to provide advice on different pills and many are now training to fit implants. When it comes to websites, check out ContraceptionChoices.org and DecolonisingContraception.co.uk, and listen to the 28ish Days Later and The Sex Agenda podcasts.” – Nikki
For more from the experts, visit DoctorFox.co.uk, Femfresh.co.uk and TheLowdown.com. Nikki is the co-author of Contraception: The Answers You’ve Been Looking For, available for pre-order now.
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