Contraception – how to choose the best method for you
Wondering what your contraception options are? Long-acting or daily, hormonal or barrier, coils, injections, implants and pills – choosing the right contraception can feel like a minefield. Our compatibility is so personal that this can add to the difficulty too.
We don’t currently know what determines how our bodies will react to contraception. We could even experience different reactions to the same contraception at different points in our lifetime.
The good news is that there’s a wealth of information available and plenty of different methods to try. This means you can find something to suit your health, lifestyle and needs. Here we explain the different contraception options to help you make an informed choice.
The different contraception options
The contraceptive pill
The pill is one of the most popular contraception options and there are lots of different variations available. The combined pill consists of the hormones estrogen and progesterone, which usually occur naturally in the ovaries. It works primarily by preventing the release of an egg, but also by thickening the mucus of the cervix. This makes it more difficult for the sperm to reach the womb. The combined pill also works to thin the womb lining, making it less likely that a fertilised egg will implant into the womb and grow.
There are also progesterone-only pills available. These are the best option of contraceptive pill if you’re unable to take estrogen. It’s also usually a better option for women over 35 and for those with health conditions that the combined pill increases the risk of, such as blood clots, migraines and heart problems. It’s important to take this pill at the same time every day. Some of them only have a three-hour window, after which they become less effective.
Pills, when taken correctly, are extremely effective, and can offer lots of non-contraceptive benefits, such as making periods lighter, shorter and improving acne. New advice says that you can take pill packets back to back. This is just as long as there’s no medical need for you to have periods or breakthrough bleeds.
It’s worth bearing in mind that you may experience negative temporary side effects such as nausea or headaches, but in most cases these should subside over time. There is also suggestion of a link between hormonal pills and low mood. The bulk of current evidence suggests that no link can be made between them and low mood.
Long Acting Reversible Contraceptives (LARCs)
One of the biggest problems with the pill is remembering to take it every day. It’s a method that doesn’t always factor in big changes in your life, such as travel, illness or a busy schedule. This is where long acting reversible contraceptives (LARCs) can be a better option.
LARCs include implants (fitted in the arm) and intrauterine methods (fitted in the uterus or womb), often called coils. Once these are in place, they last for a number of years. For this reason, they’re the most effective form of contraception available. LARCs also often use lower doses of hormones (or none at all in the case of the copper IUD). They’re more localised to the womb and so may be a good option if you experience unwanted side effects from hormonal pills.
How LARCs work
Coils fit into the womb through the cervix. You may experience some brief period-like cramping during this procedure, but this usually passes quickly. The copper coil can make periods longer and more painful, whereas the hormonal coil can often make them lighter or even disappear completely. The copper coil lasts five to 10 years depending on the type, or until they are removed.
Hormonal coils (also called intrauterine systems or IUS) can also offer non-contraceptive benefits. They’re used as treatments for heavy or painful periods and endometriosis and can last three to five years depending on the type.
The implant is another long lasting hormonal contraceptive, only this time it works through a small, flexible rod. This goes under the skin in your arm, and is safe to use while breastfeeding. You can have the implant at any time, even immediately after giving birth, or having a miscarriage or abortion. This is a good option if you need protection straight away, and it lasts for three years.
Like other hormonal contraceptives, there is a possibility that the implant will affect your periods. It might make them irregular or stop altogether and it may also have effects on your skin.
Another option available is the contraceptive injection. This slowly releases progestogen to prevent the release of an egg. You’ll need to get an injection every 12 weeks, but you can self-administer a newer injection, called Sayana Press, at home. This may be especially helpful if it is difficult to visit a GP.
It’s very effective if administered correctly, but you may experience side effects such as weight gain, headaches, mood swings and breast tenderness. If you’re looking to become pregnant soon, injections may not be for you. It can take up to a year for fertility to return to normal once you stop taking them.
There may be reasons to choose barrier methods over more long lasting options. Barrier contraceptives put a physical block in place to stop the sperm reaching the egg. Because of this, they offer protection against sexually transmitted diseases where hormonal contraceptives cannot.
Barrier methods are also a good alternative if you’re looking to avoid putting hormones in your body. Hormonal contraception can cause changes in your weight, skin and mood.
Barrier methods include male and female condoms, as well as less commonly used diaphragms and caps. These sit higher in the vagina and contain spermicidal gels and creams to stop the sperm in its tracks.
Male condoms cover the whole of the penis. When they’re used correctly, they’re around 98% effective, though they can break or fall off, which means they’re susceptible to user error, or having been used incorrectly. Female condoms insert into the vagina, but these can be more tricky to use. And again, user error is responsible for reducing their effectiveness, at around 79%. Diaphragms and caps are also less effective than hormonal methods.
While many barrier methods are made from latex, there are alternative materials available if you’re allergic.
Contraception and hormone replacement therapy
Our priorities with contraception change as we progress through our lives, from preventing pregnancies to transitioning through the menopause smoothly. Some forms of hormonal contraception, such as the Mirena coil, can be helpful for both and can be used as part of HRT in menopausal and perimenopausal women.
We spoke to Dr Sarah Ball, a menopause specialist, about how contraception can help during the menopause.
“It’s complex,” Dr Ball says. “You have to look at individual women as some are still having periods and are still fertile, while some have long stopped.”
She says it’s a relatively new idea to be thinking logically about hormones, but it could make the transition between preventing pregnancy and relieving symptoms of the menopause a smoother one.
Like the combined pill, the coil uses synthetic progesterone to stop our bodies becoming pregnant. This hormone is also part of the treatment in HRT. If you’re already receiving a dose of progesterone through your contraception, you only need to take estrogen (usually through a gel, spray or patch) to complete your hormone replacement. It’s important to make sure you’re taking both hormones as together they help to keep your mood in balance.
What contraception options are there during menopause and perimenopause?
In terms of using contraception to relieve menopausal symptoms, the coil is the first choice. Due to the increased risk of blood clots and strokes as we get older, most women come off the pill in their thirties. Even for fit, non-smokers, the combined pill has a maximum cut-off age of 50. When medical professionals are thinking about HRT and contraception, they’ll usually recommend the Mirena coil due to its lower dosage and risk of side effects.
The hormonal coil usually stops periods altogether, so you can lose part of your menopause radar as you might not notice changes in your menstrual cycle. You can still keep an eye out for symptoms like mood swings and skin changes, and once you do notice them, you know you’re already halfway there with hormone replacement.
“Mirena coils are so effective for so many women,” says Sarah. “Almost all women can have them all through their lives”.
Sarah stresses that while contraception can work as HRT, the reverse isn’t true and you should be extra vigilant about pregnancy when you’re perimenopausal. Even after your periods stop, it’s recommended to continue using contraception for two years. Not all hormonal contraception can be used as HRT either. For example, implants and injections can be used alongside HRT but can’t replace it.
If you’re at a stage in your life where you’re not trying for a baby and are starting to think about the menopause, talk to your doctor about the Mirena coil and your options of contraception and HRT.
With special thanks to Dr Annette Thwaites, an academic clinical fellow in sexual and reproductive health at UCL
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