Contraception

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There are many different and effective contraception options out there and deciding on the right one for you will be dependent upon your unique position in life.

The most effective contraceptive options are the LARCs (Long Acting Reversible Contraceptives).  The other options include barrier methods, FAM (fertility awareness method) and irreversible contraception.  Below is an outline of the common methods with a summary of their efficacy, pros and cons.

LARCs – There are 3 types of LARCs that will stop you getting pregnant for a number of months or years (IUD and Implanon).  All of them have a 99% efficacy rate – meaning that less than 1 in 100 women who use a LARC will get pregnant.  The advantages are that they are effective and low cost, you don’t have to remember to use contraception every day, they don’t interfere with sex, and once you have it removed, your fertility will return to normal.

Copper IUD – is a small intrauterine device that acts as a barrier within the uterus to prevent conception. It lasts for 5 years and has the advantage of being non-hormonal.  It can however, make your periods slightly heavier.

Mirena IUD – is a small intrauterine device that sits in the uterus like the copper IUD. In addition to acting as a barrier, it also contains progesterone which thins the lining of the uterus and also thickens the cervical mucous.  It does not routinely suppress ovulation.  The Mirena lasts for 5 years and has the advantage of making periods very light or non-existent for up to 90% of women.  Both IUDs can cause some cramping, but this usually dissipates within the first few days.  The disadvantage of the Mirena is that it usually causes some light unpredictable bleeding for the first few months after insertion and can have some mild hormonal side effects in sensitive women. Only 1/10th of the progesterone dose can be measured in the blood so blood hormone levels are very low.  The risk of infection is very low for IUDs, less than 1 in 1000.  Your doctor will usually test for any STI’s before insertion of the IUD to ensure the risk remains low.

IUD insertion usually takes place in the doctor’s office.  It takes around 5 minutes and can be a little uncomfortable.  It is a little like a pap smear at first, but the passage of the Mirena into the uterus often causes some period like cramps.  We recommend that you take some simple analgesia such as two ibuprofen and two paracetamol twenty minutes before hand and arrange for someone to drive you home afterwards.  Most women tolerate the procedure well and are fine to attend work/school the following day.  IUDs are suitable for women regardless of whether they have had a baby and also for teenagers.

Implanon – is a small rod -implant that is inserted just beneath the skin in the upper arm.  It contains progesterone which inhibits ovulation. The Implanon lasts for 3 years and around 20% of women will have no periods after insertion.  However around 40% of women will have ongoing dysfunctional bleeding with the Implanon.  Side effects can include mood disturbance, acne, breast tenderness and headaches.

Depo-provera – is a three-monthly injection of MPA (a type of progesterone).  It works by switching off the ovaries and preventing ovulation. 70% of women who have the Depo-provera have no periods after the first couple of injections.  While you have the three-monthly injections it is >99% effective.  Side effects can include weight gain and mood issues and it carries a 15% risk of bone loss or osteoporosis when taken for over 2 years.

The Combined Oral Contraceptive Pill has two hormones (oestrogen and progesterone), that prevent ovulation.  You need to take a pill every day for it to be effective.  It works by switching the ovaries off so that an egg is not released.  The pill may also make periods lighter and less painful.  It has an efficacy rate of more than 99% when taken correctly and a 91% efficacy rate when taking into account human error.  It can cause some hormone side effects such as mood disturbance, decreased libido, nausea and breast tenderness.  The pill has the advantage of often improving acne and clearing the skin as it reduces testosterone.  This can be a good choice for women who have heavy painful periods or troubles with acne.

The mini-pill or progesterone only pill works by thinning the lining of the uterus and thickening the mucous at the entrance to the uterus so that sperm cannon pass through to fertilise the egg.  It has an efficacy rate when used perfectly of 98% and an efficacy rate of 90% when taking into account human error.  It is very important to take the mini pill at the same time every day for it to be effective.  The mini pill is a good option for women who are breast feeding or in whom oestrogen is contraindicated.

The NuvaRing – is a ping-pong ball sized clear silicone ring containing progesterone and oestrogen.  It works in the same way as the combined oral contraceptive pill to prevent ovulation.  It is inserted like a tampon at the top of the vagina behind the cervix.  It is changed every 3 weeks. The NuvaRing has the advantage of not needing to take a pill every day. It has the same efficacy as the combined pill of above 99% when used correctly. More information on the NuvaRing can be found at www.nuvaring.com

Condoms – are a fine rubber or synthetic covering worn over the penis which acts as a barrier to sperm entering the uterus.  Condoms have a perfect use efficacy rate of 98% but there is a high rate of failure of about 18%.  They have the advantage of protecting against STIs, but the disadvantage of high typical use failure rate and of having to always remember to carry one with you.  They may suit women who are engaging in more casual sexual encounters over women in long term relationships.

Diaphragm – is a soft silicone cap that fits over the cervix to stop sperm from entering the uterus.  You need to insert the diaphragm before having sex and then leave it in for at least 6 hours afterwards.  Diaphragms usually need to be used in combination with a spermicide.  Many diaphragms need to be fitted by a family planning practitioner or you can purchase the Caya diaphragm, which is a one size fits all diaphragm directly online or from your local family planning centre.  The diaphragm has an efficacy rate of 94% and an efficacy rate of 88% when taking into account human error. The advantages are that they contain no hormones and don’t have an effect on your cycle or on breast feeding.  The disadvantage is that you need to be well practiced and diligent about inserting it prior to sex.  More information on the Caya diaphragm can be found at www.caya.eu/en

Fertility Awareness Methods – are methods in which a woman is taught to know when her fertile window is and to avoid sex during those day each month.  This method relies on understanding that your fertile days are the five days before ovulation and the one day after ovulation, and thus depends on knowledge of when you ovulate. This generally relies on taking your basal body temperature.  A new device called the Daysy Fertility Monitor uses a computer algorithm to predict your safe days and claims an efficacy rate of greater than 98% when used perfectly.  This method has the advantage of being hormone free but requires in-depth knowledge of your menstrual cycle and an accurate basal body temperature thermometer.  More information on Daysy can be found at www.daysy.com.au

Tubal Ligation – is a permanent method of contraception which involves a keyhole surgery to place tiny clips on your fallopian tubes to prevent the egg and sperm from meeting.  This method has a 1 in 300 failure rate and should only be used if you are 100% sure that you don’t want to conceive in the future.

If you are unsure which contraceptive method is right for you, our Eve Health gynaecologists are well placed to help you choose which method will suit you best. They will educate you about your menstrual cycle and hormones, have an in-depth discussion with you about the pros and cons of each option, and if required, are all able to insert IUDs with expertise.