Contraception to avoid pregnancy is recommended from the time you start to become sexually active until at least one to two years after menopause (one year after your last period).
Permanent contraception is a choice for couples who have completed their families.
The risk of sexually transmissible infections (STIs) is a lifelong issue and needs to be considered for all new relationships and in your choice of contraception.
Contraception options
Combined oral contraceptive pill (COCP) – 'The Pill'
How it works
Two hormones, oestrogen and progesterone, in the Pill:
- prevent the release of an egg
- change the lining of the uterus
- prevent sperm entering by thickening the mucus at the entrance of the cervix (the lower, narrow part of the uterus)
Pros
The Pill can:
- regulate the menstrual cycle
- improve pre-menstrual syndrome (PMS) and some menopausal symptoms
- possibly decrease risk of endometrial and ovarian cancer
(Breast cancer risk is still being investigated)
Cons
Disadvantages include:
- a small risk of clotting, heart attack and stroke
- smokers over 35 years should not use the Pill as there is a greater risk of heart attack and blood clots in the legs or lungs
Healthy women who are non-smokers, have normal blood pressure, are not diabetic and have no increased risk of blood clots can continue on the COCP up until menopause. There is no absolute rule on the age it should be stopped, but keep in mind it may mask the onset of menopause.
Progestogen-only pill – the 'mini-pill'
How it works
- A very small dose of progestogen
- It works by thickening the mucus in the cervix to prevent sperm entering the uterus
Pros
- Highly effective in women older than 40 due to their naturally declining fertility
- Because it doesn't contain oestrogen, the mini-pill doesn't carry the same risks as the combined pill – especially for smokers
- Can be used in women who are breastfeeding
Cons
- It must be taken at the same time every day (within 3 hours of your normal time)
- It may result in irregular periods
Condom
How it works
The fine rubber or plastic sheath is worn on an erect penis, catches sperm and stops it reaching the egg
Pros
Condoms are good for women in new relationships, as they are the only contraception that protects against sexually transmissible infections.
Cons
- Condoms have a 5-10% failure rate
- Vaginal discomfort and erectile dysfunction may cause difficulties
Mirena® Progestogen – IUD
How it works
- The Mirena® contains a slowly releasing progestogen – levonorgestrel – that stops pregnancy
- It does not stop ovulation –approximately 75% of women continue to ovulate
- The IUD thickens the cervical mucus, so that the sperm can't reach an egg
- It thins the lining of the uterus, making it unfavourable for implantation
- Inserted into the uterus through the vagina (with or without anaesthetic)
- Once inserted, you need to check once a month to make sure it is still in place by feeling for a string coming out of your cervix
Pros
- Periods are likely to involve less blood loss and discomfort
- After approx.12 months of having the Mirena in, you may not have a period at all
- It lasts up to 5-7 years, depending upon the woman's age at insertion
- It is easily removed
Cons
- Irregular spotting and bleeding can continue indefinitely in a very small number of women
- Some women may also get progestogen-related side effects such as:
- bloating
- sore breasts
- weight gain
- acne
Copper intra-uterine device – IUD
How it works
- Inserted into the uterus through the vagina (with or without anaesthetic)
- Once inserted, you need to check once a month to make sure it is still in place by feeling for a string coming out of your cervix
- The IUD is toxic to sperm and also stops a fertilised egg from settling in the uterus
Pros
- A copper-containing IUD is very effective as a medium-term, non-hormonal contraceptive
- It lasts 5 years (MultiloadR) to 10 years (TT380R) – but the IUD lifespan doubles if it is inserted after the age of 40
- It is easily removed
- It can also be used as an emergency contraceptive if inserted within 120 hours (5 days) of intercourse
Cons
Heavier, painful bleeding can be a side effect.
Implanon – 'the rod', a three year contraceptive implant containing etonogestrel
How it works
- The implant stops the production and release of eggs by releasing the hormone estonogestrel slowly and continuously
- It also thickens the mucus around the cervix to stop sperm from entering the uterus
- The matchstick-sized plastic rod is inserted under the skin of your inner upper arm by a doctor after a local anaesthetic
- It can be felt under the skin but is unlikely to be seen
Pros
- Progestogen only
- Inexpensive
- Lasts for 3 years
Cons
- Menstrual irregularities can occur, particularly in the first three months with subsequent cessation of periods in 20% of women
- 18% of women experience enough bleeding abnormalities to have the implant removed
- Some women may experience:
- acne
- breast tenderness
- mood changes
Nuva Ring – Contraceptive hormonal vaginal ring
How it works
- A small, soft, silastic (pliable plastic) ring containing low dose oestrogen and progestogen
- It is self-inserted into the vagina and remains there for three weeks (including during intercourse) then removed
- A new ring is inserted one week later, at the end of the 4 week-cycle
Pros
As well as its 'set and forget' convenience, there may also be less hormonal side effects than the oral contraceptive pill
Cons
Disadvantages include:
- a small risk of clotting, heart attack and stroke
- smokers over 35 years should not use the ring as there is a greater risk of heart attack and blood clots in the legs or lungs
Diaphragm & cap
How it works
- Diaphragms and caps (not available in Australia) are 'barrier methods' as they are placed inside the vagina to cover the entrance to the uterus, stopping sperm from reaching the uterus
- A diaphragm is a shallow dome of thin rubber that is held in place by the pelvic muscles
- A cap is a firm, cup-shaped device which fits over the cervix by suction
- These products are left inside the vagina for six hours or longer after sex,so the sperm die without reaching the egg
Pros
- Drug free contraception
- Can be used with short notice
- They may be more effective if used with a spermicide cream/gel, which kills or disables sperm
Cons
- Not as reliable as some other contraceptive methods
- Some women find them difficult to insert and therefore risk incorrect placement
- Insertion and removal may increase the risk of urinary tract infection
- Spermicide is no longer available in Australia because of the link with mucosal irritation and increased susceptibility to STIs and HIV
Postinor emergency contraception - the 'morning after pill'
How it works
- Often called the 'morning after pill', Postinor reduces the chance of pregnancy after unprotected sex
- The sooner it is taken (within 24 hours of unprotected sex), the more effective it will be
- It must be taken within 5 days
- It works by delaying the release of an egg from your ovary, or by reducing egg development – it does not prevent implantation of a fertilised egg
- After use it is important to keep using other contraception until your next period
Pros
If it fails to work, it is not harmful to the pregnancy and embryo.
Cons
- It does not protect against sexually transmissible diseases
- It can only be used for emergency situations
- It must be used as soon as possible after the event
Natural family planning method
How it works
Your 'fertile window' can last from 5 days before ovulation to 5 days after ovulation (sperm can survive for up to 5 days). After ovulation, your basal temperature rises about half a degree celsius. This approach uses your temperature to indicate when ovulation has taken place so you know when you have less chance of becoming pregnant.
You take your temperature:
- every morning to identify your basal temperature (your body's lowest temperature)
- over a number of menstrual cycles so you can predict the days you are likely to ovulate
Pros
- Doesn't require the use of any medications
- Is a quick simple method of contraception
Cons
Disadvantages include:
- greater risk of getting pregnant than other forms of contraception
- relies on taking an accurate temperature reading daily
- it does not predict ovulation, rather when ovulation has already taken place
- you are not protected from sexually transmissible infections (STIs)
- you may need to use another form of contraception during your 'fertile window'
