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Contraceptive Advice

Contraceptive Advice

Contraception, or birth control, can help you prevent pregnancies and implement family planning – that is controlling the number of children that you chose to have, and the duration of time between their births. There are many different contraceptives that are available to you. No method is 100% effective – there is always a chance that you could still get pregnant even when using birth control.

Some contraceptives also protect against Sexually Transmitted Infections (STI). You may be prescribed contraceptives for other purposes such as acne; PMS; migraines; painful, irregular or heavy periods; endometriosis; PCOS; or to cut back on bleeding if you have severe anemia.

There are four categories of birth control that are available:

  • Barrier contraceptives
  • Daily contraceptives
  • Long acting reversible contraceptives
  • Emergency contraceptives

We will help you find a birth control that is right for you. You may find some types don’t work as well for you, or cause side effects.

Barrier contraceptives

Barrier contraceptives act as an obstacle between sperm and eggs – preventing the sperm from getting to the egg. Some act as a barrier between genital contact and can be effective in preventing the spread of STIs. Barrier contraceptives include:

  • Male condoms
  • Female condoms
  • The diaphragm
Male condoms

Male condoms can only be used once. Condoms can be purchased relatively cheaply from chemists or supermarkets. They are typically made of latex, however there are latex-free condoms available for people with allergies. Condoms act as a physical barrier for semen entering the body of a partner. It is also effective in reducing the spread of STIs.

How effective are condoms?

Condoms are 98% effective with perfect use. Reasons that a condom may fail, and allow sperm to pass through, include:

  • Passed expiry date
  • Incorrect size
  • Torn or punctured
  • Stored in hot places for a long period of time
What are the side effects of condoms?

There are typically no side effects with male condoms, however irritation may occur and some people are allergic to latex.

Female condoms

A female condom is similar to male condoms in the way they work and the materials which they are made from. Female condoms are typically more expensive than male condoms and they can be more difficult to find in stores.

Female condoms are inserted into the vagina of a woman and prevent sperm from entering the uterus. They can be inserted a few hours before a sexual encounter. They fit a variety of women. The female condom is also effective in reducing the spread of many STIs.

How effective are female condoms?

Female condoms are 95% effective at preventing pregnancies when used properly. Reasons the female condom may fail includes:

  • Torn or punctured
  • Passed expiry date
  • Not inserted correctly
What are the side effects of female condoms?

There are typically no side effects, however irritation may occur and some people are allergic to latex.

Diaphragm

A diaphragm is a silicone shallow, cup-shaped, barrier contraceptive. It prevents sperm from entering the uterus. Diaphragms are perhaps less popular than they have been previously. Currently there is only one-size diaphragm sold in Australia – Caya. It is used with a special gel. They are available from some chemists and family planning clinics. Diaphragm’s do not protect against STIs. If you are worried about STIs, or are with a new partner, you should use a condom as well. They can be used multiple times over up to two years.

How do I use a diaphragm?

Before using the diaphragm, a teaspoon of the gel must be placed into the cup. Then it is inserted inside the vagina so that it covers the cervix. It can be inserted up to two hours before sex and must stay in for at least 6 hours after sex. You should not have your diaphragm inserted for more than 24 hours. Sperm are prevented from entering the uterus by the diaphragm and die in the vagina.

Before you use your diaphragm for the first time you should ask a healthcare professional to check that it fits well and that you are using it correctly.

How effective are diaphragms?

Diaphragms are 86% effective in preventing pregnancies when used correctly. Reasons that the diaphragm may fail include:

  • Incorrect fit
  • Not inserting it correctly
  • Taking it out too soon after sex (less than 6 hours)
  • Torn
  • Passed expiry date
  • Not used with the gel
What are the side effects of a diaphragm?

Some women experience increased risk of bladder infections when using the diaphragm. Very rarely toxic shock syndrome can be caused.

Daily contraceptives

Daily contraceptives are hormone-based birth control that need to be administered every single day. If you forget to take a dose you risk pregnancy. There are two main kinds of contraceptive pills: the combined oral contraceptive pill and the mini-pill

Combined Oral Contraceptive Pills (COCP)

The COCP, simply ‘the pill’ is a daily tablet that contains both oestrogen and progesterone hormones. You should try and take the pill at the same time every day. A script is required to purchase the pill from a pharmacy. The price of the pill varies by brand, and whether or not you purchase a generic. The pill does not prevent STIs so you should use condoms to prevent STI’s.

The pill typically comes in 28-day packs which include both hormonal pills and sugar pills. When taking the sugar pill you will typically have a period. You can skip the sugar pills and instead continue straight onto hormone pills to skip your periods.

How does the pill work?

The oral contraceptive pill works by stopping the ovaries from releasing an egg. The hormones also thicken the cervical mucus which can prevent sperm from going past the cervix.

What are the side effects of the pill?

There are many different brands of pills which may give you different side effects. Common side effects include:

  • Weight gain or bloating
  • Skin changes
  • Mood changes
  • Nausea
  • Headaches
  • Tender or sore breasts
  • Irregular bleeding

Some side effects subside over time.

Can I take the pill?

The Pill cannot be taken with certain health conditions, we will discuss this with you in detail when you see us.

How quickly does the pill start working?

The pill takes 7 days to start working, so you should continue to use another birth control during this time.

How effective is the pill?

The pill is over 99% effective. Efficacy can be reduced if:

  • You miss a pill
  • You vomit or have diarrhoea (making the pill leave your system)
  • You are taking medications or natural remedies (e.g. St John’s Wort).
What if I miss a pill?

You should take a pill as soon as you realise you have missed one, even if this means taking 2 in a day. If you miss a pill, then depending upon how many pills you have missed and what time of the menstrual cycle you are in you may need additional contraception and/or emergency contraception.

What if I decide I want to get pregnant?

If you decide you want to get pregnant, your fertility should return within 1-3 months after stopping the pill.

The Mini Pill

The Mini Pill contains only one hormone – progestogen. It can also be used while breastfeeding and is associated with quicker return of fertility. You must take the mini pill at the same time every day as it is more time sensitive. A script is required to purchase the pill from a pharmacy. The price of the pill varies by brand, and whether or not you purchase a generic. The pill typically comes in 28-day packs which includes only hormonal pills. There are no sugar pills. The pill does not prevent STIs so you should use condoms, especially with new partners.

How does the Mini pill work?

The mini pills work by thickening the cervix mucus which prevents sperm from entering. Sometimes the mini pill will also stop the ovaries from releasing an egg.

What are the side effects of the Mini Pill?

There are many different brands of pills which may give you different side effects. Common side effects include:

  • Skin changes
  • Mood changes
  • Headaches
  • Tender or sore breasts
  • Irregular bleeding

Some side effects subside over time.

Can I take the Mini Pill?

There are no serious risks associated with the Mini Pill. The Mini Pill may not be appropriate for you if you have severe liver disease or have been treated for breast cancer.

How quickly does the Mini Pill start working?

The mini pill can take up to 3 days to start working, so you should continue to use another birth control during this time.

How effective is the Mini Pill?

The pill is over 99% effective. Efficacy can be reduced if:

  • You take a pill more than 3 hours late
  • You vomit or have diarrhoea (making the pill leave your system)
  • You are taking medications or natural remedies (e.g. St John’s Wort). Ask your doctor if any medication you are prescribed will interfere with the pill.
What if I miss a Mini Pill?

If you miss a pill, take a pill as soon as you notice, even if it means taking 2 pills in the same day. Then return to your regular schedule. You should also use condoms for 3 days if you are having sexual intercourse. If you have had sex without a condom since you missed your pill, you may need emergency contraception.

What if I decide I want to get pregnant?

If you decide you want to get pregnant, your fertility should return quickly – within days or weeks.

Long acting reversible contraceptives

Some women forget to take the pill, or simply don’t like having to take a tablet daily. Longer active reversible contraceptives are another option that may suit you better. These birth control options last for longer length of time – few years. These include:

  • Intrauterine Devices (IUDs)
  • Subdermal contraceptive implants (Implanon)
Intrauterine devices (IUDs)

IUDs are small devices that are placed into the uterus to prevent pregnancy. IUDs can be copper or hormonal (Mirena). You will need a prescription to buy an IUD and you need a qualified GP or specialist to insert it. Both IUDs are small ‘T-shaped’ devices inserted into the uterus. Both have strings that hang down out of the cervix so that you can check the device is still in situ and so it can more easily be removed later. The strings do not hang outside of the body and cannot be seen. Neither IUD is effective in protecting against STIs. You should use condoms with new partners.

How are IUDs inserted?

You may be able to have an IUD inserted without an anaesthetic in a doctor’s surgery. If you haven’t had children, or have a tight cervix, you may need to have your IUD inserted under general anaesthesia. Removal should be possible in a doctor’s rooms.

Are there any risks of using IUDs?

Very rarely insertion may cause a hole in the uterus or an infection. If you get pregnant while using the IUD there is a small possibility, this may result in an ectopic pregnancy.

How do IUDs work?

The Copper IUD works by continually releasing a small amount of copper into the uterus. This is toxic to both the egg and the sperm and stops them from meeting. It also changes the lining of the uterus so that if an egg were fertilized it would not be able to ‘stick’ to the lining and start a pregnancy. It can also be used for emergency contraception (within 5 days of unprotected sex).

The hormonal IUD works by slowly releasing progestogen (hormone) into your uterus. This prevents the sperm and egg from meeting. It also thickens the mucus around the cervix to prevent sperm from entering the uterus. It changes the lining of the uterus so that a fertilised egg cannot stick to it to start a pregnancy. Sometimes it can also stop the ovaries from releasing eggs.

What are the side effects of IUDs?

You may experience some cramping for a few days when it is first inserted. Spotting and frequent bleeding is common in the first 3 months following insertion. Most women find this settles with time and their regular menstrual cycle returns; however, some women may find their periods heavier with the copper IUD.

You may experience cramping for a few days after your Mirena is first inserted and may have spotting or frequent bleeding for the first 3-6 months. Some women also experience headaches, tender breasts, mood changes or skin changes. These nearly always settle with time. While the Mirena is in situ many women do not have periods or only a light regular period.

How quickly do IUDs start working?

The Copper IUD starts working immediately.

Mirena is effective immediately after insertion if it is inserted in the first 7 days of the menstrual cycle, if inserted after that then it starts working after 7 days, so you should additional contraception in that time.

How effective are the IUDs?

It is more than 99% effective and lasts between 5 and 10 years. The Copper IUD may stop working if it falls out or is in the wrong position. It will also be less effective if it has been in longer than 5-10 years.

The hormonal IUD is more than 99% effective and lasts up to 5 years. The hormonal IUD might not work if it falls out, is in the wrong position or has been left in for longer than 5 years.

If you suspect your IUD has moved, use condoms until you can have it checked by a doctor. They may perform an ultrasound to do so.

What if I decide I want to get pregnant?

If you decide to fall pregnant your fertility may return very soon after removal of the IUD. You could get pregnant even if you have not had a period yet.

Subdermal contraceptive implants

This is a subdermal contraceptive implant that is inserted into the upper arm. It is a soft plastic stick which is approximately 4cm long – similar to a matchstick. You must have a prescription to purchase it and then need to see a trained doctor to insert it. The impant available in Australia is called Impanon NXT.

How is Implant inserted?

A local anaesthetic is used to numb the arm and then the implant is injected under the skin of your inner upper-arm using a special injector.

How does Implant work?

The implant contains progesterone which is slowly released into your body. This stops the ovaries from releasing an egg each month and also thickens your cervix mucus to prevent sperm entering the uterus.

What are the side effects of Implanon?

Possible side effects include:

  • Irregular bleeding
  • Headaches
  • Bloating
  • Skin changes
  • Tender breasts
  • Mood changes

These often settle with time. For many women their period patterns will change. They may be more often or irregular. Some women will experience no bleeding at all while others may have frequent or prolonged bleeding that may get better over time. Some medications can help with this bleeding.

How quickly does Implant start working?

Once inserted the it can take 7 days to start working, so you need to additional contraception during this time.

How effective is Implant?

It is more than 99% effective. It may not work if you have had it in for longer than 3 years or if you are taking some medications.

What if I decide I want to get pregnant?

If you decide you want to fall pregnant you need to have your implanon removed by a trained healthcare professional. Your fertility should return quickly.

Contraceptive injection (Depo Provera)

Depo Provera is an injection of the hormone progestogen. It is administered every 12-14 weeks by a doctor. It is injected into the upper arm or bottom muscle. You will receive a script for depo and need to collect it from the chemist and return to the doctor to have it injected. Depo does not protect against STIs.

How does Depo work?

Depo works by preventing the ovaries from releasing an egg. It also thickens the cervix mucus to prevent sperm from entering the uterus.

What are the side effects of the Depo?

Side effects of depo include:

  • Weight gain (common)
  • Bone mass density may drop. This will return once injections stop.
  • Mood changes
  • Skin changes
  • Headaches
  • Bloating
  • Tender breasts

Your period patterns will change. It could either irregular or occur more often. 60% of women will have no periods at all. Prolonged or frequent bleeding may occur but will get better with him. Medications may be prescribed to reduce bleeding.

Is Depo right for me?

Depo might not be right for you if you have severe liver disease or have been treated for breast cancer. If you wish to become pregnant in the near future, other contraceptives may be better for you.

How quickly does the Depo start working?

After the first injection, or a break, it may take up to 7-days for depo to be effective. You need to use alternative contraception in the meantime.

How effective is the Depo?

Depo is more than 99.5% effective. The injection is less effective if you have it late. Many depo users have no periods or very light bleeding while using it. It can also decrease period pain and be used while breastfeeding. It is another option for women who are sensitive to oestrogen.

What if I miss an injection?

You need to use alternative contraception until you get another injection and continue to do so for 7 days after the injection. If you missed an injection and had unprotected sex you may need emergency contraception.

What if I decide I want to get pregnant?

If you decide you want to fall pregnant, fertility can take 3 to 18 months after the last injection to return.

Emergency contraceptives

If you have had unprotected sex, missed a pill or suspect a barrier method of breaking you may need to use an emergency contraceptive. This is not a replacement for regular contraceptives, but is a backup plan to help you prevent pregnancy.

As mentioned earlier, the Copper IUD can be used as an emergency contraceptive. The other option for emergency contraception is using the morning after pill. There are two kids of pills: LNG pill and Ella One

How does the morning after pill work?

The morning after pill prevents the ovaries from releasing an egg. LNG pill can be taken up to 3 days after unprotected intercourse and Ella One up to 5 days

How effective is the morning after pill?

The morning after pill is 85% effective at preventing pregnancy. The morning after pill may not work if you are taking certain medications, if you take it too late or if you vomit soon after taking it (as it will leave your system). The Copper IUD is more than 99% effective.

Can I use the morning after pill?

Most of you can take the morning after pill.The morning after pill may not be appropriate if you are taking some types of medications or are breastfeeding.

When should I take the morning after pill?

It should be taken as soon as possible after unprotected sex but can be taken up to 4 or 5 days afterwards, depending on which pill you take.

How do I get the morning after pill?

You do not need a script for the morning after pill – you can get it from the pharmacy.

Side effects of the morning after pill

Emergency contraceptive pills may change the amount of bleeding you have in your next period. It can also make your next period late or early. If your period is more than 7 days late, take a pregnancy test as soon as you can. Other side effects include:

  • Headaches
  • Nausea
  • Bloating
  • Tender breasts
Frequently asked questions about contraceptives
Which contraceptives protect against STIs?

Only male and female condoms protect against STIs. Even then, they are not 100% effective against STIs so you should have regular sexual health checks.

How effective are contraceptives?

The efficacy (how well they work) of different contraceptives varies. They are also less effective if you do not use them perfectly, or do not take them on time.

With perfect use:

  • Condoms are 98% effective
  • Female condoms are 95% effective
  • Diaphragms are 86% effective
  • The pill is 99.5% effective
  • The Mini Pill is over 99.5% effective
  • Both the copper and hormonal IUDs are 99.5% effective
  • Implanon is 99.95% effective
  • Depo injections are 99.8% effective.
How long are you protected with contraceptives?

This again depends on which method you are using:

  • Condoms (male and female) are single use.
  • Diaphragms can last up to 2 years, but are only inserted for a maximum of 24 hours at a time.
  • The pill must be taken every day to work. It typically comes in a pack of 28
  • The Mini Pill must be taken every day at the same time for it to work. They typically come in packs of 28
  • IUDs last between 5 years (Mirena) and 10 years (Copper IUD)
  • Implanon lasts 3 years
  • Each NuvaRing lasts 3 weeks
  • Depo injections last 12-14 weeks
How long does it take for contraceptives to start working?

Barrier methods (condoms and the diaphragm) work immediately as they prevent the sperm and egg from joining. Other contraceptives take longer to start working. You will need to use barrier methods (or abstain) until then if you do not wish to fall pregnant. The time it takes for different contraceptives to start working when you first use them, or after a period of not using them, varies:

  • The pill can take 7 days to start working
  • The Mini pill can take 3 days to start working
  • Copper IUDs start working immediately, while the Mirena takes 7 days
  • Implanon takes 7 days to start working
  • NuvaRing takes 7 days to start working
  • Depo takes 7 days to start working
What contraception is good for me if I can’t take oestrogen?

Barrier methods are suitable for those who are sensitive to Oestrogen. Other methods that may be suitable for you are progesterone only contraceptives like the Mini Pill, Depot Injection, Mirena and Copper IUD.

What contraceptives are safe while breastfeeding?

Breastfeeding may delay your period returning, but you can still get pregnant so you should use contraceptives. Oestrogen-based contractions can reduce your supply of breastmilk. Depending on your personal circumstances, you should be able to use:

  • Condoms
  • The Mini Pill
  • Diaphragms
  • Depo-Provera
  • Implanon
  • IUDs
Will I still get my period when using hormonal contraception?

This depends on the type of contraceptive that you are using. You may have lighter, or no, periods using Implanon, Depo and IUDs. If you skip the sugar pills, or immediately put another NuvaRing in, you can skip a period.

What contraception is best for me?

There is no single method that suits everyone and hence it is important that we have a consultation to decide what method is ideal for you depending on your preferences and health conditions.