Your choices: a guide to contraception¹

Long-acting, reversible contraceptives (LARCS)

For many women taking a pill every day can be a bit of a chore, particularly as missing a pill can reduce the effectiveness of their contraceptive cover. However, there are alternatives. There's a group of contraceptives that can provide longer term cover (from a few of months to up to 10 years) with minimum maintenance. Although they're designed to last for a while, they are fully reversible so if you change your mind and decide to have a baby, your fertility may return some time after you stop using them. We'll take a look at each one below: they all work slightly differently and most must be fitted or administered by your doctor or healthcare professional.

Intrauterine Systems (IUS)

What is it?

The IUS is also known as 'the hormonal coil.' It is a small plastic device fitted into your womb that slowly releases the hormone progestogen. It takes about five minutes to be put in place by a trained doctor or healthcare professional and can last for up to five years.

How does it work?

It works in three ways:

• It sometimes stops you from producing an egg
• It helps your body to form a barrier against sperm
• It helps prevent any eggs that you may produce from settling in the womb

How effective is it?

The IUS is over 99% effective particularly as you don't have to remember to take any pills.

Advantages

• Does not interrupt sex
• Can works as soon as it is inserted
• Can stay in for five years
• You don't have to remember to take a pill every day
• Can be used by breastfeeding women
• Your periods usually become much lighter and shorter, and sometimes less painful. They may stop completely after the first year of use
• Can be removed at any time if you decide to become pregnant
• Suitable for women who don't want to have any further children

Disadvantages

• Certain medication can interfere with its effectiveness
• Insertion and removal must be done by a specially trained doctor or nurse
• Does not protect against sexually transmitted infections
• You might get some side effects. These side effects can include:
  • Breast tenderness, acne or headaches
  • Small chance of infection after 20 days as a result of insertion
  • May cause irregular bleeding for the first few months
  • Increase in the risk of developing ovarian cysts

Can anyone use it?

Most women can use the IUS at any age, but it won't be suitable if you have one or more of the following:  have had cancer of the womb or ovary; have breast cancer or have had it in the last five years; have active liver disease; have unexplained bleeding from the vagina; have an untreated sexually transmitted infection or pelvic infection; have had problems with their womb or cervix; suffer from migraines with aura.

Intra uterine Copper Device (IUD) or "The Coil"

What is it?

It's a small device made out of copper and plastic that is fitted inside your womb but does not rely on hormones. The copper part of the device actually kills sperm and this device can last between 5 and 10 years. It must be fitted by a trained doctor or healthcare professional and once it's been fitted your doctor or nurse must check it every six weeks or so.

How does it work?

It works in three ways:

1. By killing the sperm (the copper is toxic to sperm)
2. Stopping sperm from reaching a released egg
3. Making it more difficult for the egg to settle in the womb

How effective is it?

The IUS is over 98% effective particularly as you don't have to remember to take any pills.

Advantages

• Does not interrupt sex
• Works as soon as it is inserted
• Can stay in for between 5 and 10 years
• You don't have to remember to take a pill every day
• If inserted after the age of 40 it may stay in until the menopause
• Can be used while breastfeeding
• Can be removed at any time if you decide to become pregnant

Disadvantages

• May cause irregular bleeding
• Insertion and removal must be done by a specially trained doctor or nurse
• Does not protect against sexually transmitted infections
• You might get some side effects. These side effects can include:
  • Heavier and longer periods
  • Risk of infection after fitting in the first 20 days
  • More painful periods for some women
  • Risk of ectopic pregnancy (baby develops outside the womb)

Can anyone use it?

Most women can use IUDs at any age. However, it may not be suitable if you: have unexplained bleeding from the vagina; have an untreated sexually transmitted infection or pelvic infection; have had problems with your womb or cervix

The Injection

What is it?

As its name suggests, this contraceptive is given as an injection. The injection is usually given in the bottom, but it is sometimes given in the upper arm or leg. It gives you protection from getting pregnant for up to 12 weeks, but you must have regular injections in order to stay protected.

How does it work?

The injection contains the hormone progestogen, which is released very slowly into the body. It works in three ways:

• It stops you from producing an egg
• It helps your body to form a barrier against sperm
• It helps prevent any eggs that you may produce from settling in the womb

How effective is it?

It is over 99% effective if the injections are given regularly

Advantages

• Does not interrupt sex
• You do not have to remember to take a pill every day
• You are protected against pregnancy for up to eight or 12 weeks (depending on the type used)
• Suitable for breastfeeding women
• It may reduce heavy periods
• Hormones do not have to go through the stomach so protection is not affected by sickness or diarrhoea
• May protect against cancer of the womb
• Can be used by women who cannot take oestrogen

Disadvantages

• May cause irregular bleeding
• Injection must be given by a doctor or a nurse
• Cannot be immediately reversed in the event of side effects
• Can take time for regular periods and fertility to return to normal (you may have to wait for up to a year if you want to get pregnant)
• Does not protect against sexually transmitted infections
• You may get some side effects. These can include:
  • Increased chance of spots, headaches, tender breasts and changes in mood and sex drive
  • Weight gain

Can anyone use it?

Most women can use it, however if you're under 18 or over 45 there are certain risks associated with bone thinning (osteoporosis). Also, if you think you may want to get pregnant within a year you should consider an alternative contraceptive.

The Subdermal Implant

What is it?

This is a small flexible rod that is placed underneath the skin on the inside of the upper arm. You can feel it under the skin, but it can't be seen. It must be fitted by a doctor or healthcare professional and lasts for up to three years.

How does it work?

The rod contains the female hormone progestogen which is slowly released into the body. This stops you getting pregnant in three ways

• It stops you from producing an egg
• It helps your body to form a barrier against sperm
• It helps prevent any eggs that you may produce from settling in the womb

How effective is it?

The implant is over 99% effective particularly as you don't have to remember to take any pills.

Advantages

• Does not interrupt sex
• Works for up to three years
• May reduce painful periods
• You do not have to remember to take a pill every day
• It protects you from getting pregnant as soon as it has been fitted
• Fertility normally returns immediately after removing the implant
• Hormones do not have to go through the stomach so protection is not affected by sickness or diarrhoea
• It may reduce heavy periods

Disadvantages

• May cause irregular bleeding, no bleeding at all, acne or weight gain
• Insertion and removal must be done by a specially trained doctor
• Does not protect against sexually transmitted infections
• You may get some side effects. These can include:
  • Increased chance of getting spots or headaches
  • Some women report having tender breasts, changes in mood and sex drive

The Contraceptive Ring

What is it?

This is a plastic, see-through ring that sits inside the vagina. It is inserted once-monthly, normally on the first day of your period and left in place for three weeks, with a one week, ring-free interval, during which a withdrawal bleed occurs.

How does it work?

The contraceptive ring contains low doses of the hormones oestrogen and a progestogen which are released when the ring is activated upon contact with the vagina. The walls of the vagina then absorb the hormones and distribute them into the bloodstream in the same way as the combined pill. It protects you from pregnancy by:

• It stops you from producing an egg
• It helps your body to form a barrier against sperm
• It helps prevent any eggs that you may produce from settling in the womb

How effective is it?

The ring is 99% effective when used properly

Advantages

• You are protected from pregnancy for up to a month and do not have to worry about your contraception every day
• Does not interrupt sex
• As the hormones do not pass through the stomach it is unlikely that you will be affected by sickness or diarrhoea
• Easily reversible if you decide that you do want to get pregnant

Disadvantages

• You may get breakthrough bleeding, although this is nothing to worry about
• You may notice breast tenderness, headaches, nausea and mood changes
• There is a possibility of a temporary increase in vaginal discharge or infections
• May be expelled on straining

Can anyone use it?

Most women can use the contraceptive ring. However, if you are  over 35 years old and stopped smoking less than a year ago, are overweight (BMI of 30 kg/m or over), have a history of blood clots, high blood pressure, migraines or diabetes, you may want to talk to your doctor about whether this option is right for you. Because of the way the Contraceptive Ring is inserted, it may also not be suitable if you have a vaginal prolapse that can't hold a vaginal ring.