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Hormonal methods
The pill
There are two main types of pill, the combined pill and the progesterone-only pill (mini-pill).
The combined pill
The combined pill contains two hormones, an oestrogen and a progestogen which prevent your body from releasing an egg each month.
You must see a doctor or nurse to be prescribed the pill, they will take your full medical history in order to find the pill which is best suited to your body. There are a number of different types of the combined pill. Not every type of pill will suit everyone so it is worth discussing different options with your doctor.
How effective are they?
Reliability: > 99% effective if used correctly and consistently, but more typically can be as low as 92%
What are the advantages?
The combined pill is one of the more effective reversible forms of birth control available to women today and is also one of the methods used most widely. The pill contains hormones that prevent pregnancies in different ways, but a woman can get pregnant again once she stops using it. In addition to protecting against unwanted pregnancy, the pill may make your periods more regular, may reduce pre-menstrual complaints, period pains and cramps and gives you lighter periods. Most pills can have a positive effect on your skin and hair. The pill also has been proven to have important health benefits. For example it improves symptoms of endometriosis and polycystic ovarian syndrome, and it offers some protection against ovarian cancer and cancer of the womb.9
What are the disadvantages?
Some women may have minor side effects when they first start taking the pill, but usually these subside during the first months of use. Side effects can include bleeding between periods, headaches and breast tenderness. . If you are suffering from side effects, please discuss with your doctor.
Very rarely, a few women might suffer from thrombosis, but this is very uncommon and much rarer than the risks of thrombosis connected with being pregnant. The risk of thrombosis depends on a number of factors, including family history, age and body weight, and increases if a combination of risk factors are present. The link between thrombosis and the pill is lower than the risk of thrombosis in prgrenancy.9 Using the pill may contribute to a slight increase in the risk of having breast cancer but this risk is very small.10
The pill also does not protect against STIs.
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The progestin-only Pill (mini-Pill)
This version of the pill contains only one hormone, a progestogen. It works in a different way from the combined pill, mainly by thickening the mucus at the entrance to the womb, which makes it difficult for sperm to get through. It may also prevent ovulation in some women. You take one pill every day until all the pills in the pack are finished. Then you start a new pack the next day. This means taking pills during a period and no gap between packs. There are different types of progesterone available.
How effective are they?
Reliability: > 99% effective if used correctly and consistently, but more typically can be as low as 92%.
What are the advantages?
The progesterone-only pill offers a reliable form of birth control to women who cannot tolerate oestrogens.
What are the disadvantages?
It's really important to take the progesterone-only pill at the same time each day or it may not work. Again, it is worth discussing the different options with your doctor to find out what works best for you and your lifestyle. The margin for error is around three hours. Periods may be irregular, with some bleeding between periods, especially for the first few months. On the other hand, some women experience no bleeding at all with the progesterone-only pill. Also, the progesterone-only pill does not protect against STIs.
The IUD (intrauterine device or coil)
There are two main types of IUDs in Australia: hormonal containing and copper containing Hormonal IUD.
(1) Hormonal IUD
A hormonal IUD is a device placed in the uterus by your doctor. The hormone is released very gradually into the uterus. It prevents pregnancy by thickening the mucus in the neck of the uterus, making it difficult for sperm to enter. It also has local effects on the uterus. In some women it also intermittently prevents ovulation. It can stay in place for up to five years and a healthcare professional will remove it if it is no longer required or when its effectiveness has expired and will no longer provide a method of contraception.
How effective is it?
Reliability: over 99% effective.
What are the advantages?
The hormonal IUD provides a reliable long-term contraceptive option. After some months of adaptation, periods are usually lighter, shorter and less painful or there may be no bleeding at all. After the hormonal IUD has been removed, fertility levels will return to normal.
What are the disadvantages?
Periods may be irregular with some bleeding in between periods and in some women this may continue after the first three to five months. Initial occurrences of headaches, breast tenderness or nausea are possible. Insertion may be difficult and may be associated with complications and some pain and bleeding. Infection of the womb can occur with this method but this is uncommon. This is not usually the method of first choice for women who have not yet given birth. It does not protect against STIs.
(2) Copper IUD
This is a small plastic and copper T-shaped device, which is inserted into the cavity of the womb by a trained doctor. The copper IUD prevents pregnancy by preventing sperm and eggs from meeting by either immobilizing the sperm on their way to fallopian tubes or causing local effects on the uterus. It has two little threads that lie inside the vagina so that you can check it's in place. Copper IUDs have to be changed at either five or eight years depending on the type inserted.
How effective is it?
Reliability: over 99% effective.
What are the advantages?
The copper IUD provides a long-term contraceptive option. A healthcare professional will remove it if it is no longer required or when its effectiveness has expired and will no longer provide a method of contraception. After the copper IUD has been removed, fertility levels will return to normal.
What are the disadvantages?
With copper IUDs periods may become heavier, longer or more painful. Infection of the womb can occur with this method but this is uncommon. Insertion may be difficult and may be associated with complications and some pain and bleeding. This is not usually the method of first choice for women who have not yet given birth or for women with anaemia, heavy or painful periods or endometriosis. Copper IUDs also do not protect against STIs
Injectable contraceptives
This is a hormonal method of contraception, which is given by injection once every three months.
The injection works by preventing ovulation through the slow release of progestogen hormone into the body. They also act to thicken mucus around the neck of the womb making it difficult for sperm to enter. The injections are given by your doctor, nurse or family planning clinic so you have to remember to attend your appointment.
How effective is it?
Reliability: > 99% effective if injections given at correct intervals, but more typically can be as low as 97%
What are the advantages?
The injection is a semi-long-acting hormonal method providing effective contraception without the need for a daily dose of treatment. The available three-month injection containing only progestogen is suitable for most women who can not tolerate oestrogen or who are breast-feeding.
What are the disadvantages?
Some women find that their periods become irregular on this method, or stop altogether and some women put on weight. Some women may also experience headaches, dizziness and spotty skin. Regular periods and fertility may take up to 18 months to return after stopping injections. Injections do not protect against STIs.
Implants
This is a tiny flexible tube impregnated with the hormone progesterone, which is inserted just under the surface of the skin on the inside of your upper arm. This is done under a local anaesthetic. Implants have to be put in by a trained doctor. The hormone is released in tiny doses over a three year period, after which, it is taken out and a new one inserted. This method works by inhibiting ovulation and by thickening the mucus in the neck of the womb to make it difficult for sperm to enter. Fertility will return to normal after it is removed.
How effective is it?
Reliability: Over 99% effective
What are the advantages?
The implant is suited for women who want long-term contraception. It is also suitable for women who are breast-feeding and those who do not tolerate oestrogen. It may reduce heavy, painful periods.
What are the disadvantages?
Your periods will change with an implant. Some women have no bleeding at all and some have irregular bleeding and spotting. There can be temporary side effects headaches, mood changes and breast tenderness, but usually these subside after the first few months. Some may also notice a positive effect on their skin. The implant does not protect against STIs.
The vaginal ring
The vaginal ring is a flexible ring which is inserted into the vagina by the woman and held in place by the muscles in the vaginal wall. . It contains an oestrogen and progestogen combination. The ring releases hormones that prevent pregnancies in different ways, but a woman can get pregnant again once she stops using it. The ring may make your periods more regular, may reduce pre-menstrual complaints, period pains and cramps and give you lighter periods. It may have a positive effect on your skin and hair. It is kept in place for three weeks, and then removed by the woman for a one week break. Following the week break, a new vaginal ring is inserted.
The vaginal ring provides an alternative form of contraception with a low hormone dosage which is used only once every four weeks.
How effective is it?
Reliability: More than 99% effective if used correctly and consistently, but more typically can be as low as 92%
What are the advantages?
The ring provides an alternative form of contraception with a low dose of hormones. It may also help to make periods more regular, lighter and may reduce cramping.
What are the disadvantages?
Some women may have minor side effects when they first start using the ring, but usually these subside during the first months of use. Side effects can include nausea, bleeding between periods, headaches, breast tenderness.
Some women experience vaginal discomfort or altered discharge. The vaginal ring does not protect against STIs.
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