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Common questions about hormonal methods
Pill
Are all pills the same?
No - there are many different varieties of pill available today, and each of them offers different benefits.
What does the pill contain?
There are two main types of pill. The pill can contain two types of hormone - an oestrogen and progestogen and some pills contain progestogen only. When you become pregnant the body produces these hormones naturally, to stop you producing any more eggs. The combined pill mimics this action, so that even though you are not pregnant, ovulation is prevented. It also thickens the mucus in the cervix, which makes it difficult for sperm to get through. The progestogen only pill works by thickening the mucus at the entrance to the womb. In some women it may also prevent ovulation.
Are there any side effects or health risks with the pill?
The pill has been available and used by women since the 1960s, and serious side effects are rare. Some women may have minor side effects when they first start taking the pill, but usually these subside after about 12 weeks. More common side effects can include bleeding between periods, headaches and breast tenderness. Some brands of combined pill contain a higher dose of oestrogen. If you are on this type of pill and are suffering from side effects, it might be helpful to ask your doctor if you can switch to a lower-dose oestrogen pill. There are also different types of progestogen available, so again, it is worth discussing the different options with your doctor. Different types suit different women.
Very rarely, a few women might suffer from thrombosis, but this is very uncommon. 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 far less strong than for other risk factors, is much less than the chances of developing thrombosis if you don’t use contraception and get pregnant and varies depending on the type of contraceptive pill you take.10 If you have ever suffered a blood clot, or you have a family history of thrombosis or circulatory disease, you should let your doctor know, as the pill may not be suitable for you.
You should also inform your doctor if you are a smoker, have diabetes high blood pressure, or suffer from certain types of migraines as these conditions also increase the risk of serious side effects such as stroke. Being very overweight or immobile (for example, wheelchair users) increases the risk of thrombosis.10
See your doctor at once if you develop any of the following symptoms:
- pain and swelling in the calf of one leg
- chest pain and/or difficulty breathing
- abdominal pain
- prolonged headache - especially if you have not previously suffered from headaches
- loss of vision or weakness on one side of the body
- yellow eyes and skin (jaundice)
Although these symptoms are worrying, it must be stressed they are extremely rare and will not affect most women taking the pill.
There is an increased risk of developing breast cancer, but this is very small and returns to normal within ten years after stopping the pill.11 You need to balance this with the protection the pill can give against endometrial and ovarian cancer.10
Are there any additional health benefits to taking the pill?
Yes - as well as short-term benefits such as more regular, lighter and less painful periods, in the long-term the pill is known to reduce the risk of endometrial and ovarian cancer by as much as 80% with long term use.
How reliable is the pill?
The pill is one of the most reliable forms of contraception, giving a very high degree of protection against pregnancy when taken as instructed.
Are there any pills that offer extra benefits?
Most pills can improve the condition of your skin and hair, and help with symptoms such as acne, PMS, and cyclical bloating. It may be worth swapping pills if you are having difficulty.
Should I take a break from the pill?
There is no evidence to suggest that the pill has any effect on long-term fertility or that it is necessary to take a 'pill break'.
What if I don't like the pill I'm on - can I switch?
Lots of different pills are available, and they are all slightly different. If you find the pill you are on does not suit you, there are plenty of others to choose from! However, usually it takes some months until your body is accustomed to a certain pill and too frequent changes would prevent you from finding any appropriate type. Talk to your doctor who will assist you.
Do I have to go to my doctor to be prescribed the pill?
Your regular doctor can prescribe you the pill.
How do I start taking the pill?
The most usual way is to start taking the pill on the first day of your period. Some pills provide protection from day 1 in this way. It’s important to speak to your healthcare professional.
Do I take the pill every day?
Yes. Each pill works across a 28 day cycle including the pill-free or placebo interval, which means you have one pack for each cycle. With some you have to take a hormonal pill everyday of the cycle. With others you take a hormonal pill every day for 21 days of the cycle, and then have a hormone free break of seven days where either no pills are taken or a hormone free pill is taken. During this break, you will still be protected and you will have a menstruation-like bleed.
Is it safe to have sex during the four or seven day break?
Yes - as long as you have taken the previous pills as instructed. Also, if you do have sex during the break, it's important to start your next pack on time and make sure the pills are taken correctly.
Will my periods be affected?
The pill usually makes your periods more regular, shorter, lighter and less painful.
Do I need to take it at the same time every day?
Yes, morning or evening, it's up to you, but you do need to get into a regular routine of pill-taking. If you forget to take your pill, with most types you'll still be protected if you can take it up to 24 hours later - but it's wise not to do this too often. Progestogen only pills can only be taken up to three hours late. Refer to the leaflet in your packet for more information on the pill you’re taking.
I'm on antibiotics - how does this affect my pill?
Some antibiotics and other prescription drugs can reduce the effectiveness of the pill so always tell your doctor you're taking the pill if you are prescribed medicine.
How should I protect myself from STIs?
The pill does not offer protection against STIs (sexually transmitted infections), so, until you are sure of your partner's sexual history or sexual health, it's advisable to use a condom in addition to taking the pill.
Will the pill make me put on weight?
Although some women on the pill reported to having put on weight, it is very questionable that this could be traced back to the pill and studies have shown that the combined pill does not cause this to occur. However, with some pills you might put on weight when you start taking them, due to water retention, which makes you feel bigger. But there are today modern pills which can avoid such water retention to some extent.
You may also find your appetite increases in the first three months of pill taking - and of course if you eat more you may gain weight! Watch what you put on your plate to make sure the kilos don't creep on.
Will the pill give me spots?
Most pills can help clear up your skin. Talk to your doctor about how the right pill could combat skin impurities or even acne. Sometimes women do break out in response to their pill, and if this is the case you should consult your doctor. With many types of pill available today, you should be able to find the pill which is best for you.
Will the pill make me feel sick?
Some women do feel sick when they take the pill, but there are so many varieties available today - including modern, low-dose formulations - you should be able to find a pill to suit you.
Will I need to take a break from the pill after a few years to let my body recover?
There's no evidence or scientific rationale that this should be done. Doctors do recommend regularly reviewing your contraceptive needs particularly once you reach the age of 35. Many women continue to take the pill until hitting the menopause.
Isn’t it going to be difficult to remember?
Try to adopt a routine with your pill-taking to make it easier for yourself to remember.
Hormonal IUD (intrauterine device)
Is it painful to have a hormonal IUD inserted?
An IUD insertion is usually well tolerated by most women. Local anaesthesia may be applied to the cervix prior to the insertion. Some women may experience pain and dizziness after insertion, which usually settles after resting for a short time.
What is the difference between a hormonal IUD and a copper IUD?
The copper IUD is a small plastic T-shaped device covered by copper which is inserted in the cavity of the womb. The hormonal IUD, is made of two components: the plastic T-shaped device and a cylinder containing progestogen hormone, which is released slowly from the system. The hormonal and copper IUDs have a number of different characteristics and work in a different way, so the doctor and the patient need to find out together which option is more appropriate individually.
Can the IUS come out or get stuck in my uterus?
The IUD must be inserted by a trained healthcare professional, who will follow the necessary procedure to ensure it is correctly positioned. Occasionally, the muscular contractions of the womb during menstruation may sometimes push it out of place or expel it. Very rarely it can perforate the wall of the uterus. If a user of an IUD experiences any unusual bleeding, pain or discomfort, her doctor must be informed as soon as possible.
Will my partner or I feel it during sex?
Neither you nor your partner should feel the IUD during sexual intercourse. If you do, sexual intercourse should be avoided until your doctor has checked that the IUD is still in the correct position.
Is it safe to wear tampons during my period if I have an IUD fitted?
Tampons should not be used for 48 hours after the IUD is inserted. They should always be removed with care so as not to pull the threads of the IUD when manipulating the tampon.
Will I bleed after having a hormonal IUD fitted?
The progestogen released from the IUS causes the lining of the uterus to become very thin. When the hormonal IUD is first inserted before the lining becomes completely thinned out women may have unpredictable spotting (a small amount of blood loss). This usually clears after the first months following insertion. If it does not clear, then you should see your healthcare professional to make sure there is not another cause for the bleeding. After a few months bleeding is generally short and light or may be absent. It is uncommon for a woman’s periods to become heavier using this method.
Will the hormones in the hormonal IUD affect my periods?
Many women with a hormonal IUD find that they experience an improvement of heavy and painful periods after it is fitted. Some women may stop having their periods altogether.
Is it safe to have a hormonal IUD fitted for more than five years?
A hormonal IUD can be left in place for up to five years. After this time, it will need to be replaced with a new device.
Copper Intrauterine device (IUD, also known as the coil)
Is it painful to have a copper IUD inserted?
A copper IUD insertion is usually well tolerated by most women. Local anaesthesia may be applied to the uterine cervix prior to the insertion. Some women may experience pain and dizziness after insertion, which usually settles after resting for a short time.
Can the copper IUD be used as emergency contraception?
The copper IUD can be used as an emergency contraception and must be inserted within 5 days after unprotected sex. Because of the insertion procedure, the IUD is not suitable to be used regularly as emergency contraception.
Can the IUD come out or get stuck in my uterus?
The IUD must be inserted by a trained healthcare professional, who will follow the necessary procedure to ensure it is correctly positioned. Occasionally, the muscular contractions of the womb during menstruation may sometimes push it out of place or expel it. Very rarely it can perforate the wall of the uterus. If a user of an IUD experiences any unusual bleeding, pain or discomfort, her doctor must be informed as soon as possible.
Will my partner or I feel it during sex?
Neither you nor your partner should feel the IUD during sexual intercourse. If you do, sexual intercourse should be avoided until your doctor has checked that the IUD is still in the correct position.
Is it safe to wear tampons during my period if I have an IUD fitted?
Tampons should not be used for 48 hours after the IUD is inserted. They should always be removed with care so as not to pull the threads of the IUD when manipulating the tampon.
Will I bleed after having a copper IUD fitted?
Women using a copper IUD are more likely to experience an increase in blood loss each month than non-users. This typically occurs because of increased duration and heaviness of menstrual flow. This may also result from irregular bleeding and spotting in between periods, but this is uncommon after the first month.
Will an IUD affect my periods?
Women with an IUD can experience an increased duration and heaviness of menstrual flow.
How long is it safe to have an IUD fitted for?
An IUD can be left in place from 5 up to 8 years, depending on the type. After this time, it will need to be replaced with a new device.
Implant
Why does the implant have to be replaced after three years?
The implant contains a progestogen reservoir which is released in tiny doses during the three years to prevent pregnancy. It will need to be replaced after this time as the hormone reservoir will run out.
Can you feel it or see it from the outside?
The implant is about the size of a thin match, and people usually have it inserted under the skin of their left upper arm, not far above the elbow. It can easily be felt, but it is not very visible, except to someone who is looking for it. There will be a tiny mark at the point of insertion, but this isn’t very visible providing the implant has been inserted by a trained healthcare professional.
Is it safe to have if you play a lot of sport or could exercise cause the implant to move out of position?
Movement of the implant is very rare, even with vigorous exercise, and is not known to be serious. If you cannot feel the implant where it was originally positioned, then speak to a healthcare professional to ensure it is located and repositioned if necessary.
Will the hormones affect my periods?
Many women find that heavy, painful periods are reduced. There can sometimes be irregular bleeding particularly initially, but this may go after the first few months. For some women frequent bleeding persists.
Is the implantation procedure painful?
Local anaesthetic is used so there should be very little pain, and the procedure takes only a couple of minutes. There might be a bit of bruising or soreness afterwards.
What if I don’t want it anymore, can it be easily removed?
Yes, the implant can be removed at any time, but this must be done by a trained healthcare professional.
Injection
Do I have to go to hospital for the injections?
The injections must be given by a healthcare professional. Depending on where you live, you can have the injection done at your local doctors or family planning clinic.
What if I miss an injection – will I get pregnant?
You do need to have the injection once every three months. The amount of hormone which is injected to prevent unintended pregnancy will only last around 12 weeks, so if you miss an injection you will not be protected against pregnancy.
How many injections can you have?
If you are sexually active and do not currently wish to have children, you can continue having the injections to protect against pregnancy, providing you find the method suits you and you have regular check-ups with your healthcare professional.
What if I want to have children, will the injection affect my long-term fertility?
Periods and fertility may take up to 18 months to return after stopping injections and this may vary from woman to woman.
Does the injection make you fat?
Some women do experience weight gain, if this happens to you, speak with your healthcare professional, it may be that an alternative form of hormonal contraception is better suited to you.
Vaginal Ring
What do I do if the ring falls out?
If the ring falls out, it should be rinsed off and replaced as soon as possible. If it has been out
for less than three hours, you should still be protected against pregnancy. If it has been out for
more than 3 hours, a back-up method of birth control is needed for the next seven days. The
ring must stay in for at least 7 more days after being out for longer than 3 hours; this may
mean that you wear it for more than 21 days in total that month. Following this, a one-week
ring-free interval can occur and the next ring inserted.
What do I do if I forget to take the ring out?
If it has been in for less than 28 days then remove it, and have a seven-day ring-free interval,
then insert the next ring. You are still protected against pregnancy. If the ring has been in for
more than 28 days, remove it immediately, insert a new ring and use a back-up method of
birth control for the next 7 days. You may have irregular bleeding, or no period that month.
What do I do if I forget to insert the ring after the week’s break?
Insert the ring as soon as you remember and use a back-up birth control method for 7 days. If
you have unprotected sex after the ring has been out for more than one week, consider using
emergency contraception. You should not have more than 7 days without wearing a ring as this
puts you at risk of getting pregnant. Talk to your doctor if you are unsure.
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