Contraception

Contraception allows people to choose when and if they want to have a baby. There are several types of contraception, which work in different ways. Most contraceptives are designed for use by women. However, the male condom remains a popular choice.

Contraception is normally supplied by your doctor or by the family planning clinic. Many sexual health, or GUM (genito-urinary medicine) clinics offer contraception, including emergency contraception. Emergency contraception is also available from your GP, family planning clinics, most NHS walk-in centres (England only) and some pharmacies. You can buy male and female condoms from chemists, as well as from vending machines, supermarkets, garages and other shops.

Before recommending a contraceptive, your doctor will assess your age, medical history, and sexual lifestyle. No contraceptive is 100% reliable, and some have side effects. It is important to consider these factors when deciding what sort of protection to use.

You may need to change your contraception as you get older, after having children, or if your sexual lifestyle changes. It is worth remembering that the male condom is the only form of contraception that also protects you from sexually transmitted diseases. In all cases contraceptive methods are more reliable if used properly.

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Barrier methods

Barrier methods of contraception include diaphragms, condoms and cervical caps. They work by preventing sperm from reaching an egg by creating a physical barrier between the two. Male condoms cover the penis, female condoms line the vagina, and caps and diaphragms cover the cervix (neck of the womb). The condom offers protection against infections, as well as serious sexually transmitted diseases such as HIV.

Hormonal methods

This form of contraception affects the hormone balance in a woman’s body to stop her getting pregnant. It may be taken orally (by mouth) in the form of the combined or progestogen-only pill, in the form of an injection every two to three months, or as a contraceptive implant under the skin.

The combined pill contains both oestrogen and progestogen. These prevent ovulation (the release of an egg from the ovary each month). The mucus in the neck of the womb (cervix) becomes thicker, making it harder for sperm to reach the egg. The lining of the womb also becomes thinner, meaning that there is less chance of a fertilised egg being accepted.

The combined pill can cause side effects such as weight change and mood swings, but these often disappear after the first few months of use. It may also cause a slight rise in blood pressure, and increases the risk of heart attack or stroke. This risk is also increased in the following circumstances:

- if you have already had a blood clot,
- severe obesity,
- immobility (eg wheelchair bound),
- severe varicose veins,
- poorly controlled diabetes,
- high blood pressure,
- if you have a close family member who has had a thrombosis, heart attack, or stroke before the age of 45,
- severe migraine, or
- smoking - particularly if you are over 35.

Your doctor will consider your medical history and current state of health when prescribing the combined pill. Before you start taking the Pill, you may wish to ask your doctor about the latest knowledge regarding risks.

The progestogen-only pill has fewer side effects and risks but is less reliable. It works by thickening the mucus in the cervix (neck of the womb) to make it difficult for sperm to travel through. The progestogen-only pill does not prevent ovulation, but it often causes lighter periods and can make the menstrual cycle irregular.

Injections of progestogen are reliable and offer long-term protection. They are injected into a muscle and are usually effective for up to 12 weeks, after which another injection is given. Most women stop menstruating while they are receiving injections, although periods may be heavy and irregular at first. Injections can also cause weight gain.

Women can also have a contraceptive implant. The contraceptive implant is made up of one or more small tubes that are implanted under the skin of the upper arm by a doctor or nurse. This procedure requires a local anaesthetic and should only take about ten minutes to complete.

Implants and injections both work by releasing a steady dose of progestogen into the body. The progestogen thickens the mucus from the cervix making it difficult for sperm to reach an unfertilised egg. It may also result in the lining of the womb becoming thinner, making it unable to support a fertilised egg.

Mechanical methods

Intrauterine devices (IUDs), also known as coils, are rigid contraceptive devices that are inserted into the uterus by a doctor. An IUD works by stopping sperm from reaching the egg. It does this by releasing copper into the body, causing an increase in white blood cells in the cervix, which kill sperm. IUDs also make it harder for the egg to travel along the fallopian tubes and settle in the womb.

IUDs give immediate protection and can last for up to ten years (depending on type). The device may slightly increase your susceptibility to infections such as pelvic inflammatory disease. There is also a slight risk that it will be rejected from the uterus, or pierce the uterus and cause serious inflammation. Some types of IUD can be left until menopause if fitted after age 40.

Intrauterine systems (IUSs) are small T-shaped devices that are made of plastic and contain the hormone progestogen. They stop sperm fertilising an egg and make the womb lining unsuitable for implantation. IUSs are inserted into the uterus and start to work as soon as they are in place. They can last for up to 5 years but can be removed at any time. If they are fitted in women who are over 45 years of age, they can be left until after the menopause.

Surgical methods

Surgical contraception, or sterilisation, is an operation that can be performed on both men and women to make you infertile. It is suitable only for those who are certain they do not want to have any more children. Male sterilisation (vasectomy) is not immediately effective, and a condom must still be used until an analysis shows there is no sperm left in the semen.

Natural methods

Natural birth control does not affect the body, but is the least reliable form of birth control. It involves working out when the woman is fertile and avoiding intercourse at these times. It requires a regular menstrual cycle and is most effective in a long-term relationship.

Emergency contraception
Emergency contraception is used to prevent pregnancy occurring after unprotected sex has taken place, for example when usual contraception has failed or has not been used. If you have had unprotected sex within the previous three days, you will be prescribed an emergency pill that should be taken as soon as possible. In some cases, you may be given two pills that should be taken together as a single dose. Alternatively, an IUD may be inserted, depending on the dates of the unprotected sex and your last period.

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