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Choosing a method of contraception
There are many effective methods of contraception to choose from. Your doctor will help you to choose the right method for you, taking into account your age, whether you have had children, whether you smoke, any current illnesses and any medications you take.
Male and female condoms
The male condom is a thin tube of soft rubber that is rolled onto the erect penis and prevents sperm from entering the woman's cervix. These have the advantage of being widely available (either free or to purchase). The female condom is a soft plastic pouch that fits inside the vagina. As well as providing effective contraception, condoms help to protect against sexually transmitted infections. Solely for this protective effect, many couples use condoms in addition to another method of contraception. Condoms must be used carefully to be fully effective.
Diaphragms and caps
The diaphragm is a flexible, circular spring covered with thin rubber that fits in the vagina and covers the cervix. Diaphragms must be fitted properly by a nurse or doctor. The cap is smaller and fits neatly on the cervix. The cap also must be fitted properly by a nurse or doctor. Both devices may help to protect against some sexually transmitted infections. Diaphragms and caps must be used together with a spermicide (contraceptive jelly or cream) to be fully effective and they must be left in for at least six hours after sex.
Combined oral contraceptive pill ('the pill')
The pill is a very popular contraceptive method which is currently used by over three million women in the UK. Each pill contains two hormones, oestrogen and progestogen, which are taken each day for 21 days followed by a break of seven days, during which a withdrawal bleed or period occurs. It works by stopping ovulation (the release of the egg), making the secretions around the cervix too thick for sperm to penetrate and making the lining of the womb unfriendly for the egg. It is easy to use, does not interfere with sex and the contraceptive effect stops as soon as you stop taking it. Recently, fears about links with breast cancer and thrombosis have been raised, but the pill is a very safe method for women, particularly for those who do not smoke and who are below 35 years of age. The pill needs to be perscribed by your doctor, who will advise you on which type to take.
Progestogen-only pill ('the mini-pill')
The mini-pill contains only one hormone, a progestogen. It is taken every day without a seven-day break. It works similarly to the combined pill, but it prevents ovulation in only 40 per cent of women. Like the combined pill, it is easy and convenient. One problem is that the pill has to be taken within three hours of the usual time of taking it, otherwise the contraceptive effect is lost. It is often recommended for women who are breastfeeding. The mini-pill can be obtained from your doctor, who will discuss the different types available and which will suit you best.
An injection of a hormone called DMPA provides contraception for 12 weeks. The hormone is released gradually and prevents ovulation. It has the advantage that no further contraception needs to be used until the next injection is due. It can stop the periods altogether, which some women like, and it may help to prevent cancer of the womb. Some women find that they put on weight. The injection may take up to a year to wear off completely, so it is not suitable for women who plan to become pregnant in the near future. Your doctor will be able to advise whether this type of contraception will suit you.
Implants are a set (usually five) of small plastic tubes that are inserted under the skin of the upper arm, and can be left in place for up to five years. They release a progestogen hormone that prevents ovulation. They may cause irregular periods at first and sometimes they are difficult to remove. Implants are prescribed and fitted by your doctor.
Intrauterine device (IUD)
The IUD is a small plastic and copper device that is put inside the womb and stays in place for up to five years. The effect is to prevent fertilised eggs from implanting in the lining of the womb. It is particularly useful for women in a long-term relationship who have had children. The IUD is known to cause longer and more painful periods in some women. It is associated with infection in the womb, but this is only a problem if a woman is already at higher risk of sexually transmitted infections. In the absence of infection, it does not affect your chances of becoming pregnant after it is removed. Your doctor will discuss the suitability of the IUD with you and will fit the device if this is your choice of contraception.
Intrauterine system (IUS)
The IUS is a plastic device that is put into the womb and releases progestogen. This works in a similar way to the progestogen in the mini-pill, but without the need to take a tablet that is absorbed into the rest of the body. It makes the periods shorter and lighter and is useful for women with heavy, painful periods. However, it can be uncomfortable to insert. The intrauterine system is prescribed and fitted by your doctor.
In female sterilisation, the fallopian tubes are cut, tied or clipped so that the egg cannot travel down and meet the sperm. It is permanent and is advised only for women who have finished their families, who are usually at least in their thirties. The advantage is you never have to worry about contraception again. The failure rate for this form of contraception is very small, but it can still occur. The operation is performed under a general anaesthetic, usually as a day case.
In male sterilisation (see Vasectomy factsheet), the tube (known as the vas deferens) that carries sperm from the testicles to the penis is cut and both ends are tied off. As with female sterilisation, it is also permanent and is usually carried out only on men who have completed their families and do not wish to have any more children. Again, it is a relatively simple operation with few complications and a very high success rate.
If condoms, caps and diaphragms fail, or you forget your pill, or you do not use contraception, you can still obtain emergency contraception from your doctor. If you see your doctor within 72 hours (three days) of unprotected sex, you can have two doses of a type of contraceptive pill (the 'morning after pill'). If you see your doctor less than five days after sex, you can have an IUD inserted.
Natural methods of contraception attempt to identify the time of ovulation so that couples can avoid having sex during the time when conception is most likely. These methods include timing the menstrual cycle, taking the temperature and devices that time ovulation by testing the urine. If performed carefully, these methods can be effective.
How effective are these methods of contraception?
All types of contraception can be reliable, but the effectiveness of some methods depends on learning how to use them properly and remembering to do it. Before making a choice about your contraceptive method, discuss it fully with your doctor.
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