This article was written by one of The Food Medic team; London-based GP Dr Nirja Joshi.
Considering that over half of the population will most likely need to use some form of contraception it’s a really important conversation to have so that people feel better informed of what choices are available to them. We realise this topic can be quite overwhelming but hopefully this article will help shine some light on a huge topic and give you a simplified overview of what contraception options are available to you.
What is contraception?
Contraception, also known as birth control, is a method to prevent pregnancy (1) – although hormonal contraception may be taken for other reasons such as managing heavy periods and acne. However for the purpose of this article we are going to be focusing on the use of contraception for the prevention of pregnancy . Contraception,, is mostly ‘female dependent’, in that it relies on a woman to be involved in using a particular method of contraception, however, it is important for men to be aware about the different methods as well.
Where can I get contraception from?
Your GP or local sexual health clinic is the best place to start when thinking about contraception. There are some special cases such as emergency contraception, and now the progesterone only pill, which you may be able to obtain from pharmacies (2).
I am under 16 can I get contraception?
This is a really important question. Yes, you can. The important thing to note, is that if you are young, or considered vulnerable, it will be part of normal practice for the clinician to ask you more detailed questions about your sexual history. This is to ensure your safety, so it is important to be honest in these consultations (3).
Which method will suit me?
Women have a lot to think about when choosing a contraceptive method. The factors which come into play can include your age, your medical history, your medications, whether you smoke, your family history and your body mass index (BMI) (3). Your clinician will help guide you as to what may be best suited to you if you are unsure. In addition, it is important to think about how reliably you may be able to remember taking a tablet, or when you may want to plan a family. The last thing to always consider, is that aside from condoms, contraceptive methods do not provide protection against sexual infection. If you have a new partner or multiple partners, consider using condoms as an additional method to reduce the risk of sexual infection (4).
This type of contraception is creating a physical barrier between the sperm and the egg. This includes, most commonly, the condom but also includes diaphragms and caps. Condoms are 98% effective as contraception with correct use. The difficulty is, that most people do not use condoms as they should be, or throughout sexual intercourse (4). Condoms offer the benefit of also reducing the risk of sexually transmitted diseases which other methods of contraception do not offer (4). If you would like to refresh yourself on the correct use of a condom, please find more information here
There are two main types of contraceptive pill, which vary depending on the hormones present in each pill.
The combined contraceptive pill has oestrogen and progesterone (5). This form of contraception was traditionally taken for 21 days with a 7 day break, in which you would have a breakthrough bleed. More recently, guidelines have changed so that you would be able to take 3 months of this pill ‘back to back’, which would mean that you would not have a bleed for that time (5). It is more effective in terms of contraception as people forget to take their pill and also can be better for those who suffer with heavy bleeding or period pain, as it reduces the number of periods you would have in a year, and the bleeds you have may be lighter and less painful (5).
The combined pill can be very beneficial for individuals, particularly those who suffer with conditions such as endometriosis. It is less helpful for those who may forget to take a pill, or those with certain medical conditions such as migraine with aura, history of blood clots or certain cancers (5).
The progesterone only pill is a type of pill which should be taken every day without a break (6). The bleeding pattern can vary between individuals, but most commonly, patients become concerned about unscheduled bleeding (6). The progesterone only pill can cause irregular bleeding which can be concerning if you have not had that before. This is helpful if you are worried about knowing when to take breaks and restart pills, or if you’re not able to take oestrogen due to a medical condition or a medication you are taking (6).
Studies looking at depression and hormonal contraception have found conflicting results however, mood changes are often reported as reasons to stop certain types of contraception. We really need more research here to better understand the link between hormonal contraception and depression – if you do think your contraception is impacting your mood, speak to your GP. There is no evidence to show that the combined pill causes weight gain, however, it can cause an increase in appetite which can, in some people, lead to weight gain (5).
Long acting contraception
Sterilisation is possible for both men and women. Most people consider this as an option once their family is thought to be complete. It is important to consider the sterilisation procedure as irreversible. And hence consider all possibilities e.g. if you were to leave your current relationship and start a new one, would you never want children again? This is a difficult situation to consider, but it is certainly important. It will be normal procedure to have counselling before having either male or female sterilisation (9).
Male sterilisation occurs as a day procedure under local anaesthetic. It means that the man’s tubes which carry the sperm, are cut and hence sperm should not be able to travel into semen (8). Female sterilisation is more invasive than male sterilisation. It involves surgery, generally keyhole surgery (laparoscopy), to tie the woman’s tubes (fallopian tubes), to prevent the egg from reaching the womb (9). It is important to consider the risks e.g. general anaesthetic, internal bleeding and infection risk (9).
When people think about the coil, they may get confused as there is more than one type. In this article, we will concentrate on the two main types of coil, copper (non hormonal), and Mirena (hormonal).
A coil is a small plastic device which is placed in your womb via your cervix. Imagine the procedure much like a smear test, then the device is inserted into your womb. The consultation and procedure take around half an hour (10). It is advisable to take some pain relief before the procedure, and plan to keep activities light for the rest of the day.
The copper coil can remain in situ for 5 to 10 years. The main side effects reported are that periods can become heavier or more painful for the first 6 months (10). It is a great option for women who are not keen on hormonal contraception or are unable to take hormonal contraception.
The hormonal coil (Mirena), can remain in situ for 5 years (11). It releases hormones locally in the womb which has a direct impact on the womb lining, by keeping it thin. This means that as well as contraception, a lot of women benefit from using the Mirena coil to help with heavy or painful bleeding. Some women may not have periods at all when using the Mirena coil (11).
The coils can be removed at any time if you choose to. It is important to know that prior to having a coil, it is normal to have a consultation and ensure that you are not pregnant at the time of coil fitting. To ensure this, you may be asked to use an alternative method until your coil fitting to mitigate this risk (10).
The implant can be fitted within a half an hour appointment, and will last as contraception for 3 years (12). It releases a progestogen and it is a small matchstick size rod which is placed in your upper arm. Local anaesthetic is used to insert the implant, and you may have some tenderness or bruising at the site of insertion (12). The implant can be removed at any time. Some women may get irregular bleeding, and others may have no bleeding at all, some women may experience mood swings or worsening of acne (12).
There is a contraceptive injection which can be given at your local GP or sexual health clinic. The injection lasts 13 weeks (13). This is really helpful if you do not feel that taking a pill each day is for you, and you might want something longer term, but for months not years.
The implant and the injection have a similar side effect profile to the progesterone only pill, in that it can cause unscheduled bleeding, but it also carries a risk of thinning of the bones if used over a prolonged period of time, this is particularly important if you are under 18 or over 45 (13).
There are other methods too
There are other methods too (1) such as a vaginal ring, contraceptive patch, diaphragms and natural family planning which we have not covered in today’s article, but please have a look at this link if you would like to learn more: https://www.nhs.uk/conditions/contraception/
If you have had unprotected sex, and are not covered otherwise by contraception, you may need to take Emergency Contraception if you don’t wish to get pregnant (EC). EC comes in two main forms, tablets and an intrauterine device (7).
The most effective method of contraception at any point in your cycle is an intrauterine device, sometimes known as an IUD or copper coil (7). This is a small device which sits in your womb, and can stay in for up to 5 years. It does not contain any hormones and works by irritating the lining of your womb which prevents a pregnancy from implanting (7).
This would involve a visit to a sexual health clinic, or in some cases, your GP, who could insert the IUD which can work in terms of emergency contraception as well as provide ongoing contraception for several years.
The other main form of EC is generally known as ‘the morning after pill’ (7). This is because this tablet is generally taken as soon as possible after sexual intercourse. Which type of pill you are offered will depend on several factors; when you are likely to have ovulated, whether you’ve taken EC already in the same cycle and how long after sexual intercourse you are seeking the pill. With both of the main options on the market, the sooner you take the pill, the more effective it is at preventing pregnancy. You can obtain this EC from a GP, a sexual health clinic, or your pharmacy may offer it as well (there may be a charge for this).
After taking the morning after pill, you may have unscheduled bleeding, and some abdominal cramps. If you would like to be certain that the EC has worked, you are advised to take a pregnancy test 2-3 weeks following the unprotected sex (7).
Have you just had a baby?
If you are looking for contraception after giving birth, please have a look at this link for further information on when it is safe to start a particular method, and whether it is suitable with your medical history and breastfeeding: https://www.nhs.uk/conditions/contraception/when-contraception-after-baby/
It is important to remember that there are lots of choices with regards to choosing the best type of contraception for you. In practice, a lot of women base their knowledge on what has worked well for their friends, but it is important to consider factors such as when you might want to have a baby, your periods, how reliably you feel you could take tablets or whether a procedure would suit you.
Please do ask others about their experience, but keep in mind, every woman’s experience of a type of contraception is different, and sometimes, it is worth trying a method to see if it works well for you. If you have any questions about your individual situation, do consult your GP or sexual health clinic.
- National Library of Medicine. Birth Control [Internet]. 20220317 [cited 2022 Mar 20]. Available from: https://medlineplus.gov/birthcontrol.html
- Medicines and Healthcare products Regulatory Agency. First progestogen-only contraceptive pills to be available to purchase from pharmacies [Internet]. 20210708 [cited 2022 Mar 20]. Available from: https://www.gov.uk/government/news/first-progesterone-only-contraceptive-pills-to-be-available-to-purchase-from-pharmacies
- NHS. Getting contraception [Internet]. [cited 2022 Mar 21]. Available from: https://www.nhs.uk/live-well/sexual-health/getting-contraception/#:~:text=Contraception%20services%20are%20free%20and,the%20information%20and%20decisions%20involved.
- NHS. Condoms [Internet]. 2020 [cited 2022 Mar 25]. Available from: https://www.nhs.uk/conditions/contraception/male-condoms/
- NHS. The Combined Pill [Internet]. 2020 [cited 2022 Mar 25]. Available from: https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/
- NHS. The Progesterone Only Pill [Internet]. 2021 [cited 2022 Mar 25]. Available from: https://www.nhs.uk/conditions/contraception/the-pill-progestogen-only/
- NHS. Emergency Contraception [Internet]. 2018 [cited 2022 Mar 17]. Available from: https://www.nhs.uk/conditions/contraception/emergency-contraception/
- NHS. Vasectomy (male sterilisation) [Internet]. 2021 [cited 2022 Mar 20]. Available from: https://www.nhs.uk/conditions/contraception/vasectomy-male-sterilisation/
- NHS. Female sterilsation [Internet]. 2021 [cited 2022 Mar 18]. Available from: https://www.nhs.uk/conditions/contraception/female-sterilisation/
- NHS. Intrauterine device (IUD) [Internet]. 2021 [cited 2022 Mar 24]. Available from: https://www.nhs.uk/conditions/contraception/iud-coil/
- NHS. Intrauterine system (IUS) [Internet]. 2021 [cited 2022 Mar 26]. Available from: https://www.nhs.uk/conditions/contraception/ius-intrauterine-system/
- NHS. Contraceptive Implant [Internet]. 2021 [cited 2022 Mar 27]. Available from: https://www.nhs.uk/conditions/contraception/contraceptive-implant/
- NHS. The contraceptive injection [Internet]. 2018 [cited 2022 Mar 27]. Available from: https://www.nhs.uk/conditions/contraception/contraceptive-injection/