Contraception: the ins and outs

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Contraception: the ins and outs

  • Varsity Living
    Varsity Living

    Did you know that there are 15 methods of contraception available to you?
    Don’t worry if you didn’t – an overwhelming 92% of us are unaware of the range of options available. Different methods suit different people – there is no one-size-fits-all with contraception. That’s why it’s important to explore the best option for you with your nurse or GP. There is a contraceptive out there to suit your lifestyle. So, for example, if you keep forgetting to take the pill, you may want to find a method that doesn’t rely on your memory. Here’s a run-down of the 15 methods that might suit you better.
    Your chosen contraception protects you against pregnancy, but don’t forget, using condoms and contraception together is the only way to protect yourself and your partner against both unintended pregnancy and STIs.
    If, after reading this article you have further questions, then please ask in the sexual health forum or speak to your nurse or GP. For further information on contraception see the FPA information guide

    a. Condoms

    What?
    You’d think it obvious, no? But some people still don’t realise that condoms are the only form of contraception that actively protect against pregnancy AND STDs including HIV.

    Where?
    They are relatively expensive in shops, but can be obtained for free from your local family planning clinic. They can also be obtained for free at various places around universities and colleges where they are given away for free.

    Why Worry?
    There’s no need to be embarrassed about buying condoms. Personally, I think people ought not to have this stigma if they’re actually doing the right thing by getting condoms. If you are too embarrassed to be buying them – sex ought not to be on the agenda. But anyway…!
    Condom boxes always carry leaflets explaining the how/when/why aspects, so there’ll be no step by step right here.

    Do’s and Dont’s of Condoms:
    Always check the use by date. A condom that is out of date is not an effective one.

    Check that they are European and have been certified. There should be a mark on the packaging. Cheap and often unsafe imports are around.

    Open the foil package with your fingers, not your teeth. Do this gently so that you don’t risk damaging it

    Check the condom is intact

    Hold the teated end and roll it on

    Dispose by firmly holding the shaft, and sliding it off

    Tie a knot in the end and dispose in a BIN. They do not flush down toilets

    Dispose of them before going to sleep, condoms do go pop when you stand on them

    No, its not funny to put one over your head

    • Condoms are not made for recycling

    • Wearing two does not improve your chances of preventing pregnancy and STDs. In fact, the friction makes them more likely to tear

    • You can also get femidoms, which are a condom alternative to be worn by women. I personally think they’re really good, as I have had issues using regular condoms in the past and the newest sort don’t rustle like it is commonly thought. They can be really useful for couples who don’t like using regular condoms.

    b. Oral Contraceptives
    Basically, pills contain two hormones, oestrogen and progestogen. They stop the production and release of eggs from the ovary. [it’s easier to think they “trick” your body into thinking it’s pregnant if you get confused] They also thicken your cervical lining to make it harder for sperm to get anywhere near your womb [that’s why you might have them fall right back down after sex – nice.]
    Pills are based on 28 day cycles. Sometimes you’ll get 21 pills in a pack with an instruction to take all of them then take 7 pill free days for a bleed. Some contain 21 “active” pills and 7 sugar pills just to serve as reminders.
    You may have heard of the mini-“pop” pill. This contains only one hormone – progestogen. Taking this pill lowers the side effects that you can get from taking the 2 hormone contraceptive pills, but it is also less effective at preventing pregnancy. The other disadvantage to most POPs is that they need to be taken at the same time each day (within a 3 hours window) in comparison to combined pills where the window is 12 hours.
    Another mini-pill that is more commonly used is Cerazette. It is progestogen only but gives you the 12 hour window. Unfortunately, it is difficult to predict the side effects of this pill but approximately one third will stop having periods all together, another third will have periods but far less frequently than previously and the final third can end up having no effect to their periods, or constantly bleeding. Cerazette is taken every day (all the pills are active) and there is no pill-break like you have with combined pills.
    When you get your pill, you generally start it on the first day of your period for instant protection. However, if you start it on another day, mid cycle or whatever, make sure you use other forms of contraception [ie condoms] for at least seven days. When starting the pill for the first time, you ought to take it on the first day of your period. This protects you from pregnancy immediately. If you take your pill at exactly the same time each day, you’re likely to get up to just-under 100% effectiveness. Effectiveness lessens when you don’t take it within the same hour each day.
    You can take packs back-to-back. I’d only really recommend you do this if you have to for holidays or exams or whatever, but I wouldn’t take more than 3 packs in a row. You can delay your period as long as you take the pills, but it is important to bleed at least 4 times a year in order to clean out your uterus and to decrease the risk of bone thinning – something which is currently being investigated in relation to birth control.

    ⎫ Missing Pills
    The leaflet in you pack details what to do if you miss a pill, however, here’s a quick rundown.
    If you have missed one pill – don’t freak out. Take it as soon as you remember – even if you’re taking it the next day at the same time as the pill for that day. If you want to be super careful, take extra precautions such as the condom for the next week.
    If you have missed more than one, especially near the beginning or end of your packet, you ought to use extra protection during sex. If you’ve already had sex without a condom, consider emergency contraception.

    ⎫ The pill can generally be affected by
    Diarrhoea and vomiting Antibiotics Epilepsy medication St Johns Wort – which can interfere with more than just the pill, actually. Definitely consult the warning label if you’re on the pill, patch, implant or injection to be on the safe side
    You should always “double dutch” [if you really want to have sex whilst you’re vomiting and having diarrhoea….(!)] if you’re experiencing the above problems. This means to use both the pill and the condom.
    Side effects:
    Side effects vary between the 23 brands available, and of course, the millions of women taking them. Here are some general ones:
    • Headache
    • diarrhoea, constipation, nausea, vomiting or abdominal pain
    • Breast tenderness/swelling
    • Spotting
    • Fluctuation in sex drive
    • Weight changes
    • Depression/mood swings
    • Irregular brown patches on the skin
    • Alteration of bleeding
    • Problems wearing contact lenses
    • Infrequent or no periods after stopping the pill

    The more serious side effects come in to play especially if you’re a big migraine sufferer or smoke. Yes, honestly, you are at a higher risk of thrombosis and clots if you are on the pill. You are also at an increased risk of breast cancer, which is why you should check your breasts monthly. Happily, the pill can protect against certain cancers of the womb and possibly the bowel. It can also help with acne.

    ⎫ Contraceptive Injections
    In England, the contraceptive injection used is generally Depo-Provera [12 weeks] or Noristerat [8 weeks]
    They both contain progestogen and therefore thicken the cervical lining and stop ovulation much like the pill.

    ⎫ Good Stuff
    The difference to the pill is that you don’t have to remember to take it every day, and also that your periods should eventually stop. Poof! Gone. [obviously the downside is this bone-thinning risk that everyone’s been going on about. If you take calcium supplements or keep your levels up with a glass of milk [as all women of childbearing ages should anyway] you should be okay]
    It also works to prevent womb cancer and pelvic inflammatory disease.

    ⎫ The Down Side
    yes. Sadly.
    If you’re experiencing side effects like headaches and skin problems, you can’t just stop them or remove the hormones from your system, because it’s been injected and will remain there for at least 8 weeks.
    Your periods may take a long while to return after you stop the injection, so bear that in mind if you’re planning babies.
    Obviously, this will not prevent STIs or anything of that sort. So condoms are to be used in conjunction until you’re sure your partner is disease free.
    You totally should not have the injection if you suffer or have suffered from:
    • cancer of your reproductive organs, [breasts/womb]
    • unexplained bleeding of vagina
    • a heart attack or stroke
    • severe depression
    • active liver disease

    ⎫ Effectiveness
    generally 99% effective. Which is rather good, thanks.

    c. The Implant
    For further information, explanation on how to get it and how it’s put in and personal experiences see The Contraceptive Implant.

    Norplant:
    The implant has been met with heavy scepticism, with one type even being taken off the listing because it caused so much scarring. It has been predominantly discontinued in South Africa. This lasts 5 years.

    Implanon:
    It’s a small, flexible tube that is about the same size as a Kirby grip, containing progestogen. It releases it steadily into the bloodstream from the comfiness of your upper arm. It lasts for three years.
    It basically does what most contraceptives in the body do; thicken mucus around your cervix, thins your uterine lining and also prevents egg release [and therefore bleeds, in time].
    When it is put in [usually first day of period], you are likely to be given a local anaesthetic, then have the implant injected. You will probably be bruised and sore for a few days. You’ll be able to feel and fiddle with it, but resist that temptation for a while! You will be protected from the word go!
    When you’re getting it removed, it is cut out. You can get another one popped in right away if you want. However, if you want it permanently removed, you must use condoms during the week before it is removed, because sperm can live inside you for 7 days, and you lost protection as soon as the implant is taken out.
    You ought to have a checkup after the first three months, then just once a year providing you’re not having problems.

    The Good Stuff
    • The implant really is the most effective form, at over 99% pregnancy prevention
    • It’s not like you have to remember to do anything!
    • It does not interfere with sex.
    • You still breastfeed
    • It is good for those who can’t take oestrogen for whatever reason
    • It can be removed if you have trouble with it, and you can get pregnant right after removal
    • It offers protection against pelvic inflammatory disease.

    The Bad Side
    • It can go a few ways; you could have irregular bleeding, no bleeding at all, or prolonged bleeding for a while. This is annoying, but it can’t harm you
    • Your usual headaches, spots, dizziness, weight gain, sore boobies
    • Very rarely, infection in the site
    • It can be difficult to remove. There have only been 2 or 3 cases of migration, though
    • Harmless ovarian cysts, with a little pelvic pain
    • Mood swings
    • No STI protection [duh]
    • Liver disease
    • Unexplained bleeding from the vagina
    • Cancer of the reproductive organs
    • Heart attacks or strokes
    Or if you could be pregnant

    d. The Patch
    This patch [amusingly] comes in three different colours, and you pick the one that matches your skin tone the best. [or whatever goes with your outfit, I guess]
    They’re about 5×5 cm, and you splat them on your upper arm, shoulder or bottom for a whole week. It should be changed on the 8th day for three weeks and then you should give yourself a patch free week. DON’T put it on your breasts or broken skin. Just don’t.
    It acts just the same as the pill, in that oestrogen and progestogen are pumped into your system, thickening the cervical mucus, and preventing egg release. You’re protected right away if you take it on the first day of your period.

    Good Side
    Protects you and stays on even when you’re a hardcore swimmer.
    You don’t need to remember to take a pill every day.
    It’s 99% effective.
    It is not affected by diarrhoea or vomiting

    Bad Side
    The patch has had its fair share of bad press recently. But it shouldn’t harm you if you’ve gone through the right channels to get it, and aren’t suffering from certain conditions/diseases mentioned below.
    Obviously there’s the obligatory risk of skin/headache problems and the fact that it will not protect you from STIs.
    You can gain or lose weight, have mood swings and get a little bit of skin irritation.
    People can see it [and say OMFG SLUT ]
    Then there’s the increased risk of certain cancers and thrombosis/clotting
    Yes, it can fall off – but you ought to be able to reapply it.
    Do not use this if:

    • you think you might be pregnant

    • you are breastfeeding

    • you smoke and are over 35
    You have or have had • thrombosis (blood clots) • a heart abnormality or circulatory disease, including raised blood pressure • severe migraines or migraines with aura • breast cancer • active liver/gall bladder disease • diabetes • unexplained bleeding from your vagina

    e. NuvaRing
    This is pretty newish, and it’s not really as mainstream over here as the pill and whatnot (it is not currently available on the NHS in the UK), but it’s a pretty novel idea. In layman’s terms, it’s a flexible ring that you put in the vagina [much like a diaphragm] and you leave it there for 3 weeks [21 days] as is the normal cycle, and then remove it for your seven day bleed. http://www.nuvaring.com can give you their lowdown on it.
    The website is pretty unhelpful when it comes to asking whether you can “run nuvarings together” as is possible with the pill. That is something you’d have to take up with your doctor.
    It contains oestrogen and progestin just like your average pill.

    Good Stuff
    You don’t have to remember a pill every day
    It’s 99% effective
    8/10 men can’t feel it during intercourse. [although I guess it sucked for the 20% who could]
    You don’t really feel it and it can’t get “lost”
    Spotting is dead rare
    It’s low dosage and steady release mean less hormonal ups and downs

    Bad stuff
    The common side effects are:
    Vaginal infections and irritation
    Vaginal discharge
    Headache
    Upper respiratory tract infection
    Sinusitis
    Weight gain
    Nausea

    The rare:

    Vomiting
    Change in appetite
    Abdominal cramps and bloating
    Breast tenderness or enlargement
    Irregular vaginal bleeding or spotting
    Changes in menstrual cycle
    Temporary infertility after treatment
    Fluid retention
    Spotty darkening of the skin, particularly on the face
    Rash
    Weight changes
    Depression
    Intolerance to contact lenses

    So it’s much like other hormone based contraceptives.

    f. Diaphragms/caps
    It is a silicone/rubber flexible dome that is inserted into the vagina before sex. It has to be left inside for about 6 hours after sex to ensure sperm cannot pass through the cervix. Spermicidal jelly must be used with it to kill any that gets past the diaphragm.
    It may be embarrassing to have one fitted, the doctor/nurse has to feel inside the vagina, to see where the cervix is, and how wide it is. Several sizes of diaphragms may be tested (placed inside you and the doctor/nurse feels around) before the right one is chosen.
    It can be inserted hours before sex – so sex does not have to be postponed whilst the diaphragm is prepared. Before sex begins, additional spermicide does need to be reinserted.

    Good Stuff
    • It protects against some STIs and is 92-96% effective against pregnancy
    • It’s good for you regardless of your medical conditions [except if you’re allergic to rubber/silicone]
    • When inserted correctly, it cannot be felt by either partner.
    • Non-hormonal.

    Bad stuff
    • You have to have it fitted by a doctor/nurse first time around.
    • It can interrupt passion.
    • You have to use it in conjunction with spermicidal jelly.
    • You have to leave it in 8 hours after sex [otherwise the little guys will fight their way in]
    • It can cause cystitis.
    • If you put on weight/miscarry/abort you have to get it refitted.

    g. The Intra-Uterine System [IUS] – Mirena
    Whilst it sounds like a hot new car feature, it’s actually a T shaped contraption that is fitted up there by a doctor or nurse. It releases small amounts of the hormone progestogen to thin the lining of your uterus so fertilised eggs cannot implant in it. It also thickens the cervical mucus to make it harder for sperm to get through.
    It’s not generally a “young persons” contraceptive device. It’s more suited to women who have had children, really, though it is possible to have one even if you have no kids. They take about 15 minutes to put in – but I suggest some painkillers before, since it can be uncomfy

    Good stuff
    • It lasts for 5 years
    • It’s 99% effective
    • It can lighten your periods [yaaay]. In fact, Mirena is commonly recommended as a treatment for heavy periods.
    • The hormone levels are low and mainly localised to the uterus, so if you have had problems with hormonal contraceptives in the past, this could suit you.

    The down side
    • It can move out of place and become less effective – so regular checkups are needed, and you need to make sure you know how to check the threads that hang down from it
    • No STI protection
    • You can get irregular bleeding, breast tenderness and skin problems at first
    • You can be subject to harmless cysts, but with a little pelvic pain
    • Occasionally infections up to 20 days after insertion can occur
    • Perforation of the womb [this is totally rare, albeit serious] and may require surgery
    • Don’t go for this if you’ve had strokes, thrombosis, cancer of your reproductive organs, or if you are currently suffering from an STD.
    • If you are very sensitive to hormones, you may still suffer from hormonal side effects – headache, mood changes, low sex drive etc – especially in the first few months after insertion
    • Your partner may be able to feel the threads during sex. If this is the case, you can have them trimmed.
    [edit]
    h. The Intra-Uterine System [IUD] – Paragard,
    Similarly to the IUS, this is a T-shaped device fitted into the uterus. Unlike the Mirena, however, it has no hormones; instead, it is made of copper which acts as a spermicide.
    It’s not generally a “young persons” contraceptive device. It’s more suited to women who have had children, really, though it is possible to have one even if you have no kids. They take about 15 minutes to put in – but I suggest some painkillers before, since it can be uncomfy

    Good stuff
    • Depending on the make you go for, it lasts between 3 and 10 years.
    • It’s 99% effective
    • No hormones, so if you’re especially sensitive to them, it might be a good choice
    • Can be fitted as emergency contraception.

    The down side
    • It can move out of place and become less effective – so regular checkups are needed, and you need to make sure you know how to check the threads that hang down from it
    • No STI protection
    • It can make your periods longer, heavier and more painful.
    • Occasionally infections up to 20 days after insertion can occur
    • Perforation of the womb [this is totally rare, albeit serious] and may require surgery
    • You may have some mild cramping and bleeding after insertion as your body adjusts.

    Other
    These are all general, reversible forms of contraception. The next step up is the more permanent solutions of vasectomies and tube tying. Tube tying itself is only 99% effective anyway, and way ahead of most of our time right now, so let’s not get into that right now.

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