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Contraception

7-minute read

Contraception is the use of hormones, devices or surgery to prevent a woman from becoming pregnant. It allows couples to choose if and when they want to have a baby.

Most types of contraception don’t protect against sexually transmitted infections (STIs). The male and female condoms are the only form of contraception that help to protect against STIs as well as preventing pregnancy. Therefore, if you’re using another type of contraception, such as the contraceptive pill, you should also consider using a condom to protect yourself against getting an STI.

Types of contraception

Condoms (male and female)

Condoms are a form of barrier contraception. They prevent pregnancy by stopping sperm from reaching and fertilising an egg. Condoms also help to protect against STIs, including HIV, and stop them being passed from one sexual partner to another. Condoms are used during penetrative sex (vaginal or anal) and oral sex to protect against STIs.

Male condoms are 98% effective at preventing pregnancy when they are used correctly but with real life use, they can be less effective (88%) due to incorrect use or breakage.

Similarly, female condoms can be 95% effective at preventing pregnancy if used correctly, but in real life, effectiveness can be around 79%.

Combined contraceptive pill

The combined contraceptive pill, usually just referred to as the ‘pill’, contains synthetic (man-made) versions of the female hormones oestrogen and progesterone, which women produce naturally in their ovaries. It is quoted as being 99.5% effective if taken as per instructions. With typical or ‘real life’ use, it is 93% effective.

The pill is usually taken to prevent pregnancy but it can also be used to treat:

  • painful periods
  • heavy periods
  • premenstrual syndrome
  • endometriosis

You should not take the combined oral contraceptive pill if you have had a blood clot, or you have health conditions, including severe liver problems or are on certain medications. If you smoke, the risk of serious side effects is increased. You should not take the pill if you are aged over 35 and smoke. Always ask your doctor if this is the safest choice of contraceptive for you.

Progestogen-only contraceptive pill

The progestogen-only pill, sometimes called the mini pill, doesn't contain any oestrogen. With typical (real-life) use, it is not as effective as the combined pill because it must be taken at the exact same time every day. It is an option for women who have side effects when they take oestrogen, or who cannot have the combined pill for health reasons. This contraceptive is commonly used just after childbirth especially when a mother is breastfeeding.

Contraceptive implants and injections

Contraceptive implants and injections are long-acting, effective, reversible and progestogen-only methods of contraception. Implants are over 99% effective in preventing pregnancy and injections are 94 to 99.8% effective. Neither method protects against STIs. The injection is given every 12 to 14 weeks and the implant lasts for 3 years.

Diaphragms

Diaphragms are a barrier method of contraception used by women. They fit inside the vagina and prevent sperm from passing through the entrance of the womb (cervix). Again these forms of contraception do not prevent STIs.

Emergency contraception

A woman can use emergency contraception to prevent pregnancy after having unprotected sex, or if a method of contraception has failed. There are 2 types of emergency contraception:

  • emergency contraceptive pill (morning after pill), which contains progesterone and works by stopping or delaying the release of an egg from the ovaries (ovulation). You can get it from a doctor or from most pharmacies without a prescription. You need to take it as soon as possible, preferably within 24 hours of having sex, but it will still work for up to 5 days. It prevents up to 85% of pregnancies
  • the copper intrauterine device (IUD) (see below)

Intrauterine devices (IUD)

An intrauterine device (IUD) is a small, T-shaped contraceptive device made from plastic and copper that fits inside the womb (uterus). The IUD used to be called a ‘coil’ or a ‘loop’. It’s a long-acting and reversible method of contraception, which can stay in the womb for 5 to 10 years depending on the type. It can also be an effective emergency contraception if fitted by a healthcare professional within 5 days (120 hours) of having unprotected sex. Some IUDs contain hormones that are gradually released to prevent pregnancy. These IUDs can also be used to manage heavy periods. IUDs are 99% effective.

Vasectomy

Vasectomy or ‘male sterilisation’ is a simple and reliable method of contraception. It’s usually considered permanent and is therefore a big decision that should be fully discussed with your doctor beforehand. A vasectomy is a quick and relatively painless surgical procedure that blocks the tubes that carry sperm. It’s usually done under local anaesthetic.

Female sterilisation

Female sterilisation is an effective form of contraception that permanently prevents a woman from being able to get pregnant. Like a vasectomy, female sterilisation is a big decision that should be fully discussed with your doctor.

The operation usually involves cutting or blocking the fallopian tubes, which carry eggs from the ovaries to the womb (uterus). This prevents the eggs from reaching the sperm and being fertilised. It’s a fairly minor operation and many women can return home the same day.

Vaginal ring

The vaginal ring is a small, soft plastic ring that’s placed inside the vagina. It is removed after 21 days. Seven days later a new ring is used. A vaginal ring is about 4mm thick and 5.5cm in diameter. It contains oestrogen and progestogen, so it’s not suitable for women who can’t take contraception that contains oestrogen. Your doctor or family planning nurse will tell you the best time to put the first ring in your vagina. If used correctly, the vaginal ring is 99.5% effective but with ‘real life’ use, it is 93% effective.

When can I use contraception again after having a baby?

It’s possible to become pregnant again very soon after the birth of a baby, even if you’re breastfeeding and your periods haven’t returned. You ovulate (release an egg) about 2 weeks before your period arrives, so your fertility may have returned before you realise it.

It’s important to sort out contraception from the start. If you had your baby in hospital, you should discuss contraception with your doctor or midwife before going home. You’ll also be asked about contraception at your 6-week postnatal check, but you can discuss it at any time with your midwife, doctor or local family planning/sexual health clinic.

If you’re not breastfeeding, you can choose any type of contraception. You can start using the Pill or vaginal ring 6 weeks after you have had your baby. The contraceptive injection can be started straight after your baby is born.

If you’re breastfeeding, you can use condoms or a contraceptive implant right away. You can start using an IUD after 4 weeks, a contraceptive injection, the mini pill, a diaphragm or vaginal ring after 6 weeks.

How effective is contraception?

The effectiveness of contraception depends on factors such as:

  • your age
  • how often you have sex
  • whether you use the contraceptive correctly

Most types of contraception are over 99% effective if used correctly. This means that fewer than 1 in 100 women who use contraception will become pregnant each year. The male condom is 98% effective if it’s used correctly and consistently. It’s the only type of contraception that protects against STIs as well as pregnancy.

Where can I get contraception?

Places where you can get contraception include:

  • your doctor
  • sexual health or family planning clinic
  • pharmacy

If you're not sure which contraception option is right for you, take the quiz at Marie Stopes' site, Contraception.

Stopping contraception

You may need to change the type of contraception that you use as you get older, after having children, or if your sex life changes in any way.

Fertility usually starts to decline from around age 37, although you will still need to use contraception after this time to prevent unplanned pregnancy. Most women will have reached the menopause by the time they’re 55 years old and can usually be advised to stop using contraception around this time.

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Last reviewed: August 2020


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