Oral contraceptives (the pill)
Oral contraceptives are those that you take in the form of a pill. There are two main types:
- the combined pill, which contains the hormones oestrogen and progestogen
- the progestogen-only pill, which contains progestogen only
There are lots of different types and brands of combined oral contraceptive pills that are licensed in the UK including, for example Microgynon 30®, Loestrin 30® or Rigevidon®. They differ by the types and amounts of progestogen and oestrogen they contain.
The progesterone-only pill (POP) is also known as the ‘mini pill’. Different types and brands include:
- Norgeston® – contains a type of progestogen called levonorgestrel
- Noriday® and Micronor®– contains a type of progestogen called norethisterone
- Cerazette®, Aizea®, Cerelle® Feanolla® and Nacrez® – these all contain a type of progestogen called desogestel
Different types of oral contraceptives are suitable for different people. Your nurse or GP will discuss these with you to help work out which one will be best for you.
The contraceptive patch is a combined form of contraception meaning it contains both oestrogen and progestogen. In the UK, Evra® is the only licensed combined contraceptive patch. The patch is beige and measures 20cm2 (smaller than the average post-it note). You stick it onto your skin and each day it releases hormones, which go through your skin and into your bloodstream.
Contraceptive vaginal ring
Again the vaginal ring is a combined form of contraception containing oestrogen and progestogen. In the UK, NuvaRing® is the only licensed combined contraceptive vaginal ring. It’s made from a flexible, see-through material and measures just over 5cm from one side to the other.
The contraceptive injection only contains the hormone progestogen. There are three types of progestogen-only contraceptive injections that are licensed in the UK. The most common is Depo-Provera®. Others include Sayana Press® and Noristerat®, although the latter is now rarely used.
The implant is also a progestogen-only form of contraception. In the UK there’s only one brand of contraceptive implant that is currently licensed – Nexplanon®. The implant is a flexible plastic rod – about the size of a matchstick, which is inserted underneath the skin on your upper arm.
Contraceptive intrauterine system (IUS)
An IUS is a small plastic T-shaped device, which your GP or nurse inserts through your vagina and into your uterus. The IUS releases a set amount of progestogen hormone (levonorgestrel) each day. In the UK, there are three different brands of IUS available: Mirena®, Levosert® and Jaydess®.
Barrier methods – condoms, diaphragms and caps
Barrier methods include both male and female condoms, contraceptive diaphragms and caps.
There are lots of types and brands of male condoms. You put the condom over the penis before having sex. They come in different shapes, sizes, textures and colours. However, there is only one brand of female condom available in the UK – Femidom®. Female condoms are placed into the vagina before sex.
There are two different types of contraceptive diaphragms. Coiled spring diaphragms and arcing spring diaphragms. Before you have sex you place the contraceptive diaphragm up through your vagina so that it sits over your cervix. Arching spring diaphragms fold in two places, which make them easier to insert. They’re also useful if your vaginal muscles are weak. Coiled spring diaphragms have a softer spring, so may feel more comfortable.
Contraceptive caps are similar to diaphragms, but are slightly smaller. They come in three different sizes. If you use a diaphragm or cap you should use a spermicide with it. The only licensed spermicide in the UK is Gygel®.
Contraceptive intrauterine device (IUD)
IUDs are similar to the IUS (above). However, rather than releasing a progestogen hormone they contain copper, which has the contraceptive effect. There are lots of different types and brands of copper IUDs available in the UK. The ones that can be left in your uterus for a long period of time (long-acting IUDs) are preferable. This is because they’ll need to be removed and replaced less often.
Natural family planning
Natural family planning includes:
- the fertility planning method
- the lactational amenorrhoea method (this method can only be used after childbirth)
Natural family planning is about working out how fertile you are at any given time, so you can plan when to, or not to have sex to reduce (or increase) your chances of becoming pregnant. However, it’s not seen as a particularly reliable form of contraception.
Emergency contraception is used to stop you becoming pregnant if you’ve had unprotected sex (sex without using some form of contraception). In general, the sooner you use it the more effective it is. There are both hormonal and non-hormonal types. Emergency hormonal contraception includes:
- Levonorgestrel – a progestogen-only form of contraception such as Levonelle®One Step and Levonelle®1500
- Ulipristal acetate – such as ellaOne®
The copper IUD can be used as a non-hormonal form of emergency contraception.
Sterilisation is a permanent form of contraception. There are two types of operation to sterilise either a man or woman.
- Vasectomy for men.
- Tubal occlusion for women.
Combined oral contraceptives
Combined oral contraceptives mainly work by stopping your ovaries from releasing an egg (ovulation). They also have an effect on the mucus in your cervix and the lining of your womb (endometrium). This prevents sperm from reaching the egg and prevents a fertilised egg implanting in your womb if ovulation occurs.
Progestogen-only forms of contraception work in a similar way. However, some women continue to ovulate while taking them. If you do, the other effects, for example on the lining of your womb and cervical mucus help to prevent conception.
Barrier methods – condoms, diaphragms and caps
Barrier methods, in particular male and female condoms, stop you getting pregnant by creating a barrier that sperm cannot cross. They also create a barrier to female cervical secretions, and so protect against some sexually transmitted infections (STIs).
Diaphragms and caps do not protect against STIs. They sit over your cervix and block semen from entering your womb. Semen is the greyish white bodily fluid that contains sperm and is expelled from a man’s penis during ejaculation. You use diaphragms and caps with a spermicide to kill the sperm and further prevent an egg becoming fertilised.
Contraceptive intrauterine device (IUD)
Copper in IUDs is toxic to the egg (ovum) and sperm and so prevents fertilisation. An IUD might also work by stopping a fertilised egg from implanting in your womb. IUDs can be used up to 120 hours (the equivalent of five days) after unprotected sex as emergency contraception.
Natural family planning
Natural family planning involves working out how fertile you are, or your partner is, so you can work out when you are least (or most) likely to get pregnant if you have unprotected sex. The fertility planning method involves monitoring signs of fertility. It’s not a very effective form of contraception. For more information, see our section: How do I use my chosen contraceptive?
How levonorgestrel works isn’t fully understood, but it’s thought that it mainly works by inhibiting ovulation (ie it stops your ovaries from releasing an egg).
Ulipristal acetate works by inhibiting or delaying ovulation.
For information on the copper containing IUD, see above.
Sterilisation in both men and women works by obstructing the natural path of the male and female sex cells (sperm and egg). In women the fallopian tubes are closed during a surgical procedure (tubal occlusion). During a vasectomy the vas deferens is closed. This is the tube that takes sperm, which is made in the testis, to the ejaculatory duct where it is then expelled from the penis via the urethra during sex.
Oral contraceptives (the pill)
Most contraceptive pills come in a calendar strip. With the combined pill, you should take one pill at the same time each day for three weeks (21 days). This is then followed by a seven-day break.
There’s no break with the progestogen-only pill. You should take one pill at the same time each day.
Taking your pill at the same time each day will help you to get into a good routine and hopefully avoid missing pills. Try setting an alarm on your mobile phone, or strap your pill pack to your tooth brush with an elastic band as a reminder. If you do miss a pill, consult the patient information leaflet that comes with your medicine, or contact your pharmacist, nurse or GP for advice. For some types of progestogen-only pills it’s really important that you take them at the same time each day, as even a three-hour delay can reduce how effective they are.
Your GP or nurse will tell you how to start taking the pill and what to do if you miss one. The advice will be different depending on which oral contraceptive you’re prescribed.
On the same day each week for three weeks, you’ll need to stick one patch to a clean, dry, lotion-free, healthy (ie not red or broken), hairless area of skin. You can stick the patch to the outer part of your upper arm, upper torso (but not your breasts), lower tummy (abdomen) or bum. Once you have applied the patch for three consecutive weeks (on day one, eight and 15), take a break on week four (days 22–28). Remember to change where you stick the patch each week to prevent your skin from becoming aggravated.
For more information on when to start using the patch, speak to your nurse or GP. If you delay starting a new patch, consult the patient information leaflet that comes with your patch, or speak to your pharmacist, nurse or GP for advice.
Contraceptive vaginal ring
You’ll need to talk to your GP or nurse about when to start using the vaginal ring. On the day that you start, you’ll need to place the ring high up into your vagina. You might need to pinch it between your thumb and forefinger. It may also help if you squat, lie down or put one leg up. Once the ring is in place, leave it there for three weeks. It’s a good idea to check regularly that the ring is still in place as it may come away from your vagina:
- if it isn’t inserted properly in the first place
- when you remove a tampon
- during sex
- if you’re constipated
After three weeks, you’ll need to remove the ring by hooking it out with your finger, break for seven days and then insert a new ring to start the cycle again.
For more information about contraceptive vaginal rings or what to do if you delay starting a new ring, consult the patient information leaflet that comes with your contraceptive vaginal ring or speak to your pharmacist, nurse or GP for advice.
A health professional will give you your contraceptive injection. How regularly you have the injection will depend on the type. You have Depo-Provera® (the most common injection) every 12 weeks. It’s injected into either your upper arm or bum. Sayana Press® is given between every 12 and 13 weeks. It’s a subcutaneous injection meaning that it’s injected into the fatty layer just underneath your skin. You’ll have the injection in the front part of your upper thigh or abdomen.
A healthcare professional, who has been specially trained, will insert the implant just below the skin into the inside part of your upper arm. The implant can be left in place for up to three years, but you can have it removed whenever you want.
Contraceptive intrauterine system (IUS)
A specially trained healthcare professional will insert your IUS. When it’s inserted there’ll be two loose threads. These are used to remove the IUS at a later date. You should check the threads regularly to make sure the IUS is in place. Your GP or nurse will discuss with you how to check your threads and what to do if you’re unable to feel them. You’ll usually need to have it checked around six weeks after it has been fitted. You’ll have further check-ups, but this will depend on the type of IUS.
You can keep the IUS in place for between three and five years, depending on which type you have. You’ll need to have the IUS removed by a trained healthcare professional. You can have it removed at any time. It’s important to read the patient information leaflet that comes with your chosen form of contraception. If you’re unsure about anything or want more information, talk to your GP or nurse.
Barrier methods – condoms, diaphragms and caps
Barrier methods of contraception are put in place before sex and removed afterwards. Male condoms are put over the penis, whereas the female condom is placed into the vagina.
Always make sure that the condom is within the use-by date and that you use a new condom each time you have sex. Don’t use spermicides or oil-based lubricants with male condoms as they can destroy the latex, causing them to fail and increase your chance of getting pregnant or catching certain STIs.
Diaphragms and caps are quite similar. If you’re using a cap or diaphragm, you put it up into your vagina before you have sex, so that it sits over your cervix. You can put it in place up to three hours before you have sex.
You should use a spermicide with your diaphragm or cap. For more information on how to apply it to your diaphragm or cap, read the patient information leaflet that comes with the spermicide.
You should leave the diaphragm or cap in place for six hours after you’ve had sex. Overall, you should only leave a diaphragm in for a maximum of 30 hours and caps for 48 hours.
You can reuse your diaphragm or cap, but make sure you wash it after you’ve used it with a mild unscented soap, dry it properly and keep it somewhere cool. Always check for wear and tear and replace your diaphragm if needed.
Contraceptive intrauterine device (IUD)
IUDs are used in a similar way to IUSs (above), except they can be left in place for between five and ten years.
Natural family planning
The fertility planning method involves monitoring signs of fertility.
- Your body temperature. Your body temperature rises slightly after ovulation until your next period (menses). You can usually have sex without additional protection three days after the rise in temperature until you have your period.
- How wet your vagina is. Vaginal wetness is due to secretions from your cervix (the neck of your womb). Cervical secretions indicate that you are in a fertile stage of your cycle. You are especially fertile when the secretions are wet, clear and stretchy (a bit like raw egg white). Your fertile period usually ends four days after the last day that you notice these wet, clear and sticky secretions.
- How long your cycle lasts over a set amount of time (usually 12 cycles). This can help you to work out the earliest (first fertile day) and latest time (last fertile day) in your cycle. Your first fertile day is the number of days in your shortest cycle minus 20. And the last fertile day is the number of days in your longest cycle minus 10. So if your shortest cycle is 27 days and your longest 33, your fertile window is between seven and 23 days. If you don’t want to get pregnant, you should use another form of contraception during this time. If your cycle is regularly between 26 and 32 days long, you can use the Standard Days method ®. This is when you avoid sex from days eight to 19.
There are also devices that measure the level of certain hormones in your body. Don’t rely on any of the above indicators alone; use them in combination to have the best chance of accurately predicting when you are least (or most) fertile.
The lactational amenorrhoea method is the other method of natural family planning. If you’ve just had a child and are breastfeeding, this suppresses ovulation for around six months. Some people choose to use this time as a form of natural contraception.
These methods aren’t very reliable, so make sure you speak to your GP or a family planning nurse before trying any of them.
Emergency contraception should be used as suggested in an emergency, eg if you had sex without using adequate contraception. It is available from your GP practice, and contraception, sexual health and young people’s clinics. You can also get some emergency contraceptives from your local pharmacy.
Read the patient information leaflet that comes with your emergency contraception and follow your nurse or GP’s advice on how to use it.
Both male and female sterilisation involves having an operation (see above: How they work for more information). The operations are permanent. You won’t be able to have children, so there’s no need to use any other form of contraception going forward. If you have a vasectomy, however, you’ll need to have a test around 12 weeks after your operation to make sure there’s no sperm before you rely on it for contraception.
Contraception and contraceptive advice should be accessible to all men and women in the UK, and is available from your local GP practice, contraceptive or sexual health clinic or a young people’s service.
Which type of contraception is most suitable for you will depend on your own personal situation and circumstances. You should discuss these with your GP or nurse to make sure you have the correct form of contraception for your needs.
You may not be able to have certain combined hormonal contraceptives if you:
- are over 35
- are obese
- have, or are at risk of venous thromboembolism (VTE)
- smoke, or have recently quit
- have, or have had breast cancer
- have problems with your liver
- have migraines with or without aura
- have heart disease
- have high blood pressure
- have diabetes with certain complications
If you’re having surgery, you might need to stop taking or using certain types of combined hormonal contraception four weeks before your procedure. You can usually go back to using it two weeks after you’re fully mobile again.
If you become pregnant while using hormonal contraception, including the combined oral contraceptive pill, the patch, vaginal ring, progestogen-only pill, implant or injection, there’s no evidence that it will harm you or your baby. But, if you’re using the contraceptive vaginal ring, progestogen-only pill, IUS, IUD or implant, be aware that there might be a possibility of ectopic pregnancy. If you find out that you’re pregnant, stop using or taking your contraception. If you have an IUS or IUD fitted, you should see your GP immediately for advice.
When deciding which form of contraception to use, there are lots of things for you to consider. For example, whether there are any side-effects or complications associated with your chosen method of contraception and how effective it is. You should be able to find this information in the patient information leaflet that comes with your contraceptive.
Here we’ve outlined some things to consider. But for more detail, or if you are unsure about anything, ask your nurse or GP.
Some types of hormonal contraception can cause side-effects, including:
- changes in your bleeding patterns – all types of hormonal contraception can cause this
- breast tenderness – this is mainly associated with combined hormonal contraception, including the pill, patch and vaginal ring, and progestogen-only forms of hormonal contraception including the pill and intrauterine system
- weight gain – this is usually associated with the contraceptive injection onlyM
- acne – certain IUSs and implants can cause acne; however, it can get better over time and some types might even improve acne if you have it
- discomfort or pain when it’s injected or inserted – this is associated with the contraceptive injection, implant, IUS or IUD
There aren’t many side-effects associated with non-hormonal contraceptives. Some people are allergic to the materials used to make them, eg latex used in male condoms. You may also be more likely to get a urinary tract infection (UTI) if you use a diaphragm, but in general that’s about all.
Some types of hormonal contraceptives are associated with certain complications.
- Increased risk of ovarian cysts. Ovarian cysts are associated with the progestogen-only pill and IUS; however, they are usually reversible.
- Increased risk of cervical cancer. All types of combined contraceptives (the pill, patch and vaginal ring) and the progestogen-only injection can increase your risk of cervical cancer. Your risk usually increases the longer you use these types of contraception, but will return to normal with time when you stop using them.
- Increased risk of breast cancer. It’s possible that your risk of breast cancer increases with some progestogen-only forms of contraception, including the pill, implant and injection, and all types of combined hormonal contraception. After stopping the contraception, with time your risk will return to normal.
- Decrease in bone density. The contraceptive injection can decrease something called your bone mineral density if you use it for more than a year. This usually goes back to normal after stopping the injection. Although the mineral in your bone may have decreased, there’s no evidence that it makes you more prone to fractures.
- Increased risk of pelvic inflammatory disease. Although the risk is low, this is linked to the insertion of an IUD or IUS.M/li>
- Increased risk of ectopic pregnancy. If you use your contraception correctly, it’s unlikely that you’ll become pregnant. But if you do and are using the progestogen-only pill, IUD or IUS, there’s a greater risk than with other forms of contraception that your pregnancy may be ectopic. This is when a fertilised egg implants outside of your womb. If you use these types of contraception, the risk of having an ectopic pregnancy is, however, lower than if you have sex without using some form of contraception and become pregnant.
- Increased risk of venous thromboembolism (VTE). VTE is where a blood clot forms in one of the large veins, usually in one of your legs, and can sometimes break off and travel in your blood stream to your lungs. The risk is associated with all combined forms of contraception, but is very low. The risk can change depending on the type of combined contraceptive and the progestogen it contains. Although low, the risk is seen to be higher with the patch and vaginal ring than with the pill. Overall, however, the risk of VTE is lower than if you were to become pregnant.
The risk of these complications is very low and will also depend on which hormonal contraception you’re using. These risks might also be lower than if you were to get pregnant. If you’re worried or would like more information about these complications, speak to your nurse or GP.
With all forms of contraception there’s a risk that they won’t be effective – how great this risk is will depend on the type of contraception that you’re using. For more information read the patient information leaflet that comes with your contraceptive, or speak to your nurse or GP.
Hormonal contraceptives can interact with other medicines, which reduce how well they work. This includes some epilepsy medicines, certain antibiotics and antivirals, and herbal products that contain St. John’s wort. The contraceptive injection and IUSs aren’t affected by these, but the medicine used in the emergency contraceptive ellaOne® (ulipristal acetate) can affect their efficacy. As well as being used in some emergency contraceptives, ulipristal acetate is also sometimes used to treat severe symptoms of uterine fibroids.
Your partner shouldn’t be able to feel your IUS or IUD during sex. However, they might be able to feel the threads that are attached to it. If the IUD or IUS is uncomfortable for you or your partner during sex, see your GP or nurse. They can cut the treads shorter.
The withdrawal method involves the man withdrawing his penis, during sex before he ejaculates. It’s not that reliable as there’s a risk that the man won’t withdraw in time and also that sperm may leak out of the penis before ejaculation.
Unless there’s a reason that a particular form of contraception isn’t suitable for you, you can continue to use it for as long as needed – age alone isn’t usually a problem. However, if you’re over 50, your doctor might want you to switch to a different type. For more information, speak to your nurse or GP.
If you don’t want to get pregnant you should use contraception until you have your menopause. Your menopause is when you stop having periods and can no longer get pregnant. Your GP can advise which type of contraception to use. If you’re using non-hormonal methods of contraception, the general advice is to use contraception until a year after your last period if you’re over 50, or two years if you’re under 50.
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Reviewed by Laura Blanks, Bupa Health Content Team, February 2017
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Next review due February 2020
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