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Understanding SRH

Contraception

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What is contraception?

Contraception refers to anything that is used to prevent pregnancy. Without the use of contraception, sex usually results in sperm fertilising an egg, which can lead to pregnancy. While pregnancy and having children can be an important part of life for some people, not everyone is ready or able to have children! Contraception is also referred to as family planning, birth control or protection.

It is important to note that not all contraception methods prevent you from sexually transmitted infections or diseases (STIs and STDs). To read more about STD prevention, click here.

Abstinence means choosing not to have sex. Abstinence can be a great choice for young people as it is 100% effective in preventing pregnancy and also sexually transmitted diseases.

To read more about abstinence, click here.

Who should use contraception?

Contraception should be used by anyone who has penetrative vaginal sex but doesn’t want children. It is important to remember that most types of contraception, other than condoms, offer no protection against sexually transmitted infections (STIs)). People who have sex that can’t result in pregnancy, like oral sex or men who have sex with men, don’t need contraception but still need protection from STIs!

There are many different types of contraception available and it’s important to choose what is right for you. It is helpful to read about the options available and talk to your doctor about what is the best method for you. Here is some brief information to get you started.

When choosing the type of contraception you want to use, there are a few important things to consider:

  • Reliability: What is the risk of a particular method resulting in accidental pregnancy?
  • Price: Some methods are free, others can be quite costly. This should be considered when you are choosing what suits your needs best.
  • Reversibility: Some methods are temporary and your fertility will return to normal after you stop using the contraception. With some other methods it may take weeks to months to return to normal fertility.
  • Accessibility: Some methods require access to a doctor semi-regularly for insertion, prescriptions or check-ups whereas others can be used without the assistance of a doctor/nurse.

Contraception is an important part of having a healthy discussion about safe sex, which anyone engaging in sexual activity (that could result in pregnancy) should be having. It is the responsibility of all partners involved to make sure contraception is discussed when necessary, but the decision is ultimately made by the person who will be using the contraceptive device on their own body.

Types of Contraception

Type How does it work? Positives Negatives Important Information Common Side Effects
Condoms Provide a barrier to the sperm entering the vagina Protects against sexually transmitted infections
Readily available
Chance of breaking Always check the use-by date

88-98% effective
Unsuitable if you have a latex allergy, latex free condoms available from pharmacies.
Combined oral contraceptive pill Estrogen and progesterone pill is taken for 3 weeks with one week of placebo pills, prevents ovulation, alters lining of the womb, thickens cervical mucus. Non-invasive

Simple instructions to follow

Fertility returns quickly after stopping the pill
Have to take the pill everyday, can be expensive

No STI protection
Tablet taken daily

93-99% effective (lower if not taken correctly)
Changes in mood, headaches
Intra-uterine hormonal device A device in the uterus releases a low dose of progesterone. Thickens mucus outside the cervix and alters the lining of the womb Effective for 5 years

Only requires self-checking threads once a month

Often reduces period flow significantly (in 95% of women)

Fertility returns immediately after removal

Safe during breastfeeding
Need to see a doctor to insert & remove the device

No STI protection
This method requires a small device to be placed inside the uterus, through the cervix. This can be done in a doctor's office or under anaesthesia.

99.5% effective
Irregular bleeding

Cramping pain after insertion (2-3 days)

Device may fall out (rare)

1/500 risk of causing a break in the wall of the uterus during insertion, usually heals without further problems.
Intra-uterine copper device Device inside the uterus changes the lining of the womb and prevents the sperm and egg from meeting Effective for 5-10 years

Fertility returns immediately after removal

Safe during breastfeeding
Many women report heavier bleeding with the copper IUD

No STI protection
This method requires a small device to be placed inside the uterus , through the cervix. This can be done in a doctor's office or under anaesthesia.

>99% effective
Irregular bleeding

Cramping pain after insertion (2-3 days)

1/500 risk of causing a hole in the uterus during insertion

Device may fall out (rarely)
Implant device (Implanon) Device in the arm releases a low dose of progesterone, Thickens mucus outside the cervix and alters the lining of the womb. Lasts for 3 years

Safe during breastfeeding

Fertility returns quickly after removal
Need to see a doctor to insert the device

No STI protection
Small plastic device inserted underneath the skin in the arm. The procedure takes ~10-15mins

>99.95% effective
Irregular bleeding, mood swings, weight gain
Progesterone only contraceptive pill (mini-pill) Progesterone pill taken at the same time daily, thickens cervical mucus. Safe in breastfeeding

Fertility returns quickly after stopping the pill
Have to take the pill at the same time every day

No STI protection
Tablet taken daily

93-99% effective (lower if not taken correctly)
Irregular bleeding, mood swings, headaches
Contraceptive vaginal ring (Nuva-ring) Ring inserted into the vagina, releases progesterone to thicken cervical mucus and oestrogen to prevent ovulation Local hormone effect only

Safe in breastfeeding

Fertility returns quickly after the ring is removed
Expensive

Device needs to be refrigerated

Some women may find the device uncomfortable

No STI protection
Soft plastic ring inserted in a similar way to a tampon

Each ring lasts 4 weeks

Can be left in during sex or taken out

May be ineffective if left out for more than 24hr

Can interact with other medications (consult with your doctor)

93-99% effective
Irregular bleeding, sore breasts, mood changes, skin changes
Depot injection Injection of progesterone, thickens cervical mucus No maintenance needed between injections Fertility may take some months to return after stopping the injections

No STI protection
An injection into the arm every 3 months

99.5% effective
Irregular bleeding, weight gain, decreases bone density (long term use)
Vasectomy (male) A minor surgical procedure to block the tubes which carry sperm Permanent Requires surgery, dependent on cooperation of male partner

No STI protection
Requires a test to prove the procedure has worked

99.5% effective

Permanent
Minor risk of infection or bleeding from surgery
Tubal ligation (female) A minor surgical procedure to block the tubes through which the egg travels to the uterus Nil changes to menstrual cycle, no medication/device required Requires surgery

No STI protection
>99% effective

Permanent
Minor risk of infection or bleeding from surgery
Emergency contraception (“morning-after pill”) Used when there is a risk of pregnancy in the last 72 hours. This pill should be taken as soon as possible after having unprotected sex for the best chance at preventing pregnancy.

Insertion of the copper IUD can also be used as emergency contraception
Readily available at most pharmacies Can be expensive

No STI protection
85-99% effective (dependent on timing) Failure to prevent pregnancy, irregular bleeding
Withdrawal Removing the penis before ejaculation No medication or devices required Not very effective, high risk of pregnancy

No STI protection
Removing the penis before ejaculation

80-96% effective

This method requires cooperation and communication between both partners
Fertility awareness/cycle tracking Tracking the menstrual cycle to work out which days of the month ovulation occurs. By not having sex on “fertile days”, when ovulation occurs, pregnancy is less likely to occur. No medication or device required No STI protection Variably effective (76-88%)

Apps available on smartphone, highly variable between individual people
Breastfeeding When some women breastfeed they don’t have menstrual periods for that time. That means that ovulation doesn’t occur and pregnancy won’t result.

This method is highly variable between women.
No device or medication required No STI protection 98% effective only if:

your baby is exclusively breastfed (no other food)

AND

you haven’t had a period since delivery

AND

your baby is less than 6 months old

If any of the above is not the case, this method is not effective

Using Natural Forms of Birth Control

Other “natural” forms of birth control that don’t require medicine or devices include withdrawal, fertility awareness and breastfeeding.

Some women may elect to utilise “cycle-tracking” in order to prevent pregnancy. This can be done via a number of different apps available on a smartphone. However, please note that this method has a high failure rate (i.e. pregnancy could result) and is not recommended by health providers for those seeking effective contraception.

The above is a list of commonly available contraceptive methods but all methods may affect individuals differently. It is important to consult your doctor to find the most appropriate contraceptive option for you. Some women find they need to trial a few different methods before finding one that works best for them.

The below references have been used to compile this information, and each website contains useful information sheets about the above mentioned contraceptive methods.

References

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