Contraception
Contraception is the term used when discussing how to prevent a pregnancy. There are a number of methods of contraception - different methods suit different people at different times in their lives. They all have advantages and drawbacks and some are more effective at decreasing the chance of pregnancy than others. Note that certain forms of contraception – the barrier’ methods using a condom or cap can also help prevent the spread of many sexually transmitted infections.
When you do not wish to become pregnant it is important to think about what method might be most suitable, Some people think that ‘withdrawal’ (taking the penis out of the vagina before ejaculation) is a method of preventing a baby – this is just not the case. As soon as the male becomes aroused sexually and there is the beginning of stiffness in the penis, then sperm can appear. It is even possible to make a baby by rubbing the hard penis on the outside of the woman’s entrance or labia and not even putting the penis inside the vagina.
'Natural family planning' (timing intercourse to coincide with times in the monthly cycle when you are least likely to conceive) is used by some couples but its success depends on very close monitoring of a number of characteristics (eg. waking temperature) and it is not very reliable – especially for young people (since sperm are found on the tip of the penis as soon as it is erect).
> Condoms
> The Pill
> Progesterone Only Pill or 'Mini Pill'
> Contraceptive Injections
> Contraceptive IUD (intrauterine devices / coils)
> Intrauterine System (IUS)
> Contraceptive Implants
> Emergency Contraception Pills
>
Emergency Intrauterine Devices
> Male and Female Sterilisation
> Natural Family Planning
There are a number of websites which give excellent information about contraception - Family Planning Association, Brook Advisory Service, Patient UK.
Birmingham NHS Walk-in Centre (Mon-Sat 8am-6pm, Sunday 11-5pm)
The walk-in centre provides confidential healthcare advice and treatment for a wide range of minor illnesses and injuries such as: coughs; colds; flu-like symptoms; minor cuts and wounds; contraception advice – emergency contraception; services for adolescents – health issues, spots, drugs, alcohol, sex and periods, health checks etc.
Brook Advisory Service 0121 643 5431 (Mon: 10am-6pm Tue-Fri: 11am-6pm Sat: 10am-4pm)
Brook offers a comprehensive sexual health service including: contraception, emergency contraception, pregnancy testing, chlamydia testing, cervical smear tests, terminal referrals and free counselling. Disabled access is provided and interpreters are available.
Note that this service is only available to the under-25s.
Family Planning Clinics (Heart of Birmingham Primary Care Trust)
The Family Planning Clinics provide advice, contraception, chlamydia screening, advice on sexually transmitted infections, pregnancy testing, menopause counselling and HRT advice. Clinic times and locations are available here and a map of the Birmingham services also available.
Sexual Health and Contraception Helpline 0845 310 1334 (Mon-Fri 6am-6pm)
The Family Planning Association (FPA) run this helpline advising on contraception, sexually transmitted infections and pregnancy choices (including pregnancy planning and abortion). They also hold a comprehensive database of all family planning personnel in the UK and can refer you to other services.
Condoms
Male condom (sheath): Made of very thin latex or polyurethane this lubricated barrier fits over the man’s erect penis and prevents pregnancy by stopping the sperm meeting the egg. If used properly it is 98% effective and is also very good at preventing sexually transmitted infections. (more information)
Female condom : This is put inside the vagina, which it lines, and is held in place by a ring at either end. It prevents the spread of sexually transmitted infections and drastically decreases the chance of pregnancy (95% effective if used properly). (more information)
The Pill
The combined contraceptive pill (the pill, COC) works by altering the body's hormones so that an egg is not released from the ovary - it contains two hormones called oestrogen and progestogen. It also changes the mucus in the neck of the womb so that sperm find it difficult to move towards the egg and causes a thinning of the womb lining. The result is that, when taken properly and regularly, the pill is 99% effective.
It is an excellent method of contraception for many women but there are some who will be unable to use the COC. Women with some types of migraine, raised blood pressure, a history of thrombosis are some examples. (more info)
Progesterone Only Pill or 'Mini Pill'
The mini pill works by thickening the mucous plug in the neck of the womb and so preventing sperm from reaching the inside to fertilise the egg. One type of mini pill also works by stopping ovulation so that no egg is released. When taken reliably the mini pill is an excellent method of contraception at 99% effective. (more information)
Contraceptive Injections
The contraception injection is a progestogen hormone method that is given every 12 weeks (DepoProvera) or every 8 weeks (Norethisterat). It is a very reliable method, preventing 99% of all pregnancies that might have occurred but does need you to remember to attend for the injection at regular intervals. It works by preventing ovulation so that there is no egg to fertilise and also by altering the mucous plug in the neck of the womb to prevent sperm reaching up the genital tract. The injection can cause irregular periods or in many users no periods at all. It is not recommended as a first choice of contraception in young teenagers and older women near the menopause because of some concerns about its possible effect on bones. However, because it is so reliable and other methods may not be suitable, it is regularly given in these age groups. (more info)
Contraceptive IUD (intrauterine devices / coil)
An IUD is a small plastic device covered with copper which when placed in the womb acts as a very effective contraceptive. It works by making the inside of the womb’ unfriendly to the egg and sperm such that they are unable to survive. The coil is fitted by a trained doctor or nurse – an instrument in inserted into the vagina (just as when a smear is taken) and the neck of the womb, the cervix, is seen. The coil is then slipped through a plastic tube directly into the womb. Coils can be used by women and girls who have not had children as well as those with a family. It can be a little uncomfortable at the time of the fitting but simple pain relieving tablet will usually control the period like pain that some women feel. It is a very safe and effective method of contraception – it even works better than sterilisation in the first few years after insertion. Coils last between 3 and 10 years and in the older woman may be left longer to cover the time of the menopause.(more info)
Coils do not prevent sexually transmitted infections and this is important to remember. Before a coil is fitted the doctor or nurse will ask you about your risk of having an STI and offer to test you for infection. This is a wise precaution. If you have a coil and meet a new sex partner it is always wise to use a condom as well.
The IUD is very simple to remove by your doctor or nurse –we usually avoid the second half of the menstrual cycle. Just a quick tug on the threads should remove the device through the cervix.
Some GPs and practice nurses with special training fit the IUD at the surgery. You may also contact a GP Surgery who fits IUDs to patients who are registered elsewhere and they will be able to help (an Enhanced Service Practice). For more information about GPs providing such services near you, see our GP page. You can also obtain a coil from a family planning clinic or for those under 25 at Brook.
Intrauterine System (IUS)
The IUS is like a coil but is different in being coated with the hormone progestogen. It is fitted into the womb in a similar way to the IUD by a trained doctor or nurse and works as a contraceptive for 5 years. Mirena is the only device currently available in the UK. It works by thinning the lining of the womb, altering the mucous to make the environment unfriendly to sperm and it also affects ovulation – some women do not ovulate with a Mirena in place. This is a very effective method of contraception at over 99% in other words 1 women in every 100 will become pregnant every year. (remember that if you take 100 women who do not use contraception then 80 of those women will become pregnant within 1 year)
The Mirena is easy to insert by a trained doctor or nurse Some GPs and practice nurses with special training fit the Mirena at the surgery. You may also contact a GP Surgery who fits the IUS to patients who are registered elsewhere and they will be able to help (GPs providing these services are those who off ‘Enhanced Service in Implants’)
You can obtain an IUS from a family planning clinic or for those under 25 at Brook. (more information).
Contraceptive Implants
An ‘implant' (often known as Implanon) is a small flexible rod which releases progestogen and prevents pregnancy by stopping the release of eggs and thickening the vaginal mucus. The device is quick and easy to insert – a small injection of local anaesthetic is given to the inner part of the upper arm and then the rod is painlessly slipped under the skin through a needle. The rod cannot be seen after insertion but can be felt with the end of your finger. Fitting takes about 5 minutes – most of this time is spent waiting for the anaesthetic to work! Side effects are those of any contraceptive which is based on a ‘progestogen type of hormone’. The periods may become irregular or disappear or unusually some patients have a small amount of continuous daily loss. It is a highly effective contraceptive and last for 3 years but must be inserted and removed by a trained doctor or a nurse. Removal may take a little longer than insertion and is also carried out under local anaesthetic. Implanon offers no protection from sexually transmitted infections (STIs). (more info)
Where can you obtain an Implant? Some GPs and practice nurses with special training fit the device at the surgery. You may also contact a GP Surgery who fits Implants to patients who are registered elsewhere and they will be able to help. All these GPs offer an ‘Enhanced Service for Contraceptive Implants’. Alternatively, you should contact a local family planning clinic or if you are under 25 contact Birmingham Brook. (more information)
Emergency Contraception Pills
This emergency contraceptive pill (containing a large dose of progestogen which is in the ‘mini-pill’) can be used up to 72 hours (3 days) following unprotected sex. We know that the emergency pill also works up to 120 hours from when you had unprotected sex but is less reliable with time. It works by stopping ovulation, fertilisation and implantation of the egg. This can be used if another contraceptive method fails (eg. condom splitting) or if no contraception is used at all. The sooner after unprotected sex this pill is taken, the greater are its chances of preventing pregnancy. (more info).
It is safe to have more than one dose in a month but do remember that this is not a method of regular contraception – it is for emergency use only. There are no absolute reasons why you should not take it – women with blood pressure problems, diabetes and so on can take the emergency pill.
Where can you obtain the emergency contraceptive pill? You can buy the emergency pill over the counter at your pharmacist – he/she may charge a fee of around £22 but some pharmacies are able to give you a free supply. The emergency pill is also available from Boots Walk in Centre, Birmingham Brook in those under the age of 25, your local GP Surgery and a family planning clinic. Calthorpe Clinic also provide this service. Remember – the sooner the better!
If you are too late for the emergency contraceptive pill (over 72 hours) or may wish to have a longer term method of contraception you should consider having an emergency IUD fit. The coil is more effective than the emergency pill and does not need to be taken out when, as you hope, your period arrives and you are not pregnant.
Emergency Intrauterine Device
An IUD (see above) can be fitted up to five days after unprotected sex or up to five days after when it is calculated you would probably have ovulated (lost an egg from the ovary). It works by preventing fertilization and implantation of the egg – it does not cause abortion under UK law. This is an almost 100% effective method of emergency contraception and you should seriously consider this method if it is very important not to conceive. The coil can then be safely removed, or left as long term contraception if you wish. (more info).
Where can you obtain the emergency IUD? A local GP Surgery may be able to offer this service if they fit IUDs. You could contact Birmingham Brook in those under the age of 25, or a family planning clinic will be able to help more info. Remember – the sooner the better!
Male and Female Sterilisation
In men this process is known as a ‘vasectomy’ in which the tubes carrying sperm are blocked or cut in a minor operation. It is a safe minor operation which is carried out by a trained surgeon who may also be a GP. It is very reliable and works in almost 100% of people receiving a vasectomy. (more information)
Female sterilisation involves blocking of the fallopian tubes using Filshie clips in a more serious operation than male sterilisation, which often requires a general anaesthetic. Although a permanent method of contraception it is about 99.5% effective but it fails in 1 in 200 of cases. This is because the tubes can grow back together and a pregnancy can then occur. There is a trend against female sterilisation because there are other methods now available that work just as well and do not carry the risks of an operation into the abdomen and an anaesthetic. (more information).
Sterilisation is a permanent method of contraception which offers no protection from sexually transmitted infections. (more info)
Natural Family Planning
Natural family planning is about preventing a pregnancy through knowledge of the woman’s menstrual cycle. It depends on understanding when she is mostly likely to be fertile and avoiding intercourse during that time. Using body temperature, the state of mucous secretions and a knowledge of ovulation (most women ovulate 12 to 16 days before their expected period, an estimate of fertility can be made. Some women find this quite effective but it should be remembered that it is possible to ovulate at any time in the menstrual cycle – even during the period! Other methods exist including 'Persona' (a test measuring hormone levels). (more information)
