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Contraception

Information on female hormonal contraception options available in the UK

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Dr Hilary Jones discusses the different contraceptive methods.

Contraception has revolutionised the way people think about sex, allowing many to stay protected from sexual infections and prevent unwanted pregnancies. In particular hormonal contraceptives are now widely considered as the most effective form of female contraception to prevent pregnancy, and they offer other benefits as well such as alleviating menstrual cramps and controlling acne breakouts.

Below, we provide further information regarding each hormonal contraceptive option as well as emergency contraceptive options and additional advice you may need. Alternatively, if you wish to obtain your preferred method, you can start the free online consultation with one of our registered doctors and receive the pill within 24 hours.

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What is contraception?

Contraception refers to techniques or devices that prevent conception. Since ancient times, men and women have practiced contraceptive measures, Coitus interruptus (otherwise known as the 'withdrawal method'), for example. is widely considered to be over 2000 years old and is mentioned in ancient religious texts. Still practiced by many couples today, it does not guarantee protection against pregnancy, and offers no protection against STIs.

Whilst women for thousands of years have used what they considered to be effective forms of contraception in the form of pastes and fruit acids inserted into or rubbed on the vagina, clinically tested female hormone contraceptives ('combined contraceptives') were not commercially introduced until the 1960s.

As of 2015, 76% of UK women use contraception and it is most commonly available as hormonal protection that has a whole other host of benefits as well.

How effective is contraception?

Female contraception is proven to be one of the most common and effective ways to prevent pregnancy. Reliable and safe, if used correctly, all types of contraception treatments are proven to be more than 99% effective.

Condoms, for example have a 98% efficacy rate in the male form and 95% in the female.

menstrual phases

Types of contraception

What contraceptive methods are currently available? There are 15 different types of contraception available with the vast majority of them being suitable for use by women. This makes contraceptive methods very versatile and tolerable:

Combined pill* Mini pill* Condom (male) Condom (female)
Contraceptive Patch* Diaphragm The Implant Contraceptive Injection
Vaginal Ring* Intrauterine system (IUS) Intrauterine device (IUD) Cervical Cap
Spermicide Contraceptive Sponge Sterilisation Emergency contraception*

Hormonal contraception is the most popular choice for many women, as it comes in various forms, including the 21-day mini-pill or the contraceptive patch, to provide you with ultimate peace of mind and it is convenient to take.. Whilst the contraceptive pill is the most popular, there are also natural contraception options available such as the fertility awareness method (FAM), another name for natural family planning (NFP), that those unable to take hormonal contraception can discover. You can also compare the different methods of contraception method that suits your body as well as your lifestyle.

For more information about family planning and contraceptive assistance, you might like to look at Brook [1] , the sexual health service for young people, or the Family Planning Association website [2] .

*Sold at HealthExpress

Fertility awareness method (FAM)

Fertility awareness methods (FAM) work by figuring out when a woman is in the most fertile phase of her monthly cycle, and then avoiding unprotected sex during this period.

If the right methods are followed, natural contraception can be up to 99% effective. Some of the things that you're required to do are:

  • Monitoring body temperature
  • Monitoring secretions from the cervix
  • Monitoring the length of your menstrual cycle

It can take three to six monthly cycles to learn the methods sufficiently.

Natural family planning (NFP)

This is another name for FAM natural contraception, and involves the same methods, and offers the same protection percentages. Natural contraception is perfect for couples that don't want to use chemicals, hormones, or use physical devices.

It's important to remember that only barrier methods of contraception such as condoms can offer protection against both sexually transmitted infections (STIs) as well as pregnancy. For more information on any of these types of contraception, see our 'How to take contraception' section.

Which type of contraception do I choose?

Dependant on lifestyle choices and/or hereditary conditions, certain contraceptive methods may not be suitable for you. Luckily, it is not too difficult finding one that works. Try our contraceptive tool below for more clarity on the type of contraception that may work best for you. It is then best to seek the advice of a professional before taking or using a hormonal contraceptive for the first time, or if you are changing to a new contraceptive. Alternatively, a repeat prescription can be reordered at the doctors, or here online to save you the time and convenience.

It's good to have a clear idea on the wide range of contraception available to you before visiting your GP. Many are used to prescribing the same pill, and may not offer the full range of options, especially if you're not clear yourself which would be best for you. Having a thorough understanding of what ingredients or benefits each type of hormonal contraceptive offers will enable you to make the best choice, but ultimately the doctor will know which is safest for your use.

Also note that certain contraception after childbirth can affect breast milk and isn't advised. More information on pregnancy and breastfeeding on hormonal contraception can be found at the 'What precautions to take with contraception' section.

Contraception Tool

How does hormonal contraception work?

Hormonal contraceptives essentially all work the same way in preventing pregnancy, and are equal in effectiveness, however each method differs on how it is taken detailed further below.

Contraception Preventing sperm from reaching the egg Blocking the reproductive function in the form of sterilisation Preventing an egg from being released Preventing a fertilised egg from reaching the uterus

Mini pill vs the combined pill – what are the differences?

The main difference between the combined oral contraceptive and the mini pill is that the combined pill contains two hormones (progestogen and oestrogen) and the mini-pill contains only progestogen.

The mini pill is taken for the full 28 days of your cycle with no seven-day break, as opposed to most combined pills, which are taken for 21 days. The mini pill is a more suitable alternative for women who are sensitive to oestrogen.

Combined pill Mini-pill
Examples Yasmin, Dianette & Microgynon Micronor, Noriday & Cerazette
Effectiveness > 99% > 99%
Use Once a day for 21 days with seven day break Used everyday for 28 days with no break
How it's administered Orally (Tablets swallowed with water) Orally (Tablets swallowed with water)
Ingredients Oestrogen and progestogen Progestogen
Main Benefits - Contraception
- Can help regulate periods and help minimise the severity of PMS symptoms
- Contraception
- Can minimise the severity of PMS symptoms - Can be taken by most women who can't take the combined pill
Main side effects Headache,
breast tenderness,
changes in menstrual bleeding,
migraines,
unwanted hair growth
Spotting,
irregular periods,
changes in menstrual bleeding,
unwanted hair growth
Who shouldn't take it Pregnant women,
breastfeeding women,
migraine sufferers,
women who weigh over 14 stone,
women with high blood pressure,
women using other contraceptives
Pregnant,
women who weigh over 14 stone,
women using other contraceptives

By missing a pill or two, effectiveness can be significantly reduced and there is a greater risk of pregnancy.

Does the patch or ring work differently to the pill?

All contraceptive methods work the same way in terms of preventing conception once the synthetic hormones are in the system; the only difference is the way they're applied. For example, the patch is placed on your skin and is applied once a week whilst the ring is inserted in the vagina for 3 weeks before a break. These can be better options if you tend to frequently forget taking oral medication such as the pill.

Benefits of using hormonal contraception?

Hormonal contraception is mainly used to prevent pregnancy. In fact, the FPA have said that 8 out of 10 women in the UK may have fallen pregnant if they hadn't use a form of contraception. It is proven to provide around 99% effectiveness if used properly for women looking to avoid conceiving until they are ready to, making that the main benefit for most women.[4] However, there are few other secondary benefits why a woman might be prescribed hormonal contraception:

  • Painful periods – During your period, chemicals called prostaglandins can cause some of the pain you experience including cramping. Hormonal contraception controls and reduces the amount of this chemical your body excretes, reducing cramping and discomfort.
  • Heavy and long periods – Women lose on average 2 tablespoons of blood each month. For those that lose more, it can be very distressing and leads to anemia. Not only will your periods become shorter but lighter too.
  • Unpredictable menstruation – Contraception give the woman reliability for the time of the month, especially if they are prone to being erratic.
  • Endometriosis – Going on the pill helps control the amount of uterine tissue that clings and builds up around your ovaries. Fallopian tubes and other parts of the pelvic cavity. Not only does this improve long-term effects such as fertility, but it also helps alleviate the short-term symptoms.
  • Acne – Women have a small level of testosterone, which can often be the cause of acne and other skin problems. Using contraception adjusts this balance leaving you with clearer skin.
  • Polycystic Ovary Syndrome – PCOS directly affects the hormonal imbalance causing inconsistent and sometimes painful periods as well as excess facial hair and weight gain. Using hormonal contraceptives can controls many symptoms associated with.
  • Pelvic Inflammatory Disease - If PID isn't monitored and controlled, it can lead to infertility down the line. By using hormonal contraception, the progestogen present makes it difficult for the disease to flourish.
  • Can reduce the risk of certain cancers – The risk of developing ovarian and endometrial cancers are significantly reduced whilst taking the pill and the ring.

Although these hormonal contraceptives are only prescribed for contraception purposes, your doctor may deem any of the above conditions as a necessary enough reason to provide a contraceptive method.

  • Reduced period pain

    Hormonal contraception controls and reduces the pain caused by prostaglandins reducing cramping and discomfort.

  • Heavy and long period reduction

    Hormonal contraception can make periods shorter and lighter also.money.

  • Reduced risk of endometriosis

    Hormonal contraceptive help to control the amount of uterine tissue that clings and builds up around the ovaries

  • Treat PID

    If pelvic inflammatiory disease is not monitored or controlled, it can lead to infertility. The use of hormonal contraception can help make it difficult for the disease to flourish.

  • Improved skin appearance

    Certain contraceptive pills can help women who suffer from acne due to hormone imbalance.and discomfort.

  • Treat PCOS

    Polycystic ovary syndrome can affect the hormones causing painful periods, excess facial hair and weight gain. Hormonal ontraceptives can help to control manyassociated symptoms.

  • Regular menstruation

    contraception can provide more menstrual regularity, especially if they are prone to being erratic.

  • Reduced risk of certain cancers

    Hormonal contraceptives can reduced the risk of developing ovarian and endometrial cancers.are prone to being erratic.

How to use contraceptive methods

There will be specific instructions for each type of contraceptive, and perhaps for each pill too. For example, the combined pill have a couple of options that work like the mini pill, needing to be taken for 28 days with 21 active pills and 7 inactive pills. Whilst you can head to our specific pages dedicated to the combined, mini, ring and patch for usage instructions, here is a quick review:

Combined – The majority of combined contraceptives last for three months (three pill packs) containing 21 pills following by a 7-day break where you'll experience a withdrawal bleed like a period. Then you start the next pack and repeat the process. Some combined pill options contain 28 pills per month, but 7 are "show pills" and you will still experience a withdrawal bleed. You need to take at a similar time everyday for them to be effective.

Mini – The mini pill, also known as the POP pill, contains 28 pills in each pack that should be taken in the right order. Each pack is clearly labelled so you don't forget and you're usually offered a course of three months. Most will experience a withdrawal bleed.

Patch – The contraceptive patch (Evra) is applied once a week at around the same time for three weeks with one patch free week, working in the same way as the combined pill. However, you only have to remember it three times per month so is popular with women who like to forget about taking their contraception.

Ring – The vaginal contraceptive ring (NuvaRing) is inserted into the vagina once a month. Once inserted, you can forget it is there for 21 days before removing and experiencing a ring free week and withdrawal bleeding.

Implant – Only a trained medical professional can fit you with the implant, which reduces room for error. It is no bigger than a matchstick and releases hormones into your bloodstream. Once inserted, it won't move for three years and will need to be taken out by your doctor. You can then have the new implant contraception fitted at the same time.

Barrier protection – Most commonly referred to condoms or dental dams. Dental dams are purely used for oral whilst condoms are for penetrative sex. Whilst it isn't advised to use condoms as your sole method of contraception, they are the only form that can protect against STIs.

Diaphragm – Not the most popular method of contraception as it requires some effort to insert and remove. It is still 92-96% effective and can be kept in for 30 hours before needing too be removed.

Injection – The contraceptive injection is similar to the implant and must be administered by a medical professional. It releases the hormones directly into your bloodstream and is often injected into your bottom. Like the pill, it all be over 99% effective if used on the first day of your period, up to five days after if not. It can last up to 13 weeks.

Intrauterine Device (IUD) – Before inserting the IUD, also known as the coil, you will need an examination to judge what size is needed, and it is also advised to get fully tested for STIs. The insertion is similar to a smear test and can take around 15-20 minutes. This can be uncomfortable and lead to cramping, but many women who use the IUD then don't need to worry about contraception for 5-10 years.

Cervical Cap – This option is extremely similar to a diaphragm. You can insert yourself before sex and is 92-96% effective.

Spermicide – Available in many different forms including gel, cream, foam and suppositories, spermicide can be included in conjunction with condoms, the cervical cap or a diaphragm. They can be used alone, but they are far more effective used with other contraceptive options.

Contraceptive Sponge – The sponge should be squeezed once before inserting, with clean hands obviously. This activates the spermicide and it can be worn for up to 30 hours before removing. If used correctly, it is 91% effective although generally not offered to those who have had children before.

Emergency Contraception – More commonly known as the 'morning after pill' in the UK there are two types; Levonelle and EllaOne. Both are most effective when taken as soon after unprotected sex as possible.

Preventing pregnancy is the main aim of contraceptive use, however it's important to note that they aren't an effective form of protection against STIs. Barrier methods such as condoms offer the best defence against most sexually transmitted infections and should be considered in addition to hormonal contraception if you are uncertain about the health of your sexual partner(s).

What do I do if I forget to use contraception?

If you forget to use a condom, it's important to get tested and to use a morning after pill.

If you're on an oral contraceptive, then the advice will depend on the type of pill you are taking, and you should always read the label before starting any medication. For a brief overview, see below:

Combined pill

If you are taking the combined pill and miss one, it is recommended that you take the missed pill as soon as possible and then take the next scheduled pill at the normal time, even if this means taking two pills at once.

Missing one pill shouldn't affect the effectiveness of the combined pill, however it is recommended that you use a barrier contraceptive, such as a condom, for the next 7 days as an extra precaution, as well as for your own peace of mind.

Mini pill

As the mini pill contains only progestogen, the importance of taking the pill on time is much greater. With both the combined pill and the mini pill, starting a new course of pills late will reduce your contraceptive protection, and you will therefore have to use barrier contraceptives.

The patch and ring

Likewise, if you forget to replace your patch or ring you should apply or insert a new one immediately and use a barrier contraceptive such as a condom for seven days afterwards.

What are the side effects of contraception?

Whilst there will always be a risk of side effects when taking any medication, contraceptive side effects are often minor, temporary and extremely manageable. These will also depend on the individual and the type of contraception you are taking.

Those side effects considered common only happen to one in ten women and include headaches, nausea, slight weight gain, slight spotting between periods and mood changes. These often happen during the first three months of taking the medication. Side effects considered uncommon include severe migraines, skin rash, loss of sex drive, slight breast enlargement and severe nausea, whilst side effects considered rare include vaginal discharge, breast discharge, increased sex drive, melisma (chloasma) and difficulty wearing contact lenses.

If you have any side effects that you feel need additional management, especially after the first three months, contact your doctor for a review. If you're not happy with your current pill, you can choose another one that you feel is more suited to your body and lifestyle.

It's important to remember the side effects for the birth control pill are often fleeting. Women tend to experience the pill side effects within the first three months of taking contraception, or when starting a new course of treatment, so do give each choice time if you are experiencing minor side effects; it could still be the best route for you. Otherwise, there are many other options available for you to try.

For severe side effects, it is advised to stop your dosage and visit your doctor. Do remember to continue protecting yourself against pregnancy with barrier methods such as condoms, or avoid having sex until you have discovered the most effective method for you.

What precautions to take with contraception

Certain contraception types have ideal storage instructions, so ensure you read the patient information leaflet carefully and dispose of any used pill packets and wrappers in a safe manner. All contraceptive methods should also be kept out of the reach of children.

If you think you may be pregnant, ensure you take a pregnancy test as soon as possible. If it is positive, then stop taking/using the hormonal contraceptive method immediately and seek emergency contraception options if required. However, using a contraceptive pill whilst unknowingly pregnant is not known to harm the growth of the unborn baby.

Contrary to common belief, hormonal contraceptives do not cause ectopic pregnancy (foetal growth outside the womb, leading to an undeveloped baby) although a few cases have been reported in the use of IUDs.

Other precautions include:

  • Smoking
  • Overweight / Obesity
  • Diabetes
  • High blood pressure
  • Family history of thrombosis
  • High cholesterol levels
  • Vein inflammation (phlebitis)
  • Immobility
  • Age

Each method can vary, and even each pill, so always remember to research your chosen method carefully before taking.

Do I need to use contraception after giving birth?

Unless you are ready to conceive again, you will need to use contraception after giving birth to protect yourself against pregnancy. What contraception you can use will largely depend on whether you are breastfeeding or not. It is always best to contact your doctor after pregnancy for advice on what contraception to take. If you are not breastfeeding but are having sexual intercourse and not using protection, you are able to get pregnant within as little as three weeks after pregnancy. It is therefore usually recommended that you start using contraception 21 days after giving birth if you are sexually active, for effective protection against pregnancy.

Can I use contraception if I am breastfeeding?

The short answer is yes, although breastfeeding will determine the type of contraception that you will be able to use. The mini pill and the injection can be used as they both contain progestogen only. If you are breastfeeding you will not be able to use combined hormonal contraception such as the pill, the ring or the implant, due to the risk of the oestrogen affecting milk production.

There has been evidence to suggest that breastfeeding alone can act as a form of contraception, although this will depend on circumstances such as how long you have been breastfeeding for and if your normal monthly cycle has resumed. However, most doctors will generally recommend that you use additional contraception to ensure you are protected.

Myths surrounding contraception

Long-term effects of contraception

Reports regarding the pill, mini pill, patch or ring damaging your long-term health are highly exaggerated. Nearly all women can take these forms of contraception over a longer period of time safely.

It is recommended that you review your contraception every six months with a healthcare professional as changes in your health and body such as blood pressure may affect your choice of contraception.

Contraception and weight gain

Weight gain whilst taking contraception is the most common query in terms of side effects, and also the most common myth. However research has shown you can protect yourself against pregnancy without the added pounds. The majority of studies show that a small percentage of women experience some weight gain but this can often be classed as water retention, and this is a temporary effect. Any water retention associated with the pill should disappear within 3 months of taking the birth control.

Contraception and breast cancer

There is an on-going debate with some studies highlighting the risk of breast cancer, however this remains very much open and more recent studies have said the risk of breast cancer caused by the pill is extremely minor. For more information of the cancer risks associated with birth control, please visit the NHS resources.[3]

Contraception and other forms of cancer

There is an increased risk of developing cervical cancer by taking the pill, but this is again minor and regular smear tests will help identify this. The good news is contraceptive pills have also been shown to actually reduce your risk of cancer of the ovaries, womb and bladder.

Where can I obtain contraception?

Speaking with your GP or sexual health clinic:

There are several ways of obtaining the right contraception, and one of the main ones is going to your GP. Your doctor, or another sexual health professional, will be able to advise you on the most suitable contraceptive methods available and be able to issue a prescription.

What we offer for contraception:

At HealthExpress, you can buy online in the UK and we offer many options of combined and mini pill as well as the contraceptive patch and ring.

As contraception is only available on prescription in the UK, you must fill in a consultation before purchase to confirm it's fully safe to use.

  • No waiting around for appointments and prescriptions
  • 14 combined pill and 4 mini pill options available
  • Free next day delivery on orders before 4pm
  • Free same day delivery to London postcodes on orders before 4pm
  • All inclusive service from consultation to delivery
  • Fully registered by GMC UK, National Pharmacy Association and CareQuality Commission

Registered Pharmacy

Sources

Dr Hilary Jones, HealthExpress Medical Advisor

How do I know which contraceptive pill is right?

With over 20 different contraceptive pills available, it is essential that you find the one that is best for you and your body. This will usually depend on your overall health, lifestyle, and age. As oral contraceptive pills range from the combined pill which contains both oestrogen and progestogen, to the mini pill which contains progestogen only, knowing the difference between each pill will go a long way in helping you make an informed choice. If you seek advice on the contraceptive pill you should talk to a medical professional such as your G.P. Alternatively you can complete an online consultation here at HealthExpresss, where a doctor can prescribe the most suitable contraceptive for you.

Click here to find your contraceptive