Contraception

Expertise Understanding Discretion

In one year, 80% of women who have sex without contraception will get pregnant.

If you are sexually active, you should look at different methods of contraception to decide which one suits you. If you have a partner, it’s a good idea to include him in your decision.
 

Myths About Contraception

False: The Pill is bad for your health

The modern Pill has health benefits.  Ovarian cancer is one of the most common reproductive cancer in women.  The hormones in the Pill reduce your risk of this by up to 50% if you have been on it for five years.

The Pill can also have preventative effects on the development of endometrial cancer (cancer of the lining of the womb), and arthritis. Links between the Pill and breast cancer are still unproven.  All women should have regular breast checks, and pap tests for pre-cancerous changes in the cervix.

Many women think they should give their bodies “a rest” from the Pill particularly if they want to get pregnant later. This is nonsense because the way the Pill works “rests” your body 13 times a year anyway.

However, if you smoke there are more risks with the Pill because the combination dramatically increases the risk of heart disease, blood clots and strokes. This is particularly true for women over thirty five.

 

False: IUD’s cause pelvic inflammatory disease

IUD’s have been associated with pelvic infections, but the devices which were the major culprits are no longer used.  Modern IUD’s are quite safe and some can be left in for up to ten years. The new hormone IUS (Mirena) and a mini copper IUD can be used by young women who haven’t had children.

 

False:  The worst pills to miss are in the middle of the packet

The worst pills to miss are those at the start and end of the pack because they extend your “Pill-free” time and allow you to start ovulating.  If you are more than 24 hours late with a Combined Pill, use condoms for the next 7 days.

If there are less than 7 hormone pills left you should miss the sugar pills and start the next cycle when you have finished the packet you are on. This will mean missing your period which is quite okay and not unhealthy.

If you take the progestogen-only Pill (the Mini Pill), forgetting it makes a big difference as you lose protection if it is taken three hours late.

The Pill will NOT protect you from any sexually transmitted diseases. Only condoms can protect you against sexually transmitted diseases like HIV/AIDS, the Wart Virus, Chlamydia, and Hepatitis B.

 

Contraception - Blue Water Medical
 
False:  Withdrawal is a good method of contraception if the man has self-control

 
Withdrawal is a good way to get pregnant.  Sperm are present in pre-ejaculation fluid and even if he ejaculates on you (at the opening of the vagina) rather in you, a few hundred thousand sperm can find their way inside with relative ease.

 

contraception1

Condoms
Diaphragm
The Pill
The Nuvaring
LARCs
The Injection
Tubal Sterilisation

instructions-diaphragm

The condom is a thin sheath of rubber which covers the penis for protection against pregnancy and some sexually transmitted infections (STIs). The best are the ones with a reservoir tip at the end. Some are lubricated and some are not. Some are coloured or ribbed. Some contain spermicide. All condoms are roughly the same size, but some may be shaped a little differently.

Effectiveness

The condom is an effective method of contraception if used correctly. Failure rates are as low as 2-3%.

Advantages

Condoms are easily obtained from chemists, sexual health centres, supermarkets and vending machines. They are cheap. There are no side effects. Protection is immediate. Condoms give almost 100% protection against STIs.

Disadvantages

A few people are allergic to latex but non-latex condoms are also available. Their use can interrupt sexual activity, as they must be unrolled onto an erect penis. They must always be used to prevent pregnancy. Condoms occasionally break but are less likely to if used with a water-based lubricant (not vaseline).

What if the Condom breaks?

You can go to the chemist and get the Emergency Pill (Morning After Pill) without a doctors prescription. This can be used up to 72 hours after intercourse but the sooner you seek advice the better.

To be effective, the condom must be used correctly;

  • The condom must be placed over the penis before any genital contact (penis and vaginal area). It is not safe to put the condom on just before ejaculation.
  • Check the expiry date on the condom packet.
  • Open the packet very carefully.
  • Make sure the condom is the right way on so it rolls down easily.
  • Squeeze the air out of the tip of the condom.
  • Keep hold of the rim and unroll the condom onto the erect penis before you start having sex.
  • Use it with a water-based lubricant on the outside of the condom.
  • Occasionally check that the condom is still on during intercourse.
  • Immediately after ejaculating hold the condom firmly and withdraw the penis while still erect.
  • After removing the condom, wipe the rest of the semen from the penis with a tissue.
  • Wrap the used tissue and condom, put it in a bag and place in the rubbish bin.

diaphragm

The diaphragm is a shallow latex dome with a firm but flexible rim. One end goes behind the cervix and the other end tucks under the pubic bone thus covering the cervix and preventing sperm from entering the uterus. The pelvic muscles hold it in place. Women who are allergic to latex can’t use it.

It can be put in any time before sex which makes it easier than a condom. Once you have had sex, in order for the sperm in the vagina to die, it needs to be left in for at least six hours.

With perfect use the failure rate has been quoted as 6% over 12 months but in reality it can be much higher (14% over 12 months).

Traditionally spermicide was used with a diaphragm. However there isn’t any supporting evidence showing that this decreases the pregnancy rate.

instructions-diaphragm

Some women wear the diaphragm all the time. They remove and wash it every day, immediately reinserting it. This means that you don’t forget to put it in before having sex. It still needs to be left in for six hours after intercourse. If you are going to do this, it is a good idea to have two diaphragms so one can be aired each day to reduce odour.

After using your diaphragm wash it in warm water with a mild soap. Dry it and store away from heat. A little corn flour helps keep it dry. Oil based lubricants and vaginal medicines/pessaries can damage the rubber. Talcum powder has theoretical risks if it is put in the vagina.

Most diaphragms last for two years .

You can use the diaphragm during a period. It is recommended that you leave it in for no more than 12 hours. There is a very small risk of toxic shock with anything left in the vagina for a long time.

Your diaphragm should be completely comfortable if it is the correct fit and in the correct position. Some men can feel it during sex but this is not usually a problem. If your diaphragm is uncomfortable for you or your partner it should be checked. You may need a different size or type of diaphragm. If your weight changes by more than five kilos or if you have been pregnant, you should get the size of your diaphragm checked.

Not many GPs fit diaphragms but NSW Family Planning and some women’s health centres fit them.

Diaphragms don’t give you protection against sexually transmitted disease (STIs). Condoms are effective against STIs and can be teamed up with a diaphragm giving a very low pregnancy rate.

the pill

The Morning After Pill or Emergency Pill


This is a special dose oral contraceptive called Postinor 1. You take it to reduce the chance of pregnancy after unprotected sex. For example, if you were raped, did not use contraception, or perhaps used a condom which broke or slipped off, or when the contraceptive pill may not be working ( late pills, vomiting or diahorrea).

The emergency pill works in two ways: it can delay ovulation or, if ovulation has taken place, it can stop a fertilised egg from implanting in the womb. If you have unprotected sex and you don’t want to get pregnant you need to take the emergency pill within three days. After taking the emergency pill, a small number of women experience nausea. Some also get sore breasts, headaches and light bleeding but this stops after a few days. Most women have their period at the usual time but it can be early or late by seven days. If you have not had a period by this time have a pregnancy test.

The emergency pill contains progesterone and no oestrogen. Women who cannot take oestrogen can take the emergency pill.

You should keep on using other contraception, ( the pill or condoms), for the rest of your cycle in case you ovulate AFTER taking the emergency pill. The emergency pill is not a substitute for regular contraception. It is for emergencies only and will not protect you from sexually transmitted diseases. If you do not have a regular method of contraception talk to your doctor.

The Pill

The Pill is made up of 2 hormones – oestrogen and progesterone. They stop the woman’s ovaries from releasing an egg each month, which means that a pregnancy cannot happen.
Most women can take the pill, but you should not take it if:

  • You have had a deep venous thrombosis (blood clotting), stroke or heart attack.
  • You have severe liver problems.
  • You have focal migraine.
  • You have unusual bleeding from your vagina that has not been diagnosed.
  • You may not be able to take it if:
  • You are breastfeeding.
  • You have high blood pressure, diabetes, gall bladder disease, kidney disease, tuberculosis, severe depression, or epilepsy.
  • You have had cancer of the breast, uterus, cervix or ovaries.
  • You are over 35 and smoke, or you are under 35 and smoke more than 15 cigarettes a day.
  • If any of these things apply to you, talk it over with your doctor.

How do I take the Pill?

The pill comes in a 21 day or 28 day pack. Both packs contain 21 hormone pills. With the 21 day pack a seven day break is taken between packs. The 28 day pack contains seven hormone-free pills (placebo, dummy, sugar, red pills) which also provide a routine seven day break. During the seven day break you will have a period. Some new Pills have 24 active pills and only four hormone-free pills.

You should begin your first pill packet on the first day of your period, on the day of your termination or on the day after. You should use another form of contraception as well as the pill for the first seven active pills of the first packet.

It is quite safe to miss a period while on the pill. Just skip the hormone-free pills and continue taking hormone pills from your next packet. This may not work as well with triphasic pills so ask your doctor how best to do this. Don’t do this with the first packet after your termination.

What if I miss a Pill?

If you are late taking a pill (but less than 24 hours late), take it as soon as you remember and the next one at the usual time. You will still be protected against pregnancy. If you are more than 24 hours late take your pill as soon as possible but you are not safe until you have had seven more pills. If you have forgotten more than one pill, take both pills (up to two) together but you are not covered until you have taken seven more pills. You will have to use another form of contraception during this time (condoms). If you have less than seven hormone pills left to take in your current pack you should miss out on your seven dummy pills break (or hormone-free pill section) and go straight onto the hormone pills in the next pack.

There is a great app myPill. It reminds you to take the pill and gives advice if you make a mistake.

If you have severe diarrhoea, or vomiting within two hours of taking the Pill, it may not be absorbed properly. Assume that the pills taken at this time have not worked and follow the instructions in the previous paragraph. Doctors are not sure if antibiotics can effect the Pill. Some epilepsy, TB drugs and St John’s Wort can stop the Pill working. If you are not sure if you are protected, use another form of contraception (condoms) as well as the Pill while taking the medicine and for the next seven days after you stop the medication.

pills

Are there side effects?

Most women feel fine while they’re on the Pill but it is common to have some side effects at first. You could have breakthrough bleeding in between periods, sore breasts and nausea for the first couple of months. This usually settles down during your third packet of Pills. Other side effects such as putting on weight, less desire for sex, and feeling irritable, are rare. They may be due to the Pill but can also be caused by other things in your life. If you are worried talk to your doctor who may suggest another type of Pill or method of contraception. Serious health risks caused by the Pill are rare. The most dangerous is blood clotting.

Warning signs are :

  • severe sudden chest pain
  • severe pain in your calf or swelling in one leg
  • sudden blurred vision or loss of sight
  • severe sudden headache.

If you have any of these signs contact your doctor immediately or go to your nearest hospital.

The Pill does have some health benefits. You have less chance of getting pelvic infection, cancer of the ovaries, cancer of the endometrium (lining of the womb), anaemia, non cancerous breast lumps, and cysts on the ovaries. When you are taking the Pill, periods are less painful, bleeding is lighter and more regular and there is less premenstrual tension. Acne may also clear up.

It is good to have your blood pressure taken and a breast check when you have your prescription renewed each year. You should also have a pap smear every two years unless otherwise advised by your doctor.

The Pill and Cancer

You can find out about the Pill and cancer on this link

The Mini Pill (progesterone only)

The Mini Pill contains a very small amount of only one hormone, a progesterone. It is sometimes called the progesterone only pill. It works mainly by making the mucus at the entrance to the uterus thicker so that sperm cannot get through to meet the egg. It also works by changing the lining of the uterus, and in some women it stops the monthly release of an egg. The Mini Pill prevents pregnancy, but it is not as effective as the combined pill.

Who can take the Mini Pill?

Most women can take the Mini Pill. You may not be able to take it if:

  • You have had an ectopic pregnancy
  • You have an undiagnosed vaginal bleeding problem
  • You have cancer of the breast or reproductive organs

Unlike the combined pill you can take the Mini Pill if:

  • You are breastfeeding
  • You have history of blood clotting, stroke or heart attack (but check with your doctor first)
  • You smoke heavily.
  • You are over 40 years old

How do you take the Mini Pill?

You must take the Mini Pill every day without a break. It always comes in a 28 day pack. Every pill is a hormone (progesterone) pill and you do not have a break between packs.

Starting the Mini Pill

If you are having periods you should start your first pill on the first day of your period. If you are not having periods (e.g. during breast feeding) you can start the Mini Pill at any time. You will have some protection from pregnancy within three hours of taking your first pill, but it may be 48 hours before you have full protection. Because of this you should use back-up contraception e.g. condoms.

You should take the Mini Pill at the same time every day, so take your first pill at the time that you intend to continue taking it. It works best as a contraceptive between 3 and 21 hours after you take each pill so if you usually have sex at night or in the afternoon, take the pill in the morning.

If you miss a Mini Pill

If you forget a Mini Pill or are more than three hours late in taking it, take one pill as soon as possible and the next one at the usual time. You will have some protection from three hours after taking the late pill but it is best to use other contraception as well for the next 48 hours.

When the Mini Pill might not work

If you have diarrhea, or vomiting, the Mini Pill may not get into your system properly and you could become pregnant. Assume that the pill has not worked and follow the steps under ‘If you miss a Mini Pill’. Some medical drugs may stop the Mini Pill from working so you should speak to your doctor about this.

Possible side effects

There are very few side effects with the Mini Pill but it is fairly common to have spot bleeding between periods and periods may be further apart or closer than usual. If the Mini Pill fails there is a slight risk that the pregnancy may be ectopic (in the fallopian tube). This is very rare but dangerous. If you think you may be pregnant see your doctor immediately.

Periods and the Mini Pill

While you are taking the Minipill your periods may be regular, they may be irregular of they may stop altogether. It is not possible to make periods regular or to delay or cut out periods while on this pill.

Getting pregnant after the Mini Pill

If you want to become pregnant, simply stop taking the pill.

 

The Nuvaring is a new way of using the combined contraceptive Pill. The Pill hormones are embedded in the plastic ring and stop you making an egg. It is rare to become pregnant with a Nuvaring.

The ring sits at the back on the roof of the vagina. The hormones are gradually released into the bloodstream. The hormone levels are steady rather than fluctuating up and down. This fluctuation occurs with the Pill which is absorbed from the gut.

The effective hormone dose is lower than the Pill meaning less side effects and serious risks. However, if there are risk factors for the Pill it will still be a potential problem with the Nuvaring. Speak to your doctor about this.

The Nuvaring is particularly good for women who forget to take the Pill, have a problem with frequent vomiting or diarrhoea or have hormone side effects from standard pills. Spot bleeding or untimely bleeding are less because of the constant and stable hormone level.

The Nuvaring will not harm the vagina, is hygienic and cannot travel into the uterus. It is rare that it falls out or is uncomfortable. It is unlikely you or your partner will be aware of it during sex.

Like the Pill, there are some medicines that will react with it and you should check with your doctor or chemist. They include St John’s Wort, some epilepsy and TB drugs. Doctors are not sure if it is effected by antibiotics.

There are instructions with the Nuvaring on how to start using it. Then it’s simple — in for three weeks, out for one week. You can program your mobile phone to remind you. It’s usually best to start on a weekend — it’s easier to remember than a weekday.

In the week off, you will have a period. Insert a new ring after seven days even if you are still bleeding.

A money saving hint: The Nuvaring carries enough hormone to last four weeks. You can leave it in for four weeks rather than three, have one week off and have a period every five weeks. Just make sure you wear it for three weeks the first time you use it.

 

LARCs are long acting reversible contraceptives. This means that if you don’t like the method or wish to become pregnant you just have the device removed. The three monthly injection will just run out. They are also good value for money. While the initial cost may seem high there is a considerable saving in just one year of use. Their pregnancy rate is very low — much less than the pill or condoms. There are four LARC methods available:

IUDs

Copper Intra Uterine Devices (IUDs)

An IUD is a small device containing copper that is placed into the uterus by a doctor. No one knows how they work but the lining of the uterus changes, the egg is prevented from implanting and sperm movement is affected. The IUD is effective as soon as it is inserted and can be inserted up to five days after unprotected sex to stop pregnancy.

The IUD can be removed at any time and fertility returns very quickly. There is a remote chance of pregnancy occurring if there has been sex within seven days of it being removed. If you don’t want this to happen, abstain or use a condom for seven days before hand.

In Australia there are two types of copper IUDs:

  • the Multiload which lasts for five years
  • the CU-TT 380 standard that lasts for ten years and
  • the short stem version that lasts for five years.

multiload

Copper IUDs can make periods heavier, longer and more painful. Most women who have had children find the difference in periods is minor. However, if you have heavy or painful periods, it may not be suitable. The Mirena IUS (below) lessens periods and may be a better option. Women who haven’t had children often find the copper IUD too much with their periods and most doctors recommend the Mirena. The short stem copper IUD may also be suitable for such women.

Insertion takes about five minutes. Some women, especially if they haven’t had children, find it is moderately painful for a few minutes and then it eases off. Most women find it only slightly painful, a little worse than a pap smear. You can choose to have it inserted under IV sedation (asleep). This entails fasting for five hours and having someone to drive you home.

When it is inserted there are two fine nylon threads that are cut 1 – 2 cm from the cervix which is at the far end of the vagina. These strings enable you to check the IUD is in place. When the IUD is removed the doctor gently pulls on the strings and it comes out. This is usually not painful. Most men aren’t bothered by the strings but they can be trimmed if there is a problem.

Sex is not recommended on the day of insertion.

When is the IUD inserted?

Usually from the first day of your period up to day twelve. The IUD is effective as soon as it is inserted and can be inserted up to five days after unprotected sex to stop pregnancy. It can be inserted straight after a surgical termination and at the check up after a medical termination.

Who can’t use a Copper IUD?

Most women can but it is important that there is no chance of pregnancy when it is inserted. Other contraindications are uncommon and your doctor will be able to check if there are any problems. It can be inserted six weeks after a vaginal delivery and ten weeks after a caesarian.

What can go wrong?

Pregnancy is rare. About four woman in a thousand will fall pregnant each year with a copper IUD. The pregnancy rate is higher with a copper IUD than a Mirena. You can continue the pregnancy but it is better to have the IUD removed.
Ectopic pregnancy is very rare but it is more common with a copper IUD than a Mirena. An ultrasound will detect this.

Infection. Approximately 1 in 400 will develop an infection during the first month after insertion. Possible signs of infection are increasing pelvic pain, increasing bleeding (moderate to heavy) and sometimes a temperature. This can be treated with antibiotics and usually the IUD can be left in.

Infection after the first month is usually related to STIs (sexually transmitted infections). If you are not in a stable relationship, use condoms and have STI checks for you and any new partners. In most situations infection is caused by Chlamydia and is treatable. Infection can spread from the uterus and damage the fallopian tubes affecting fertility. A Chlamydia infection is no worse for women with an IUD than for women using another method.

The IUD can expel or fall out (1:50). It is usually obvious but not always. Normal periods will quickly return and there is a chance of pregnancy. It is a good idea to check every month that the strings are in place. Sometimes the strings can move up into the cervical canal or the uterus and they can’t be felt. The IUD will still be working but you can’t check if it is there. An ultrasound will show it’s presence. Removing the IUD without any strings can be more uncomfortable. A special hook needs to be inserted into the uterus to remove the device but this can be done under IV sedation (asleep).

There are no hormone side effects.

The most serious but least common problem is perforation, or pushing through the wall of the uterus during insertion. If this occurs, keyhole surgery is necessary to remove the IUD.

Changes in Bleeding

Periods can be heavier, longer and more painful. For most women these changes are minor. There will be light bleeding for a few days to a few weeks after insertion. Occasional spotting can occur between periods for the first two to three months. The spot bleeding is much less and settles more quickly than with the Mirena IUS.

The Mirena IUS

(IntraUterine Contraceptive System – IUS)

The Mirena is a contraceptive method that sits in the uterus. It has a small plastic frame, about the size of a fifty cent piece. It carries a sleeve which has a hormone, levonorgestrol, embedded in it. This is one of the hormones that can be found in the contraceptive pill. The amount of the hormone that enters the blood stream is much les than the pill.

mirena

The Mirena prevents pregnancy by stopping the sperm from entering the uterus. The hormone is released gradually for five years. The Mirena can be removed at any time and fertility returns very quickly.

There is a remote chance of pregnancy occurring if there has been sex in the previous seven days of the IUS being removed. If you don’t want this to happen, abstain or use a condom for seven days before the IUS is removed.

The Mirena is very effective — about as good as tubal ligation. It is also used to treat heavy menstrual bleeding. It makes periods shorter, lighter and less painful. Some women will get no periods or just occasional spotting.

Insertion takes about five minutes. Some women, especially if they haven’t had children, find it is moderately painful for a few minutes and then eases off. Most women find it only slightly painful, a little worse than a pap smear. You can choose to have it inserted under IV sedation (asleep). This entails fasting for five hours and having someone to drive you home.

When it is inserted there are two fine nylon threads that are cut one to two cm from the cervix which is at the far end of the vagina. These strings enable you to check the IUS is in place. When the Mirena is removed the doctor gently pulls on the strings and the IUS comes out. This is usually not painful. Most men aren’t bothered by the strings but they can be trimmed if there is a problem.

You shouldn’t have sex on the day the IUS is inserted.

When is the IUS inserted?

Usually from the first day of your period up to day seven. It can be inserted straight after a surgical termination and at the check up after a medical termination.

Who can’t use a Mirena?

Most women can but it is important that there is no chance of pregnancy when it is inserted. If it isn’t inserted with a period it will take seven days to work. Other contraindications are uncommon and your doctor will be able to check if there are any problems

It can be inserted six weeks after a vaginal delivery and ten weeks after a caesarian.

What can go wrong?

Pregnancy is rare. You can continue the pregnancy but it is better to have the IUS removed.
Ectopic pregnancy is very rare. An ultrasound will detect this.

Infection. Approximately 1 in 400 will develop an infection during the first month after insertion. Possible signs of infection are increasing pelvic pain, increasing bleeding (moderate to heavy) and sometimes a temperature. Infection can be treated with antibiotics and usually the Mirena can be left in. Infection after the first month is usually related to STIs (sexually transmitted infections). If you are not in a stable relationship, use condoms and have STI checks for you and any new partner. In most situations infection is caused by Chlamydia, and is treatable. Infection can spread from the uterus and damage the fallopian tubes affecting fertility. Recent studies have shown that a Chlamydia infection is no worse for women with an IUS than for women using other methods.

The Mirena can expel or fall out (1:50). This is usually obvious but not always. Normal periods will quickly return and there is a chance of pregnancy. It is a good idea to check every month that the strings are in place. Sometimes the strings can move up into the cervical canal or the uterus and you can’t feel them. The IUS will still be working but you can’t check if it is there. An ultrasound will show it’s presence.

Removing the Mirena without the strings can sometimes be more uncomfortable. A special hook needs to be inserted into the uterus to remove the device. In this situation, it can be better to have IV sedation (asleep).

Hormone side effects are uncommon and less likely than the pill. Changes can include ovarian cysts, acne, breast tenderness, headaches , mood changes and depression.

The most serious but least common problem is perforation, or pushing through the wall of the uterus during insertion. If this happens, keyhole surgery is needed to remove the IUS.

Changes in bleeding.

After insertion there will be light to moderate bleeding for a few days and then light bleeding. Bleeding and spotting (usually a pantishield is all that is needed ) will gradually reduce but, for a small group of women, it can take three to six months to settle. The average is six weeks. In the meantime periods will be getting lighter and some women (20%) will have none.

www.mirena-us.com

Implanon

Implanon is a flexible rod (4cm by 2mm) that is placed under the skin on the inside of the upper arm in the bicipital groove. It contains a progesterone hormone, etonogestrel, which is similar to one of the hormones in the pill. It works by stopping an egg being released from the ovary, makes it hard for the sperm to enter the uterus, and it thins the blood lining so it’s difficult for a fertilized egg to implant. Its pregnancy rate is almost zero (99.9% effective) and is better than tubal ligation (female sterilization).

It should be inserted from the first day of your period and up to day five. It is effective immediately. If you have irregular cycles or aren’t getting periods (eg breast feeding) it can be inserted at any time as long as you aren’t pregnant. Abstain from sex for two weeks or use condoms. A urine pregnancy test should show positive if a pregnancy has occurred over 14 days before. If you have a negative test then it’s okay to insert but it will take 7 days before it is effective (use condoms or abstain for this time).

implanon

It can be inserted at the time of a surgical or medical termination and will be effective immediately. If it is inserted at a post termination check up it is important that there has either been no sex, or careful condom use, and it will take seven days to begin to work.

The implant can only be inserted by doctors who are trained to do so. A small amount of local anaesthetic is injected and once the skin is numb, the doctor inserts it with an introducer needle. Because the skin has been numbed it doesn’t hurt.

The skin is again numbed with local and a small cut, 1 to 2 mm, is made when the Implanon is removed. After insertion and removal a plastic dressing keeps the incision dry. The dressing should stay on for three days. You can shower with it on.

After insertion your arm is firmly wrapped with a crepe bandage to reduce bruising. The bandage can come off for ten minutes to have a shower but keep it on for 24 hours. Your arm may be bruised and sore for a week or two. Anything that involves heavy lifting on the day of insertion can increase the bruising.

While you can feel the bar (see your doctor if you can’t feel it) it is difficult to see. It can be itchy for a few weeks and it is best not to fiddle with it. A tiny scar may be visible but it is not easy to see unless you scar very easily.
Implanon lasts for three years. At the end of that time, the old one can be removed and a new one inserted at the same time. It is effective immediately and there is no need to have a break.

If the device is left in longer than three years, the pregnancy rate increases, with a chance of an ectopic or tubal pregnancy. If the Implanon is removed because of side effects, these should subside very quickly with periods back to normal in a month or two. Fertility returns very quickly. Some women have fallen pregnant the day after the device was removed.

Advantages

  • Implanon is 99.9% effective
  • It is reversible
  • It is not dependent on you remembering to take it
  • Vomiting or diarrhoea do not affect it
  • Periods are often less heavy and painful and 25% of women have no periods.
  • It can be used when breast feeding
  • It can have less side effects than the pill
  • Women who can’t take oestrogen may be able to use it safely eg high blood pressure, focal migraines, but check with your doctor.

Possible side effects

Just like the pill there can be hormone side effects such as weight gain or loss, mood changes and depression, sore breasts, headaches and bloating. Women who have acne usually see an improvement in their skin, but for 15 % of those women, it can get worse.

The biggest problem can be changes with your periods. Some women (25%) have no periods at all. Some get occasional light bleeding, or something similar to a monthly period.

However, 25% have more bleeding — irregular, light to moderate, and sometimes prolonged for weeks. This can often be helped by different medication. If your bleeding does change adversely, hang on, see your doctor for medicine to stop the bleeding and give it at least three months, preferably six, to settle down. Often, the nuisance bleeding just stops.

Some medicines can react with Implanon and stop it working. These include:

  • St John’s Wort — an herbal treatment for depression
  • Some anti-epileptics
  • Some mental health disorder drugs
  • TB medicines and some anti HIV medicines

You can’t have Implanon:

  • If you are pregnant

  • Have a progesterone sensitive cancer (some breast and liver cancers)
  • If you have a history of blood clots, heart disease, stroke or severe liver disease, you will need to check with your doctor.

Depo-Provera or Depo Ralovera (Depot Medroxyprogesterone Acetate) is a contraceptive injection of a chemical similar to the hormone progesterone which your ovaries produce. The three monthly injection protects you from pregnancy for 12 weeks by stopping the release of an egg from your ovaries. However if you delay having your next injection for over two weeks there is a small risk of pregnancy

It is a very effective contraceptive. If 1000 women were each to use it for a year only four or five may become pregnant. There are fewer accidental pregnancies with the injection than with the oral contraceptive pill.

If you want to use the three monthly injection you should tell your doctor if:

  • you could be pregnant
  • you have unusual or irregular vaginal bleeding.

You should also tell your doctor if you have had any of the following health problems:

  • cancer of the breast or genitals
  • a history of severe depression
  • disease of the heart, liver or kidneys
  • a history of blood clots

The drug is injected into the muscle of your upper arm every twelve weeks. The first injection should be given during the first five days of your menstrual cycle (the first day of bleeding is day one). In this way you are protected from pregnancy immediately. If you have the injection on the same day as an abortion it will be effective immediately.

If you have irregular cycles or aren’t getting periods (eg breast feeding) it can be given at any time as long as you aren’t pregnant. Abstain from sex for two weeks or use condoms. A urine pregnancy test should show positive if a pregnancy has occurred over 14 days before.If you have a negative test then it’s okay to have it but it will take 7 days before it is effective (use condoms or abstain for this time).

It can be injected at the time of a surgical or medical termination and will be effective immediately. If it is given at a post termination check up it is important that there has either been no sex, or careful condom use, and it will take seven days to begin to work.

The injection changes your periods. They often become irregular and may last longer. Bleeding is usually light and may be continual. This can be treated. After several injections your periods may stop altogether. This is normal and does not harm you. After 14 weeks from the last injection, there is a chance that you may start ovulating again.

It also reduces the incidence of monilia (thrush/candida). When you stop the injections your periods will return to normal although for some women, this may take up to 18 months. Some women have weight gain, headaches or depression and side effects can last for three months or longer.

Some studies have shown that there can be a loss of bone density (bone thinning). This can increase the chance of osteoporosis after menopause. Young women (under 18) are more at risk of this.

Most women find that it takes about 10 months after the last injection to become pregnant. Sometimes it takes longer but the number of injections you have does not affect this. Some women conceive when they are only a few weeks late having the injection. If you stop the injections and do not want to become pregnant you must use another form of contraception.

 

This is a permanent form of contraception. The operation blocks the Fallopian tubes so that the sperm cannot travel up from the uterus, enter the tubes, fertilise an egg and begin a pregnancy. The egg is harmlessly absorbed by the body.

The most common method is Laparoscopic Sterilisation usually with a general anaesthetic. It is a day surgery procedure so you can go home later in the day.

One or two incisions are made in the abdomen, one at the navel and one below the pubic hair line. A laparoscope (like a tiny telescope) is inserted through the incision so the surgeon can see the tubes which are then blocked by clips, rings, or cut and tied off.

Your hormones are not affected by the operation. You will continue to have periods and your menopause will not be affected. Sexual sensation and your sex drive will not be affected. Sex for some couples improves as there is no longer any anxiety about an unwanted pregnancy.

The operation is effective immediately but it is important to use contraception right up to the day of the operation.

Complications are Uncommon

After a general anaesthetic some patients can be nauseated and tired for a day or two. There can be some mild to medium abdominal and shoulder tip pain for a few days. You should be feeling normal within seven days. Serious complications are uncommon but there is always a small chance of infection, damage to other internal organs and serious reaction to the anaesthetic.

Failure is uncommon but can occur. It has been quoted as 2-9 per 1000 operations and may happen many years after the procedure. If it does, there is a chance of an ectopic pregnancy which can be dangerous but will be detected by ultrasound.

Reversal is possible but may not be successful. Only 50% of women will fall pregnant after a reversal so a decision to have a Tubal Sterilisation needs some serious thought.

For sterilisation, you need to be referred by your GP or Blue Water Medical to a specialist gynaecologist or a hospital’s gynaecology outpatients.

 

ABORTION
  • What Happens when I have an abortion?
  • How do I prepare?
  • What will I need to bring?
  • What else do I need to know?
  • What can I expect?
  • What happens next?
MEDICAL ABORTION
  • What is a Medical Termination of Pregnancy (MTOP)?
  • How does it Work?
  • Conditions where you will not be able to have a MTOP
  • Other Considerations
  • How do I make an appointment for (MTOP)?
  • What to bring.
  • What Happens Afterwards
  • MTOP vs STOP Comparison
  • Risks Associated
CONTRACEPTION
  • Condoms
  • Diaphragm
  • Pills
  • The Nvaring
  • LARCS
  • The Injection
  • Sterilisation
WOMEN’S HEALTH
  • Women’s Checks
  • Pap Smears
  • Breast Checks
  • Vaginal Problems
  • Menopause
  • Contraception
  • IUD & IUS Insertion and Removal
  • Pregnancy Counselling
  • Pregnancy Terminations
  • Sexually Transmitted Infection
VASECTOMIES
  • Information
  • Questions
  • Risks
  • After Care
OTHER INFORMATION
  • Meet our Doctors
  • STI’s
  • Pregnancy
  • Counselling
  • Support
  • Men’s Issues
  • Coping
  • Risks
  • Articles
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