Everything you need to know about contraception

Despite it being such an important topic, as a nation we are still fairly reserved when it comes to talking about contraception. However, YourGP’s Dr Cathrow is here to break down those barriers, talk openly about all available options, and delve into the pros and cons of each method. Read on to discover how you can be sure you’re using the right one for you.

Hormonal versus non-hormonal contraception
Contraception can be split in to two types – hormonal and non-hormonal. In the UK, the hormonal types are most commonly prescribed – this includes the pill (combined and progestogen only), the implant, the injection and the Mirena coil. Another hormonal coil called Jaydess is also available but doesn’t last as long as the Mirena. There is also an option for a hormonal vaginal ring, and hormonal contraceptive patches. Non-hormonal contraceptives include condoms, the copper coil, and the diaphragm.

Making the right choice for you
When choosing a form of contraception, it is important to consider five important questions:

1. How is it taken/used?
   Condoms and diaphragms need to be ready and available close to the point of having sex. Pills are taken every day, or for 3 weeks out of 4. Coils and implants need to be fitted by an appropriately trained healthcare professional. Patches and vaginal rings can be left in place for weeks at a time.
2. How long does it last?
   Condoms and the diaphragm have the shortest period of efficacy against pregnancy. The pill, if taken correctly will offer protection against pregnancy for the duration that it is taken. There are a variety of long-acting progestogen contraceptives, including the injection which offers contraceptive protection for 3 months, the implant which lasts 3 years as does the Jaydess coil, and the Mirena coil which lasts for 5 years. Certain types of copper coil top the list of longevity – lasting 10 years from date of insertion.
3. How reliable is it?
   When used correctly, each time you have sex, diaphragms (or caps) offer up to 96% protection and male condoms are 98% effective. The progestogen only pill (POP), the combined oral contraceptive pill (COCP), the hormonal patch and vaginal ring, copper (intrauterine device or IUD) and hormonal coils (intrauterine system or IUS) are all more than 99% reliable when used properly.
4. Will it suit a person’s lifestyle?
   The only contraception that can effectively protect against STIs are condoms. For full protection against pregnancy and STIs, condoms plus another form of contraception is recommended. Long acting contraceptives or LARCS, which includes coils, injections and implants are excellent for those who may forget to take tablets or have a busy lifestyle. Pills and patches can be very helpful in controlling a woman’s periods.
5. Is it safe to use when taking into account a person’s medical history?
   Some people cannot take certain hormones. It is essential that you discuss your medical history with a healthcare professional when deciding what options are best. A history of blood clots or migraine with aura, for example, may mean that certain hormonal contraceptives are not appropriate.

Give it some time
It can take time to find the right contraceptive for you, but with a thorough consultation and discussion around pros and cons of a certain product, a list of options can be drawn up and discussed. Most of the time, contraceptives suit an individual if there has been a thorough discussion surrounding past history and current wishes.

We will usually recommend using a particular contraceptive for at least 3 months to gain a full insight into how the method is suiting you. If things are going well, we suggest carrying on. If things are not going so well, we can recommend alternatives.

Why the coil is such a popular choice
The coil is a ‘fit and forget’ method of contraception. The copper coil tops the list – with some lasting up to 10 years! Mirena is excellent as it can also help with problematic periods and, for many women, it will cause periods to stop altogether. In women over 45, Mirena can be left in place until the age of 55 if there is no bleeding.

The Jaydess is a slightly smaller progestogen only coil that is particularly useful in teenagers and those who have not had a baby by vaginal delivery.

Everything you need to know about a coil fitting
A coil fitting appointment takes about half an hour from start to finish – this includes a pre-procedure consultation, the fitting itself, and any aftercare. The actual insertion of a coil usually takes a maximum of just 5 minutes.

Throughout the actual fitting, we guide you through the whole procedure and we do our best to make you as comfortable as possible. After a quick vaginal examination to check the tilt of the womb and location of the cervix, a speculum is passed into the vagina so that we can get a clear view of the cervix. This is very similar to getting a smear taken. Once this is in place, the cervix is stabilised and the length of the womb (uterus) is measured using a straw-like instrument called a sound. After a measurement is taken, the coil is set to the right size and is inserted through the cervix. Once in place, the coil strings are cut so that they remain within the vagina.

For most women, getting a coil fitted is not particularly uncomfortable, but you may experience some period-type cramping. It can help to take some over-the-counter painkillers half an hour before the appointment. It is common to have some mild cramping and spotting for up to 24hrs after insertion, but this usually settles quickly. You will be offered a coil check at 6 weeks where we can look to check the strings, but you can do this yourself by feeling for them if you prefer.

Side effects to be aware of
The copper coil does have the potential to make periods heavier, so it may not be the best option if you have heavy periods already. On the other hand, the hormonal coils usually make periods lighter or even non-existent. The hormone delivered from these coils is considered ‘localised’ and most women do not experience any side effects. However, some women do experience some side effects that are usually associated with PMS. It’s always best to speak to your healthcare provider if you have any questions about side effects.

There is no one-size-fits-all
The coil can be used by most women and is an excellent choice if you are looking for a long-acting, safe and reliable contraceptive. But remember, you should also always seek to protect yourself against STIs, which the coil does not.
Some women who have had surgery to the cervix, including laser surgery (LLETZ and biopsy), can sometimes find that inserting a coil is more difficult – this can be due to narrowing of the cervical opening due to scar tissue. Some women with large fibroids low down in the womb may also find insertion more difficult.

But remember, these are all issues to discuss with your healthcare provider so that you can be sure your chosen method of contraception is the right one for you.

The doctor will see you now…
Dr Cathrow is available to discuss your personal contraception options and advise which method will suit you best. To book your appointment, just email reception@your.gp or call us on 0131 225 5656.